1
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Weiß M, Gutzeit J, Appel KS, Bahmer T, Beutel M, Deckert J, Fricke J, Hanß S, Hettich-Damm N, Heuschmann PU, Horn A, Jauch-Chara K, Kohls M, Krist L, Lorenz-Depiereux B, Otte C, Pape D, Reese JP, Schreiber S, Störk S, Vehreschild JJ, Hein G. Depression and fatigue six months post-COVID-19 disease are associated with overlapping symptom constellations: A prospective, multi-center, population-based cohort study. J Affect Disord 2024; 352:296-305. [PMID: 38360365 DOI: 10.1016/j.jad.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Depression and fatigue are commonly observed sequelae following viral diseases such as COVID-19. Identifying symptom constellations that differentially classify post-COVID depression and fatigue may be helpful to individualize treatment strategies. Here, we investigated whether self-reported post-COVID depression and post-COVID fatigue are associated with the same or different symptom constellations. METHODS To address this question, we used data from COVIDOM, a population-based cohort study conducted as part of the NAPKON-POP platform. Data were collected in three different German regions (Kiel, Berlin, Würzburg). We analyzed data from >2000 individuals at least six months past a PCR-confirmed COVID-19 disease, using elastic net regression and cluster analysis. The regression model was developed in the Kiel data set, and externally validated using data sets from Berlin and Würzburg. RESULTS Our results revealed that post-COVID depression and fatigue are associated with overlapping symptom constellations consisting of difficulties with daily activities, perceived health-related quality of life, chronic exhaustion, unrestful sleep, and impaired concentration. Confirming the overlap in symptom constellations, a follow-up cluster analysis could categorize individuals as scoring high or low on depression and fatigue but could not differentiate between both dimensions. LIMITATIONS The data presented are cross-sectional, consisting primarily of self-reported questionnaire or medical records rather than biometric data. CONCLUSIONS In summary, our results suggest a strong link between post-COVID depression and fatigue, highlighting the need for integrative treatment approaches.
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Affiliation(s)
- Martin Weiß
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany.
| | - Julian Gutzeit
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
| | - Katharina S Appel
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Frankfurt, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Thomas Bahmer
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927 Großhansdorf, Germany
| | - Manfred Beutel
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Jürgen Deckert
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | - Sabine Hanß
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Nora Hettich-Damm
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, Department of Internal Medicine I, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany; Clinical Trial Center Würzburg (CTC/ZKS), University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Anna Horn
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Kamila Jauch-Chara
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Mirjam Kohls
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | | | - Christian Otte
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
| | - Daniel Pape
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Stefan Schreiber
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, Department of Internal Medicine I, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Jörg Janne Vehreschild
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Frankfurt, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, Cologne, Germany; German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Grit Hein
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
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2
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Jakwerth CA, Weckmann M, Illi S, Charles H, Zissler UM, Oelsner M, Guerth F, Omony J, Nemani SSP, Grychtol R, Dittrich AM, Skevaki C, Foth S, Weber S, Alejandre Alcazar MA, van Koningsbruggen-Rietschel S, Brock R, Blau S, Hansen G, Bahmer T, Rabe KF, Brinkmann F, Kopp MV, Chaker AM, Schaub B, von Mutius E, Schmidt-Weber CB. 17q21 Variants Disturb Mucosal Host Defense in Childhood Asthma. Am J Respir Crit Care Med 2024; 209:947-959. [PMID: 38064241 DOI: 10.1164/rccm.202305-0934oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/07/2023] [Indexed: 03/13/2024] Open
Abstract
Rationale: The strongest genetic risk factor for childhood-onset asthma, the 17q21 locus, is associated with increased viral susceptibility and disease-promoting processes.Objectives: To identify biological targets underlying the escalated viral susceptibility associated with the clinical phenotype mediated by the 17q21 locus.Methods: Genome-wide transcriptome analysis of nasal brush samples from 261 children (78 healthy, 79 with wheezing at preschool age, 104 asthmatic) within the ALLIANCE (All-Age-Asthma) cohort, with a median age of 10.0 (range, 1.0-20.0) years, was conducted to explore the impact of their 17q21 genotype (SNP rs72163891). Concurrently, nasal secretions from the same patients and visits were collected, and high-sensitivity mesoscale technology was employed to measure IFN protein levels.Measurements and Main Results: This study revealed that the 17q21 risk allele induces a genotype- and asthma/wheeze phenotype-dependent enhancement of mucosal GSDMB expression as the only relevant 17q21-encoded gene in children with preschool wheeze. Increased GSDMB expression correlated with the activation of a type-1 proinflammatory, cell-lytic immune, and natural killer signature, encompassing key genes linked to an IFN type-2-signature (IFNG, CXCL9, CXCL10, KLRC1, CD8A, GZMA). Conversely, there was a reduction in IFN type 1 and type 3 expression signatures at the mRNA and protein levels.Conclusions: This study demonstrates a novel disease-driving mechanism induced by the 17q21 risk allele. Increased mucosal GSDMB expression is associated with a cell-lytic immune response coupled with compromised airway immunocompetence. These findings suggest that GSDMB-related airway cell death and perturbations in the mucosal IFN signature account for the increased vulnerability of 17q21 risk allele carriers to respiratory viral infections during early life, opening new options for future biological interventions.The All-Age-Asthma (ALLIANCE) cohort is registered at www.clinicaltrials.gov (pediatric arm, NCT02496468).
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Affiliation(s)
- Constanze A Jakwerth
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
- Member of the German Center for Lung Research (DZL), Germany
| | - Markus Weckmann
- Member of the German Center for Lung Research (DZL), Germany
- Division of Epigenetics in Chronic Lung Disease, Priority Area Chronic Lung Diseases, Research Center Borstel-Leibniz Lung Center, Borstel, Germany
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany
- Airway Research Center North, Borstel, Lübeck, Kiel, Grosshansdorf, Germany
| | - Sabina Illi
- Member of the German Center for Lung Research (DZL), Germany
- Institute for Asthma and Allergy Prevention, Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
- Comprehensive Pneumology Center-Munich, Munich, Germany
| | - Helen Charles
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
- Member of the German Center for Lung Research (DZL), Germany
| | - Ulrich M Zissler
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
- Member of the German Center for Lung Research (DZL), Germany
| | - Madlen Oelsner
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
- Member of the German Center for Lung Research (DZL), Germany
| | - Ferdinand Guerth
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
- Member of the German Center for Lung Research (DZL), Germany
| | - Jimmy Omony
- Member of the German Center for Lung Research (DZL), Germany
- Institute for Asthma and Allergy Prevention, Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
- Comprehensive Pneumology Center-Munich, Munich, Germany
| | - Sai Sneha Priya Nemani
- Member of the German Center for Lung Research (DZL), Germany
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany
- Airway Research Center North, Borstel, Lübeck, Kiel, Grosshansdorf, Germany
| | - Ruth Grychtol
- Member of the German Center for Lung Research (DZL), Germany
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Hanover, Germany
| | - Anna-Maria Dittrich
- Member of the German Center for Lung Research (DZL), Germany
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Hanover, Germany
| | - Chrysanthi Skevaki
- Member of the German Center for Lung Research (DZL), Germany
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics and
| | - Svenja Foth
- Member of the German Center for Lung Research (DZL), Germany
- Universities of Giessen and Marburg Lung Center, Philipps University Marburg and University Children's Hospital Marburg, University of Marburg, Marburg, Germany
| | - Stefanie Weber
- Member of the German Center for Lung Research (DZL), Germany
- Universities of Giessen and Marburg Lung Center, Philipps University Marburg and University Children's Hospital Marburg, University of Marburg, Marburg, Germany
| | - Miguel A Alejandre Alcazar
- Member of the German Center for Lung Research (DZL), Germany
- Institute for Lung Health and Cardio-Pulmonary Institute, Universities of Giessen and Marburg Lung Center, Giessen, Germany
- Translational Experimental Pediatrics, Experimental Pulmonology, Department of Pediatrics
- Center for Molecular Medicine Cologne and Cologne Excellence Cluster on Stress Responses in Aging-associated Diseases, and
- Pediatric Pulmonology and Allergology, Department of Pediatrics, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; and
| | - Silke van Koningsbruggen-Rietschel
- Member of the German Center for Lung Research (DZL), Germany
- Pediatric Pulmonology and Allergology, Department of Pediatrics, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; and
| | - Robert Brock
- Member of the German Center for Lung Research (DZL), Germany
- Pediatric Pulmonology and Allergology, Department of Pediatrics, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; and
| | - Samira Blau
- Member of the German Center for Lung Research (DZL), Germany
- Pediatric Pulmonology and Allergology, Department of Pediatrics, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; and
| | - Gesine Hansen
- Member of the German Center for Lung Research (DZL), Germany
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Hanover, Germany
- Cluster of Excellence 2115 (RESIST), Hannover Medical School, Hanover, Germany
| | - Thomas Bahmer
- Member of the German Center for Lung Research (DZL), Germany
- Airway Research Center North, Borstel, Lübeck, Kiel, Grosshansdorf, Germany
- Internal Medicine Department I, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany
| | - Klaus F Rabe
- Member of the German Center for Lung Research (DZL), Germany
- Airway Research Center North, Borstel, Lübeck, Kiel, Grosshansdorf, Germany
- LungenClinic Grosshansdorf GmbH and Medical Clinics, Christian Albrechts University, Kiel, Germany
| | - Folke Brinkmann
- Member of the German Center for Lung Research (DZL), Germany
- Division of Epigenetics in Chronic Lung Disease, Priority Area Chronic Lung Diseases, Research Center Borstel-Leibniz Lung Center, Borstel, Germany
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany
- Airway Research Center North, Borstel, Lübeck, Kiel, Grosshansdorf, Germany
| | - Matthias Volkmar Kopp
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Airway Research Center North, Borstel, Lübeck, Kiel, Grosshansdorf, Germany
| | - Adam M Chaker
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical School, Technical University of Munich, Munich, Germany
| | - Bianca Schaub
- Member of the German Center for Lung Research (DZL), Germany
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
- Comprehensive Pneumology Center-Munich, Munich, Germany
| | - Erika von Mutius
- Member of the German Center for Lung Research (DZL), Germany
- Institute for Asthma and Allergy Prevention, Helmholtz Center Munich, German Research Center for Environmental Health, Munich, Germany
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Carsten B Schmidt-Weber
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
- Member of the German Center for Lung Research (DZL), Germany
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3
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Appel KS, Nürnberger C, Bahmer T, Förster C, Polidori MC, Kohls M, Kraus T, Hettich-Damm N, Petersen J, Blaschke S, Bröhl I, Butzmann J, Dashti H, Deckert J, Dreher M, Fiedler K, Finke C, Geisler R, Hanses F, Hopff SM, Jensen BEO, Konik M, Lehnert K, de Miranda SMN, Mitrov L, Miljukov O, Reese JP, Rohde G, Scherer M, Tausche K, Tebbe JJ, Vehreschild JJ, Voit F, Wagner P, Weigl M, Lemhöfer C. Definition of the Post-COVID syndrome using a symptom-based Post-COVID score in a prospective, multi-center, cross-sectoral cohort of the German National Pandemic Cohort Network (NAPKON). Infection 2024:10.1007/s15010-024-02226-9. [PMID: 38587752 DOI: 10.1007/s15010-024-02226-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The objective examination of the Post-COVID syndrome (PCS) remains difficult due to heterogeneous definitions and clinical phenotypes. The aim of the study was to verify the functionality and correlates of a recently developed PCS score. METHODS The PCS score was applied to the prospective, multi-center cross-sectoral cohort (in- and outpatients with SARS-CoV-2 infection) of the "National Pandemic Cohort Network (NAPKON, Germany)". Symptom assessment and patient-reported outcome measure questionnaires were analyzed at 3 and 12 months (3/12MFU) after diagnosis. Scores indicative of PCS severity were compared and correlated to demographic and clinical characteristics as well as quality of life (QoL, EQ-5D-5L). RESULTS Six hundred three patients (mean 54.0 years, 60.6% male, 82.0% hospitalized) were included. Among those, 35.7% (215) had no and 64.3% (388) had mild, moderate, or severe PCS. PCS severity groups differed considering sex and pre-existing respiratory diseases. 3MFU PCS worsened with clinical severity of acute infection (p = .011), and number of comorbidities (p = .004). PCS severity was associated with poor QoL at the 3MFU and 12MFU (p < .001). CONCLUSION The PCS score correlated with patients' QoL and demonstrated to be instructive for clinical characterization and stratification across health care settings. Further studies should critically address the high prevalence, clinical relevance, and the role of comorbidities. TRAIL REGISTRATION NUMBER The cohort is registered at www. CLINICALTRIALS gov under NCT04768998.
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Affiliation(s)
- Katharina S Appel
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Carolin Nürnberger
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Christian Förster
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Maria Cristina Polidori
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Mirjam Kohls
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Tanja Kraus
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Nora Hettich-Damm
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Julia Petersen
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Sabine Blaschke
- Emergency Department, University Medical Center Göttingen, Göttingen, Germany
| | - Isabel Bröhl
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jana Butzmann
- Medical Faculty, Institute of Medical Microbiology and Hospital Hygiene, University Hospital Magdeburg, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Hiwa Dashti
- Practice for General Medicine Dashti, Eberswalde, Germany
| | - Jürgen Deckert
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Karin Fiedler
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Carsten Finke
- Department of Neurology, Charité Berlin, Berlin, Germany
| | - Ramsia Geisler
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Frank Hanses
- Emergency Department and Department for Infection Control an Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Sina M Hopff
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Björn-Erik O Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Margarethe Konik
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Kristin Lehnert
- DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Susana M Nunes de Miranda
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Lazar Mitrov
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Olga Miljukov
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Jens-Peter Reese
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine, Goethe University Frankfurt, University Hospital, Medical Clinic I, Frankfurt/Main, Germany
| | - Margarete Scherer
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Kristin Tausche
- Department of Internal Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Johannes J Tebbe
- Department of Gastroenterology and Infectious Diseases, Klinikum Lippe, Lippe, Germany
| | - Jörg Janne Vehreschild
- Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian Voit
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Patricia Wagner
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Weigl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
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4
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Hartung TJ, Bahmer T, Chaplinskaya-Sobol I, Deckert J, Endres M, Franzpötter K, Geritz J, Haeusler KG, Hein G, Heuschmann PU, Hopff SM, Horn A, Keil T, Krawczak M, Krist L, Lieb W, Maetzler C, Montellano FA, Morbach C, Neumann C, Nürnberger C, Russ AK, Schmidbauer L, Schmidt S, Schreiber S, Steigerwald F, Störk S, Zoller T, Maetzler W, Finke C. Predictors of non-recovery from fatigue and cognitive deficits after COVID-19: a prospective, longitudinal, population-based study. EClinicalMedicine 2024; 69:102456. [PMID: 38333368 PMCID: PMC10847699 DOI: 10.1016/j.eclinm.2024.102456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Background Despite the high prevalence and major disability associated with fatigue and cognitive deficits after SARS-CoV-2 infection, little is known about long-term trajectories of these sequelae. We aimed to assess long-term trajectories of these conditions and to identify risk factors for non-recovery. Methods We analyzed longitudinal data from the population-based COVIDOM/NAPKON-POP cohort in Germany. Participants with confirmed SARS-CoV-2 infection were assessed at least 6 months (baseline) and again at least 18 months (follow-up) after infection using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) Scale (cutoff ≤ 30) and the Montreal Cognitive Assessment (MoCA, cutoff ≤ 25). Predictors of recovery from fatigue or cognitive deficits between assessments were identified through univariate and multivariable logistic regression models. The COVIDOM study is registered at the German registry for clinical studies (DRKS00023742) and at ClinicalTrials.gov (NCT04679584). Findings Between 15 November 2020 and 9 May 2023, a total of 3038 participants were assessed at baseline (median 9 months after infection) and 83% responded to invitations for follow-up (median 26 months after infection). At baseline, 21% (95% confidence interval (CI) [20%, 23%]) had fatigue and 23% (95% CI [22%, 25%]) had cognitive deficits according to cutoff scores on the FACIT-Fatigue or MoCA. Participants with clinically relevant fatigue (at baseline) showed significant improvement in fatigue scores at follow-up (Hedges' g [95% CI] = 0.73 [0.60, 0.87]) and 46% (95% CI [41%, 50%]) had recovered from fatigue. Participants with cognitive deficits showed a significant improvement in cognitive scores (g [95% CI] = 1.12 [0.90, 1.33]) and 57% (95% CI [50%, 64%]) had recovered from cognitive deficits. Patients with fatigue exhibiting a higher depressive symptom burden and/or headache at baseline were significantly less likely to recover. Significant risk factors for cognitive non-recovery were male sex, older age and <12 years of school education. Importantly, SARS-CoV-2 reinfection had no significant impact on recovery from fatigue or cognitive deficits. Interpretation Fatigue and cognitive deficits are common sequelae after SARS-CoV-2 infection. These syndromes improved over time and about half of the patients recovered within two years. The identified risk factors for non-recovery from fatigue and cognitive deficits could play an important role in shaping targeted strategies for treatment and prevention. Funding Funded by the German Federal Ministry of Education and Research (BMBF; grant number 01KX2121) and German Research Foundation (DFG) Excellence Cluster "Position Medicine in Information".
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Affiliation(s)
- Tim J. Hartung
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig Holstein, Campus Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | | | - Jürgen Deckert
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Uniklinik Würzburg, Germany
| | - Matthias Endres
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
| | | | - Johanna Geritz
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Karl G. Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Grit Hein
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Uniklinik Würzburg, Germany
| | - Peter U. Heuschmann
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany
- University Hospital Würzburg, Clinical Trial Center, Würzburg, Germany
| | - Sina M. Hopff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Germany
| | - Anna Horn
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany
| | - Thomas Keil
- Charité - Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Lilian Krist
- Charité - Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | | | - Corina Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Felipe A. Montellano
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Würzburg, Germany
- Germany University Hospital Würzburg, Department of Neurology, Würzburg, Germany
| | - Caroline Morbach
- University Hospital Würzburg, Department for Medicine I and Comprehensive Heart Failure Center, Germany
| | - Christian Neumann
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Carolin Nürnberger
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany
| | - Anne-Kathrin Russ
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Lena Schmidbauer
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany
| | - Sein Schmidt
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Clinical Study Center, Germany
| | - Stefan Schreiber
- Internal Medicine Department I, University Hospital Schleswig Holstein, Campus Kiel, Germany
| | - Flo Steigerwald
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Stefan Störk
- University Hospital Würzburg, Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Germany
| | - Thomas Zoller
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory and Critical Care Medicine, Berlin, Germany
| | - Walter Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Carsten Finke
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - NAPKON Study Group
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
- Internal Medicine Department I, University Hospital Schleswig Holstein, Campus Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
- Department of Medical Informatics, University Medical Center Göttingen, Germany
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Uniklinik Würzburg, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
- Institute of Epidemiology, Kiel University, Germany
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science, Würzburg, Germany
- University Hospital Würzburg, Clinical Trial Center, Würzburg, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Germany
- Charité - Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
- University Hospital Würzburg, Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Würzburg, Germany
- Germany University Hospital Würzburg, Department of Neurology, Würzburg, Germany
- University Hospital Würzburg, Department for Medicine I and Comprehensive Heart Failure Center, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Clinical Study Center, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory and Critical Care Medicine, Berlin, Germany
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5
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Shi Y, Strobl R, Apfelbacher C, Bahmer T, Geisler R, Heuschmann P, Horn A, Hoven H, Keil T, Krawczak M, Krist L, Lemhöfer C, Lieb W, Lorenz-Depiereux B, Mikolajczyk R, Montellano FA, Reese JP, Schreiber S, Skoetz N, Störk S, Vehreschild JJ, Witzenrath M, Grill E. Persistent symptoms and risk factors predicting prolonged time to symptom-free after SARS‑CoV‑2 infection: an analysis of the baseline examination of the German COVIDOM/NAPKON-POP cohort. Infection 2023; 51:1679-1694. [PMID: 37231313 PMCID: PMC10212223 DOI: 10.1007/s15010-023-02043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE We aimed to assess symptoms in patients after SARS-CoV-2 infection and to identify factors predicting prolonged time to symptom-free. METHODS COVIDOM/NAPKON-POP is a population-based prospective cohort of adults whose first on-site visits were scheduled ≥ 6 months after a positive SARS-CoV-2 PCR test. Retrospective data including self-reported symptoms and time to symptom-free were collected during the survey before a site visit. In the survival analyses, being symptom-free served as the event and time to be symptom-free as the time variable. Data were visualized with Kaplan-Meier curves, differences were tested with log-rank tests. A stratified Cox proportional hazard model was used to estimate adjusted hazard ratios (aHRs) of predictors, with aHR < 1 indicating a longer time to symptom-free. RESULTS Of 1175 symptomatic participants included in the present analysis, 636 (54.1%) reported persistent symptoms after 280 days (SD 68) post infection. 25% of participants were free from symptoms after 18 days [quartiles: 14, 21]. Factors associated with prolonged time to symptom-free were age 49-59 years compared to < 49 years (aHR 0.70, 95% CI 0.56-0.87), female sex (aHR 0.78, 95% CI 0.65-0.93), lower educational level (aHR 0.77, 95% CI 0.64-0.93), living with a partner (aHR 0.81, 95% CI 0.66-0.99), low resilience (aHR 0.65, 95% CI 0.47-0.90), steroid treatment (aHR 0.22, 95% CI 0.05-0.90) and no medication (aHR 0.74, 95% CI 0.62-0.89) during acute infection. CONCLUSION In the studied population, COVID-19 symptoms had resolved in one-quarter of participants within 18 days, and in 34.5% within 28 days. Over half of the participants reported COVID-19-related symptoms 9 months after infection. Symptom persistence was predominantly determined by participant's characteristics that are difficult to modify.
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Affiliation(s)
- Yanyan Shi
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel (UKSH Kiel), Kiel, Germany
| | - Ramsia Geisler
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt Am Main, Germany
| | - Peter Heuschmann
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Anna Horn
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
| | - Hanno Hoven
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Keil
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, University Hospital Jena, Jena, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bettina Lorenz-Depiereux
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- German Centre for Mental Health, Site Jena-Magdeburg-Halle, Halle, Germany
| | - Felipe A Montellano
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Jens Peter Reese
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
| | - Stefan Schreiber
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel (UKSH Kiel), Kiel, Germany
| | - Nicole Skoetz
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Jörg Janne Vehreschild
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt Am Main, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn‑Cologne, Cologne, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany.
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany.
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6
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Alhamdan F, Greulich T, Daviaud C, Marsh LM, Pedersen F, Thölken C, Pfefferle PI, Bahmer T, Potaczek DP, Tost J, Garn H. Identification of extracellular vesicle microRNA signatures specifically linked to inflammatory and metabolic mechanisms in obesity-associated low type-2 asthma. Allergy 2023; 78:2944-2958. [PMID: 37486026 DOI: 10.1111/all.15824] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023]
Abstract
RATIONALE AND OBJECTIVE Plasma extracellular vesicles (EVs) represent a vital source of molecular information about health and disease states. Due to their heterogenous cellular sources, EVs and their cargo may predict specific pathomechanisms behind disease phenotypes. Here we aimed to utilize EV microRNA (miRNA) signatures to gain new insights into underlying molecular mechanisms of obesity-associated low type-2 asthma. METHODS Obese low type-2 asthma (OA) and non-obese low type-2 asthma (NOA) patients were selected from an asthma cohort conjointly with healthy controls. Plasma EVs were isolated and characterised by nanoparticle tracking analysis. EV-associated small RNAs were extracted, sequenced and bioinformatically analysed. RESULTS Based on EV miRNA expression profiles, a clear distinction between the three study groups could be established using a principal component analysis. Integrative pathway analysis of potential target genes of the differentially expressed miRNAs revealed inflammatory cytokines (e.g., interleukin-6, transforming growth factor-beta, interferons) and metabolic factors (e.g., insulin, leptin) signalling pathways to be specifically associated with OA. The miR-17-92 and miR-106a-363 clusters were significantly enriched only in OA. These miRNA clusters exhibited discrete bivariate correlations with several key laboratory (e.g., C-reactive protein) and lung function parameters. Plasma EV miRNA signatures mirrored blood-derived CD4+ T-cell transcriptome data, but achieved an even higher sensitivity in identifying specifically affected biological pathways. CONCLUSION The identified plasma EV miRNA signatures and particularly the miR-17-92 and -106a-363 clusters were capable to disentangle specific mechanisms of the obesity-associated low type-2 asthma phenotype, which may serve as basis for stratified treatment development.
