1
|
Gäckler A, Ertasoglu O, Rohn H, Friebus-Kardash J, Ickerott PC, Witzke O, Kribben A, Vogt B, Dahdal S, Arampatzis S, Eisenberger U. Urinary Biomarkers for Cell Cycle Arrest TIMP-2 and IGFBP7 for Prediction of Graft Function Recovery after Kidney Transplantation. Int J Mol Sci 2024; 25:4169. [PMID: 38673754 PMCID: PMC11050222 DOI: 10.3390/ijms25084169] [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] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
TIMP-2 and IGFBP7 have been identified and validated for the early detection of renal injury in critically ill patients, but data on recovery of allograft function after kidney transplantation (KTx) are scarce. In a prospective observational multicenter cohort study of renal transplant recipients, urinary [TIMP-2] × [IGFBP7] was evaluated daily from day 1 to 7 after KTx. Different stages of early graft function were defined: immediate graft function (IGF) (decrease ≥ 10% in serum creatinine (s-crea) within 24 h post KTx); slow graft function (SGF) (decrease in s-crea < 10% within 24 h post KTx); and delayed graft function (DGF) (any dialysis needed within the first week after KTx). A total of 186 patients were analyzed. [TIMP-2] × [IGFBP7] was significantly elevated as early as day 1 in patients with DGF compared to SGF and IGF. ROC analysis of [TIMP-2] × [IGFBP7] at day 1 post-transplant for event "Non-DGF" revealed a cut-off value of 0.9 (ng/mL)2/1000 with a sensitivity of 87% and a specificity of 71%. The positive predictive value for non-DGF was 93%. [TIMP-2] × [IGFBP7] measured at day 1 after KTx can predict early recovery of transplant function and is therefore a valuable biomarker for clinical decision making.
Collapse
Affiliation(s)
- Anja Gäckler
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Onurcan Ertasoglu
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Hana Rohn
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (H.R.); (O.W.)
| | - Justa Friebus-Kardash
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Philipp-Christopher Ickerott
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (H.R.); (O.W.)
| | - Andreas Kribben
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Julie-von-Jenner-Haus, Freiburgstraße 15, 3010 Bern, Switzerland; (B.V.); (S.D.); (S.A.)
| | - Suzan Dahdal
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Julie-von-Jenner-Haus, Freiburgstraße 15, 3010 Bern, Switzerland; (B.V.); (S.D.); (S.A.)
| | - Spyridon Arampatzis
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Julie-von-Jenner-Haus, Freiburgstraße 15, 3010 Bern, Switzerland; (B.V.); (S.D.); (S.A.)
| | - Ute Eisenberger
- Department of Nephrology, University Medicine Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany (J.F.-K.); (A.K.); (U.E.)
| |
Collapse
|
2
|
Boss K, Waterstradt K, Schnurr K, Paar M, Stolpe S, Ickerott P, Wieneke U, Spitthöver R, Oettl K, Kribben A. Binding and detoxification efficiency of albumin decline after haemodialysis. Nephrol Dial Transplant 2024; 39:215-221. [PMID: 37558390 PMCID: PMC10828194 DOI: 10.1093/ndt/gfad133] [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: 03/19/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Albumin, as the most abundant plasma protein, represents a target structure for both drug and physicochemical therapeutic approaches to eliminate uraemic toxins more efficiently. Potentially, this approach could reduce mortality of haemodialysis patients. However, little is known about albumin functional properties in these patients and its alteration by haemodialysis treatment. METHODS The binding and detoxification efficiency of albumin were assessed by electron paramagnetic resonance spectroscopy using a spin-labelled fatty acid. Binding efficiency (BE) reflects strength and amount of bound fatty acids under certain ethanol concentration. Detoxification efficiency (DTE) reflects the molecular flexibility of the patient's albumin molecule, thus the ability to change the conformation depending on ethanol concentration. Percentage of BE and DTE are depicted in relation to healthy individuals (100%). RESULTS Fifty-eight patients (59% male, median age 68 years, median time on haemodialysis 32 months) were included in the study. Before haemodialysis treatment, albumin binding and detoxification efficiency were substantially below healthy individuals [median BE 52% (interquartile range, IQR, 45%-59%); median DTE 38% (IQR 32-49%)]. After haemodialysis treatment, median BE and DTE significantly decreased [BE 28% (IQR 20-41%); DTE 11% (IQR 7%-27%; P < .001)]. BE and DTE decline after haemodialysis was not dependent on age, sex or treatment modalities, but was to a certain extent on the level of non-esterified fatty acids. CONCLUSION Albumin binding and detoxification efficiency of fatty acids in maintenance haemodialysis patients were substantially below those in healthy individuals and even declined after dialysis treatment. These findings might be helpful when considering new therapeutic approaches in maintenance haemodialysis patients.