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Affiliation(s)
- Fahd Alhamdan
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Member of the German Center for Lung Research (DZL) and the Universities of Giessen and Marburg Lung Center (UGMLC), Medical Faculty, Philipps University of Marburg, Marburg, Germany
- Department of Medicine, Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timm Greulich
- Department of Medicine, Pulmonary and Critical Care Medicine, German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Marburg, Germany
| | - Christian Daviaud
- Laboratory for Epigenetics & Environment, Centre National de Recherche en Génomique Humaine, CEA-Institut de Biologie François Jacob, Université Paris-Saclay, France
| | - Leigh M Marsh
- Division of Physiology and Pathophysiology, Ludwig Boltzmann Institute for Lung Vascular Research and Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Frauke Pedersen
- Lungen Clinic Großhansdorf GmbH, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN), Großhansdorf, Germany
| | - Clemens Thölken
- Institute of Medical Bioinformatics and Biostatistics, Medical Faculty, Philipps University of Marburg, Marburg, Germany
| | - Petra Ina Pfefferle
- Comprehensive Biobank Marburg (CBBMR), Member of the German Biobank Alliance (GBA) and the German Center for Lung Research (DZL), Medical Faculty, Philipps University of Marburg, Marburg, Germany
| | - Thomas Bahmer
- Lungen Clinic Großhansdorf GmbH, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN), Großhansdorf, Germany
- Department for Internal Medicine I, Campus Kiel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), University Hospital Schleswig-Holstein, Kiel, Germany
| | - Daniel P Potaczek
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Member of the German Center for Lung Research (DZL) and the Universities of Giessen and Marburg Lung Center (UGMLC), Medical Faculty, Philipps University of Marburg, Marburg, Germany
- Center for Infection and Genomics of the Lung (CIGL), Member of the German Center for Lung Research (DZL) and Universities of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University of Giessen, Giessen, Germany
- Bioscientia MVZ Labor Mittelhessen GmbH, Gießen, Germany
| | - Jörg Tost
- Laboratory for Epigenetics & Environment, Centre National de Recherche en Génomique Humaine, CEA-Institut de Biologie François Jacob, Université Paris-Saclay, France
| | - Holger Garn
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Member of the German Center for Lung Research (DZL) and the Universities of Giessen and Marburg Lung Center (UGMLC), Medical Faculty, Philipps University of Marburg, Marburg, Germany
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7
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Shahrokny P, Maison N, Riemann L, Ehrmann M, DeLuca D, Schuchardt S, Thiele D, Weckmann M, Dittrich AM, Schaub B, Brinkmann F, Hansen G, Kopp MV, von Mutius E, Rabe KF, Bahmer T, Hohlfeld JM, Grychtol R, Holz O. Increased breath naphthalene in children with asthma and wheeze of the All Age Asthma Cohort (ALLIANCE). J Breath Res 2023; 18:016003. [PMID: 37604132 DOI: 10.1088/1752-7163/acf23e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/21/2023] [Indexed: 08/23/2023]
Abstract
Exhaled breath contains numerous volatile organic compounds (VOCs) known to be related to lung disease like asthma. Its collection is non-invasive, simple to perform and therefore an attractive method for the use even in young children. We analysed breath in children of the multicenter All Age Asthma Cohort (ALLIANCE) to evaluate if 'breathomics' have the potential to phenotype patients with asthma and wheeze, and to identify extrinsic risk factors for underlying disease mechanisms. A breath sample was collected from 142 children (asthma: 51, pre-school wheezers: 55, healthy controls: 36) and analysed using gas chromatography-mass spectrometry (GC/MS). Children were diagnosed according to Global Initiative for Asthma guidelines and comprehensively examined each year over up to seven years. Forty children repeated the breath collection after 24 or 48 months. Most breath VOCs differing between groups reflect the exposome of the children. We observed lower levels of lifestyle-related VOCs and higher levels of the environmental pollutants, especially naphthalene, in children with asthma or wheeze. Naphthalene was also higher in symptomatic patients and in wheezers with recent inhaled corticosteroid use. No relationships with lung function or TH2 inflammation were detected. Increased levels of naphthalene in asthmatics and wheezers and the relationship to disease severity could indicate a role of environmental or indoor air pollution for the development or progress of asthma. Breath VOCs might help to elucidate the role of the exposome for the development of asthma. The study was registered at ClinicalTrials.gov (NCT02496468).
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Affiliation(s)
- P Shahrokny
- Fraunhofer ITEM, Department of Clinical Airway Research, German Center for Lung Research (BREATH, DZL), Hannover, Germany
| | - N Maison
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Germany German Center for Lung Research (CPC-M, DZL), Munich, Germany
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - L Riemann
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (BREATH, DZL), Hannover, Germany
- Clinician Scientist Program TITUS, Else-Kröner-Fresenius-Stiftung, Hannover Medical School, Hannover, Germany
- Institute of Immunology, Hannover Medical School, Hannover, Germany
| | - M Ehrmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Germany German Center for Lung Research (CPC-M, DZL), Munich, Germany
| | - D DeLuca
- German Center for Lung Research (BREATH, DZL), Hannover, Germany
| | - S Schuchardt
- Fraunhofer ITEM, Bio- and Environmental Analytics, Hannover, Germany
| | - D Thiele
- Division of Pediatric Pulmonology and Allergology, University Children's Hospital, German Center for Lung Research (ARCN, DZL), Luebeck, Germany
- Institute of Medical Biometry and Statistics (IMBS), University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - M Weckmann
- Division of Pediatric Pulmonology and Allergology, University Children's Hospital, German Center for Lung Research (ARCN, DZL), Luebeck, Germany
- Epigenetics of Chronic Lung Disease, Priority Research Area Chronic Lung Diseases, Leibniz Lung Research Center Borstel, Borstel, Germany
| | - A M Dittrich
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (BREATH, DZL), Hannover, Germany
| | - B Schaub
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Germany German Center for Lung Research (CPC-M, DZL), Munich, Germany
| | - F Brinkmann
- Division of Pediatric Pulmonology and Allergology, University Children's Hospital, German Center for Lung Research (ARCN, DZL), Luebeck, Germany
| | - G Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (BREATH, DZL), Hannover, Germany
| | - M V Kopp
- Division of Pediatric Pulmonology and Allergology, University Children's Hospital, German Center for Lung Research (ARCN, DZL), Luebeck, Germany
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - E von Mutius
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Germany German Center for Lung Research (CPC-M, DZL), Munich, Germany
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - K F Rabe
- LungenClinic Grosshansdorf and Department of Medicine, Christian-Albrechts-University Kiel, German Center for Lung Research (ARCN, DZL), Grosshansdorf, Germany
| | - T Bahmer
- LungenClinic Grosshansdorf and Department of Medicine, Christian-Albrechts-University Kiel, German Center for Lung Research (ARCN, DZL), Grosshansdorf, Germany
- Internal Medicine Department I, University Hospital Schleswig-Holstein, UKSH - Campus Kiel, German Center for Lung Research (ARCN, DZL), Kiel, Germany
| | - J M Hohlfeld
- Fraunhofer ITEM, Department of Clinical Airway Research, German Center for Lung Research (BREATH, DZL), Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - R Grychtol
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (BREATH, DZL), Hannover, Germany
| | - O Holz
- Fraunhofer ITEM, Department of Clinical Airway Research, German Center for Lung Research (BREATH, DZL), Hannover, Germany
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8
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Liu Z, Hollmann C, Kalanidhi S, Grothey A, Keating S, Mena-Palomo I, Lamer S, Schlosser A, Kaiping A, Scheller C, Sotzny F, Horn A, Nürnberger C, Cejka V, Afshar B, Bahmer T, Schreiber S, Vehreschild JJ, Miljukov O, Schäfer C, Kretzler L, Keil T, Reese JP, Eichner FA, Schmidbauer L, Heuschmann PU, Störk S, Morbach C, Riemekasten G, Beyersdorf N, Scheibenbogen C, Naviaux RK, Williams M, Ariza ME, Prusty BK. Increased circulating fibronectin, depletion of natural IgM and heightened EBV, HSV-1 reactivation in ME/CFS and long COVID. medRxiv 2023:2023.06.23.23291827. [PMID: 37425897 PMCID: PMC10327231 DOI: 10.1101/2023.06.23.23291827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Myalgic Encephalomyelitis/ Chronic Fatigue syndrome (ME/CFS) is a complex, debilitating, long-term illness without a diagnostic biomarker. ME/CFS patients share overlapping symptoms with long COVID patients, an observation which has strengthened the infectious origin hypothesis of ME/CFS. However, the exact sequence of events leading to disease development is largely unknown for both clinical conditions. Here we show antibody response to herpesvirus dUTPases, particularly to that of Epstein-Barr virus (EBV) and HSV-1, increased circulating fibronectin (FN1) levels in serum and depletion of natural IgM against fibronectin ((n)IgM-FN1) are common factors for both severe ME/CFS and long COVID. We provide evidence for herpesvirus dUTPases-mediated alterations in host cell cytoskeleton, mitochondrial dysfunction and OXPHOS. Our data show altered active immune complexes, immunoglobulin-mediated mitochondrial fragmentation as well as adaptive IgM production in ME/CFS patients. Our findings provide mechanistic insight into both ME/CFS and long COVID development. Finding of increased circulating FN1 and depletion of (n)IgM-FN1 as a biomarker for the severity of both ME/CFS and long COVID has an immediate implication in diagnostics and development of treatment modalities.
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Affiliation(s)
- Zheng Liu
- Institute for Virology and Immunobiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Claudia Hollmann
- Institute for Virology and Immunobiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Sharada Kalanidhi
- Stanford Genome Technology Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Arnhild Grothey
- Institute for Virology and Immunobiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Sam Keating
- Institute for Virology and Immunobiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Irene Mena-Palomo
- Institute for Medical Data Sciences, University Hospital Würzburg, Würzburg
| | - Stephanie Lamer
- Rudolf Virchow Center, Center for Translational Bioimaging, Julius-Maximilians-University of Würzburg, Germany
| | - Andreas Schlosser
- Rudolf Virchow Center, Center for Translational Bioimaging, Julius-Maximilians-University of Würzburg, Germany
| | - Agnes Kaiping
- Institute for Virology and Immunobiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Carsten Scheller
- Institute for Virology and Immunobiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Franzeska Sotzny
- Institute for Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Horn
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Carolin Nürnberger
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Vladimir Cejka
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center and Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Boshra Afshar
- Institute for Virology and Immunobiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein UKSH - Campus Kiel, Kiel, Germany
| | - Stefan Schreiber
- Internal Medicine Department I, University Hospital Schleswig-Holstein UKSH - Campus Kiel, Kiel, Germany
| | - Jörg Janne Vehreschild
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Germany
| | - Olga Miljukov
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Christian Schäfer
- University Medicine Greifswald, Institute of Clinical Chemistry and Laboratory Medicine, Greifswald, Germany
| | - Luzie Kretzler
- Charité - Universitätsmedizin Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Thomas Keil
- Charité - Universitätsmedizin Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Felizitas A Eichner
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Lena Schmidbauer
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, Würzburg, Germany
- Institute for Medical Data Sciences, University Hospital Würzburg, Würzburg
- Clinical Trial Center, University Hospital Würzburg, Würzburg
| | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center and Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center and Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Niklas Beyersdorf
- Institute for Virology and Immunobiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | - Carmen Scheibenbogen
- Institute for Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robert K Naviaux
- Departments of Medicine, Pediatrics, and Pathology, University of California, San Diego School of Medicine, San Diego, USA
| | - Marshall Williams
- Institute for Behavioral Medicine Research (IBMR), The Ohio State University, Columbus, Ohio, USA
| | - Maria E Ariza
- Institute for Behavioral Medicine Research (IBMR), The Ohio State University, Columbus, Ohio, USA
| | - Bhupesh K Prusty
- Institute for Virology and Immunobiology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
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9
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Lemhöfer C, Bahmer T, Baumbach P, Besteher B, Boekel A, Finke K, Katzer K, Lehmann-Pohl K, Lewejohann JC, Loudovici-Krug D, Nowka M, Puta C, Quickert S, Reuken PA, Walter M, Stallmach A. Variations and Predictors of Post-COVID Syndrome Severity in Patients Attending a Post-COVID Outpatient Clinic. J Clin Med 2023; 12:4013. [PMID: 37373706 DOI: 10.3390/jcm12124013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
A relevant proportion of patients suffer from long-lasting impairments following an acute SARS-CoV-2 infection. The proposed post-COVID syndrome (PCS) score may improve comparison in the course and classification of affected patients. A prospective cohort of 952 patients presenting to the post-COVID outpatient clinic at Jena University Hospital, Germany, was enrolled. Patients received a structured examination. PCS score was calculated per visit. A total of 378 (39.7%) and 129 (13.6%) patients of the entire population visited the outpatient clinic two or three times, respectively (female: 66.4%; age: 49.5 (SD = 13) years). The initial presentation took place, on average, 290 (SD = 138) days after acute infection. The most frequently reported symptoms were fatigue (80.4%) and neurological impairments (76.1%). The mean PCS scores of patients with three visits were 24.6 points (SD = 10.9), 23.0 points (SD = 10.9) and 23.5 points (SD = 11.5) (p = 0.407), indicating moderate PCS. Female sex (p < 0.001), preexisting coagulation disorder (p = 0.021) and coronary artery disease (p = 0.032) were associated with higher PCS scores. PCS is associated with a multitude of long-lasting problems. The PCS score has proven its capability to objectify and quantify PCS symptoms in an outpatient setting. The influence of therapeutic measures on various PCS aspects should be the subject of further analyses.
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Affiliation(s)
- Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), 35392 Grosshansdorf, Germany
| | - Philipp Baumbach
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Andrea Boekel
- Department of Rehabilitation and Sports Medicine, Hanover Medical School, 30625 Hanover, Germany
| | - Kathrin Finke
- Department of Neurology, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Katrin Katzer
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Katja Lehmann-Pohl
- Center for Sepsis Control & Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Jan-Christoph Lewejohann
- Department of Emergency Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Dana Loudovici-Krug
- Institute of Physical and Rehabilitation Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Matthias Nowka
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Christian Puta
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Stefanie Quickert
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Philipp Alexander Reuken
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University Jena, 07747 Jena, Germany
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10
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Jensen-Kondering U, Maurer CJ, Brudermann HCB, Ernst M, Sedaghat S, Margraf NG, Bahmer T, Jansen O, Nawabi J, Vogt E, Büttner L, Siebert E, Bartl M, Maus V, Werding G, Schlamann M, Abdullayev N, Bender B, Richter V, Mengel A, Göpel S, Berlis A, Grams A, Ladenhauf V, Gizewski ER, Kindl P, Schulze-Zachau V, Psychogios M, König IR, Sondermann S, Wallis S, Brüggemann N, Schramm P, Neumann A. Patterns of acute ischemic stroke and intracranial hemorrhage in patients with COVID-19 : Results of a retrospective multicenter neuroimaging-based study from three central European countries. J Neurol 2023; 270:2349-2359. [PMID: 36820915 PMCID: PMC9947908 DOI: 10.1007/s00415-023-11608-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is an infection which can affect the central nervous system. In this study, we sought to investigate associations between neuroimaging findings with clinical, demographic, blood and cerebrospinal fluid (CSF) parameters, pre-existing conditions and the severity of acute COVID-19. MATERIALS AND METHODS Retrospective multicenter data retrieval from 10 university medical centers in Germany, Switzerland and Austria between February 2020 and September 2021. We included patients with COVID-19, acute neurological symptoms and cranial imaging. We collected demographics, neurological symptoms, COVID-19 severity, results of cranial imaging, blood and CSF parameters during the hospital stay. RESULTS 442 patients could be included. COVID-19 severity was mild in 124 (28.1%) patients (moderate n = 134/30.3%, severe n = 43/9.7%, critical n = 141/31.9%). 220 patients (49.8%) presented with respiratory symptoms, 167 (37.8%) presented with neurological symptoms first. Acute ischemic stroke (AIS) was detected in 70 (15.8%), intracranial hemorrhage (IH) in 48 (10.9%) patients. Typical risk factors were associated with AIS; extracorporeal membrane oxygenation therapy and invasive ventilation with IH. No association was found between the severity of COVID-19 or blood/CSF parameters and the occurrence of AIS or IH. DISCUSSION AIS was the most common finding on cranial imaging. IH was more prevalent than expected but a less common finding than AIS. Patients with IH had a distinct clinical profile compared to patients with AIS. There was no association between AIS or IH and the severity of COVID-19. A considerable proportion of patients presented with neurological symptoms first. Laboratory parameters have limited value as a screening tool.
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Affiliation(s)
- Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, UKSH, Campus Kiel, Kiel, Germany.
- Department of Neuroradiology, UKSH, Campus Lübeck, Lübeck, Germany.
| | - Christoph J Maurer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Hanna C B Brudermann
- Institute of Medical Biometry and Statistics (IMBS), UKSH, Campus Lübeck, Lübeck, Germany
| | - Marielle Ernst
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center, Göttingen, Germany
| | - Sam Sedaghat
- Department of Radiology and Neuroradiology, UKSH, Campus Kiel, Kiel, Germany
- Department of Radiology, University of California San Diego, San Diego, USA
| | - Nils G Margraf
- Department of Neurology, UKSH, Campus Kiel, Kiel, Germany
| | - Thomas Bahmer
- Department of Internal Medicine, UKSH, Campus Kiel, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, UKSH, Campus Kiel, Kiel, Germany
| | - Jawed Nawabi
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM), Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
| | - Estelle Vogt
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM), Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Laura Büttner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM), Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Bartl
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Medical Center Knappschaftskrankenhaus, Bochum, Germany
| | - Gregor Werding
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Medical Center Knappschaftskrankenhaus, Bochum, Germany
| | - Marc Schlamann
- Department of Radiology, Neuroradiology Division, University of Cologne, Cologne, Germany
| | - Nuran Abdullayev
- Department of Radiology, Neuroradiology Division, University of Cologne, Cologne, Germany
- GFO Clinics Troisdorf, Radiology and Neuroradiologie, Troisdorf, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Vivien Richter
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tübingen, Tübingen, Germany
| | - Siri Göpel
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Valentin Ladenhauf
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Kindl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Inke R König
- Institute of Medical Biometry and Statistics (IMBS), UKSH, Campus Lübeck, Lübeck, Germany
| | | | - Sönke Wallis
- Department of Internal Medicine, UKSH, Campus Lübeck, Lübeck, Germany
| | | | - Peter Schramm
- Department of Neuroradiology, UKSH, Campus Lübeck, Lübeck, Germany
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11
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Nitsche C, Frauchiger BS, Thiele D, Oestreich MA, Husstedt BL, Grychtol RM, Maison N, Foth S, Meyer M, Jakobs N, Bahmer T, Hansen G, von Mutius E, Kopp M. Quality Control of Nitrogen Multiple Breath Washout in a Multicenter Pediatric Asthma Study. Klin Padiatr 2023; 235:66-74. [PMID: 36657454 DOI: 10.1055/a-1976-9232] [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] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Nitrogen multiple breath washout (N2MBW) is a lung function test increasingly used in small airway diseases. Quality criteria have not yet been globally implemented and time-consuming retrospective overreading is necessary. Little data has been published on children with recurrent wheeze or asthma from multicentered studies. METHODS Children with wheeze or asthma and healthy controls were included in the longitudinal All Age Asthma Cohort (ALLIANCE). To assess ventilation inhomogeneity, N2MBW tests were performed in five centers from 2013 until 2020. All N2MBW tests were centrally overread by one center. Multiple washout procedures (trials) at the visit concluded to one test occasion. Tests were accepted if trials were technically sound (started correctly, terminated correctly, no leak, regular breathing pattern) and repeatable within one test occasion. Signal misalignment was retrospectively corrected. Factors that may impact test quality were analyzed, such as experience level. RESULTS N2MBW tests of n=561 participants were analyzed leading to n=949 (68.3%) valid tests of n=1,390 in total. Inter-center test acceptability ranged from 27.6% to 77.8%. End-of-test criterion and leak were identified to be the most common reasons for rejection. Data loss and uncorrectable signal misalignment led to rejection of 58% of trials in one center. In preschool children, significant improvement of test acceptability was found longitudinally (χ2(8)=18.6; p=0.02). CONCLUSION N2MBW is feasible in a multicenter asthma study in children. However, the quality of this time-consuming procedure is dependent on experience level of staff in preschool children and still requires retrospective overreading for all age groups.
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Affiliation(s)
- Catharina Nitsche
- University Children's Hospital, Division of Paediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein Campus Luebeck, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany
| | - Bettina Sarah Frauchiger
- Department of Paediatrics, Division of Paediatric Respiratory Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik Thiele
- Institute for Medical Biometry and Statistics, University of Luebeck, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany
| | - Marc-Alexander Oestreich
- Department of Paediatrics, Division of Paediatric Respiratory Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Berrit Liselotte Husstedt
- University Children's Hospital, Division of Paediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein Campus Luebeck, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany
| | - Ruth Margarethe Grychtol
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH); Member of the German Center for Lung Research (DZL), Germany
| | - Nicole Maison
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany.,Dr von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M); Member of the German Center for Lung Research (DZL), Germany
| | - Svenja Foth
- University Children's Hospital Marburg, University of Marburg, Marburg, Germany.,Member of the German Center for Lung Research (DZL) , Universities of Giessen and Marburg Lung Center (UGMLC), Marburg, Germany
| | - Meike Meyer
- Department of Paediatrics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nikolas Jakobs
- University Children's Hospital, Division of Paediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein Campus Luebeck, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany
| | - Thomas Bahmer
- Internal Medicine Department I, Pneumology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany.,LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany
| | - Gesine Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH); Member of the German Center for Lung Research (DZL), Germany
| | - Erika von Mutius
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany.,Dr von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M); Member of the German Center for Lung Research (DZL), Germany
| | - Matthias Kopp
- Department of Paediatrics, Division of Paediatric Respiratory Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,University Children's Hospital, Division of Paediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein Campus Luebeck, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany
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12
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Abdo M, Kirsten AM, von Mutius E, Kopp M, Hansen G, Rabe KF, Watz H, Trinkmann F, Bahmer T. Minimal Clinically Important Difference for Impulse Oscillometry in Adults with Asthma. Eur Respir J 2023; 61:13993003.01793-2022. [PMID: 36758985 PMCID: PMC10160799 DOI: 10.1183/13993003.01793-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Impulse oscillometry (IOS) allows an effort-independent evaluation of small airway function in asthma. Unfortunately, well-determined minimal clinically important differences (MCID) for IOS-measures are lacking. Here, we provide MCIDs for frequently used IOS-measures, namely frequency dependence of resistance (FDR) and area of reactance (AX) in patients with asthma. METHODS We performed IOS at baseline and 1 year later in adult patients with mild to severe asthma (n=235). In a two-step approach, we first applied a distribution-based method to statistically determine the MCID. Next, we validated the proposed MCID according to patient-reported outcome measures (PROMs) of Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT). We used multivariable analyses to investigate the proposed MCIDs as predictors for improvements in PROMs in comparison to the established MCID of FEV1. RESULTS The proposed MCID was a decline of≥0.06 kPa·L-1·s-1 and≥0.65 kPa·L-1 for FDR and AX, respectively. Patients who had changes beyond the MCID for both FDR and AX showed greater improvements in all PROMs than those who had not. The mean improvements in PROMs were beyond the established MCID for ACQ and AQLQ and approximated the MCID for ACT score. Multivariable analyses demonstrated the MCID for both FDR and AX as independent predictors for the MCID of all PROMs. The MCID for FDR was a stronger predictor of all PROMs than the MCID for FEV1. CONCLUSION This study provides MCIDs for IOS-derived measures in adult patients with asthma and emphasizes that small airway function is a distinguished endpoint beyond the conventional measure of FEV1.
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Affiliation(s)
- Mustafa Abdo
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Anne-Marie Kirsten
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany.,Institute of Asthma and Allergy Prevention, Helmholtz Centre, Munich, Germany
| | - Matthias Kopp
- Department of Pediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland.,Division of Pediatric Pneumology & Allergology, University Hospital Schleswig-Holstein-Campus Luebeck, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany
| | - Gesine Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Henrik Watz
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Frederik Trinkmann
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany.,Institute of Asthma and Allergy Prevention, Helmholtz Centre, Munich, Germany.,Department of Pediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland.,These authors contributed equally to this work
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.,University Hospital Schleswig-Holstein-Campus Kiel, Department for Internal Medicine I, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Kiel, Germany.,These authors contributed equally to this work
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13
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Winkelmann S, Korth A, Voss B, Nasr MA, Behrend N, Pudszuhn A, Hofmann VM, Schendzielorz P, Maetzler C, Hermes A, Borzikowsky C, Bahmer T, Lieb W, Schreiber S, Stork S, Montellano FA, Witzenrath M, Keil T, Krawczak M, Laudien M, On Behalf Of The Napkon Study Group NSG. Persisting chemosensory dysfunction in COVID-19 - a cross-sectional population-based survey. Rhinology 2023; 61:12-23. [PMID: 36323438 DOI: 10.4193/rhin22.176] [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: 02/02/2023]
Abstract
BACKGROUND Chemosensory dysfunction (CD) has been reported as a common symptom of SARS-CoV-2 infection, but it is not well understood whether and for how long changes of smell, taste and chemesthesis persist in infected individuals. METHODOLOGY Unselected adult residents of the German federal state of Schleswig-Holstein with Polymerase Chain Reaction (PCR)-test-confirmed SARS-CoV-2 infection were invited to participate in this large cross-sectional study. Data on the medical history and subjective chemosensory function of participants were obtained through questionnaires and visual analogue scales (VAS). Olfactory function (OF) was objectified with the Sniffin Sticks test (SST), including threshold (T), discrimination (D) and identification (I) test as well as summarized TDI score, and compared to that in healthy controls. Gustatory function (GF) was evaluated with the suprathreshold taste strips (TS) test, and trigeminal function was tested with an ampoule containing ammonia. RESULTS Between November 2020 and June 2021, 667 infected individuals (mean age: 48.2 years) were examined 9.1 months, on average, after positive PCR testing. Of these, 45.6% had persisting subjective olfactory dysfunction (OD), 36.2% had subjective gustatory dysfunction (GD). Tested OD, tested GD and impaired trigeminal function were observed in 34.6%, 7.3% and 1.8% of participants, respectively. The mean TDI score of participants was significantly lower compared to healthy subjects. Significant associations were observed between subjective OD and GD, and between tested OD and GD. CONCLUSION Nine months after SARS-CoV-2 infection, OD prevalence is significantly increased among infected members of the general population. Therefore, OD should be included in the list of symptoms collectively defining Long-COVID.
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Affiliation(s)
- S Winkelmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - A Korth
- Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - B Voss
- Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - M A Nasr
- Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - N Behrend
- Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - A Pudszuhn
- Department of Otorhinolaryngology, Head and Neck Surgery, Charity-Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - V M Hofmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Charity-Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - P Schendzielorz
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Wurzburg, Wurzburg, Germany
| | - C Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - A Hermes
- Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - C Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - T Bahmer
- Division of Pneumology, Department of Medicine 1, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - W Lieb
- Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - S Schreiber
- Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - S Stork
- Comprehensive Heart Failure Center and Dept. Internal Medicine I, University Hospital Wurzburg, Wurzburg, Germany
| | - F A Montellano
- Comprehensive Heart Failure Center and Dept. Internal Medicine I, University Hospital Wurzburg, Wurzburg, Germany; Institute of Clinical Epidemiology and Biometry, University of Wurzburg, Wurzburg, Germany; Department of Neurology, University Hospital Wurzburg, Wurzburg, Germany
| | - M Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charity - Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Berlin, Germany
| | - T Keil
- Institute of Clinical Epidemiology and Biometry, University of Wurzburg, Wurzburg, Germany; Institute of Social Medicine, Epidemiology and Health Economics, Charity-Universitatsmedizin Berlin, Berlin, Germany
| | - M Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - M Laudien
- Department of Otorhinolaryngology, Head and Neck Surgery, Kiel University, University Medical Centre Schleswig-Holstein, Kiel, Germany
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14
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Yusuf KO, Miljukov O, Schoneberg A, Hanß S, Wiesenfeldt M, Stecher M, Mitrov L, Hopff SM, Steinbrecher S, Kurth F, Bahmer T, Schreiber S, Pape D, Hofmann AL, Kohls M, Störk S, Stubbe HC, Tebbe JJ, Hellmuth JC, Erber J, Krist L, Rieg S, Pilgram L, Vehreschild JJ, Reese JP, Krefting D. Consistency as a Data Quality Measure for German Corona Consensus Items Mapped from National Pandemic Cohort Network Data Collections. Methods Inf Med 2023. [PMID: 36596462 DOI: 10.1055/a-2006-1086] [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: 01/05/2023]
Abstract
BACKGROUND As a national effort to better understand the current pandemic, three cohorts collect sociodemographic and clinical data from coronavirus disease 2019 (COVID-19) patients from different target populations within the German National Pandemic Cohort Network (NAPKON). Furthermore, the German Corona Consensus Dataset (GECCO) was introduced as a harmonized basic information model for COVID-19 patients in clinical routine. To compare the cohort data with other GECCO-based studies, data items are mapped to GECCO. As mapping from one information model to another is complex, an additional consistency evaluation of the mapped items is recommended to detect possible mapping issues or source data inconsistencies. OBJECTIVES The goal of this work is to assure high consistency of research data mapped to the GECCO data model. In particular, it aims at identifying contradictions within interdependent GECCO data items of the German national COVID-19 cohorts to allow investigation of possible reasons for identified contradictions. We furthermore aim at enabling other researchers to easily perform data quality evaluation on GECCO-based datasets and adapt to similar data models. METHODS All suitable data items from each of the three NAPKON cohorts are mapped to the GECCO items. A consistency assessment tool (dqGecco) is implemented, following the design of an existing quality assessment framework, retaining their-defined consistency taxonomies, including logical and empirical contradictions. Results of the assessment are verified independently on the primary data source. RESULTS Our consistency assessment tool helped in correcting the mapping procedure and reveals remaining contradictory value combinations within COVID-19 symptoms, vital signs, and COVID-19 severity. Consistency rates differ between the different indicators and cohorts ranging from 95.84% up to 100%. CONCLUSION An efficient and portable tool capable of discovering inconsistencies in the COVID-19 domain has been developed and applied to three different cohorts. As the GECCO dataset is employed in different platforms and studies, the tool can be directly applied there or adapted to similar information models.
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Affiliation(s)
- Khalid O Yusuf
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Olga Miljukov
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Anne Schoneberg
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Sabine Hanß
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Wiesenfeldt
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Melanie Stecher
- Department I for Internal Medicine, University Hospital Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Lazar Mitrov
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Sina Marie Hopff
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Sarah Steinbrecher
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Florian Kurth
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany.,Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm Großhansdorf, Germany
| | - Stefan Schreiber
- Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Daniel Pape
- Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Anna-Lena Hofmann
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Mirjam Kohls
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department Clinical Research & Epidemiology, University Hospital Würzburg, Comprehensive Heart Failure Center, and Department Internal Medicine I, Würzburg, Germany
| | | | - Johannes J Tebbe
- Department of Gastroenterology and Infectious Diseases, University Medical Center East Westphalia-Lippe, Klinikum Lippe, Lemgo, Germany
| | - Johannes C Hellmuth
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Johanna Erber
- Department II of Internal Medicine, Technical University of Munich, School of Medicine, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Siegbert Rieg
- Department of Medicine II, Division of Infectious Diseases, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lisa Pilgram
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany.,Department of Nephrology and Medical Intensive Care, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Jörg J Vehreschild
- Department I for Internal Medicine, University Hospital Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.,Department of Nephrology and Medical Intensive Care, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Jens-Peter Reese
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Dagmar Krefting
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany.,Campus Institute Data Science (CIDAS), Georg-August-University, Göttingen, Germany
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15
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Tran F, Harris DM, Scharmacher A, Graßhoff H, Sterner K, Schinke S, Käding N, Humrich JY, Cabral-Marques O, Bernardes JP, Mishra N, Bahmer T, Franzenburg J, Hoyer BF, Glück A, Guggeis M, Ossysek A, Küller A, Frank D, Lange C, Rupp J, Heyckendorf J, Gaede KI, Amital H, Rosenstiel P, Shoenfeld Y, Halpert G, Rosenberg AZ, Schulze-Forster K, Heidecke H, Riemekasten G, Schreiber S. Increased protease-activated receptor 1 autoantibodies are associated with severe COVID-19. ERJ Open Res 2022; 8:00379-2022. [PMID: 36575710 PMCID: PMC9571165 DOI: 10.1183/23120541.00379-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 12/30/2022] Open
Abstract
In patients with severe #COVID19, increased levels of autoantibodies against PAR1 were found. These might serve as allosteric agonists of PAR1 on endothelial cells and platelets, and thus might contribute to the pathogenesis of microthrombosis in COVID-19. https://bit.ly/3pqM9Vv.
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Affiliation(s)
- Florian Tran
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany,Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany,Florian Tran ()
| | - Danielle M.M. Harris
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany,Institute for Human Nutrition and Food Science, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Alena Scharmacher
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Hanna Graßhoff
- Department of Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Kristina Sterner
- Department of Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Susanne Schinke
- Department of Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Nadja Käding
- Department of Infectious Diseases and Microbiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Jens Y. Humrich
- Department of Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Otávio Cabral-Marques
- Department of Immunology, Instituto de Ciencias Biomedicas, Universidade de São Paulo, São Paulo, SP, Brazil,Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil,Network of Immunity in Infection, Malignancy, and Autoimmunity, Universal Scientific Education and Research Network, Sao Paulo, SP, Brazil,Department of Medicine, Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil,Laboratory of Medical Investigation 29, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Joana P. Bernardes
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Neha Mishra
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Thomas Bahmer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany,LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Jeanette Franzenburg
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany,Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bimba F. Hoyer
- Section for Rheumatology, Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Andreas Glück
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Martina Guggeis
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany,Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Alexander Ossysek
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Andre Küller
- Department of Internal Medicine III, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, University Medical Center Schleswig-Holstein, Kiel, Germany,German Centre for Cardiovascular Research (DZHK), partner site Hamburg, Kiel, Lübeck, Germany
| | - Christoph Lange
- Research Center Borstel, Borstel, Germany,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Borstel, Germany,Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany,Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Jan Heyckendorf
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany,Research Center Borstel, Borstel, Germany,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Borstel, Germany,Airway Research Center North (ARCN), Members of the German Center for Lung Research (DZL), Borstel, Germany
| | - Karoline I. Gaede
- Research Center Borstel, Borstel, Germany,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Borstel, Germany,Airway Research Center North (ARCN), Members of the German Center for Lung Research (DZL), Borstel, Germany,BioMaterialBank Nord, Borstel, Germany
| | - Howard Amital
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel,Ariel University, Ariel, Israel,Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Saint-Petersburg, Russia
| | - Gilad Halpert
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel
| | - Avi Z. Rosenberg
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Gabriela Riemekasten
- Institute for Human Nutrition and Food Science, University Medical Center Schleswig-Holstein, Kiel, Germany,Priority Area Asthma and Allergy, Research Center Borstel, Airway Research Center North (ARCN), Members of the German Center for Lung Research (DZL), Borstel, Germany,These authors contributed equally
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany,Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany,These authors contributed equally
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16
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Hartung TJ, Neumann C, Bahmer T, Chaplinskaya-Sobol I, Endres M, Geritz J, Haeusler KG, Heuschmann PU, Hildesheim H, Hinz A, Hopff S, Horn A, Krawczak M, Krist L, Kudelka J, Lieb W, Maetzler C, Mehnert-Theuerkauf A, Montellano FA, Morbach C, Schmidt S, Schreiber S, Steigerwald F, Störk S, Maetzler W, Finke C. Fatigue and cognitive impairment after COVID-19: A prospective multicentre study. EClinicalMedicine 2022; 53:101651. [PMID: 36133318 PMCID: PMC9482331 DOI: 10.1016/j.eclinm.2022.101651] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/16/2022] [Accepted: 08/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Reliable estimates of frequency, severity and associated factors of both fatigue and cognitive impairment after COVID-19 are needed. Also, it is not clear whether the two are distinct sequelae of COVID-19 or part of the same syndrome." METHODS In this prospective multicentre study, frequency of post-COVID fatigue and cognitive impairment were assessed in n = 969 patients (535 [55%] female) ≥6 months after SARS-CoV-2 infection with the FACIT-Fatigue scale (cut-off ≤30) and Montreal Cognitive Assessment (≤25 mild, ≤17 moderate impairment) between November 15, 2020 and September 29, 2021 at University Medical Center Schleswig-Holstein, Campus Kiel and University Hospital Würzburg in Germany. 969 matched non-COVID controls were drawn from a pre-pandemic, randomised, Germany-wide population survey which also included the FACIT-Fatigue scale. Associated sociodemographic, comorbid, clinical, psychosocial factors and laboratory markers were identified with univariate and multivariable linear regression models. FINDINGS On average 9 months after infection, 19% of patients had clinically relevant fatigue, compared to 8% of matched non-COVID controls (p < 0.001). Factors associated with fatigue were female gender, younger age, history of depression and the number of acute COVID symptoms. Among acute COVID symptoms, altered consciousness, dizziness and myalgia were most strongly associated with long-term fatigue. Moreover, 26% of patients had mild and 1% had moderate cognitive impairment. Factors associated with cognitive impairment were older age, male gender, shorter education and a history of neuropsychiatric disease. There was no significant correlation between fatigue and cognitive impairment and only 5% of patients suffered from both conditions. INTERPRETATION Fatigue and cognitive impairment are two common, but distinct sequelae of COVID-19 with potentially separate pathophysiological pathways. FUNDING German Federal Ministry of Education and Research (BMBF).
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Key Words
- CI, confidence interval
- COVID-19
- COVID-19, Coronavirus Disease 2019
- CRP, C-reactive protein
- CSF, cerebrospinal fluid
- Cognitive dysfunction
- Fatigue
- GAD-7, 7-item anxiety screening questionnaire
- MoCA, Montreal Cognitive Assessment
- NAPKON, National Pandemic Cohort Network
- PCR, polymerase chain reaction
- PHQ-8, 8-item depression module of the Patient Health Questionnaire
- PSQI, Pittsburgh Sleep Quality Index
- Post-acute COVID-19 syndrome
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Distress Syndrome caused by Corona Virus 2
- VIF, variance inflation factor
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Affiliation(s)
- Tim J. Hartung
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Christian Neumann
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | | | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- Excellence Cluster NeuroCure, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
| | - Johanna Geritz
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Hanna Hildesheim
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Sina Hopff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne, Duesseldorf, Germany
| | - Anna Horn
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jennifer Kudelka
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Corina Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Felipe A. Montellano
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- University Hospital Würzburg, Department for Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
| | - Sein Schmidt
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Clinical Study Center, Berlin, Germany
| | - Stefan Schreiber
- Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Klinik für Innere Medizin I, Kiel, Germany
| | - Flo Steigerwald
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Walter Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Carsten Finke
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Corresponding author at: Department of Neurology, Charité – Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
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17
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Lemmel S, Weckmann M, Wohlers A, Jirmo AC, Grychtol R, Ricklefs I, Nissen G, Bachmann A, Singh S, Caicedo J, Bahmer T, Hansen G, Von Mutius E, Rabe KF, Fuchs O, Dittrich AM, Schaub B, Happle C, Carpenter AE, Kopp MV, Becker T. In vitro neutrophil migration is associated with inhaled corticosteroid treatment and serum cytokines in pediatric asthma. Front Pharmacol 2022; 13:1021317. [PMID: 36304163 PMCID: PMC9593213 DOI: 10.3389/fphar.2022.1021317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Different asthma phenotypes are driven by molecular endotypes. A Th1-high phenotype is linked to severe, therapy-refractory asthma, subclinical infections and neutrophil inflammation. Previously, we found neutrophil granulocytes (NGs) from asthmatics exhibit decreased chemotaxis towards leukotriene B4 (LTB4), a chemoattractant involved in inflammation response. We hypothesized that this pattern is driven by asthma in general and aggravated in a Th1-high phenotype. Methods: NGs from asthmatic nd healthy children were stimulated with 10 nM LTB4/100 nM N-formylmethionine-leucyl-phenylalanine and neutrophil migration was documented following our prior SiMA (simplified migration assay) workflow, capturing morphologic and dynamic parameters from single-cell tracking in the images. Demographic, clinical and serum cytokine data were determined in the ALLIANCE cohort. Results: A reduced chemotactic response towards LTB4 was confirmed in asthmatic donors regardless of inhaled corticosteroid (ICS) treatment. By contrast, only NGs from ICS-treated asthmatic children migrate similarly to controls with the exception of Th1-high donors, whose NGs presented a reduced and less directed migration towards the chemokines. ICS-treated and Th1-high asthmatic donors present an altered surface receptor profile, which partly correlates with migration. Conclusions: Neutrophil migration in vitro may be affected by ICS-therapy or a Th1-high phenotype. This may be explained by alteration of receptor expression and could be used as a tool to monitor asthma treatment.
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Affiliation(s)
- Solveig Lemmel
- Department of Paediatric Pneumology and Allergology, University Children’s Hospital, Lübeck, Schleswig-Holstein, Germany
| | - Markus Weckmann
- Department of Paediatric Pneumology and Allergology, University Children’s Hospital, Lübeck, Schleswig-Holstein, Germany
- Priority Research Area Chronic Lung Diseases Leibniz Lung Research Center Borstel, Epigenetics of Chronic Lung Disease, Großhansdorf, Germany
- Airway Research Center North, Member of the German Center of Lung Research (DZL), Lübeck, Germany
- *Correspondence: Markus Weckmann,
| | - Anna Wohlers
- Department of Paediatric Pneumology and Allergology, University Children’s Hospital, Lübeck, Schleswig-Holstein, Germany
| | - Adan Chari Jirmo
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center of Lung Research (DZL), Hannover, Germany
| | - Ruth Grychtol
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center of Lung Research (DZL), Hannover, Germany
| | - Isabell Ricklefs
- Department of Paediatric Pneumology and Allergology, University Children’s Hospital, Lübeck, Schleswig-Holstein, Germany
- Airway Research Center North, Member of the German Center of Lung Research (DZL), Lübeck, Germany
| | - Gyde Nissen
- Department of Paediatric Pneumology and Allergology, University Children’s Hospital, Lübeck, Schleswig-Holstein, Germany
- Airway Research Center North, Member of the German Center of Lung Research (DZL), Lübeck, Germany
| | - Anna Bachmann
- Department of Paediatric Pneumology and Allergology, University Children’s Hospital, Lübeck, Schleswig-Holstein, Germany
| | - Shantanu Singh
- Imaging Platform, Broad Institute of MIT and Harvard, Cambridge, CA, United States
| | - Juan Caicedo
- Imaging Platform, Broad Institute of MIT and Harvard, Cambridge, CA, United States
| | - Thomas Bahmer
- Department of Pneumology, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
- University Hospital Schleswig-Holstein Campus Kiel, Department for Internal Medicine I, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Kiel, Germany
| | - Gesine Hansen
- Airway Research Center North, Member of the German Center of Lung Research (DZL), Lübeck, Germany
| | - Erika Von Mutius
- University Children’s Hospital, Ludwig Maximilian’s University, German Research Center for Environmental Health (CPC-M), Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Klaus F. Rabe
- Department of Pneumology, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Oliver Fuchs
- Department of Paediatric Pneumology and Allergology, University Children’s Hospital, Lübeck, Schleswig-Holstein, Germany
- University Children’s Hospital, Ludwig Maximilian’s University, German Research Center for Environmental Health (CPC-M), Member of the German Center of Lung Research (DZL), Munich, Germany
- Department of Paediatric Respiratory Medicine, Inselspital, University Children’s Hospital of Bern, University of Bern, Bern, Switzerland
| | - Anna-Maria Dittrich
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center of Lung Research (DZL), Hannover, Germany
| | - Bianca Schaub
- University Children’s Hospital, Ludwig Maximilian’s University, German Research Center for Environmental Health (CPC-M), Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Christine Happle
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center of Lung Research (DZL), Hannover, Germany
| | - Anne E. Carpenter
- Imaging Platform, Broad Institute of MIT and Harvard, Cambridge, CA, United States
| | - Matthias Volkmar Kopp
- Department of Paediatric Pneumology and Allergology, University Children’s Hospital, Lübeck, Schleswig-Holstein, Germany
- Airway Research Center North, Member of the German Center of Lung Research (DZL), Lübeck, Germany
- Department of Paediatric Respiratory Medicine, Inselspital, University Children’s Hospital of Bern, University of Bern, Bern, Switzerland
| | - Tim Becker
- Department of Paediatric Pneumology and Allergology, University Children’s Hospital, Lübeck, Schleswig-Holstein, Germany
- Imaging Platform, Broad Institute of MIT and Harvard, Cambridge, CA, United States
- IAV GmbH, Gifhorn, Germany
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18
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Maison N, Omony J, Illi S, Thiele D, Skevaki C, Dittrich AM, Bahmer T, Rabe KF, Weckmann M, Happle C, Schaub B, Meyer M, Foth S, Rietschel E, Renz H, Kopp MV, Hansen G, von Mutius E, Grychtol R. T2-high asthma across all ages – comparative analysis in
children and adults from the ALLIANCE cohort. Klinische Pädiatrie 2022. [DOI: 10.1055/s-0042-1754451] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- N Maison
- Dr von Hauner Children's Hospital, Ludwig Maximilians
University, Asthma and Allergy, Munich, Germany
- Helmholtz Zentrum Munich, Institute for Asthma- and Allergy Prevention
(IAP), Munich, Germany
- Comprehensive Pneumology Center – Munich (CPC-M); Member of
German Center for Lung Research (DZL), Munich, Germany
| | - J Omony
- Helmholtz Zentrum Munich, Institute for Asthma- and Allergy Prevention
(IAP), Munich, Germany
- Comprehensive Pneumology Center – Munich (CPC-M); Member of
German Center for Lung Research (DZL), Munich, Germany
| | - S Illi
- Helmholtz Zentrum Munich, Institute for Asthma- and Allergy Prevention
(IAP), Munich, Germany
- Comprehensive Pneumology Center – Munich (CPC-M); Member of
German Center for Lung Research (DZL), Munich, Germany
| | - D Thiele
- University Medical Center Schleswig-Holstein, Institute of Medical
Biometry and Statistics (IMBS), Luebeck, Germany
- Airway Research Center North (ARCN), Member of the German Center for
Lung Research (DZL), Luebeck, Germany
| | - C Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry,
Philipps-University Marburg, Molecular Diagnostics, Marburg,
Germany
- Universities of Giessen and Marburg Lung Center (UGMLC), Philipps
University Marburg, German Center for Lung Research (DZL), Marburg,
Germany
| | - A-M Dittrich
- Hannover Medical School, Department of Paediatric Pneumology,
Allergology and Neonatology, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH);
Member of the German Center for Lung Research (DZL), Hannover,
Germany
| | - T Bahmer
- LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany
- Airway Research Center North (ARCN), Member of the German Center for
Lung Research (DZL), Grosshansdorf, Germany
- University Hospital Schleswig-Holstein, Campus Kiel, Internal Medicine
Department I, Pneumology, Kiel, Germany
| | - KF Rabe
- LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany
- Airway Research Center North (ARCN), Member of the German Center for
Lung Research (DZL), Grosshansdorf, Germany
| | - M Weckmann
- University Medical Center Schleswig-Holstein, Division of Paediatric
Pneumology and Allergology, Luebeck, Germany
- Airway Research Center North (ARCN), Member of the German Center for
Lung Research (DZL), Luebeck, Germany
| | - C Happle
- Hannover Medical School, Department of Paediatric Pneumology,
Allergology and Neonatology, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH);
Member of the German Center for Lung Research (DZL), Hannover,
Germany
| | - B Schaub
- Dr von Hauner Children's Hospital, Ludwig Maximilians
University, Asthma and Allergy, Munich, Germany
- Comprehensive Pneumology Center – Munich (CPC-M); Member of
German Center for Lung Research (DZL), Munich, Germany
| | - M Meyer
- University Children's Hospital, University of Cologne, Cologne,
Germany
| | - S Foth
- University Children’s Hospital Marburg, University of Marburg,
Marburg, Germany
- Universities of Giessen and Marburg Lung Center (UGMLC), Philipps
University Marburg, German Center for Lung Research (DZL), Marburg,
Germany
| | - E Rietschel
- University Children's Hospital, University of Cologne, Cologne,
Germany
| | - H Renz
- Institute of Laboratory Medicine and Pathobiochemistry,
Philipps-University Marburg, Molecular Diagnostics, Marburg,
Germany
- Universities of Giessen and Marburg Lung Center (UGMLC), Philipps
University Marburg, German Center for Lung Research (DZL), Marburg,
Germany
| | - MV Kopp
- University Children's Hospital, University of Bern, Department
of Paediatric Respiratory Medicine, Bern, Switzerland
- Airway Research Center North (ARCN), Member of the German Center for
Lung Research (DZL), Luebeck, Germany
- University Medical Center Schleswig-Holstein, Division of Paediatric
Pneumology and Allergology, Luebeck, Germany
| | - G Hansen
- Hannover Medical School, Department of Paediatric Pneumology,
Allergology and Neonatology, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH);
Member of the German Center for Lung Research (DZL), Hannover,
Germany
| | - E von Mutius
- Dr von Hauner Children's Hospital, Ludwig Maximilians
University, Asthma and Allergy, Munich, Germany
- Helmholtz Zentrum Munich, Institute for Asthma- and Allergy Prevention
(IAP), Munich, Germany
- Comprehensive Pneumology Center – Munich (CPC-M); Member of
German Center for Lung Research (DZL), Munich, Germany
| | - R Grychtol
- Hannover Medical School, Department of Paediatric Pneumology,
Allergology and Neonatology, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH);
Member of the German Center for Lung Research (DZL), Hannover,
Germany
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19
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Lommatzsch M, Suhling H, Korn S, Bergmann KC, Schreiber J, Bahmer T, Rabe KF, Buhl R, Virchow JC, Milger K. Safety of combining biologics in severe asthma: Asthma-related and unrelated combinations. Allergy 2022; 77:2839-2843. [PMID: 35585763 DOI: 10.1111/all.15379] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/03/2022] [Accepted: 05/14/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Marek Lommatzsch
- Department of Pneumology and Critical Care Medicine, University of Rostock, Rostock, Germany
| | - Hendrik Suhling
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Stephanie Korn
- IKF Pneumologie, Mainz, Germany and Department of Pneumology and Respiratory Care Medicine, University of Heidelberg, Heidelberg, Germany
| | - Karl-Christian Bergmann
- Institute of Allergology, Charité, Universitätsmedizin Berlin and Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - Jens Schreiber
- Department of Pneumonology, University Hospital, Otto-Von-Guericke-University, Magdeburg, Germany
| | - Thomas Bahmer
- University Hospital Schleswig-Holstein, Campus Kiel, Internal Medicine Department I, Kiel, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Grosshansdorf, Germany and University Hospital Schleswig-Holstein-Campus Kiel, Department for Internal Medicine I, Kiel, Germany
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | | | - Katrin Milger
- Department of Medicine V, University Hospital, LMU Munich, and Helmholtz Center Munich, Munich, Germany
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20
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Buchholz S, Künstner A, Bahmer T, Hansen G, von Mutius E, Rabe KF, Dittrich AM, Schaub B, Happle C, Kopp MV, Busch H, Weckmann M. Der Einfluss nasaler Methylierungsmuster auf den
Asthma-Phänotyp – Eine Clusteranalyse mittels Uniform Manifold
Approximation and Projection (UMAP). Klinische Pädiatrie 2022. [DOI: 10.1055/s-0042-1754463] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S Buchholz
- Klinik für Kinder- & Jugendmedizin,
Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Sektion
für Pädiatrische Pneumologie und Allergologie, Lübeck,
Germany
- Leibniz Lungenzentrum Borstel, Programmbereich Chronische
Lungenerkrankungen; Epigenetik chronischer Lungenerkrankungen, Borstel,
Germany
- Airway Research Center North (ARCN), Mitglied des Deutschen Zentrums
für Lungenforschung (DZL), Lübeck, Germany
| | - A Künstner
- Universität zu Lübeck, Lübecker Institut
für Experimentelle Dermatologie, Systembiologie, Lübeck,
Germany
| | - T Bahmer
- LungenClinic Grosshansdorf, Abteilung Pneumologie, Grosshansdorf,
Germany
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik
für Innere Medizin I, Kiel, Germany
- Airway Research Center North (ARCN), Mitglied des Deutschen Zentrums
für Lungenforschung (DZL), Grosshandsdorf, Germany
| | - G Hansen
- Medizinische Hochschule Hannover, Klinik für
Pädiatrische Pneumologie, Allergologie & Neonatologie, Hannover,
Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover
(BREATH), Mitglied des Deutschen Zentrums für Lungenforschung (DZL),
Hannover, Germany
| | - E von Mutius
- Ludwig-Maximilians-Universität, Haunersches Kinderspital,
Haunersches Kinderspital, München, Germany
- Comprehensive Pneumology Center (CPC-M), Mitglied des Deutschen
Zentrums für Lungenforschung (DZL), München,
Germany
| | - KF Rabe
- LungenClinic Grosshansdorf, Abteilung Pneumologie, Grosshansdorf,
Germany
- Airway Research Center North (ARCN), Mitglied des Deutschen Zentrums
für Lungenforschung (DZL), Grosshandsdorf, Germany
| | - A-M Dittrich
- Medizinische Hochschule Hannover, Klinik für
Pädiatrische Pneumologie, Allergologie & Neonatologie, Hannover,
Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover
(BREATH), Mitglied des Deutschen Zentrums für Lungenforschung (DZL),
Hannover, Germany
| | - B Schaub
- Ludwig-Maximilians-Universität, Haunersches Kinderspital,
Haunersches Kinderspital, München, Germany
- Comprehensive Pneumology Center (CPC-M), Mitglied des Deutschen
Zentrums für Lungenforschung (DZL), München,
Germany
| | - C Happle
- Medizinische Hochschule Hannover, Klinik für
Pädiatrische Pneumologie, Allergologie & Neonatologie, Hannover,
Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover
(BREATH), Mitglied des Deutschen Zentrums für Lungenforschung (DZL),
Hannover, Germany
| | - MV Kopp
- Inselspital, Universitätsklinik für Kinderheilkunde,
Bern, Switzerland
| | - H Busch
- Universität zu Lübeck, Lübecker Institut
für Experimentelle Dermatologie, Systembiologie, Lübeck,
Germany
| | - M Weckmann
- Klinik für Kinder- & Jugendmedizin,
Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Sektion
für Pädiatrische Pneumologie und Allergologie, Lübeck,
Germany
- Leibniz Lungenzentrum Borstel, Programmbereich Chronische
Lungenerkrankungen; Epigenetik chronischer Lungenerkrankungen, Borstel,
Germany
- Airway Research Center North (ARCN), Mitglied des Deutschen Zentrums
für Lungenforschung (DZL), Lübeck, Germany
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21
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Bahmer T, Borzikowsky C, Lieb W, Horn A, Krist L, Fricke J, Scheibenbogen C, Rabe KF, Maetzler W, Maetzler C, Laudien M, Frank D, Ballhausen S, Hermes A, Miljukov O, Haeusler KG, Mokhtari NEE, Witzenrath M, Vehreschild JJ, Krefting D, Pape D, Montellano FA, Kohls M, Morbach C, Störk S, Reese JP, Keil T, Heuschmann P, Krawczak M, Schreiber S. Severity, predictors and clinical correlates of Post-COVID syndrome (PCS) in Germany: A prospective, multi-centre, population-based cohort study. EClinicalMedicine 2022; 51:101549. [PMID: 35875815 PMCID: PMC9289961 DOI: 10.1016/j.eclinm.2022.101549] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Post-COVID syndrome (PCS) is an important sequela of COVID-19, characterised by symptom persistence for >3 months, post-acute symptom development, and worsening of pre-existing comorbidities. The causes and public health impact of PCS are still unclear, not least for the lack of efficient means to assess the presence and severity of PCS. METHODS COVIDOM is a population-based cohort study of polymerase chain reaction (PCR) confirmed cases of SARS-CoV-2 infection, recruited through public health authorities in three German regions (Kiel, Berlin, Würzburg) between November 15, 2020 and September 29, 2021. Main inclusion criteria were (i) a PCR confirmed SARS-CoV-2 infection and (ii) a period of at least 6 months between the infection and the visit to the COVIDOM study site. Other inclusion criteria were written informed consent and age ≥18 years. Key exclusion criterion was an acute reinfection with SARS-CoV-2. Study site visits included standardised interviews, in-depth examination, and biomaterial procurement. In sub-cohort Kiel-I, a PCS (severity) score was developed based upon 12 long-term symptom complexes. Two validation sub-cohorts (Würzburg/Berlin, Kiel-II) were used for PCS score replication and identification of clinically meaningful predictors. This study is registered at clinicaltrials.gov (NCT04679584) and at the German Registry for Clinical Studies (DRKS, DRKS00023742). FINDINGS In Kiel-I (n = 667, 57% women), 90% of participants had received outpatient treatment for acute COVID-19. Neurological ailments (61·5%), fatigue (57·1%), and sleep disturbance (57·0%) were the most frequent persisting symptoms at 6-12 months after infection. Across sub-cohorts (Würzburg/Berlin, n = 316, 52% women; Kiel-II, n = 459, 56% women), higher PCS scores were associated with lower health-related quality of life (EQ-5D-5L-VAS/-index: r = -0·54/ -0·56, all p < 0·0001). Severe, moderate, and mild/no PCS according to the individual participant's PCS score occurred in 18·8%, 48·2%, and 32·9%, respectively, of the Kiel-I sub-cohort. In both validation sub-cohorts, statistically significant predictors of the PCS score included the intensity of acute phase symptoms and the level of personal resilience. INTERPRETATION PCS severity can be quantified by an easy-to-use symptom-based score reflecting acute phase disease burden and general psychological predisposition. The PCS score thus holds promise to facilitate the clinical diagnosis of PCS, scientific studies of its natural course, and the development of therapeutic interventions. FUNDING The COVIDOM study is funded by the Network University Medicine (NUM) as part of the National Pandemic Cohort Network (NAPKON).
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Affiliation(s)
- Thomas Bahmer
- Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927 Großhansdorf, Germany
- Corresponding authors at: Internal Medicine Department I, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24103 Kiel, Germany.
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein, Brunswiker Straße 10, 24105 Kiel, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Niemannsweg 11, 24105 Kiel, Germany
| | - Anna Horn
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Klaus F. Rabe
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927 Großhansdorf, Germany
- LungenClinic Grosshansdorf, Pneumology, Wöhrendamm 80, 22927 Großhansdorf, Germany
| | - Walter Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Corina Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Martin Laudien
- ENT Department, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Derk Frank
- Internal Medicine Department III, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Sabrina Ballhausen
- Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Anne Hermes
- Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Niemannsweg 11, 24105 Kiel, Germany
| | - Olga Miljukov
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Karl Georg Haeusler
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | | | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jörg Janne Vehreschild
- Medical Department 2, Hematology/ Oncology and Infectious Diseases, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, Kerpener Straße 62, 50937 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Dagmar Krefting
- Institute for Medical Informatics, University Medical Center Göttingen, Von-Siebold-Straße 3, 37075 Göttingen, Germany
| | - Daniel Pape
- Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Felipe A. Montellano
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, 97080 Würzburg, Germany
| | - Mirjam Kohls
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, 97080 Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, 97080 Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Thomas Keil
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, 97080 Würzburg, Germany
- Clinical Trial Center Würzburg (CTC/ZKS), University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein, Brunswiker Straße 10, 24105 Kiel, Germany
| | - Stefan Schreiber
- Internal Medicine Department I, University Medical Center Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
- Corresponding authors at: Internal Medicine Department I, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24103 Kiel, Germany.
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22
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Hösel K, von der Burchard C, Schunk D, Franzenburg J, Bahmer T, Frank D, Dargvainiene J, Roider JB. [Ocular manifestations in patients with COVID-19]. Ophthalmologie 2022; 119:807-812. [PMID: 35089415 PMCID: PMC8796747 DOI: 10.1007/s00347-022-01581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are only few reports on ocular symptoms and manifestations in association with coronavirus disease 2019 (COVID-19). OBJECTIVE The aim of this study is to describe ocular manifestations in the anterior and posterior segments of the eye and to analyze viral prevalence in tears of patients with COVID-19. METHODS Hospitalized COVID-19 patients treated from 16 April 2020 to 7 January 2021 at this hospital were screened for ocular manifestations in the anterior and posterior segments. Conjunctival swabs were analyzed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA. RESULTS A total of 37 patients were enrolled in this study. In the anterior segment we found chemosis of the conjunctiva (5), hyposphagma (2) and conjunctivitis (1). In 11 patients vascular alterations and potentially disease-specific manifestations of the fundus were found in one or both eyes: retinal hemorrhages (5), cotton wool spots (5) and tortuosity (5). One patient demonstrated branch artery occlusion, one had branch retinal vein occlusion and two patients had positive conjunctival swab results in one or both eyes. CONCLUSION Our findings of the anterior segment are commonly known, although not specific for COVID-19. Various vascular fundus abnormalities were found in the study; however, it is unclear whether these were correlated to systemic comorbidities or whether they were caused or exacerbated by COVID-19. This study suggests that the risk of viral transmission via tears is low.
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Affiliation(s)
- Kristin Hösel
- Klinik für Augenheilkunde, UKSH Kiel, Arnold-Heller-Str. 3, 24104, Kiel, Deutschland.
| | | | - Domagoj Schunk
- Department of Internal Medicine, UKSH Kiel, Kiel, Deutschland
| | | | - Thomas Bahmer
- Department of Internal Medicine, UKSH Kiel, Kiel, Deutschland
| | - Derk Frank
- Department of Internal Medicine, UKSH Kiel, Kiel, Deutschland
- DZHK (German Centre for Cardiovascular Research), Kiel, Deutschland
| | | | - Johann B Roider
- Klinik für Augenheilkunde, UKSH Kiel, Arnold-Heller-Str. 3, 24104, Kiel, Deutschland
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23
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Schons M, Pilgram L, Reese JP, Stecher M, Anton G, Appel KS, Bahmer T, Bartschke A, Bellinghausen C, Bernemann I, Brechtel M, Brinkmann F, Brünn C, Dhillon C, Fiessler C, Geisler R, Hamelmann E, Hansch S, Hanses F, Hanß S, Herold S, Heyder R, Hofmann AL, Hopff SM, Horn A, Jakob C, Jiru-Hillmann S, Keil T, Khodamoradi Y, Kohls M, Kraus M, Krefting D, Kunze S, Kurth F, Lieb W, Lippert LJ, Lorbeer R, Lorenz-Depiereux B, Maetzler C, Miljukov O, Nauck M, Pape D, Püntmann V, Reinke L, Römmele C, Rudolph S, Sass J, Schäfer C, Schaller J, Schattschneider M, Scheer C, Scherer M, Schmidt S, Schmidt J, Seibel K, Stahl D, Steinbeis F, Störk S, Tauchert M, Tebbe JJ, Thibeault C, Toepfner N, Ungethüm K, Vadasz I, Valentin H, Wiedmann S, Zoller T, Nagel E, Krawczak M, von Kalle C, Illig T, Schreiber S, Witzenrath M, Heuschmann P, Vehreschild JJ. The German National Pandemic Cohort Network (NAPKON): rationale, study design and baseline characteristics. Eur J Epidemiol 2022; 37:849-870. [PMID: 35904671 PMCID: PMC9336157 DOI: 10.1007/s10654-022-00896-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
Abstract
The German government initiated the Network University Medicine (NUM) in early 2020 to improve national research activities on the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. To this end, 36 German Academic Medical Centers started to collaborate on 13 projects, with the largest being the National Pandemic Cohort Network (NAPKON). The NAPKON’s goal is creating the most comprehensive Coronavirus Disease 2019 (COVID-19) cohort in Germany. Within NAPKON, adult and pediatric patients are observed in three complementary cohort platforms (Cross-Sectoral, High-Resolution and Population-Based) from the initial infection until up to three years of follow-up. Study procedures comprise comprehensive clinical and imaging diagnostics, quality-of-life assessment, patient-reported outcomes and biosampling. The three cohort platforms build on four infrastructure core units (Interaction, Biosampling, Epidemiology, and Integration) and collaborations with NUM projects. Key components of the data capture, regulatory, and data privacy are based on the German Centre for Cardiovascular Research. By April 01, 2022, 34 university and 40 non-university hospitals have enrolled 5298 patients with local data quality reviews performed on 4727 (89%). 47% were female, the median age was 52 (IQR 36–62-) and 50 pediatric cases were included. 44% of patients were hospitalized, 15% admitted to an intensive care unit, and 12% of patients deceased while enrolled. 8845 visits with biosampling in 4349 patients were conducted by April 03, 2022. In this overview article, we summarize NAPKON’s design, relevant milestones including first study population characteristics, and outline the potential of NAPKON for German and international research activities. Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04768998.https://clinicaltrials.gov/ct2/show/NCT04747366.https://clinicaltrials.gov/ct2/show/NCT04679584
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Affiliation(s)
- Maximilian Schons
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pilgram
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
| | - Gabriele Anton
- Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Katharina S. Appel
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Alexander Bartschke
- Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carla Bellinghausen
- Department of Respiratory Medicine and Allergology, Medical Clinic 1, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Inga Bernemann
- Hannover Medical School, Hannover Unified Biobank, Hannover, Germany
| | - Markus Brechtel
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Folke Brinkmann
- Department of Paediatric Pneumology, Allergy and CF- Centre, University Children’s Hospital, Ruhr- University Bochum, Bochum, Germany
| | - Clara Brünn
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christine Dhillon
- COVID-19 Task Force, University Hospital Augsburg, Augsburg, Germany
| | - Cornelia Fiessler
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Ramsia Geisler
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Eckard Hamelmann
- Department of Pediatrics, Children’s Center Bethel, University Hospital East Westphalia, University Bielefeld, Bielefeld, Germany
| | - Stefan Hansch
- Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
| | - Frank Hanses
- Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Sabine Hanß
- University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
| | - Susanne Herold
- Department of Internal Medicine V, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany
- Department of Internal Medicine, German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University Giessen, Giessen, Germany
- Institute for Lung Health (ILH), Giessen, Germany
| | - Ralf Heyder
- NUM Coordination Office, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anna-Lena Hofmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Sina Marie Hopff
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Horn
- Insitute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Carolin Jakob
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Steffi Jiru-Hillmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Thomas Keil
- Insitute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | - Yascha Khodamoradi
- Department of Infectious Diseases, Medical Clinic 2, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Mirjam Kohls
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Monika Kraus
- Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Dagmar Krefting
- University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
| | - Sonja Kunze
- Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
| | - Florian Kurth
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, and Department of Medicine I, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Lena Johanna Lippert
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Roberto Lorbeer
- Department of Radiology, University Hospital, LMU, Munich, Germany
- Medical Heart Center of Charité and German Heart Institute Berlin, Institute of Computer-Assisted Cardiovascular Medicine, Berlin, Germany
| | - Bettina Lorenz-Depiereux
- Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Olga Miljukov
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Daniel Pape
- Department I of Internal Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Valentina Püntmann
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Lennart Reinke
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Römmele
- COVID-19 Task Force, University Hospital Augsburg, Augsburg, Germany
| | - Stefanie Rudolph
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Joint Charité and BIH Clinical Study Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Julian Sass
- Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Schäfer
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK e.V. (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Jens Schaller
- Medical Heart Center of Charité and German Heart Institute Berlin, Institute of Computer-Assisted Cardiovascular Medicine, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt – Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Mario Schattschneider
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christian Scheer
- Department of Anesthesiology and Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Margarete Scherer
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Sein Schmidt
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Clinical Study Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Julia Schmidt
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Kristina Seibel
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dana Stahl
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
- University Medicine Greifswald, Greifswald, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Maike Tauchert
- Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
| | - Johannes Josef Tebbe
- Department of Gastroenterology and Infectious Disease, University Medical Center East Westphalia-Lippe, Klinikum Lippe, Detmold, Germany
| | - Charlotte Thibeault
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
| | - Kathrin Ungethüm
- Insitute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Istvan Vadasz
- Institute for Lung Health (ILH), Giessen, Germany
- Department of Internal Medicine, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
- Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Frankfurt, Germany
| | - Heike Valentin
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
- University Medicine Greifswald, Greifswald, Germany
| | - Silke Wiedmann
- NUM Coordination Office, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Zoller
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Eike Nagel
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christof von Kalle
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Joint Charité and BIH Clinical Study Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Illig
- Hannover Medical School, Hannover Unified Biobank, Hannover, Germany
| | - Stefan Schreiber
- Department of Internal Medicine I, University Hospital Schleswig Holstein, Kiel University, Kiel, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- German Center for Lung Research (DZL), Frankfurt, Germany
| | - Peter Heuschmann
- Insitute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt,, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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24
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Degenhardt F, Ellinghaus D, Juzenas S, Lerga-Jaso J, Wendorff M, Maya-Miles D, Uellendahl-Werth F, ElAbd H, Rühlemann MC, Arora J, Özer O, Lenning OB, Myhre R, Vadla MS, Wacker EM, Wienbrandt L, Blandino Ortiz A, de Salazar A, Garrido Chercoles A, Palom A, Ruiz A, Garcia-Fernandez AE, Blanco-Grau A, Mantovani A, Zanella A, Holten AR, Mayer A, Bandera A, Cherubini A, Protti A, Aghemo A, Gerussi A, Ramirez A, Braun A, Nebel A, Barreira A, Lleo A, Teles A, Kildal AB, Biondi A, Caballero-Garralda A, Ganna A, Gori A, Glück A, Lind A, Tanck A, Hinney A, Carreras Nolla A, Fracanzani AL, Peschuck A, Cavallero A, Dyrhol-Riise AM, Ruello A, Julià A, Muscatello A, Pesenti A, Voza A, Rando-Segura A, Solier A, Schmidt A, Cortes B, Mateos B, Nafria-Jimenez B, Schaefer B, Jensen B, Bellinghausen C, Maj C, Ferrando C, de la Horra C, Quereda C, Skurk C, Thibeault C, Scollo C, Herr C, Spinner CD, Gassner C, Lange C, Hu C, Paccapelo C, Lehmann C, Angelini C, Cappadona C, Azuure C, Bianco C, Cea C, Sancho C, Hoff DAL, Galimberti D, Prati D, Haschka D, Jiménez D, Pestaña D, Toapanta D, Muñiz-Diaz E, Azzolini E, Sandoval E, Binatti E, Scarpini E, Helbig ET, Casalone E, Urrechaga E, Paraboschi EM, Pontali E, Reverter E, Calderón EJ, Navas E, Solligård E, Contro E, Arana-Arri E, Aziz F, Garcia F, García Sánchez F, Ceriotti F, Martinelli-Boneschi F, Peyvandi F, Kurth F, Blasi F, Malvestiti F, Medrano FJ, Mesonero F, Rodriguez-Frias F, Hanses F, Müller F, Hemmrich-Stanisak G, Bellani G, Grasselli G, Pezzoli G, Costantino G, Albano G, Cardamone G, Bellelli G, Citerio G, Foti G, Lamorte G, Matullo G, Baselli G, Kurihara H, Neb H, My I, Kurth I, Hernández I, Pink I, de Rojas I, Galván-Femenia I, Holter JC, Afset JE, Heyckendorf J, Kässens J, Damås JK, Rybniker J, Altmüller J, Ampuero J, Martín J, Erdmann J, Banales JM, Badia JR, Dopazo J, Schneider J, Bergan J, Barretina J, Walter J, Hernández Quero J, Goikoetxea J, Delgado J, Guerrero JM, Fazaal J, Kraft J, Schröder J, Risnes K, Banasik K, Müller KE, Gaede KI, Garcia-Etxebarria K, Tonby K, Heggelund L, Izquierdo-Sanchez L, Bettini LR, Sumoy L, Sander LE, Lippert LJ, Terranova L, Nkambule L, Knopp L, Gustad LT, Garbarino L, Santoro L, Téllez L, Roade L, Ostadreza M, Intxausti M, Kogevinas M, Riveiro-Barciela M, Berger MM, Schaefer M, Niemi MEK, Gutiérrez-Stampa MA, Carrabba M, Figuera Basso ME, Valsecchi MG, Hernandez-Tejero M, Vehreschild MJGT, Manunta M, Acosta-Herrera M, D'Angiò M, Baldini M, Cazzaniga M, Grimsrud MM, Cornberg M, Nöthen MM, Marquié M, Castoldi M, Cordioli M, Cecconi M, D'Amato M, Augustin M, Tomasi M, Boada M, Dreher M, Seilmaier MJ, Joannidis M, Wittig M, Mazzocco M, Ciccarelli M, Rodríguez-Gandía M, Bocciolone M, Miozzo M, Imaz Ayo N, Blay N, Chueca N, Montano N, Braun N, Ludwig N, Marx N, Martínez N, Cornely OA, Witzke O, Palmieri O, Faverio P, Preatoni P, Bonfanti P, Omodei P, Tentorio P, Castro P, Rodrigues PM, España PP, Hoffmann P, Rosenstiel P, Schommers P, Suwalski P, de Pablo R, Ferrer R, Bals R, Gualtierotti R, Gallego-Durán R, Nieto R, Carpani R, Morilla R, Badalamenti S, Haider S, Ciesek S, May S, Bombace S, Marsal S, Pigazzini S, Klein S, Pelusi S, Wilfling S, Bosari S, Volland S, Brunak S, Raychaudhuri S, Schreiber S, Heilmann-Heimbach S, Aliberti S, Ripke S, Dudman S, Wesse T, Zheng T, Bahmer T, Eggermann T, Illig T, Brenner T, Pumarola T, Feldt T, Folseraas T, Gonzalez Cejudo T, Landmesser U, Protzer U, Hehr U, Rimoldi V, Monzani V, Skogen V, Keitel V, Kopfnagel V, Friaza V, Andrade V, Moreno V, Albrecht W, Peter W, Poller W, Farre X, Yi X, Wang X, Khodamoradi Y, Karadeniz Z, Latiano A, Goerg S, Bacher P, Koehler P, Tran F, Zoller H, Schulte EC, Heidecker B, Ludwig KU, Fernández J, Romero-Gómez M, Albillos A, Invernizzi P, Buti M, Duga S, Bujanda L, Hov JR, Lenz TL, Asselta R, de Cid R, Valenti L, Karlsen TH, Cáceres M, Franke A. Detailed stratified GWAS analysis for severe COVID-19 in four European populations. Hum Mol Genet 2022; 31:3945-3966. [PMID: 35848942 PMCID: PMC9703941 DOI: 10.1093/hmg/ddac158] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/11/2022] [Accepted: 07/26/2022] [Indexed: 12/11/2022] Open
Abstract
Given the highly variable clinical phenotype of Coronavirus disease 2019 (COVID-19), a deeper analysis of the host genetic contribution to severe COVID-19 is important to improve our understanding of underlying disease mechanisms. Here, we describe an extended genome-wide association meta-analysis of a well-characterized cohort of 3255 COVID-19 patients with respiratory failure and 12 488 population controls from Italy, Spain, Norway and Germany/Austria, including stratified analyses based on age, sex and disease severity, as well as targeted analyses of chromosome Y haplotypes, the human leukocyte antigen region and the SARS-CoV-2 peptidome. By inversion imputation, we traced a reported association at 17q21.31 to a ~0.9-Mb inversion polymorphism that creates two highly differentiated haplotypes and characterized the potential effects of the inversion in detail. Our data, together with the 5th release of summary statistics from the COVID-19 Host Genetics Initiative including non-Caucasian individuals, also identified a new locus at 19q13.33, including NAPSA, a gene which is expressed primarily in alveolar cells responsible for gas exchange in the lung.
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Affiliation(s)
- Frauke Degenhardt
- To whom correspondence should be addressed. (Frauke Degenhardt) and (Andre Franke)
| | | | | | | | | | | | | | - Hesham ElAbd
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Malte C Rühlemann
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Jatin Arora
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA,Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA,Center for Data Sciences, Brigham and Women’s Hospital, Boston, MA, USA
| | - Onur Özer
- Research Group for Evolutionary Immunogenomics, Max Planck Institute for Evolutionary Biology, Plön, Germany,Research Unit for Evolutionary Immunogenomics, Department of Biology, University of Hamburg, Hamburg, Germany
| | - Ole Bernt Lenning
- Research Department, Stavanger University Hospital, Stavanger, Norway,Randaberg Municipality, Stavanger, Norway
| | - Ronny Myhre
- Division of Health Data and Digitalization, Department of Genetics and Bioinformatics (HDGB), Norwegian Institute of Public Health, Oslo, Norway
| | - May Sissel Vadla
- Randaberg Municipality, Stavanger, Norway,Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Eike M Wacker
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Lars Wienbrandt
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Aaron Blandino Ortiz
- Department of Intensive Care, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Adolfo de Salazar
- Ibs.Granada Instituto de Investigación Biosanitaria, Granada, Spain,Microbiology Unit. Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Adolfo Garrido Chercoles
- Clinical Biochemistry Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, San Sebastian, Spain
| | - Adriana Palom
- Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain,Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Agustín Ruiz
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | | | - Albert Blanco-Grau
- Department of Biochemistry, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Alberto Mantovani
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Zanella
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aleksander Rygh Holten
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alena Mayer
- Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Alessandra Bandera
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Alessandro Protti
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessio Aghemo
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessio Gerussi
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy,Division of Gastroenterology, School of Medicine and Surgery, Center for Autoimmune Liver Diseases, University of Milano-Bicocca, Milan, Italy
| | - Alfredo Ramirez
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Medical Faculty, Bonn, Germany,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany,Department of Psychiatry, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, San Antonio, TX, USA
| | - Alice Braun
- Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Almut Nebel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Ana Barreira
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ana Lleo
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ana Teles
- Research Group for Evolutionary Immunogenomics, Max Planck Institute for Evolutionary Biology, Plön, Germany,Research Unit for Evolutionary Immunogenomics, Department of Biology, University of Hamburg, Hamburg, Germany
| | - Anders Benjamin Kildal
- Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Andrea Biondi
- Pediatric Departement, Centro Tettamanti-European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN-University of Milano-Bicocca-Fondazione MBBM/Ospedale, San Gerardo, Italy
| | | | - Andrea Ganna
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Andrea Gori
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Andreas Glück
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Andreas Lind
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Anja Tanck
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anna Carreras Nolla
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Anna Ludovica Fracanzani
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Peschuck
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | | | - Anne Ma Dyrhol-Riise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Infectious diseases, Oslo University Hospital, Oslo, Norway
| | | | - Antonio Julià
- Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain
| | | | - Antonio Pesenti
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Voza
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ariadna Rando-Segura
- Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellatera, Spain
| | - Aurora Solier
- Department of Respiratory Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), University of Alcalá, Madrid, Spain
| | - Axel Schmidt
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Beatriz Cortes
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Beatriz Mateos
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Beatriz Nafria-Jimenez
- Clinical Biochemistry Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, San Sebastian, Spain
| | - Benedikt Schaefer
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria,Christian Doppler Laboratory of Iron and Phosphate Biology at the Department of Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Björn Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty Heinrich Heine University, Duesseldorf, Germany
| | - Carla Bellinghausen
- Department of Respiratory Medicine and Allergology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Carlo Maj
- Institute of Genomic Statistics and Bioinformatics, University Hospital Bonn, Medical Faculty University of Bonn, Bonn, Germany
| | - Carlos Ferrando
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain,Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Carmen de la Horra
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | - Carmen Quereda
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | | | | | - Chiara Scollo
- Department of Transfusion Medicine and Haematology Laboratory, San Gerardo Hospital, Monza, Italy
| | - Christian Herr
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital Saarland, Homburg, Germany
| | - Christoph D Spinner
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christoph Gassner
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,Institute of Translational Medicine, Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
| | - Christoph Lange
- Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany,Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany,Clinical Tuberculosis Unit, German Center for Infection Research (DZIF), Borstel, Germany
| | - Cinzia Hu
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cinzia Paccapelo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Clara Lehmann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany,German Center for Infection Research (DZIF), Cologne, Germany
| | | | - Claudio Cappadona
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Clinton Azuure
- Research Group for Evolutionary Immunogenomics, Max Planck Institute for Evolutionary Biology, Plön, Germany,Research Unit for Evolutionary Immunogenomics, Department of Biology, University of Hamburg, Hamburg, Germany
| | | | - Cristiana Bianco
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Cea
- Department of Biochemistry, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Cristina Sancho
- Osakidetza Basque Health Service, Basurto University Hospital, Respiratory Service, Bilbao, Spain
| | - Dag Arne Lihaug Hoff
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway,Department of Medicine, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Daniela Galimberti
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Prati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - David Haschka
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - David Jiménez
- Department of Respiratory Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), University of Alcalá, Madrid, Spain
| | - David Pestaña
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - David Toapanta
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Eduardo Muñiz-Diaz
- Immunohematology Department, Banc de Sang i Teixits, Autonomous University of Barcelona, Barcelona, Spain
| | - Elena Azzolini
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Elena Sandoval
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Eleonora Binatti
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy,Division of Gastroenterology, School of Medicine and Surgery, Center for Autoimmune Liver Diseases, University of Milano-Bicocca, Milan, Italy
| | - Elio Scarpini
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Elisabetta Casalone
- Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Eloisa Urrechaga
- Osakidetza Basque Health Service, Galdakao Hospital, Respiratory Service, Galdakao, Spain,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Elvezia Maria Paraboschi
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Emanuele Pontali
- Department of Infectious Diseases, E.O. Ospedali Galliera, Genova, Italy
| | - Enric Reverter
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Enrique J Calderón
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | - Enrique Navas
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Erik Solligård
- Geminicenter for Sepsis Research, Institute of Circulation and Medical Imaging (ISB), NTNU, Trondheim, Norway,Clinic of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ernesto Contro
- Accident and Emergency and Emergency Medicine Unit, San Gerardo Hospital, Monza, Italy
| | | | - Fátima Aziz
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Federico Garcia
- Ibs.Granada Instituto de Investigación Biosanitaria, Granada, Spain,Microbiology Unit. Hospital Universitario Clinico San Cecilio, Granada, Spain,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Félix García Sánchez
- Histocompatibilidad y Biologia Molecular, Centro de Transfusion de Madrid, Madrid, Spain
| | | | - Filippo Martinelli-Boneschi
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy,Neurology Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Florian Kurth
- Charite Universitätsmedizin Berlin, Berlin, Germany,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany,Department of Medicine I, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Blasi
- Respiratory Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | | - Francisco J Medrano
- Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain,Internal Medicine Department, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Francisco Mesonero
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Francisco Rodriguez-Frias
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain,Department of Biochemistry, University Hospital Vall d’Hebron, Barcelona, Spain,Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellatera, Spain,Biochemistry Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Regensburg, Germany,Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
| | - Fredrik Müller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | | | - Giacomo Bellani
- Department Emergency, Anesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Grasselli
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianni Pezzoli
- Fondazione Grigioni per il Morbo di Parkinson and Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy
| | - Giorgio Costantino
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giulia Cardamone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Neurointensive Care Unit, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Foti
- Department Emergency, Anesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Lamorte
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Matullo
- Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Guido Baselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Holger Neb
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ilaria My
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Ingo Kurth
- Institute of Human Genetics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Isabel Hernández
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Isabell Pink
- Department of Pneumology, Hannover Medical School, Hannover, Germany
| | - Itziar de Rojas
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Iván Galván-Femenia
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Jan Cato Holter
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Jan Egil Afset
- Osakidetza Basque Health Service, Basurto University Hospital, Respiratory Service, Bilbao, Spain,Department of Medical Microbiology, Clinic of Laboratory Medicine, St. Olavs hospital, Trondheim, Norway
| | - Jan Heyckendorf
- Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany,Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany,Clinical Tuberculosis Unit, German Center for Infection Research (DZIF), Borstel, Germany
| | - Jan Kässens
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Jan Kristian Damås
- Department of Infectious Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway,Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
| | - Jan Rybniker
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany,German Centre for Infection Research (DZIF), Cologne, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Javier Ampuero
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Digestive Diseases Unit, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Javier Martín
- Institute of Parasitology and Biomedicine Lopez-Neyra, CSIC, Granada, Spain
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany,German Research Center for Cardiovascular Research, Lübeck, Germany,University Heart Center Lübeck, Lübeck, Germany
| | - Jesus M Banales
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain,Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Joan Ramon Badia
- Respiratory ICU, Institut Clínic Respiratory, Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Joaquin Dopazo
- Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,Bioinformatics Area, Fundación Progreso y Salud, and Institute of Biomedicine of Sevilla (IBIS), Sevilla, Spain
| | - Jochen Schneider
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital Saarland, Homburg, Germany
| | - Jonas Bergan
- Department of Research, Ostfold Hospital Trust, Gralum, Norway
| | - Jordi Barretina
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Jörn Walter
- Department of Genetics & Epigenetics, Saarland University, Saarbrücken, Germany
| | - Jose Hernández Quero
- Ibs.Granada Instituto de Investigación Biosanitaria, Granada, Spain,Department of Infectious Diseases, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Josune Goikoetxea
- Infectious Diseases Service, Osakidetza, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Juan Delgado
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | - Juan M Guerrero
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain
| | - Julia Fazaal
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Julia Kraft
- Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Schröder
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Kari Risnes
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway,Department of Research, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Karina Banasik
- Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karl Erik Müller
- Medical Department, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Karoline I Gaede
- Research Center Borstel, BioMaterialBank Nord, Borstel, Germany,German Center for Lung Research (DZL), Airway Research Center North (ARCN), Borstel, Germany,Popgen 2.0 Network (P2N), Kiel, Germany
| | - Koldo Garcia-Etxebarria
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain
| | - Kristian Tonby
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Infectious diseases, Oslo University Hospital, Oslo, Norway
| | - Lars Heggelund
- Medical Department, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Laura Izquierdo-Sanchez
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain,Biodonostia Health Research Institute, Donostia University Hospital, San Sebastian, Spain
| | - Laura Rachele Bettini
- Pediatric Departement, Centro Tettamanti-European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN-University of Milano-Bicocca-Fondazione MBBM/Ospedale, San Gerardo, Italy
| | - Lauro Sumoy
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | | | | | | | - Lindokuhle Nkambule
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA,Stanley Center for Psychiatric Research & Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lisa Knopp
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty Heinrich Heine University, Duesseldorf, Germany
| | - Lise Tuset Gustad
- Geminicenter for Sepsis Research, Institute of Circulation and Medical Imaging (ISB), NTNU, Trondheim, Norway,Clinic of Medicine and Rehabilitation, Levanger Hospital, Nord-Trondelag Hospital Trust, Levanger, Norway
| | | | - Luigi Santoro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luis Téllez
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Luisa Roade
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Department of Respiratory Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | | | - Maider Intxausti
- Osakidetza Basque Health Service, Basurto University Hospital, Respiratory Service, Bilbao, Spain
| | - Manolis Kogevinas
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Mar Riveiro-Barciela
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellatera, Spain
| | - Marc M Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Mari E K Niemi
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - María A Gutiérrez-Stampa
- Osakidetza, OSI Donostialdea, Altza Primary Care, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Maria Carrabba
- Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria E Figuera Basso
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Maria Grazia Valsecchi
- Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt & Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria Manunta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Mariella D'Angiò
- Pediatric Departement, Centro Tettamanti-European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN-University of Milano-Bicocca-Fondazione MBBM/Ospedale, San Gerardo, Italy
| | - Marina Baldini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marina Cazzaniga
- Phase 1 Research Centre, ASST Monza, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marit M Grimsrud
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Surgery, Inflammatory Diseases and Transplantation, Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway,Division of Surgery, Inflammatory Diseases and Transplantation, Department of Transplantation Medicine, Norwegian PSC Research Center, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Marta Marquié
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | | | - Mattia Cordioli
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Maurizio Cecconi
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Mauro D'Amato
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain,Gastrointestinal Genetics Lab, CIC bioGUNE—BRTA, Derio, Spain,Department of Medicine and Surgery, LUM University, Casamassima, Italy
| | - Max Augustin
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany,German Center for Infection Research (DZIF), Cologne, Germany
| | - Melissa Tomasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mercè Boada
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Michael J Seilmaier
- Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Wittig
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | | | | | - Miguel Rodríguez-Gandía
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | | | - Monica Miozzo
- University of Milan, Milan, Italy,Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Natale Imaz Ayo
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Natalia Blay
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Natalia Chueca
- Microbiology Unit. Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Nicola Montano
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicole Braun
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nicole Ludwig
- Department of Human Genetics, Center of Human and Molecular Biology, University Hospital Saarland, Homburg/Saar, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, RWTH Aachen University Hospital, Aachen, Germany
| | - Nilda Martínez
- Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | | | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,German Center for Infection Research (DZIF), Cologne, Germany,Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Orazio Palmieri
- Gastroenterology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Paola Faverio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Pulmonary Unit, San Gerardo Hospital, Monza, Italy
| | | | - Paolo Bonfanti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Infectious Diseases Unit, San Gerardo Hospital, Monza, Italy
| | - Paolo Omodei
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | | | - Pedro Castro
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Pedro M Rodrigues
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain,Ikerbasque, Basque Foundation for Science, Bilbao, Spain,Biodonostia Health Research Institute, Donostia University Hospital, San Sebastian, Spain
| | - Pedro Pablo España
- Osakidetza Basque Health Service, Galdakao Hospital, Respiratory Service, Galdakao, Spain
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Philipp Schommers
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany,German Center for Infection Research (DZIF), Cologne, Germany
| | | | - Raúl de Pablo
- Department of Intensive Care, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, SODIR-VHIR research group, Barcelona, Spain
| | - Robert Bals
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital Saarland, Homburg, Germany
| | - Roberta Gualtierotti
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rocío Gallego-Durán
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - Rosa Nieto
- Department of Respiratory Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), University of Alcalá, Madrid, Spain
| | - Rossana Carpani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rubén Morilla
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | | | - Sammra Haider
- Department of Medicine, Møre & Romsdal Hospital Trust, Molde, Norway
| | - Sandra Ciesek
- Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany,German Centre for Infection Research (DZIF), Frankfurt am Main, Germany
| | - Sandra May
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Sara Bombace
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Sara Marsal
- Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain
| | - Sara Pigazzini
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Sebastian Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Serena Pelusi
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sibylle Wilfling
- Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany,Zentrum für Humangenetik Regensburg, Regensburg, Germany,Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Silvano Bosari
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sonja Volland
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Soumya Raychaudhuri
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA,Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA,Center for Data Sciences, Brigham and Women’s Hospital, Boston, MA, USA,Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Stefanie Heilmann-Heimbach
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Stefano Aliberti
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Susanne Dudman
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Tanja Wesse
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Tenghao Zheng
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
| | | | - Thomas Bahmer
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Thomas Eggermann
- Institute of Human Genetics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Thomas Illig
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Tomas Pumarola
- Department of Microbiology, University Hospital Vall d’Hebron, Barcelona, Spain,Autonoma University of Barcelona, Barcelona, Spain
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty Heinrich Heine University, Duesseldorf, Germany
| | - Trine Folseraas
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Surgery, Inflammatory Diseases and Transplantation, Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway,Division of Surgery, Inflammatory Diseases and Transplantation, Department of Transplantation Medicine, Norwegian PSC Research Center, Oslo University Hospital Rikshospitalet, Oslo, Norway,Division for Cancer Medicine, Surgery and Transplantation, Section for Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Ulf Landmesser
- Berlin Institute of Health, Charite Universitätsmedizin Berlin, Berlin Germany
| | - Ulrike Protzer
- Institute of Virology, Technical University Munich/Helmholtz Zentrum München, Munich, Germany,German Center for Infection Research (DZIF), Munich, Germany
| | - Ute Hehr
- Zentrum für Humangenetik Regensburg, Regensburg, Germany
| | - Valeria Rimoldi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Valter Monzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vegard Skogen
- Department of Infectious Diseases, University Hospital of North Norway, Tromsø, Norway,Faculty of Health Sciences, UIT The Arctic University of Norway, Norway
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty Heinrich Heine University, Duesseldorf, Germany
| | - Verena Kopfnagel
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Vicente Friaza
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | - Victor Andrade
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Victor Moreno
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Catalan Institute of Oncology (ICO), Barcelona, Spain,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain,Universitat de Barcelona (UB), Barcelona, Spain
| | - Wolfgang Albrecht
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Wolfgang Peter
- Stefan-Morsch-Stiftung, Birkenfeld, Germany,Faculty of Medicine and University Hospital Cologne, Institute for Transfusion Medicine, University of Cologne, Cologne, Germany
| | | | - Xavier Farre
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Xiaoli Yi
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Xiaomin Wang
- Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt & Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Anna Latiano
- Gastroenterology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Siegfried Goerg
- Institute of Transfusionsmedicine, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Petra Bacher
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,Institute of Immunology, Christian-Albrechts-University of Kiel and UKSH Schleswig-Holstein, Kiel, Germany
| | - Philipp Koehler
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Heinz Zoller
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria,Christian Doppler Laboratory of Iron and Phosphate Biology at the Department of Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva C Schulte
- Institute of Virology, Technical University Munich/Helmholtz Zentrum München, Munich, Germany,Institute of Psychiatric Phenomics and Genomics, University Medical Center, University of Munich, Munich, Germany,Department of Psychiatry, University Medical Center, University of Munich, Munich, Germany
| | | | - Kerstin U Ludwig
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Javier Fernández
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain,European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain
| | - Manuel Romero-Gómez
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Digestive Diseases Unit, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Agustín Albillos
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Pietro Invernizzi
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy,Division of Gastroenterology, School of Medicine and Surgery, Center for Autoimmune Liver Diseases, University of Milano-Bicocca, Milan, Italy
| | - Maria Buti
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellatera, Spain
| | - Stefano Duga
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain
| | | | | | | | | | | | | | | | - Andre Franke
- To whom correspondence should be addressed. (Frauke Degenhardt) and (Andre Franke)
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25
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Abdo M, Pedersen F, Kirsten AM, Veith V, Biller H, Trinkmann F, von Mutius E, Kopp M, Hansen G, Rabe KF, Bahmer T, Watz H. Longitudinal Impact of Sputum Inflammatory Phenotypes on Small Airway Dysfunction and Disease Outcomes in Asthma. J Allergy Clin Immunol Pract 2022; 10:1545-1553.e2. [PMID: 35257957 DOI: 10.1016/j.jaip.2022.02.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about the relationship between airway inflammatory phenotypes and some important asthma features such as small airway dysfunction (SAD). OBJECTIVE To describe the longitudinal impact of airway inflammatory phenotypes on SAD and asthma outcomes. METHODS We measured eosinophil and neutrophil counts in induced sputum at baseline and 1 year later to stratify 197 adult patients with asthma into 4 inflammatory phenotypes. We conducted a comprehensive assessment of lung function using spirometry, body plethysmography, impulse oscillometry, and inert gas single and multiple breath washouts. We compared lung function, asthma severity, exacerbation frequency, and symptom control between the phenotypes. We studied the longitudinal impact of persistent sputum inflammatory phenotypes and the change of sputum cell counts on lung function. RESULTS Patients were stratified into eosinophilic (23%, n = 45), neutrophilic (33%, n = 62), mixed granulocytic (22%, n = 43), and paucigranulocytic (24%, n = 47) phenotypes. Patients with eosinophilic and mixed granulocytic asthma had higher rates of airflow obstruction and severe exacerbation as well as poorer symptom control than patients with paucigranulocytic asthma. All SAD measures were worse in patients with eosinophilic and mixed asthma than in those with paucigranulocytic asthma (all P values <.05). Eosinophilic asthma also indicated worse distal airflow obstruction, increased ventilation inhomogeneity (all P values <.05), and higher tendency for severe exacerbation (P = .07) than neutrophilic asthma. Longitudinally, persistent mixed granulocytic asthma was associated with the worst follow-up measures of SAD compared with persistent neutrophilic, persistent paucigranulocytic, or nonpersistent asthma phenotypes. In patients with stable forced expiratory volume in 1 second (FEV1), the mean increase in small airway resistance (R5-20) was greater in patients with persistent mixed granulocytic asthma (+103%) than in patients with persistent neutrophilic (+26%), P = .040, or persistent paucigranulocytic asthma (-41%), P = .028. Multivariate models adjusted for confounders and treatment with inhaled or oral corticosteroids or antieosinophilic biologics indicated that the change of sputum eosinophil rather than neutrophil counts is an independent predictor for the longitudinal change in FEV1, forced expiratory flow at 25% to 75% of forced vital capacity, specific effective airway resistance, residual lung volume, and lung clearance index. CONCLUSIONS In asthma, airway eosinophilic inflammation is the main driver of lung function impairment and poor disease outcomes, which might also be aggravated by the coexistence of airway neutrophilia to confer a severe mixed granulocytic asthma phenotype. Persistent airway eosinophilia might be associated with dynamic SAD even in patients with stable FEV1.
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Affiliation(s)
- Mustafa Abdo
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.
| | - Frauke Pedersen
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany; Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Anne-Marie Kirsten
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Vera Veith
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Heike Biller
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Frederik Trinkmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany; Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPD-BW), University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), and Institute of Asthma and Allergy Prevention, Helmholtz Centre, Munich, Germany
| | - Matthias Kopp
- Department of Pediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland; Division of Pediatric Pneumology & Allergology, University Hospital Schleswig-Holstein-Campus Luebeck, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany
| | - Gesine Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany; Department for Internal Medicine I, University Hospital Schleswig-Holstein-Campus Kiel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Kiel, Germany
| | - Henrik Watz
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
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26
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Herrera-Luis E, Ortega VE, Ampleford EJ, Sio YY, Granell R, de Roos E, Terzikhan N, Vergara EE, Hernandez-Pacheco N, Perez-Garcia J, Martin-Gonzalez E, Lorenzo-Diaz F, Hashimoto S, Brinkman P, Jorgensen AL, Yan Q, Forno E, Vijverberg SJ, Lethem R, Espuela-Ortiz A, Gorenjak M, Eng C, González-Pérez R, Hernández-Pérez JM, Poza-Guedes P, Sardón O, Corcuera P, Hawkins GA, Marsico A, Bahmer T, Rabe KF, Hansen G, Kopp MV, Rios R, Cruz MJ, González-Barcala FJ, Olaguibel JM, Plaza V, Quirce S, Canino G, Cloutier M, Del Pozo V, Rodriguez-Santana JR, Korta-Murua J, Villar J, Potočnik U, Figueiredo C, Kabesch M, Mukhopadhyay S, Pirmohamed M, Hawcutt DB, Melén E, Palmer CN, Turner S, Maitland-van der Zee AH, von Mutius E, Celedón JC, Brusselle G, Chew FT, Bleecker E, Meyers D, Burchard EG, Pino-Yanes M. Multi-ancestry genome-wide association study of asthma exacerbations. Pediatr Allergy Immunol 2022; 33:e13802. [PMID: 35754128 PMCID: PMC9671132 DOI: 10.1111/pai.13802] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Asthma exacerbations are a serious public health concern due to high healthcare resource utilization, work/school productivity loss, impact on quality of life, and risk of mortality. The genetic basis of asthma exacerbations has been studied in several populations, but no prior study has performed a multi-ancestry meta-analysis of genome-wide association studies (meta-GWAS) for this trait. We aimed to identify common genetic loci associated with asthma exacerbations across diverse populations and to assess their functional role in regulating DNA methylation and gene expression. METHODS A meta-GWAS of asthma exacerbations in 4989 Europeans, 2181 Hispanics/Latinos, 1250 Singaporean Chinese, and 972 African Americans analyzed 9.6 million genetic variants. Suggestively associated variants (p ≤ 5 × 10-5 ) were assessed for replication in 36,477 European and 1078 non-European asthma patients. Functional effects on DNA methylation were assessed in 595 Hispanic/Latino and African American asthma patients and in publicly available databases. The effect on gene expression was evaluated in silico. RESULTS One hundred and twenty-six independent variants were suggestively associated with asthma exacerbations in the discovery phase. Two variants independently replicated: rs12091010 located at vascular cell adhesion molecule-1/exostosin like glycosyltransferase-2 (VCAM1/EXTL2) (discovery: odds ratio (ORT allele ) = 0.82, p = 9.05 × 10-6 and replication: ORT allele = 0.89, p = 5.35 × 10-3 ) and rs943126 from pantothenate kinase 1 (PANK1) (discovery: ORC allele = 0.85, p = 3.10 × 10-5 and replication: ORC allele = 0.89, p = 1.30 × 10-2 ). Both variants regulate gene expression of genes where they locate and DNA methylation levels of nearby genes in whole blood. CONCLUSIONS This multi-ancestry study revealed novel suggestive regulatory loci for asthma exacerbations located in genomic regions participating in inflammation and host defense.
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Affiliation(s)
- Esther Herrera-Luis
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Tenerife, Spain
| | - Victor E Ortega
- Division of Respiratory Medicine, Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Elizabeth J Ampleford
- Department of Internal Medicine, Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Yang Yie Sio
- Department of Biological Sciences, National University of Singapore, Singapore City, Singapore
| | - Raquel Granell
- MRC Integrative Epidemiology Unit (IEU), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emmely de Roos
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Natalie Terzikhan
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ernesto Elorduy Vergara
- Institute of Computation Biology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Natalia Hernandez-Pacheco
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Javier Perez-Garcia
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Tenerife, Spain
| | - Elena Martin-Gonzalez
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Tenerife, Spain
| | - Fabian Lorenzo-Diaz
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Tenerife, Spain.,Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC), Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Tenerife, Spain
| | - Simone Hashimoto
- Department of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Andrea L Jorgensen
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Qi Yan
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susanne J Vijverberg
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Paediatric Respiratory Medicine and Allergy, Emma's Children Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ryan Lethem
- MRC Integrative Epidemiology Unit (IEU), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Antonio Espuela-Ortiz
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Tenerife, Spain
| | - Mario Gorenjak
- Center for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Celeste Eng
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ruperto González-Pérez
- Allergy Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Tenerife, Spain.,Severe Asthma Unit, Allergy Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Tenerife, Spain
| | - José M Hernández-Pérez
- Pulmonary Medicine, Hospital Universitario de N.S de Candelaria, Santa Cruz de Tenerife, Spain.,Pulmonary Medicine, Hospital General de La Palma, La Palma, Santa Cruz de Tenerife, Spain
| | - Paloma Poza-Guedes
- Allergy Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Tenerife, Spain.,Severe Asthma Unit, Allergy Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Tenerife, Spain
| | - Olaia Sardón
- Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia, San Sebastián, Spain.,Department of Pediatrics, University of the Basque Country (UPV/EHU), San Sebastián, Spain
| | - Paula Corcuera
- Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia, San Sebastián, Spain
| | - Greg A Hawkins
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Annalisa Marsico
- Computational Health Center, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Pneumology, Grosshansdorf, Germany.,Airway Research Center North (ARCN), Members of the Germany Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Pneumology, Grosshansdorf, Germany.,Airway Research Center North (ARCN), Members of the Germany Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Gesine Hansen
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Matthias Volkmar Kopp
- Division of Pediatric Pneumology & Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Airway Research Center North (ARCN), Members of the Germany Center for Lung Research (DZL), Lübeck, Germany.,Department of Paediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Raimon Rios
- Programa de Pós Graduação em Imunologia (PPGIm), Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Maria Jesus Cruz
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - José María Olaguibel
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Servicio de Alergología, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Vicente Plaza
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Santiago Quirce
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Michelle Cloutier
- Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA
| | - Victoria Del Pozo
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Immunology Department, Instituto de Investigación Sanitaria Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Javier Korta-Murua
- Department of Pediatrics, University of the Basque Country (UPV/EHU), San Sebastián, Spain
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Uroš Potočnik
- Laboratory for Biochemistry, Molecular Biology and Genomics, Faculty for Chemistry and Chemical Engineering, University of Maribor, Maribor, Slovenia
| | - Camila Figueiredo
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Michael Kabesch
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany
| | - Somnath Mukhopadhyay
- Academic Department of Paediatrics, Brighton and Sussex Medical School, Royal Alexandra Children's Hospital, Brighton, UK.,Population Pharmacogenetics Group, Biomedical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Munir Pirmohamed
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Daniel B Hawcutt
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.,Alder Hey Children's Hospital, Liverpool, UK.,NIHR Alder Hey Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, UK
| | - Erik Melén
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children's Hospital, South General Hospital, Stockholm, Sweden
| | - Colin N Palmer
- Population Pharmacogenetics Group, Biomedical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Anke H Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Paediatric Respiratory Medicine and Allergy, Emma's Children Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Erika von Mutius
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Guy Brusselle
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Fook Tim Chew
- Department of Biological Sciences, National University of Singapore, Singapore City, Singapore
| | - Eugene Bleecker
- Division of Genetics, Genomics, and Precision Medicine, Department of Internal Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Deborah Meyers
- Division of Genetics, Genomics, and Precision Medicine, Department of Internal Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Esteban G Burchard
- Severe Asthma Unit, Allergy Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Tenerife, Spain.,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Maria Pino-Yanes
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Tenerife, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Instituto de Tecnologías Biomédicas (ITB), Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Tenerife, Spain
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27
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Habener A, Grychtol R, Gaedcke S, DeLuca D, Dittrich AM, Happle C, Abdo M, Watz H, Pedersen F, König IR, Thiele D, Kopp MV, von Mutius E, Bahmer T, Rabe KF, Meyer-Bahlburg A, Hansen G. IgA + memory B cells are significantly increased in patients with asthma and small airways dysfunction. Eur Respir J 2022; 60:13993003.02130-2021. [PMID: 35595320 DOI: 10.1183/13993003.02130-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/25/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Comprehensive studies investigated the role of T cells in asthma leading to personalised treatment options targeting severe eosinophilic asthma. However, little is known about the contribution of B cells to this chronic inflammatory disease. In this study, we investigated the contribution of various B cell populations to specific clinical features in asthma. METHODS In the All Age Asthma Cohort (ALLIANCE) a subgroup of 154 adult asthma patients and 28 healthy controls were included for B cell characterisation by flow cytometry. Questionnaires, lung function measurements, blood differential counts and allergy testing of participants were analysed together with comprehensive data on B cells via association studies and multivariate linear models. RESULTS Patients with severe asthma showed decreased immature B cell populations while memory B cells were significantly increased compared to both mild-moderate asthma patients and healthy controls. Furthermore, increased frequencies of immunoglobulin A positive (IgA+) memory B cells were associated with impaired lung function and specifically with parameters indicative for augmented resistance in the peripheral airways. Accordingly, asthma patients with small airway dysfunction (SAD) defined by impulse oscillometry showed increased frequencies of IgA+ memory B cells, particularly in patients with mild to moderate asthma. Additionally, IgA+ memory B cells significantly correlated with clinical features of SAD such as exacerbations. CONCLUSIONS With this study we demonstrate for the first time a significant association of increased IgA+ memory B cells with asthma and SAD, pointing towards future options for B cell-directed strategies in preventing and treating asthma.
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Affiliation(s)
- Anika Habener
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,These authors contributed equally to this work
| | - Ruth Grychtol
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,These authors contributed equally to this work
| | - Svenja Gaedcke
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - David DeLuca
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Anna Maria Dittrich
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Christine Happle
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Mustafa Abdo
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Lübeck, Germany.,LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Henrik Watz
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Frauke Pedersen
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Lübeck, Germany.,LungenClinic Grosshansdorf, Grosshansdorf, Germany.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Inke Regina König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Lübeck, Germany
| | - Dominik Thiele
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Lübeck, Germany
| | - Matthias Volkmar Kopp
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Section for Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Campus Centrum Lübeck, Germany.,Department of Pediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.,Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Thomas Bahmer
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Lübeck, Germany.,LungenClinic Grosshansdorf, Grosshansdorf, Germany.,University Hospital Schleswig-Holstein, Campus Kiel, Internal Medicine I, Pneumology, Kiel, Germany
| | - Klaus Friedrich Rabe
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Lübeck, Germany.,LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | | | - Gesine Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany .,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Cluster of Excellence RESIST (EXC 2155), German Research Foundation (DFG), Hannover Medical School, Hannover, Germany
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28
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Rønnow SR, Sand JMB, Staunstrup LM, Bahmer T, Wegmann M, Lunding L, Burgess J, Rabe K, Sorensen GL, Fuchs O, Mutius EV, Hansen G, Kopp MV, Karsdal M, Leeming DJ, Weckmann M. A serological biomarker of type I collagen degradation is related to a more severe, high neutrophilic, obese asthma subtype. Asthma Res Pract 2022; 8:2. [PMID: 35418159 PMCID: PMC9006548 DOI: 10.1186/s40733-022-00084-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/28/2022] [Indexed: 11/11/2022] Open
Abstract
Background Asthma is a heterogeneous disease; therefore, biomarkers that can assist in the identification of subtypes and direct therapy are highly desirable. Asthma is a chronic inflammatory disease that leads to changes in the extracellular matrix (ECM) by matrix metalloproteinases (MMPs) degradation causing fragments of type I collagen that is released into circulation. Objective Here, we asked if MMP-generated type I collagen (C1M) was associated with subtypes of asthma. Methods C1M was serologically assessed at baseline in the adult participants of the All Age Asthma study (ALLIANCE) (n = 233), and in The Prospective Epidemiological Risk Factor study (PERF) (n = 283). In addition, C1M was assessed in mice sensitized to ovalbumin (OVA) and challenged with OVA aerosol. C1M was evaluated in mice with and without acute neutrophilic inflammation provoked by poly(cytidylic-inosinic) acid and mice treated with CP17, a peptide inhibiting neutrophil accumulation. Results Serum C1M was significantly increased in asthmatics compared to healthy controls (p = 0.0005). We found the increased C1M levels in asthmatics were related to blood neutrophil and body mass index (BMI) in the ALLIANCE cohort, which was validated in the PERF cohort. When patients were stratified into obese (BMI > 30) asthmatics with high neutrophil levels and uncontrolled asthma, this group had a significant increase in C1M compared to normal-weight (BMI < 25) asthmatics with low neutrophil levels and controlled asthma (p = 0.0277). C1M was significantly elevated in OVA mice with acute neutrophilic inflammation compared to controls (P = 0.0002) and decreased in mice treated with an inhibitor of neutrophil infiltration (p = 0.047). Conclusion & clinical relevance C1M holds the potential to identify a subtype of asthma that relates to severity, obesity, and high neutrophils. These data suggest that C1M is linked to a subtype of overall inflammation, not only derived from the lung. The link between C1M and neutrophils were further validated in in vivo model. Trial registration (ALLIANCE, NCT02419274). Supplementary information The online version contains supplementary material available at 10.1186/s40733-022-00084-6.
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Affiliation(s)
| | | | - Line Mærsk Staunstrup
- Nordic Bioscience A/S, Herlev, Denmark.,University of Southern Denmark, The Faculty of Health Science, Odense, Denmark
| | - Thomas Bahmer
- University of Copenhagen, Health, Copenhagen, Denmark.,LungenClinic Grosshansdorf GmbH, Großhansdorf, Germany
| | - Michael Wegmann
- University of Copenhagen, Health, Copenhagen, Denmark.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany
| | - Lars Lunding
- University of Copenhagen, Health, Copenhagen, Denmark.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany
| | - Janette Burgess
- Division of Asthma Mouse Model, Priority Area Asthma & Allergy, Leibniz-Center for Medicine and Biosciences Borstel, Borstel, Germany
| | - Klaus Rabe
- University of Copenhagen, Health, Copenhagen, Denmark.,LungenClinic Grosshansdorf GmbH, Großhansdorf, Germany
| | - Grith Lykke Sorensen
- Department of Pathology and Medical Biology, Medical Biology Section, University Medical Center, Groningen, The Netherlands
| | - Oliver Fuchs
- University Childrens Hospital, Inselspital Bern, Bern, Switzerland
| | - Erika V Mutius
- Dr. von Hauner Children's Hospital, University Hospital Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Gesine Hansen
- University Childrens Hospital, Department of Pediatric Pneumology, Allergology and Neonatology Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Matthias Volkmar Kopp
- LungenClinic Grosshansdorf GmbH, Großhansdorf, Germany.,Division of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Campus Centrum Lübeck, Lübeck, Germany
| | | | | | - Markus Weckmann
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Division of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Campus Centrum Lübeck, Lübeck, Germany
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29
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Maison N, Omony J, Illi S, Thiele D, Skevaki C, Dittrich AM, Bahmer T, Rabe KF, Weckmann M, Happle C, Schaub B, Meier M, Foth S, Rietschel E, Renz H, Hansen G, Kopp MV, von Mutius E, Grychtol R. T-high asthma phenotypes across life span. Eur Respir J 2022; 60:13993003.02288-2021. [PMID: 35210326 DOI: 10.1183/13993003.02288-2021] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/04/2022] [Indexed: 11/05/2022]
Abstract
RATIONALE In adults, personalised asthma treatment targets patients with T2-high and eosinophilic asthma phenotypes. It is unclear whether such classification is achievable in children. OBJECTIVES To define T2-high asthma with easily accessible biomarkers and compare resulting phenotypes across all ages. METHODS In the multicenter clinical ALL Age Asthma Cohort (ALLIANCE), 1125 participants (n=776 asthmatics, n=349 controls) were recruited and followed for 2 years (1 year in adults). Extensive clinical characterisation (questionnaires, blood differential count, allergy testing, lung function and sputum induction (in adults) was performed at baseline and follow-ups. Interleukin (IL)-4, IL-5 and IL-13 were measured after stimulation of whole blood with LPS or anti-CD3/CD28. MEASUREMENTS AND MAIN RESULTS Based on blood eosinophil counts and allergen-specific serum IgE antibodies (sIgE), patients were categorised into four mutually exclusive phenotypes: "Atopy-only", "Eosinophils-only", "T2-high" (eosinophilia+atopy) and "T2-low" (neither eosinophilia nor atopy). The T2-high phenotype was found across all ages, even in very young children in whom it persisted to a large degree even after 2 years of follow-up. T2-high asthma in adults was associated with childhood onset suggesting early origins of this asthma phenotype. In both children and adults, the T2-high phenotype was characterised by excessive production of specific IgE to allergens (p<0.0001) and, from school age onwards, by increased production of IL-5 after anti-CD3/CD28 stimulation of whole blood. CONCLUSIONS Using easily accessible biomarkers, patients with T2-high asthma can be identified across all ages delineating a distinct phenotype. These patients may benefit from therapy with biologicals even at younger age.
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Affiliation(s)
- Nicole Maison
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany.,Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M; Member of German Center for Lung Research (DZL), Munich, Germany
| | - Jimmy Omony
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M; Member of German Center for Lung Research (DZL), Munich, Germany
| | - Sabina Illi
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M; Member of German Center for Lung Research (DZL), Munich, Germany
| | - Dominik Thiele
- Institute of Medical Biometry and Statistics (IMBS), University Medical Center Schleswig-Holstein, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Chrysanthi Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-University Marburg, Marburg, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL), Marburg, Germany
| | - Anna-Maria Dittrich
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH); Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Thomas Bahmer
- University Hospital Schleswig-Holstein, Campus Kiel, Internal Medicine Department I, Pneumology, Kiel, Germany.,LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Klaus Friedrich Rabe
- LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Markus Weckmann
- Division of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Christine Happle
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH); Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Bianca Schaub
- Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M; Member of German Center for Lung Research (DZL), Munich, Germany
| | - Meike Meier
- Faculty of Medicine, University Children's Hospital, University of Cologne, Cologne, Germany
| | - Svenja Foth
- Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL), Marburg, Germany.,University Children's Hospital Marburg, University of Marburg, Marburg, Germany
| | - Ernst Rietschel
- Faculty of Medicine, University Children's Hospital, University of Cologne, Cologne, Germany
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-University Marburg, Marburg, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL), Marburg, Germany.,Department of Clinical Immunology and Allergology, Sechenov University, Moscow, Russia
| | - Gesine Hansen
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH); Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Matthias Volkmar Kopp
- Division of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Munich, Germany.,Department of Pediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Erika von Mutius
- Institute for Asthma- and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Center for Environmental Health (GmbH), Munich, Germany .,Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.,Comprehensive Pneumology Center - Munich (CPC-M; Member of German Center for Lung Research (DZL), Munich, Germany
| | - Ruth Grychtol
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH); Member of the German Center for Lung Research (DZL), Hannover, Germany
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Schlicht K, Rohmann N, Geisler C, Hollstein T, Knappe C, Hartmann K, Schwarz J, Tran F, Schunk D, Junker R, Bahmer T, Rosenstiel P, Schulte D, Türk K, Franke A, Schreiber S, Laudes M. Correction: Circulating levels of soluble Dipeptidylpeptidase-4 are reduced in human subjects hospitalized for severe COVID-19 infections. Int J Obes (Lond) 2021; 46:243. [PMID: 34671109 PMCID: PMC8526988 DOI: 10.1038/s41366-021-00988-y] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kristina Schlicht
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Nathalie Rohmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Corinna Geisler
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Tim Hollstein
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Carina Knappe
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Katharina Hartmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Jeanette Schwarz
- Institute of Clinical Chemistry, University of Kiel, Kiel, Germany.,Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany.,Division of Pneumology, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Domagoj Schunk
- Interdisciplinary Emergency Center, University of Kiel, Kiel, Germany
| | - Ralf Junker
- Institute of Clinical Chemistry, University of Kiel, Kiel, Germany
| | - Thomas Bahmer
- Division of Pneumology, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Dominik Schulte
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Kathrin Türk
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Stefan Schreiber
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany.,Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Matthias Laudes
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany.
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31
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Alhamdan F, Marsh LM, Pedersen F, Alhamwe BA, Thölken C, Pfefferle PI, Bahmer T, Greulich T, Potaczek DP, Garn H. Differential Regulation of Interferon Signaling Pathways in CD4 + T Cells of the Low Type-2 Obesity-Associated Asthma Phenotype. Int J Mol Sci 2021; 22:ijms221810144. [PMID: 34576307 PMCID: PMC8469911 DOI: 10.3390/ijms221810144] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022] Open
Abstract
In the era of personalized medicine, insights into the molecular mechanisms that differentially contribute to disease phenotypes, such as asthma phenotypes including obesity-associated asthma, are urgently needed. Peripheral blood was drawn from 10 obese, non-atopic asthmatic adults with a high body mass index (BMI; 36.67 ± 6.90); 10 non-obese, non-atopic asthmatic adults with normal BMI (23.88 ± 2.73); and 10 healthy controls with normal BMI (23.62 ± 3.74). All asthmatic patients were considered to represent a low type-2 asthma phenotype according to selective clinical parameters. RNA sequencing (RNA-Seq) was conducted on peripheral blood CD4+ T cells. Thousands of differentially expressed genes were identified in both asthma groups compared with heathy controls. The expression of interferon (IFN)-stimulated genes associated with IFN-related signaling pathways was specifically affected in obese asthmatics, while the gap junction and G protein-coupled receptor (GPCR) ligand binding pathways were enriched in both asthma groups. Furthermore, obesity gene markers were also upregulated in CD4+ T cells from obese asthmatics compared with the two other groups. Additionally, the enriched genes of the three abovementioned pathways showed a unique correlation pattern with various laboratory and clinical parameters. The specific activation of IFN-related signaling and viral infection pathways might provide a novel view of the molecular mechanisms associated with the development of the low type-2 obesity-associated asthma phenotype, which is a step ahead in the development of new stratified therapeutic approaches.
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Affiliation(s)
- Fahd Alhamdan
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Member of the German Center for Lung Research (DZL) and the Universities of Giessen and Marburg Lung Center, Medical Faculty, Philipps University of Marburg, D-35043 Marburg, Germany; (F.A.); (D.P.P.)
| | - Leigh M. Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research, A-8010 Graz, Austria;
| | - Frauke Pedersen
- Lungen Clinic Grosshansdorf GmbH, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), D-22927 Großhansdorf, Germany; (F.P.); (T.B.)
| | - Bilal Alashkar Alhamwe
- Clinic for Hematology, Oncology and Immunology, Center for Tumor Biology and Immunology, Institute of Tumor Immunology, Medical Faculty, Philipps University of Marburg, D-35043 Marburg, Germany;
- College of Pharmacy, International University for Science and Technology (IUST), Daraa 15, Syria
| | - Clemens Thölken
- Institute of Medical Bioinformatics and Biostatistics, Medical Faculty, Philipps University of Marburg, D-35037 Marburg, Germany;
| | - Petra Ina Pfefferle
- Comprehensive Biobank Marburg (CBBMR), Member of the German Biobank Alliance (GBA) and the German Center for Lung Research (DZL), Medical Faculty, Philipps University of Marburg, D-35043 Marburg, Germany;
| | - Thomas Bahmer
- Lungen Clinic Grosshansdorf GmbH, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), D-22927 Großhansdorf, Germany; (F.P.); (T.B.)
- Department for Internal Medicine I, Campus Kiel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Timm Greulich
- Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research, University Medical Center Giessen and Marburg, Department of Medicine, D-35043 Marburg, Germany;
| | - Daniel P. Potaczek
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Member of the German Center for Lung Research (DZL) and the Universities of Giessen and Marburg Lung Center, Medical Faculty, Philipps University of Marburg, D-35043 Marburg, Germany; (F.A.); (D.P.P.)
| | - Holger Garn
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Member of the German Center for Lung Research (DZL) and the Universities of Giessen and Marburg Lung Center, Medical Faculty, Philipps University of Marburg, D-35043 Marburg, Germany; (F.A.); (D.P.P.)
- Correspondence: ; Tel.: +49-6421-2866040
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32
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Maison N, Herbrüggen H, Schaub B, Schauberger C, Foth S, Grychtol R, Abdo M, Watz H, Nikolaizik W, Rabe KF, Kopp MV, Hansen G, von Mutius E, Bahmer T, Omony J. Impact of imposed social isolation and use of face masks on asthma course and mental health in pediatric and adult patients with recurrent wheeze and asthma. Allergy Asthma Clin Immunol 2021; 17:93. [PMID: 34530911 PMCID: PMC8444172 DOI: 10.1186/s13223-021-00592-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background There is currently a dramatic increase in the number of COVID-19 cases worldwide, and further drastic restrictions in our daily life will be necessary to contain this pandemic. The implications of restrictive measures like social-distancing and mouth-nose protection on patients with chronic respiratory diseases have hardly been investigated. Methods Our survey, was conducted within the All Age Asthma Cohort (ALLIANCE), a multicenter longitudinal observational study. We assessed the effects of COVID-19 imposed social isolation and use of facial masks, on asthma course and mental health in patients with asthma and wheezing. Results We observed a high rate of problems associated with using facemasks and a significant reduction in the use of routine medical care. In addition to unsettling impacts, such as an increase in depression symptoms in adults, an astonishing and pleasing effect was striking: preschool children experienced an improvement in disease condition during the lockdown. This improvement can be attributed to a significant reduction in exposure to viral infections. Conclusion Long-term observation of this side effect may help improve our understanding of the influence of viral infections on asthma in early childhood.
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Affiliation(s)
- Nicole Maison
- Department of Paediatric Allergology, Dr Von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany. .,Comprehensive Pneumology Center, Munich (CPC-M), Munich, Germany. .,German Center for Lung Research (DZL), Munich, Germany. .,Institut Für Asthma- Und Allergieprävention (IAP), Helmholtz Zentrum Munich, Deutsches Forschungszentrum Für Gesundheit Und Umwelt (GmbH), Munich, Germany.
| | - Heidrun Herbrüggen
- German Center for Lung Research (DZL), Munich, Germany.,LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany.,Airway Research Center North (ARCN), Grosshansdorf, Germany
| | - Bianca Schaub
- Department of Paediatric Allergology, Dr Von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.,Comprehensive Pneumology Center, Munich (CPC-M), Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Christina Schauberger
- Department of Paediatric Allergology, Dr Von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.,Comprehensive Pneumology Center, Munich (CPC-M), Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany
| | - Svenja Foth
- German Center for Lung Research (DZL), Munich, Germany.,University Children's Hospital Marburg, University of Marburg, Marburg, Germany.,University of Giessen Marburg Lung Center (UGMLC), Giessen, Germany
| | - Ruth Grychtol
- German Center for Lung Research (DZL), Munich, Germany.,Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Mustafa Abdo
- German Center for Lung Research (DZL), Munich, Germany.,LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany.,Airway Research Center North (ARCN), Grosshansdorf, Germany
| | - Henrik Watz
- German Center for Lung Research (DZL), Munich, Germany.,Airway Research Center North (ARCN), Grosshansdorf, Germany.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Wilfried Nikolaizik
- German Center for Lung Research (DZL), Munich, Germany.,University Children's Hospital Marburg, University of Marburg, Marburg, Germany.,University of Giessen Marburg Lung Center (UGMLC), Giessen, Germany
| | - Klaus F Rabe
- German Center for Lung Research (DZL), Munich, Germany.,LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany.,Airway Research Center North (ARCN), Grosshansdorf, Germany
| | - Matthias V Kopp
- German Center for Lung Research (DZL), Munich, Germany.,Airway Research Center North (ARCN), Grosshansdorf, Germany.,Institute for Medical Biometry and Statistics, University Luebeck, University Medical Centre Schleswig-Holstein, Campus, Luebeck, Germany
| | - Gesine Hansen
- German Center for Lung Research (DZL), Munich, Germany.,Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Erika von Mutius
- Department of Paediatric Allergology, Dr Von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.,Comprehensive Pneumology Center, Munich (CPC-M), Munich, Germany.,German Center for Lung Research (DZL), Munich, Germany.,Institut Für Asthma- Und Allergieprävention (IAP), Helmholtz Zentrum Munich, Deutsches Forschungszentrum Für Gesundheit Und Umwelt (GmbH), Munich, Germany
| | - Thomas Bahmer
- German Center for Lung Research (DZL), Munich, Germany.,LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany.,Airway Research Center North (ARCN), Grosshansdorf, Germany.,Internal Medicine Department I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jimmy Omony
- Institut Für Asthma- Und Allergieprävention (IAP), Helmholtz Zentrum Munich, Deutsches Forschungszentrum Für Gesundheit Und Umwelt (GmbH), Munich, Germany
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Maqhuzu PN, Kreuter M, Bahmer T, Kahn N, Claussen M, Holle R, Schwarzkopf L. Cost drivers in the pharmacological treatment of interstitial lung disease. Respir Res 2021; 22:218. [PMID: 34344376 PMCID: PMC8335870 DOI: 10.1186/s12931-021-01807-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/17/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Treatments of interstitial lung diseases (ILDs) mainly focus on disease stabilization and relief of symptoms by managing inflammation or suppressing fibrosis by (in part costly) drugs. To highlight economic burden of drug treatment in different ILD-subtypes we assessed cost trends and therewith-associated drivers. METHODS Using data from the German, observational HILDA study we estimated adjusted mean medication costs over 36-month intervals using one- and two-part Generalized Estimating Equation (GEE) regression models with a gamma distribution and log link. Next, we determined factors associated with costs. RESULTS In Idiopathic pulmonary fibrosis (IPF) mean per capita medication costs increased from €1442 before to €11,000€ at the end of study. In non-IPF subtypes, the increase took place at much lower level. Mean per capita ILD-specific medication costs at the end of the study ranged between €487 (other ILD) and €9142 (IPF). At baseline, higher FVC %predicted values were associated with lower medication costs in IPF (-9%) and sarcoidosis (-1%). During follow up higher comorbidity burden escalated costs in progressive fibrosing ILD (PF-ILD) (+52%), sarcoidosis (+60%) and other ILDs (+24%). The effect of disease duration was not uniform, with cost savings in PF-ILD (-8%) and sarcoidosis (-6%), but increased spending in IPF (+11%). CONCLUSION Pharmacological management of ILD, in particular of IPF imposes a substantial economic burden on the healthcare system. Strategies to reduce comorbidity burden and early treatment may reduce the impact of ILDs on the healthcare system.
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Affiliation(s)
- Phillen Nozibuyiso Maqhuzu
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, and German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf GmbH Pneumology, Member of the German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Großhansdorf, Germany
- University Hospital Schleswig-Holstein Campus Kiel, Internal Medicine I, Member of the German Center for Lung Research (DZL), Arnold-Heller-Str. 3 /Haus 41a, 24105, Kiel, Germany
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, and German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Martin Claussen
- LungenClinic Grosshansdorf GmbH Pneumology, Member of the German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Großhansdorf, Germany
| | - Rolf Holle
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Marchioninistr. 15, 81377, Munich, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
- Institut Fuer Therapieforschung (IFT), Leopoldstr. 175, 80804, Munich, Germany
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Weckmann M, Bahmer T, Bülow Sand JM, Rank Rønnow S, Pech M, Vermeulen C, Faiz A, Leeming DJ, Karsdal MA, Lunding L, Oliver BGG, Wegmann M, Ulrich-Merzenich G, Juergens UR, Duhn J, Laumonnier Y, Danov O, Sewald K, Zissler U, Jonker M, König I, Hansen G, von Mutius E, Fuchs O, Dittrich AM, Schaub B, Happle C, Rabe KF, van de Berge M, Burgess JK, Kopp MV. COL4A3 is degraded in allergic asthma and degradation predicts response to anti-IgE therapy. Eur Respir J 2021; 58:13993003.03969-2020. [PMID: 34326188 DOI: 10.1183/13993003.03969-2020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/28/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asthma is a heterogeneous syndrome substantiating the urgent requirement for endotype-specific biomarkers. Dysbalance of fibrosis and fibrolysis in asthmatic lung tissue leads to reduced levels of the inflammation-protective collagen 4 (COL4A3). OBJECTIVE To delineate the degradation of COL4A3 in allergic airway inflammation and evaluate the resultant product as a biomarker for anti-IgE therapy response. METHODS The serological COL4A3 degradation marker C4Ma3 (Nordic Bioscience, Denmark) and serum cytokines were measured in the ALLIANCE cohort (pediatric cases/controls: 134/35; adult cases/controls: 149/31). Exacerbation of allergic airway disease in mice was induced by sensitising to OVA, challenge with OVA aerosol and instillation of poly(cytidylic-inosinic). Fulacimstat (chymase inhibitor, Bayer) was used to determine the role of mast cell chymase in COL4A3 degradation. Patients with cystic fibrosis (CF, n=14) and CF with allergic broncho-pulmonary aspergillosis (ABPA, n=9) as well as severe allergic, uncontrolled asthmatics (n=19) were tested for COL4A3 degradation. Omalizumab (anti-IgE) treatment was assessed by the Asthma Control Test. RESULTS Serum levels of C4Ma3 were increased in asthma in adults and children alike and linked to a more severe, exacerbating allergic asthma phenotype. In an experimental asthma mouse model, C4Ma3 was dependent on mast cell chymase. Serum C4Ma3 was significantly elevated in CF plus ABPA and at baseline predicted the success of the anti-IgE therapy in allergic, uncontrolled asthmatics (diagnostic odds ratio 31.5). CONCLUSION C4Ma3 level depend on lung mast cell chymase and are increased in a severe, exacerbating allergic asthma phenotype. C4Ma3 may serve as a novel biomarker to predict anti-IgE therapy response.
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Affiliation(s)
- Markus Weckmann
- Division of Pediatric Pneumology & Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany
| | - Thomas Bahmer
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany.,Department of Pneumology, LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | | | - Sarah Rank Rønnow
- Nordic Bioscience A/S, Herlev, Denmark.,The Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Martin Pech
- Division of Pediatric Pneumology & Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany
| | - Cornelis Vermeulen
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, , GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands
| | - Alen Faiz
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, , GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands.,Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, , GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands.,Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,School of Medical and Molecular Biosciences, University of Technology, Sydney, NSW, Australia
| | | | | | - Lars Lunding
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany.,Division of Asthma-Exacerbation & -Regulation; Program Area Asthma & Allergy, Leibniz-Center for Medicine and Biosciences Borstel
| | - Brian George G Oliver
- Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,School of Medical and Molecular Biosciences, University of Technology, Sydney, NSW, Australia
| | - Michael Wegmann
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany.,Division of Asthma-Exacerbation & -Regulation; Program Area Asthma & Allergy, Leibniz-Center for Medicine and Biosciences Borstel
| | | | - Uwe R Juergens
- Department of Pneumonology, Medical Clinic II, University Hospital Bonn
| | - Jannis Duhn
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Yves Laumonnier
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Olga Danov
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Katherina Sewald
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Ulrich Zissler
- Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, German Research Center for Environmental Health (CPC-M), Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Marnix Jonker
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, , GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands.,Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, , GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands
| | - Inke König
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany.,Institute for Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Gesine Hansen
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center of Lung Research (DZL), Germany
| | - Erika von Mutius
- University Children's Hospital, Ludwig Maximilian's University, Munich, Germany.,German Research Center for Environmental Health (CPC-M), Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Oliver Fuchs
- Division of Pediatric Pneumology & Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany.,Department of Paediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Anna-Maria Dittrich
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center of Lung Research (DZL), Germany
| | - Bianca Schaub
- University Children's Hospital, Ludwig Maximilian's University, Munich, Germany.,German Research Center for Environmental Health (CPC-M), Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Christine Happle
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center of Lung Research (DZL), Germany
| | - Klaus F Rabe
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany.,Department of Pneumology, LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Maarten van de Berge
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, , GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands
| | - Janette Kay Burgess
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center Groningen, , GRIAC (Groningen Research Institute for Asthma and COPD), Groningen, The Netherlands.,Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, Australia.,Discipline of Pharmacology, Faculty of Medicine, The University of Sydney, NSW, Australia
| | - Matthias Volkmar Kopp
- Division of Pediatric Pneumology & Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Germany.,Department of Paediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
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Abdo M, Trinkmann F, Kirsten AM, Biller H, Pedersen F, Waschki B, Von Mutius E, Kopp M, Hansen G, Rabe KF, Bahmer T, Watz H. The Relevance of Small Airway Dysfunction in Asthma with Nocturnal Symptoms. J Asthma Allergy 2021; 14:897-905. [PMID: 34285516 PMCID: PMC8286106 DOI: 10.2147/jaa.s313572] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/19/2021] [Indexed: 11/23/2022] Open
Abstract
Rationale Small airway dysfunction (SAD) is a frequent feature of asthma that has been linked to disease severity and poor symptom control. However, little is known about the role of SAD in nocturnal asthma. Objective To study the association between the severity of SAD and frequency of nocturnal symptoms compared to conventional lung function testing. Methods We assessed the frequency of self-reported nocturnal symptoms through the asthma control test. We studied the impact of nocturnal asthma using the Asthma Quality of Life Questionnaire (AQLQ) and the Multidimensional Fatigue Inventory (MFI-20). We assessed the lung function using spirometry, body plethysmography, impulse oscillometry, single and multiple inert gas washout and measured markers of T2-inflammation (blood and sputum eosinophils; fractional exhaled nitric oxide (FeNo)). We stratified the patients according to the presence and frequency of nocturnal asthma. Results A total of 166 asthma patients were enrolled in the analysis. Eighty-seven patients (52%) reported to have nocturnal symptoms at least once in the last four weeks. The odds ratio of nocturnal asthma correlated with the severity of all non-spirometric measures of SAD, yet neither with airflow obstruction (FEV1 and FEV/FVC) nor with large airway resistance (R20). Patients with frequent nocturnal asthma (n = 29) had a numerical increase of T2 markers and more severe SAD, as indicated by all non-spirometric measures of SAD (all p-values < 0.05), worse overall asthma control, increased fatigue and reduced quality of life (all p-values < 0.01) compared to patients with infrequent nocturnal asthma (n = 58) or patients without nocturnal asthma (n = 79). We identified 63 patients without airflow obstruction, nearly 43% of them (n = 27) had nocturnal asthma. In this subgroup, only markers of air trapping and ventilation heterogeneity were significantly elevated and correlated with the frequency of nocturnal symptoms: LCI (Spearman’s coefficient = −0.42, p < 0.001), RV% (−0.32, p = 0.02). Conclusion SAD is closely associated to asthma with nocturnal symptoms. Spirometry might underestimate the broad spectrum of distal lung function impairments in this population of patients.
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Affiliation(s)
- Mustafa Abdo
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Frederik Trinkmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Biomedical Informatics, Heinrich-Lanz-Center, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany
| | - Anne-Marie Kirsten
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Heike Biller
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Frauke Pedersen
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.,Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Benjamin Waschki
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Erika Von Mutius
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), and Institute of Asthma and Allergy Prevention, Helmholtz Centre, Both Munich, Germany
| | - Matthias Kopp
- Department of Pediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland.,Division of Pediatric Pneumology & Allergology, University Hospital Schleswig-Holstein-Campus Luebeck, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany
| | - Gesine Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.,University Hospital Schleswig-Holstein-Campus Kiel, department for Internal Medicine I, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Kiel, Germany
| | - Henrik Watz
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
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Malik M, Kunze AC, Bahmer T, Herget-Rosenthal S, Kunze T. SARS-CoV-2: Viral Loads of Exhaled Breath and Oronasopharyngeal Specimens in Hospitalized Patients with COVID-19. Int J Infect Dis 2021; 110:105-110. [PMID: 34242768 PMCID: PMC8260556 DOI: 10.1016/j.ijid.2021.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 12/13/2022] Open
Abstract
Background SARS-CoV-2 seems mainly transmissible via respiratory droplets. We compared the time-dependent SARS-CoV-2 viral load in serial pharyngeal swab with exhaled breath (EB) samples of hospitalized COVID-19 patients. Methods In this prospective proof of concept study, we examined hospitalized patients who initially tested positive for SARS-CoV-2. Paired oronasopharyngeal swab and EB specimens were taken at different days of hospitalization. EB collection was performed through a simple, noninvasive method using an electret air filter-based device. SARS-CoV-2 RNA detection was determined with real-time quantitative reverse transcription polymerase chain reaction. Results Of 187 serial samples from 15 hospitalized patients, 87/87 oronasopharyngeal swabs and 70/100 EB specimens tested positive. Comparing the number of SARS-CoV-2 copies, the viral load of the oronasopharyngeal swabs was significantly higher (CI 99%, P<<0,001) than for EB samples. The mean viral load per swab was 7.97 × 106 (1.65 × 102-1.4 × 108), whereas EB samples showed 2.47 × 103 (7.19 × 101-2.94 × 104) copies per 20 times exhaling. Viral loads of paired oronasopharyngeal swab and EB samples showed no correlation. Conclusions Assessing the infectiousness of COVID-19 patients merely through pharyngeal swabs might not be accurate. Exhaled breath could represent a more suitable matrix for evaluating infectiousness and might allow screening for superspreader individuals and widespread variants such as Delta.
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Affiliation(s)
- Madiha Malik
- Department of Clinical Pharmacy, Pharmaceutical Institute, Kiel University, Gutenbergstraße 76, 24118 Kiel, Germany.
| | - Ann-Cathrin Kunze
- Department of Internal Medicine, Rotes Kreuz Krankenhaus, St.-Pauli-Deich 24, 28199 Bremen, Germany
| | - Thomas Bahmer
- Department of Internal Medicine I, Pulmonology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Stefan Herget-Rosenthal
- Department of Internal Medicine, Rotes Kreuz Krankenhaus, St.-Pauli-Deich 24, 28199 Bremen, Germany
| | - Thomas Kunze
- Department of Clinical Pharmacy, Pharmaceutical Institute, Kiel University, Gutenbergstraße 76, 24118 Kiel, Germany.
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Abdo M, Uddin M, Goldmann T, Marwitz S, Bahmer T, Holz O, Kirsten AM, Trinkmann F, von Mutius E, Kopp M, Hansen G, Rabe KF, Watz H, Pedersen F. Raised sputum extracellular DNA confers lung function impairment and poor symptom control in an exacerbation-susceptible phenotype of neutrophilic asthma. Respir Res 2021; 22:167. [PMID: 34082773 PMCID: PMC8173872 DOI: 10.1186/s12931-021-01759-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Extracellular DNA (e-DNA) and neutrophil extracellular traps (NETs) are linked to asthmatics airway inflammation. However, data demonstrating the characterization of airway inflammation associated with excessive e-DNA production and its impact on asthma outcomes are limited. Objective To characterize the airway inflammation associated with excessive e-DNA production and its association with asthma control, severe exacerbations and pulmonary function, particularly, air trapping and small airway dysfunction. Methods We measured e-DNA concentrations in induced sputum from 134 asthma patients and 28 healthy controls. We studied the correlation of e-DNA concentrations with sputum neutrophils, eosinophils and macrophages and the fractional exhaled nitric oxide (FeNO). Lung function was evaluated using spirometry, body plethysmography, impulse oscillometry and inert gas multiple breath washout. We stratified patients with asthma into low-DNA and high-DNA to compare lung function impairments and asthma outcomes. Results Patients with severe asthma had higher e-DNA concentration (54.2 ± 42.4 ng/µl) than patients with mild-moderate asthma (41.0 ± 44.1 ng/µl) or healthy controls (26.1 ± 16.5 ng/µl), (all p values < 0.05). E-DNA concentrations correlated directly with sputum neutrophils (R = 0.49, p < 0.0001) and negatively with sputum macrophages (R = − 0.36, p < 0.0001), but neither with sputum eosinophils (R = 0.10, p = 0.26), nor with FeNO (R = − 0.10, p = 0.22). We found that 29% of asthma patients (n = 39) had high e-DNA concentrations above the upper 95th percentile value in healthy controls (55.6 ng /μl). High-DNA was associated with broad lung function impairments including: airflow obstruction of the large (FEV1) and small airways (FEF50%, FEF25–75), increased air trapping (RV, RV/TLC), increased small airway resistance (R5-20, sReff), decreased lung elasticity (X5Hz) and increased ventilation heterogeneity (LCI), (all P values < 0.05). We also found that high e-DNA was associated with nearly three-fold greater risk of severe exacerbations (OR 2·93 [95% CI 1.2–7.5]; p = 0·012), worse asthma control test (p = 0.03), worse asthma control questionnaire scores (p = 0.01) and higher doses of inhaled corticosteroids (p = 0.026). Conclusion Increased production of extracellular DNA in the airway characterizes a subset of neutrophilic asthma patients who have broad lung function impairments, poor symptom control and increased risk of severe exacerbations.
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Affiliation(s)
- Mustafa Abdo
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany
| | - Mohib Uddin
- Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Torsten Goldmann
- Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
| | - Sebastian Marwitz
- Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
| | - Thomas Bahmer
- Department for Internal Medicine I, Airway Research Center North (ARCN), German Center for Lung Research (DZL), University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany
| | - Olaf Holz
- Fraunhofer ITEM, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Anne-Marie Kirsten
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Frederik Trinkmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Biomedical Informatics, Heinrich-Lanz-Center, University Medical Center Mannheim, Mannheim, Germany
| | - Erika von Mutius
- Dr Von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Matthias Kopp
- Department of Pediatric Pneumology, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland.,Division of Pediatric Pneumology and Allergology, University Hospital Schleswig-Holstein-Campus Luebeck, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany
| | - Gesine Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany
| | - Henrik Watz
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Frauke Pedersen
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany. .,Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.
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Bahmer T, Wälscher J, Fisser C, Groth EE, Schreiber T, Koch M, Raspe M. [Young Respiratory Physicians in Germany - Current Situation and Future Perspectives]. Pneumologie 2021; 75:761-775. [PMID: 33853133 DOI: 10.1055/a-1397-6275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Demographic changes in the society and among doctors, as well as changing attitudes towards and norms of how living should be structured are creating challenges regarding the organization of work environment in the hospital. In addition, organization of medical training is increasingly being influenced by economic considerations as well as a high level of medical specialization. We asked young respiratory physicians how they assessed their current situation with respect to quality of medical training and organization of their work environment. METHODS From September to November 2019, we performed an online survey adressing young respiratory physicians in Germany. Participants were recruited via three emails (baseline and reminders after 2 and 6 weeks) sent by the German Respiratory Society (DGP) and the German Union of Pulmonologists (BdP). The questionnaire consisted of a maximum of 62 questions. Apart from own questions that had been aligned with other questionnaires from similar surveys in other medical specialties, we also assessed the effort-reward ratio (ER ratio) based on the short version of the effort-reward imbalance questionnaire (16 questions). RESULTS We recuited n = 224 participants (33.8 ± 4.5 years, 5.4 ± 2.9 years of medical training, 54.4 % female , 86.8 % with German nationality). A little under half of the interviewees (n = 103, 46 %) reported to be very or generally satisfied with their working conditions, while n = 60 (27 %) were unsure. The main reasons for not being satisfied were long working hours and high work-load, as well as a lack of streamlining the work environment in the hospital to the specific needs of doctors. Despite the fact that many participants were satisfied, a large majority (n = 166, 88.2 %) depicted an unfavorable effort-reward ratio imbalance (adjusted mean 1.89 ± 2.18). CONCLUSION Compared to many other European countries and internationally, the German healthcare system offers high-quality patient care and a well-equipped work environment. Increasing demands in the health care sector, however, are leading to a gratification crisis that not only harms the health and work performance of doctors but is also leading to reduced attractiveness of the job that might possibly lead to the search for new fields of activity or migration. Respiratory medicine is a discipline of growing interest and motivating young doctors to secure the promotion of this discipline is increasingly important. Factors harming the growth of this discipline should be immediately addressed. The results of this survey might help leaders in the field to restructure the work environment and medical education according to the actual needs.
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Affiliation(s)
- T Bahmer
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Medizinische Klinik I, Abteilung für Pneumologie, Kiel.,Airway Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL)
| | - J Wälscher
- Universitätsmedizin Essen, Ruhrlandklinik, Klinik für Pneumologie, Zentrum für interstitielle und seltene Erkrankungen, Essen
| | - C Fisser
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin II, Regensburg
| | - E E Groth
- Airway Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL).,LungenClinic Grosshansdorf, Pneumologie, Großhansdorf
| | - T Schreiber
- Krankenhaus Bethanien gGMBH, Klinik für Pneumologie und Allergologie, Solingen
| | - M Koch
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin II, Regensburg
| | - M Raspe
- Charité - Universitätsmedizin Berlin, Mitglied der Freien Universität Berlin, Humboldt-Universität zu Berlin und des Berlin Institute of Health, Medizinische Klinik m. S. Infektiologie und Pneumologie, Berlin
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Abdo M, Waschki B, Kirsten AM, Trinkmann F, Biller H, Herzmann C, von Mutius E, Kopp M, Hansen G, Rabe KF, Bahmer T, Watz H. Persistent Uncontrolled Asthma: Long-Term Impact on Physical Activity and Body Composition. J Asthma Allergy 2021; 14:229-240. [PMID: 33737816 PMCID: PMC7966302 DOI: 10.2147/jaa.s299756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/19/2021] [Indexed: 12/25/2022] Open
Abstract
Rationale Asthma, obesity and physical activity (PA) are interrelated. However, longitudinal data with objective PA measures and direct assessment of body composition are still lacking. Objective To study the impact of symptom control on PA and body composition. Methods In a longitudinal cohort study of the German Center for Lung Research, we assessed the body composition of 233 asthma patients and 84 healthy controls using bioelectrical impedance analysis. PA (ie average daily steps and time of at least moderate activity, steps/min) was measured by accelerometry for one week. Asthma control was assessed by ACT score, ACQ-5 score and history of severe exacerbations. After two years of follow-up, we studied changes in physical activity and body composition in relation to asthma control. Results Patients with uncontrolled asthma had increased fat mass and decreased muscle mass compared to patients with controlled asthma or healthy controls. Both fat mass and muscle mass correlated better with asthma control than the body mass index (BMI). In multivariate regressions adjusted for age and sex, asthma control and physical activity were independent predictors of body composition (R2 = 0.61, p < 0.001). Persistent uncontrolled asthma patients (n=64) had lower physical activity at both baseline (6614 steps/118 min) and follow-up (6195/115). Despite having stable BMI, they also had significant muscle loss (−1.2%, −0.88 kg, p<0.01) and fat accumulation (+1%, +1.1 kg, p<0.01). By contrast, temporarily uncontrolled or controlled asthma patients had higher physical activity at baseline (8670/156) and follow -up (9058/153) with almost unchanged body composition. Conclusion Persistent uncontrolled asthma is associated with sustained physical inactivity and adverse changes in body composition that might be overlooked by relying solely on BMI. Physical activity is an independent predictor of body composition and reliable long-term marker of symptom control.
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Affiliation(s)
- Mustafa Abdo
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Benjamin Waschki
- Department of Cardiology and Pneumology at Hospital Itzehoe, Itzehoe, Germany
| | - Anne-Marie Kirsten
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Frederik Trinkmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Biomedical Informatics, Heinrich-Lanz-Center, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany
| | - Heike Biller
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Christian Herzmann
- Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Matthias Kopp
- Department of Pediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland.,Division of Pediatric Pneumology & Allergology, University Hospital Schleswig-Holstein-Campus Luebeck, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany
| | - Gesine Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.,University Hospital Schleswig-Holstein-Campus Kiel, Department for Internal Medicine I, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Kiel, Germany
| | - Henrik Watz
- Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
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Bahmer T. Daily, Once-Weekly, or No Asthma Controller Therapy At All: The Annoying Issue with Disease Remission in Clinical Asthma Trials. Am J Respir Crit Care Med 2021; 203:273-275. [PMID: 33030964 PMCID: PMC7874318 DOI: 10.1164/rccm.202008-3161ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Thomas Bahmer
- Internal Medicine Department I University Hospital Schleswig-Holstein Kiel, Germany and.,Airway Research Center North (ARCN) German Center for Lung Research (DZL) Grosshansdorf, Germany
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Holz O, Waschki B, Watz H, Kirsten A, Abdo M, Pedersen F, Weckmann M, Fuchs O, Dittrich AM, Hansen G, Kopp MV, von Mutius E, Rabe KF, Hohlfeld JM, Bahmer T. Breath volatile organic compounds and inflammatory markers in adult asthma patients: negative results from the ALLIANCE cohort. Eur Respir J 2021; 57:13993003.02127-2020. [PMID: 33008938 PMCID: PMC7876421 DOI: 10.1183/13993003.02127-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Olaf Holz
- Fraunhofer ITEM, Hannover, Germany.,German Center for Lung Research, BREATH.,O. Holz and B. Waschki contributed equally
| | - Benjamin Waschki
- University Hospital Hamburg-Eppendorf, Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,LungenClinic Grosshansdorf, Grosshansdorf, Germany.,German Center for Lung Research, ARCN.,O. Holz and B. Waschki contributed equally
| | - Henrik Watz
- German Center for Lung Research, ARCN.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Anne Kirsten
- German Center for Lung Research, ARCN.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Mustafa Abdo
- LungenClinic Grosshansdorf, Grosshansdorf, Germany.,German Center for Lung Research, ARCN
| | - Frauke Pedersen
- German Center for Lung Research, ARCN.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - Markus Weckmann
- German Center for Lung Research, ARCN.,Division of Pediatric Pulmonology and Allergology, University Children's Hospital, Luebeck, Germany
| | - Oliver Fuchs
- Dept of Paediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland.,German Center for Lung Research, CPC-M
| | - Anna-Maria Dittrich
- German Center for Lung Research, BREATH.,Dept of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- German Center for Lung Research, BREATH.,Dept of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Matthias V Kopp
- German Center for Lung Research, ARCN.,Division of Pediatric Pulmonology and Allergology, University Children's Hospital, Luebeck, Germany
| | - Erika von Mutius
- German Center for Lung Research, CPC-M.,Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Grosshansdorf, Germany.,German Center for Lung Research, ARCN
| | - Jens M Hohlfeld
- Fraunhofer ITEM, Hannover, Germany.,German Center for Lung Research, BREATH.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,J.M. Hohlfeld and T. Bahmer contributed equally
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Grosshansdorf, Germany.,University Hospital Schleswig-Holstein, Campus Kiel, Internal Medicine Department I, Pneumology, Kiel, Germany.,J.M. Hohlfeld and T. Bahmer contributed equally
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42
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Ellrichmann M, Bethge J, Boesenkoetter J, Conrad C, Noth R, Bahmer T, Nikolaus S, Aden K, Zeissig S, Schreiber S. Subclinical Pulmonary Involvement in Active IBD Responds to Biologic Therapy. J Crohns Colitis 2021; 15:1339-1345. [PMID: 33544122 PMCID: PMC8521732 DOI: 10.1093/ecco-jcc/jjab024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Increased mortality from respiratory diseases was observed in epidemiological studies of patients with ulcerative colitis [UC] as a potentially underestimated extraintestinal manifestation. We therefore investigated the presence of pulmonary manifestations of inflammatory bowel disease [IBD] and the potential effect of tumour necrosis factor alpha [TNF-α] inhibitors on pulmonary function tests [PFT] in a prospective, longitudinal study. METHODS In all, 92 consecutive patients with IBD (49 Crohn´s disease [CD], 43 UC) and 20 healthy controls were recruited. Fifty patients with IBD were in remission, and 42 had active disease with 22 of these being examined before and 6 weeks after initiating anti-TNF therapy. Pulmonary function tests [PFT] were evaluated using the Medical Research Council [MRC] dyspnoea index and a standardized body plethysmography. IBD activity was assessed using Harvey-Bradshaw index for CD and partial Mayo score for UC. Data are presented as mean ± standard error of the mean [SEM]. RESULTS Patients with active IBD showed significant reduction of PFT. Forced expiration [Tiffeneau index] values [FEV1%] were significantly reduced in IBD patients with active disease [78.8 ± 1.1] compared with remission [86.1 ± 0.9; p = 0.0002] and with controls [87.3 ± 1.3; p = 0.001]. Treatment with anti-TNF induced a significant relief in obstruction [p = 0.003 for FEV1% in comparison with baseline levels]. The level of pulmonary obstruction significantly correlated with clinical inflammation scores [HBI or Mayo]. CONCLUSIONS: PATIENTS with active IBD present with significant obstructive abnormalities in their PFTs. Obstruction is related to inflammatory activity, with anti-TNF improving PFTs. Pulmonary obstruction and possibly chronic bronchopulmonary inflammation is an overlooked problem in active IBD that is probably obscured by intestinal symptoms.
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Affiliation(s)
- M Ellrichmann
- Medical Department I, University Medical Center Schleswig Holstein, Kiel, Germany,Corresponding author: Mark Ellrichmann, MD, PhD, , Medical Department I, Arnold-Heller-Str. 3, Haus C, 24105 Kiel, Germany. Tel.: +49-431-500-22220; fax: +49-431-500-22378;
| | - J Bethge
- Medical Department I, University Medical Center Schleswig Holstein, Kiel, Germany
| | - J Boesenkoetter
- Medical Department I, University Medical Center Schleswig Holstein, Kiel, Germany
| | - C Conrad
- Medical Department I, University Medical Center Schleswig Holstein, Kiel, Germany
| | - R Noth
- Medical Department I, University Medical Center Schleswig Holstein, Kiel, Germany
| | - T Bahmer
- Medical Department I, University Medical Center Schleswig Holstein, Kiel, Germany
| | - S Nikolaus
- Medical Department I, University Medical Center Schleswig Holstein, Kiel, Germany
| | - K Aden
- Medical Department I, University Medical Center Schleswig Holstein, Kiel, Germany
| | - S Zeissig
- Department of Medicine I, University Medical Center Dresden, and Center for Regenerative Therapies Dresden [CRTD], Dresden, Germany
| | - S Schreiber
- Medical Department I, University Medical Center Schleswig Holstein, Kiel, Germany
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43
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Bahmer T, Krauss‐Etschmann S, Buschmann D, Behrends J, Watz H, Kirsten A, Pedersen F, Waschki B, Fuchs O, Pfaffl MW, Mutius E, Rabe KF, Hansen G, Kopp MV, König IR, Bartel S. RNA-seq-based profiling of extracellular vesicles in plasma reveals a potential role of miR-122-5p in asthma. Allergy 2021; 76:366-371. [PMID: 32627209 PMCID: PMC7818394 DOI: 10.1111/all.14486] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Thomas Bahmer
- Pneumology LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL)Airway Research Center North (ARCN) Grosshansdorf Germany
- University Hospital Schleswig‐Holstein, Campus Kiel, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN) Kiel Germany
| | - Susanne Krauss‐Etschmann
- University Hospital Schleswig‐Holstein, Campus Kiel, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN) Kiel Germany
- Leibniz Lung Center Research Center Borstel, Member of the German Center for Lung Research (DZL),Airway Research Center North (ARCN) Borstel Germany
| | - Dominik Buschmann
- Division of Animal Physiology and Immunology School of Life Sciences Weihenstephan Technical University of Munich Munich Germany
| | - Jochen Behrends
- Flow Cytometry Core Unit Leibniz Lung Center Borstel, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN) Borstel Germany
| | - Henrik Watz
- Pulmonary Research Institute LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN) Grosshansdorf Germany
| | - Anne‐Marie Kirsten
- Pulmonary Research Institute LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN) Grosshansdorf Germany
| | - Frauke Pedersen
- Pneumology LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL)Airway Research Center North (ARCN) Grosshansdorf Germany
- Pulmonary Research Institute LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN) Grosshansdorf Germany
| | - Benjamin Waschki
- Pneumology LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL)Airway Research Center North (ARCN) Grosshansdorf Germany
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany
| | - Oliver Fuchs
- Inselspital Bern University Children’s Hospital Bern Switzerland
- Department of Pediatric Pulmonology and Allergology Children’s Hospital at the University of Luebeck, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN) Luebeck Germany
| | - Michael W. Pfaffl
- Division of Animal Physiology and Immunology School of Life Sciences Weihenstephan Technical University of Munich Munich Germany
| | - Erika Mutius
- Dr. von Hauner Children's Hospital, Helmholtz Center Munich Comprehensive Pneumology Center – Munich (CPC‐M), Member of the German Center for Lung Research (DZL) Munich Germany
| | - Klaus F. Rabe
- Pneumology LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL)Airway Research Center North (ARCN) Grosshansdorf Germany
- University Hospital Schleswig‐Holstein, Campus Kiel, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN) Kiel Germany
| | - Gesine Hansen
- Department of Pediatric Pulmonology, Allergology and Neonatology Hannover Medical School, Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease (BREATH) Hannover Germany
| | - Matthias V. Kopp
- Inselspital Bern University Children’s Hospital Bern Switzerland
- Department of Pediatric Pulmonology and Allergology Children’s Hospital at the University of Luebeck, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN) Luebeck Germany
| | - Inke R. König
- Institute of Medical Biometry and Statistics University of Luebeck, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN) Luebeck Germany
| | - Sabine Bartel
- Leibniz Lung Center Research Center Borstel, Member of the German Center for Lung Research (DZL),Airway Research Center North (ARCN) Borstel Germany
- Department of Pathology and Medical Biology University of Groningen, University Medical Center Groningen, GRIAC Research Institute Groningen The Netherlands
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44
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Weckmann M, Thiele D, Liboschik L, Bahmer T, Pech M, Dittrich AM, Fuchs O, Happle C, Schaub B, Ricklefs I, Rabe KF, von Mutius E, Hansen G, König IR, Kopp MV. Cytokine levels in children and adults with wheezing and asthma show specific patterns of variability over time. Clin Exp Immunol 2020; 204:152-164. [PMID: 33202033 DOI: 10.1111/cei.13550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Levels of cytokines are used for in-depth characterization of patients with asthma; however, the variability over time might be a critical confounder. To analyze the course of serum cytokines in children, adolescents and adults with asthma and in healthy controls and to propose statistical methods to control for seasonal effects. Of 532 screened subjects, 514 (91·5%) were included in the All Age Asthma Cohort (ALLIANCE). The cohort included 279 children with either recurrent wheezing bronchitis (more than two episodes) or doctor-diagnosed asthma, 75 healthy controls, 150 adult asthmatics and 31 adult healthy controls. Blood samples were collected and 25 μl serum was used for analysis with the Bio-Plex Pr human cytokine 27-Plex assay. Mean age, body mass index and gender in the three groups of wheezers, asthmatic children and adult asthmatics were comparable to healthy controls. Wheezers (34·5%), asthmatic children (78·7%) and adult asthmatics (62·8%) were significantly more often sensitized compared to controls (4·5, 22 and 22·6%, respectively). Considering the entire cohort, interleukin (IL)-1ra, IL-4, IL-9, IL-17, macrophage inflammatory protein (MIP)-1- α and tumor necrosis factor (TNF)- α showed seasonal variability, whereas IL-1β, IL-7, IL-8, IL-13, eotaxin, granulocyte colony-stimulating factor (G-CSF), interferon gamma-induced protein (IP)-10, MIP-1 β and platelet-derived growth factor (PDGF)-BB did not. Significant differences between wheezers/asthmatics and healthy controls were observed for IL-17 and PDGF-BB, which remained stable after adjustment for the seasonality of IL-17. Seasonality has a significant impact on serum cytokine levels in patients with asthma. Because endotyping has achieved clinical importance to guide individualized patient-tailored therapy, it is important to account for seasonal effects.
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Affiliation(s)
- M Weckmann
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany
| | - D Thiele
- Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany
| | - L Liboschik
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany
| | - T Bahmer
- Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Departement for Internal Medicine I, Pneumology, University Medical Center Schleswig-Holstein, Kiel, Germany.,Department of Pneumology, Lungen Clinic Grosshansdorf, Großhansdorf, Germany
| | - M Pech
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany
| | - A-M Dittrich
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Member of the German Center of Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Lübeck, Germany
| | - O Fuchs
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Division of Respiratory Medicine, Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - C Happle
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Member of the German Center of Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Lübeck, Germany
| | - B Schaub
- Department of Pediatrics, Department of Allergology, Dr von Hauner Children's Hospital University Hospital, LMU Munich, Munich, Germany.,Member of the German Center of Lung Research (DZL), Comprehensive Pneumology Center München (CPC-M), Lübeck, Germany
| | - I Ricklefs
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany
| | - K F Rabe
- Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Departement for Internal Medicine I, Pneumology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - E von Mutius
- Department of Pediatrics, Department of Allergology, Dr von Hauner Children's Hospital University Hospital, LMU Munich, Munich, Germany.,Member of the German Center of Lung Research (DZL), Comprehensive Pneumology Center München (CPC-M), Lübeck, Germany
| | - G Hansen
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Member of the German Center of Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Lübeck, Germany
| | - I R König
- Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany
| | - M V Kopp
- Department of Pediatric Pneumology and Allergology, University Medical Center Schleswig-Holstein, Lübeck, Germany.,Member of the German Center of Lung Research (DZL), Airway Research Center North (ARCN), Lübeck, Germany.,Division of Respiratory Medicine, Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
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45
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Bernardes JP, Mishra N, Tran F, Bahmer T, Best L, Blase JI, Bordoni D, Franzenburg J, Geisen U, Josephs-Spaulding J, Köhler P, Künstner A, Rosati E, Aschenbrenner AC, Bacher P, Baran N, Boysen T, Brandt B, Bruse N, Dörr J, Dräger A, Elke G, Ellinghaus D, Fischer J, Forster M, Franke A, Franzenburg S, Frey N, Friedrichs A, Fuß J, Glück A, Hamm J, Hinrichsen F, Hoeppner MP, Imm S, Junker R, Kaiser S, Kan YH, Knoll R, Lange C, Laue G, Lier C, Lindner M, Marinos G, Markewitz R, Nattermann J, Noth R, Pickkers P, Rabe KF, Renz A, Röcken C, Rupp J, Schaffarzyk A, Scheffold A, Schulte-Schrepping J, Schunk D, Skowasch D, Ulas T, Wandinger KP, Wittig M, Zimmermann J, Busch H, Hoyer BF, Kaleta C, Heyckendorf J, Kox M, Rybniker J, Schreiber S, Schultze JL, Rosenstiel P. Longitudinal Multi-omics Analyses Identify Responses of Megakaryocytes, Erythroid Cells, and Plasmablasts as Hallmarks of Severe COVID-19. Immunity 2020; 53:1296-1314.e9. [PMID: 33296687 PMCID: PMC7689306 DOI: 10.1016/j.immuni.2020.11.017] [Citation(s) in RCA: 224] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/15/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023]
Abstract
Temporal resolution of cellular features associated with a severe COVID-19 disease trajectory is needed for understanding skewed immune responses and defining predictors of outcome. Here, we performed a longitudinal multi-omics study using a two-center cohort of 14 patients. We analyzed the bulk transcriptome, bulk DNA methylome, and single-cell transcriptome (>358,000 cells, including BCR profiles) of peripheral blood samples harvested from up to 5 time points. Validation was performed in two independent cohorts of COVID-19 patients. Severe COVID-19 was characterized by an increase of proliferating, metabolically hyperactive plasmablasts. Coinciding with critical illness, we also identified an expansion of interferon-activated circulating megakaryocytes and increased erythropoiesis with features of hypoxic signaling. Megakaryocyte- and erythroid-cell-derived co-expression modules were predictive of fatal disease outcome. The study demonstrates broad cellular effects of SARS-CoV-2 infection beyond adaptive immune cells and provides an entry point toward developing biomarkers and targeted treatments of patients with COVID-19. SARS-CoV2 infection elicits dynamic changes of circulating cells in the blood Severe COVID-19 is characterized by increased metabolically active plasmablasts Elevation of IFN-activated megakaryocytes and erythroid cells in severe COVID-19 Cell-type-specific expression signatures are associated with a fatal COVID-19 outcome
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Affiliation(s)
- Joana P Bernardes
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Neha Mishra
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Thomas Bahmer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Lena Best
- Institute for Experimental Medicine, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Johanna I Blase
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Dora Bordoni
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Jeanette Franzenburg
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, 24105 Kiel and 23562 Lübeck, Germany
| | - Ulf Geisen
- Section for Rheumatology, Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Jonathan Josephs-Spaulding
- Institute for Experimental Medicine, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Philipp Köhler
- Department I of Internal Medicine, University of Cologne and University Hospital Cologne; German Center for Infection Research, Partner Site Bonn-Cologne and Center for Molecular Medicine Cologne, University of Cologne, 50931 Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), 50937 Cologne, Germany
| | - Axel Künstner
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931, Germany
| | - Elisa Rosati
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Anna C Aschenbrenner
- Genomics & Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, 53115 Bonn, Germany; Departments of Intensive Care Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands; Systems Medicine, German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), PRECISE Platform for Genomics and Epigenomics at DZNE, and University of Bonn, 53127 Bonn, Germany
| | - Petra Bacher
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; Institute of Immunology, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Nathan Baran
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Teide Boysen
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Burkhard Brandt
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, 24105 Kiel and 23562 Lübeck, Germany
| | - Niklas Bruse
- Departments of Intensive Care Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Jonathan Dörr
- Section for Rheumatology, Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Andreas Dräger
- Department of Computer Science, Institute for Bioinformatics and Medical Informatics (IBMI), University of Tübingen and German Center for Infection Research (DZIF), Partner site Tübingen, 72076 Tübingen, Germany
| | - Gunnar Elke
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Julia Fischer
- Department I of Internal Medicine, University of Cologne and University Hospital Cologne; German Center for Infection Research, Partner Site Bonn-Cologne and Center for Molecular Medicine Cologne, University of Cologne, 50931 Cologne, Germany; Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931, Germany
| | - Michael Forster
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Sören Franzenburg
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Norbert Frey
- Department of Internal Medicine III, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Anette Friedrichs
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Janina Fuß
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Andreas Glück
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Jacob Hamm
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Finn Hinrichsen
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Marc P Hoeppner
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Simon Imm
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Ralf Junker
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, 24105 Kiel and 23562 Lübeck, Germany
| | - Sina Kaiser
- Section for Rheumatology, Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Ying H Kan
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Rainer Knoll
- Systems Medicine, German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), PRECISE Platform for Genomics and Epigenomics at DZNE, and University of Bonn, 53127 Bonn, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel and German Center for Infection Research (DZIF), TTU-TB, 23845 Borstel, Germany
| | - Georg Laue
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Clemens Lier
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, 24105 Kiel and 23562 Lübeck, Germany
| | - Matthias Lindner
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Georgios Marinos
- Institute for Experimental Medicine, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Robert Markewitz
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, 24105 Kiel and 23562 Lübeck, Germany
| | - Jacob Nattermann
- Department of Internal Medicine I and German Center for Infection Research (DZIF), University of Bonn, 53217 Bonn, Germany
| | - Rainer Noth
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Peter Pickkers
- Departments of Intensive Care Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Klaus F Rabe
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, 22927 Grosshansdorf, Germany
| | - Alina Renz
- Department of Computer Science, Institute for Bioinformatics and Medical Informatics (IBMI), University of Tübingen and German Center for Infection Research (DZIF), Partner site Tübingen, 72076 Tübingen, Germany
| | - Christoph Röcken
- Department of Pathology, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck, 23562 Lübeck, Germany
| | - Annika Schaffarzyk
- Section for Rheumatology, Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Alexander Scheffold
- Institute of Immunology, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Jonas Schulte-Schrepping
- Genomics & Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, 53115 Bonn, Germany; Systems Medicine, German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Domagoj Schunk
- Department for Emergency Medicine, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Dirk Skowasch
- Section of Pneumology, Department of Internal Medicine II, University Hospital Bonn, , 53127 Bonn, Germany
| | - Thomas Ulas
- Genomics & Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, 53115 Bonn, Germany; Systems Medicine, German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), PRECISE Platform for Genomics and Epigenomics at DZNE, and University of Bonn, 53127 Bonn, Germany
| | - Klaus-Peter Wandinger
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, 24105 Kiel and 23562 Lübeck, Germany
| | - Michael Wittig
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Johannes Zimmermann
- Institute for Experimental Medicine, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Hauke Busch
- Lübeck Institute of Experimental Dermatology, University of Lübeck, 23562 Lübeck, Germany
| | - Bimba F Hoyer
- Section for Rheumatology, Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Christoph Kaleta
- Institute for Experimental Medicine, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Jan Heyckendorf
- Department of Internal Medicine III, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Matthijs Kox
- Genomics & Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, 53115 Bonn, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, University of Cologne and University Hospital Cologne; German Center for Infection Research, Partner Site Bonn-Cologne and Center for Molecular Medicine Cologne, University of Cologne, 50931 Cologne, Germany; Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931, Germany
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany; Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany
| | - Joachim L Schultze
- Genomics & Immunoregulation, Life & Medical Sciences (LIMES) Institute, University of Bonn, 53115 Bonn, Germany; Systems Medicine, German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany; German Center for Neurodegenerative Diseases (DZNE), PRECISE Platform for Genomics and Epigenomics at DZNE, and University of Bonn, 53127 Bonn, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany.
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Jensen-Kondering U, Neumann A, Margraf NG, Gövert F, Brüggemann N, Schunk D, Bahmer T, Schramm P, Schreiber S, Jansen O. Cerebral Imaging in Patients with COVID-19 and Neurological Symptoms: First Experience from two University Hospitals in Northern Germany. ROFO-FORTSCHR RONTG 2020; 193:667-671. [PMID: 33212537 DOI: 10.1055/a-1265-7209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To describe findings on cerebral imaging in patients with COVID-19 and neurological symptoms at two German university hospitals. MATERIALS AND METHODS Patients with COVID-19 and neurological symptoms and cerebral imaging (CT or MRI) were included. A chart review regarding neurological symptoms, COVID-19 and imaging findings was conducted. RESULTS 12 patients (4 females, age 68 ± 12 years) could be included. Three patients had acute findings. Two patients had acute and subacute cerebral ischemia, one patient had additional intracranial hemorrhages and presumed central pontine myelinolysis. One patient had presumed COVID-19-associated pansinusitis. CONCLUSION Findings on cerebral imaging in patients with COVID-19 are uncommon and nonspecific. However, cerebral ischemia is regularly encountered and patients should be evaluated for stroke symptoms. KEY POINTS · Approx. 20 % of patients with COVID-19 develop neurological symptoms.. · Findings on cerebral imaging in patients with COVID-19 are heterogeneous and nonspecific.. · The most common findings are cerebral ischemia and hemorrhages.. CITATION FORMAT · Jensen-Kondering U, Neumann A, Margraf N et al. Cerebral Imaging in Patients with COVID-19 and Neurological Symptoms: First Experience from two University Hospitals in Northern Germany. Fortschr Röntgenstr 2021; 193: 667 - 671.
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Affiliation(s)
- Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Alexander Neumann
- Institute of Neuroradiology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Nils G Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Felix Gövert
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Norbert Brüggemann
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Domagoj Schunk
- Emergency Department, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Thomas Bahmer
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Peter Schramm
- Institute of Neuroradiology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Stefan Schreiber
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Abdo M, Watz H, Veith V, Kirsten AM, Biller H, Pedersen F, von Mutius E, Kopp MV, Hansen G, Waschki B, Rabe KF, Trinkmann F, Bahmer T. Small airway dysfunction as predictor and marker for clinical response to biological therapy in severe eosinophilic asthma: a longitudinal observational study. Respir Res 2020; 21:278. [PMID: 33087134 PMCID: PMC7579879 DOI: 10.1186/s12931-020-01543-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anti-T2 biological therapies have proven to effectively reduce acute exacerbations and daily doses of oral steroids in severe eosinophilic asthma. Despite the remarkable clinical efficacy, there are usually only moderate improvements in airflow limitation, suggesting that other measures of lung function like small airway dysfunction (SAD) might better reflect the clinical response. We aimed to investigate if measures of small airway function would predict and correlate with the clinical response to anti-T2 therapy. METHODS We studied data of patients who were previously included in the German prospective longitudinal All Age Asthma Cohort (ALLIANCE) that recruits asthma patients of all severity grades and inflammatory phenotypes. The selection criteria for this analysis were adult patients with severe eosinophilic asthma under treatment with anti-T2 biological agents. Asthma control was assessed by asthma control test (ACT) and number of severe exacerbations. Small airway function was assessed by the frequency dependence of resistance (FDR, R5-20)) derived from impulse oscillometry (IOS) and the mean forced expiratory flow between 25 and 75% of the forced vital capacity (FEF25-75). We also studied air trapping (RV and RV/TLC), blood eosinophils and FeNO. Patients were classified into responders and partial or non-responders. Clinical response was defined as at least 50% reduction in annualized severe exacerbations and daily oral steroid doses accompanied with a minimum increase of 3 points in the ACT score. We used a Receiver Operator Characteristic (ROC) to study the capacity of FDR in predicting clinical response compared to other clinical variable like blood eosinophils. We studied the correlation between FDR measures and clinical response, represented by the ACT score and number of exacerbations, using linear regressions. RESULTS 20 patients were included (mean age, 59 ± 9 years; 60% female; mean body mass index (BMI), 27.6 ± 5.4 kg/m2; mean absolute blood eosinophils, 570 ± 389/µl; mean number of severe exacerbations 12 months prior to initiating the biological therapy, 5.0 ± 3; mean predicted FEV1, 76 ± 21%; mean predicted FDR, 224 ± 140%; mean daily prednisolone dose, 6.4 ± 4.9 mg; mean ACT score, 15 ± 5). Responders had significantly higher baseline FDR compared to partial or non-responders but similar FEV1, FEF25-75, RV and RV/TLC. ROC analysis showed that the combination of FDR and blood eosinophils had the best predictive capacity of the clinical response among all tested clinical markers (FeNO, FEV1, FDR, blood eosinophils) with an AUC of 85% [67-100%], (CI = 0.95, p = 0.01). Linear regressions indicated better associations between improvements in FDR and ACT score (R2 = 0.42, p = 0.001) than with FEV1 and ACT score (R2 = 0.25, p = 0.013). Likewise, we observed better associations between improvements in FDR and reduction of exacerbations (R2 = 0.41, p = 0.001) than with FEV1 (R2 = 0.20, p = 0.025). CONCLUSION Our data suggest that severe SAD may represent a distinct phenotype of eosinophilic asthma that substantially improves under anti-T2 biological therapy. Measures of small airway function might be useful in selecting appropriate patients qualifying for anti-T2 biological therapy in addition to blood eosinophil count.
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Affiliation(s)
- Mustafa Abdo
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany.
| | - Henrik Watz
- Pulmonary Research Institute At the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Vera Veith
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany
| | - Anne-Marie Kirsten
- Pulmonary Research Institute At the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Heike Biller
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany
| | - Frauke Pedersen
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany.,Pulmonary Research Institute At the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Erika von Mutius
- Dr. Von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Matthias V Kopp
- Division of Pediatric Pulmonology and Allergology, University Children's Hospital Luebeck, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany
| | - Gesine Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Benjamin Waschki
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany.,Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany
| | - Frederik Trinkmann
- Department of Respiratory and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany.,Dept for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Kiel, Germany
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48
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Groth EE, Weber M, Bahmer T, Pedersen F, Kirsten A, Börnigen D, Rabe KF, Watz H, Ammerpohl O, Goldmann T. Exploration of the sputum methylome and omics deconvolution by quadratic programming in molecular profiling of asthma and COPD: the road to sputum omics 2.0. Respir Res 2020; 21:274. [PMID: 33076907 PMCID: PMC7574293 DOI: 10.1186/s12931-020-01544-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/11/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To date, most studies involving high-throughput analyses of sputum in asthma and COPD have focused on identifying transcriptomic signatures of disease. No whole-genome methylation analysis of sputum cells has been performed yet. In this context, the highly variable cellular composition of sputum has potential to confound the molecular analyses. METHODS Whole-genome transcription (Agilent Human 4 × 44 k array) and methylation (Illumina 450 k BeadChip) analyses were performed on sputum samples of 9 asthmatics, 10 healthy and 10 COPD subjects. RNA integrity was checked by capillary electrophoresis and used to correct in silico for bias conferred by RNA degradation during biobank sample storage. Estimates of cell type-specific molecular profiles were derived via regression by quadratic programming based on sputum differential cell counts. All analyses were conducted using the open-source R/Bioconductor software framework. RESULTS A linear regression step was found to perform well in removing RNA degradation-related bias among the main principal components of the gene expression data, increasing the number of genes detectable as differentially expressed in asthma and COPD sputa (compared to controls). We observed a strong influence of the cellular composition on the results of mixed-cell sputum analyses. Exemplarily, upregulated genes derived from mixed-cell data in asthma were dominated by genes predominantly expressed in eosinophils after deconvolution. The deconvolution, however, allowed to perform differential expression and methylation analyses on the level of individual cell types and, though we only analyzed a limited number of biological replicates, was found to provide good estimates compared to previously published data about gene expression in lung eosinophils in asthma. Analysis of the sputum methylome indicated presence of differential methylation in genomic regions of interest, e.g. mapping to a number of human leukocyte antigen (HLA) genes related to both major histocompatibility complex (MHC) class I and II molecules in asthma and COPD macrophages. Furthermore, we found the SMAD3 (SMAD family member 3) gene, among others, to lie within differentially methylated regions which has been previously reported in the context of asthma. CONCLUSIONS In this methodology-oriented study, we show that methylation profiling can be easily integrated into sputum analysis workflows and exhibits a strong potential to contribute to the profiling and understanding of pulmonary inflammation. Wherever RNA degradation is of concern, in silico correction can be effective in improving both sensitivity and specificity of downstream analyses. We suggest that deconvolution methods should be integrated in sputum omics analysis workflows whenever possible in order to facilitate the unbiased discovery and interpretation of molecular patterns of inflammation.
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Affiliation(s)
- Espen E Groth
- LungenClinic Grosshansdorf, Großhansdorf, Germany. .,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany. .,Department of Internal Medicine I, Pneumology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. .,Department of Oncology, Hematology and BMT with Section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Melanie Weber
- Program in Applied and Computational Mathematics, Princeton University, Princeton, NJ, USA
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Großhansdorf, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Department of Internal Medicine I, Pneumology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Frauke Pedersen
- LungenClinic Grosshansdorf, Großhansdorf, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Anne Kirsten
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Daniela Börnigen
- Bioinformatics Core Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Großhansdorf, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany
| | - Henrik Watz
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Pulmonary Research Institute at LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Ole Ammerpohl
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Institute of Human Genetics, University Medical Center Ulm, Ulm, Germany
| | - Torsten Goldmann
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Research Center Borstel, Pathology, Borstel, Germany
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Maqhuzu PN, Szentes BL, Kreuter M, Bahmer T, Kahn N, Claussen M, Holle R, Schwarzkopf L. Determinants of health-related quality of life decline in interstitial lung disease. Health Qual Life Outcomes 2020; 18:334. [PMID: 33032602 PMCID: PMC7542726 DOI: 10.1186/s12955-020-01570-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022] Open
Abstract
Background Health-related quality of life (HRQL) in interstitial lung disease (ILD) patients is impaired. We aimed to identify baseline predictors for HRQL decline within a 12-month observation period.
Methods We analyzed 194 ILD patients from two German ILD-centers in the observational HILDA study. We employed the disease-specific King’s Brief Interstitial Lung Disease questionnaire (K-BILD) with the subdomains ‘psychological impact’, ‘chest symptoms’ and ‘breathlessness and activities’, and the generic EQ-5D Visual Analog Scale (VAS). We evaluated how many patients experienced a clinically meaningful decline in HRQL. Subsequently, we investigated medical and sociodemographic factors as potential predictors of HRQL deterioration. Results Within the study population (34.0% male, Ø age 61.7) mean HRQL scores hardly changed between baseline and follow up (K-BILD: 52.8 vs. 52.5 | VAS: 60.0 vs. 57.3). On the intra-individual level, 30.4% (n = 59) experienced a clinically relevant deterioration in K-BILD total score and 35.4% (n = 68) in VAS. Lower baseline forced vital capacity (FVC) % predicted determined HRQL decline in K-BILD total score (ß-coefficient: − 0.02, p = 0.007), VAS (ß-coefficient: − 0.03, p < 0.0001), and in the subdomain ‘psychological impact’ (ß-coefficient: − 0.02, p = 0.014). Lower baseline diffusing capacity of carbon monoxide (DLCO) % predicted determined deterioration in ‘breathlessness and activities’ (ß-coefficient: − 0.04, p = 0.003) and ‘chest symptoms’ (ß-coefficient: − 0.04, p = 0.002). Additionally, increasing age predicted decline in ‘psychological impact’ (ß-coefficient: 0.06, p < 0.007). Conclusion Around a third of ILD patients experienced a clinically relevant HRQL deterioration in a 12-month period, which was associated with baseline lung function values in all K-BILD domains. As lung function values are time-dependent variables with possible improvements, in contrast to age and ILD subtype, it, thus, seems important to improve lung function and prevent its decline in order to maintain HRQL on the possibly highest level.
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Affiliation(s)
- Phillen Nozibuyiso Maqhuzu
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.
| | - Boglarka L Szentes
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf GmbH Pneumology, German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Großhansdorf, Germany.,University Hospital Schleswig-Holstein Campus Kiel, Internal Medicine I, German Center for Lung Research (DZL), Arnold-Heller-Str. 3 /Haus 41a, 24105, Kiel, Germany
| | - Nicolas Kahn
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Martin Claussen
- LungenClinic Grosshansdorf GmbH Pneumology, German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Großhansdorf, Germany
| | - Rolf Holle
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, Marchioninistr. 15, 81377, Munich, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany.,Institut Fuer Therapieforschung (IFT), Leopoldstr. 175, 80804, Munich, Germany
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50
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Schlicht K, Rohmann N, Geisler C, Hollstein T, Knappe C, Hartmann K, Schwarz J, Tran F, Schunk D, Junker R, Bahmer T, Rosenstiel P, Schulte D, Türk K, Franke A, Schreiber S, Laudes M. Circulating levels of soluble Dipeptidylpeptidase-4 are reduced in human subjects hospitalized for severe COVID-19 infections. Int J Obes (Lond) 2020; 44:2335-2338. [PMID: 32958905 PMCID: PMC7503441 DOI: 10.1038/s41366-020-00689-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022]
Abstract
Dipeptidylpeptidase (DPP)-4 is a key regulator of the incretin system. For several years DPP-4 inhibitors in addition to GLP-1 analogues are of major importance in the clinical management of obesity and type 2 diabetes. DPP-4 is also known as CD26 and represents a membrane bound protease on the surface of several eukaryotic cell types. Of interest, DPP-4, like ACE2, has been shown to serve as a binding partner for corona-like viruses to enter host immune cells. Since metabolic diseases are major risk factors for the present COVID-19 pandemic, we examined circulating soluble DPP-4 serum concentrations in patients suffering from severe COVID-19 infection and in healthy human subjects in a case control design. In this analysis sDPP-4 levels were significantly lower in COVID-19 patients compared to controls (242.70 ± 202.12 ng/mL versus 497.70 ± 188.13 ng/mL, p = 0.02). We also examined sDPP-4 serum concentrations in patients suffering from sepsis not due to corona-like viruses. In these subjects, sDPP-4 levels were not different compared to healthy case controls (p = 0.14), which might suggest the decrease of sDPP-4 to be specific for corona-like virus infections. Currently, most data point towards membrane bound ACE2 in contrast to DPP-4 as the major binding partner for COVID-19 internalization into host immune cells. However, the finding that the circulating soluble form of DPP-4 is reduced in hospitalized patients might suggest a regulatory role for both, ACE and DPP-4, in COVID-19 infections, especially since obesity and type 2 diabetes are major risk factor for a severe course of the disease
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Affiliation(s)
- Kristina Schlicht
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Nathalie Rohmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Corinna Geisler
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Tim Hollstein
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Carina Knappe
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Katharina Hartmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Jeanette Schwarz
- Institute of Clinical Chemistry, University of Kiel, Kiel, Germany.,Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany.,Division of Pneumology, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Domagoj Schunk
- Interdisciplinary Emergency Center, University of Kiel, Kiel, Germany
| | - Ralf Junker
- Institute of Clinical Chemistry, University of Kiel, Kiel, Germany
| | - Thomas Bahmer
- Division of Pneumology, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Dominik Schulte
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Kathrin Türk
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Stefan Schreiber
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany.,Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Matthias Laudes
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University of Kiel, Kiel, Germany.
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