Collapse
Affiliation(s)
- Kristina Boss
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | | | - Margret Paar
- Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Susanne Stolpe
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Philipp Ickerott
- Gemeinschaftspraxis für Nieren- und Hochdruckkrankheiten Essen-Steele, Essen, Germany
| | | | | | - Karl Oettl
- Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
3
|
Mülling N, van de Sand L, Völk K, Aufderhorst UW, van der Linden M, Horn PA, Kribben A, Wilde B, Krawczyk A, Witzke O, Lindemann M. Antibody responses after sequential vaccination with PCV13 and PPSV23 in kidney transplant recipients. Infection 2023; 51:1703-1716. [PMID: 37243960 PMCID: PMC10665231 DOI: 10.1007/s15010-023-02054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Vaccination against Streptococcus pneumoniae is recommended in transplant recipients to reduce the morbidity and mortality from invasive pneumococcal disease. Previous studies indicate that transplant recipients can produce specific antibodies after vaccination with the 13-valent pneumococcal conjugate vaccine Prevenar 13 (PCV13) or the pneumococcal polysaccharide vaccine Pneumovax 23 (PPSV23). National guidelines recommend sequential vaccination with PCV13 followed by PPSV23 in kidney transplant patients. However, there are currently no data on the serological response in kidney transplant recipients, who received a sequential vaccination with PCV13 and PPSV23. METHODS In the current study, we sequentially vaccinated 46 kidney transplant recipients with PCV13 and PPSV23 and determined global and serotype-specific anti-pneumococcal antibody responses in the year following vaccination. RESULTS Serotype-specific and global anti-pneumococcal antibody concentrations were significantly higher compared to baseline. We observed that serotype-specific antibody responses varied by serotype (between 2.2- and 2.9-fold increase after 12 months). The strongest responses after 12 months were detected against the serotypes 9N (2.9-fold increase) and 14 (2.8-fold increase). Global antibody responses also varied with respect to immunoglobulin class. IgG2 revealed the highest increase (2.7-fold), IgM the lowest (1.7-fold). Sequential vaccination with both vaccines achieved higher antibody levels in comparison with a historical cohort studied at our institute, that was vaccinated with PCV13 alone. During the 12-months follow-up period, none of the patients developed pneumococcal-associated pneumonia or vaccination-related allograft rejection. CONCLUSION In conclusion, we strongly recommend sequential vaccination over single immunization in kidney transplant recipients.
Collapse
Affiliation(s)
- Nils Mülling
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lukas van de Sand
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Kim Völk
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Mark van der Linden
- Department of Medical Microbiology, German National Reference Center for Streptococci, University Hospital Aachen (RWTH), Aachen, Germany
| | - Peter A Horn
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Adalbert Krawczyk
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| |
Collapse
|
4
|
Ülger P, Yildiz E, Tyczynski B, Findeisen H, Kribben A, Janssen OE, Herget-Rosenthal S. Effect of stress hyperglycaemia on acute kidney injury in non-diabetic critically ill patients? Int Urol Nephrol 2023; 55:3253-3259. [PMID: 37160486 DOI: 10.1007/s11255-023-03612-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Stress hyperglycaemia (SH) and acute kidney injury (AKI) occur frequently in critically ill patients, and particularly non-diabetics are associated with adverse outcome. Data is scarce on the effect of SH on AKI. We assessed whether SH (i) preceded AKI, (ii) was a risk factor of subsequent AKI, and (iii) how SH and tubular injury interacted in AKI development in critically ill, non-diabetics. METHODS Case-control study of 82 patients each with and without SH matched by propensity score for multiple demographic characteristics. AKI was defined by KDIGO criteria, SH either as blood glucose (BG) > 140 mg/dl (BG140), > 200 mg/dl (BG200), or stress hyperglycemia rate (SHR) ≥ 1.47 (SHR1.47) as measured 2 days before AKI. Urinary cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) indicated tubular injury. RESULTS In AKI, SH rates were frequent using all 3 definitions applied, but highest when BG140 was applied. SH by all 3 definitions was consistently associated with AKI. This was independent of established risk factors of AKI such as sepsis and shock. Increments of BG, urinary NGAL or cystatin C, and its products, were independently associated with the likelihood of subsequent AKI, demonstrating their reciprocal potentiating effects on AKI development. CONCLUSIONS SH is frequent in critically ill, non-diabetics with AKI. SH was identified as an independent risk factor of AKI. Higher BG combined with tubular injury may potentiate their adverse effects on AKI.
Collapse
Affiliation(s)
- Perihan Ülger
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
| | - Ebru Yildiz
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
| | | | - Hajo Findeisen
- Department of Medicine, Rotes Kreuz Krankenhaus, St. Pauli Deich 24, 28199, Bremen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
| | - Onno E Janssen
- Endokrinologikum, and Asklepios Medical School, Hamburg, Germany
- Subsidiary of the Semmelweis University, Budapest, Hungary
| | - Stefan Herget-Rosenthal
- Department of Nephrology, University Duisburg-Essen, Essen, Germany.
- Department of Medicine, Rotes Kreuz Krankenhaus, St. Pauli Deich 24, 28199, Bremen, Germany.
| |
Collapse
|
5
|
Boss K, Stolpe S, Müller A, Wagner B, Wichert M, Assert R, Volbracht L, Stang A, Kowall B, Kribben A. Effect of serum creatinine difference between the Jaffe and the enzymatic method on kidney disease detection and staging. Clin Kidney J 2023; 16:2147-2155. [PMID: 37915891 PMCID: PMC10616437 DOI: 10.1093/ckj/sfad178] [Citation(s) in RCA: 1] [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: 04/26/2023] [Indexed: 11/03/2023] Open
Abstract
Background Serum creatinine (SCr), mainly determined by the Jaffe or an enzymatic method, is the central marker to assess kidney function. Deviations between these two methods may affect the diagnosis and staging of acute kidney injury (AKI) and chronic kidney disease (CKD). Methods The results of the first parallel SCr measurement (Jaffe and enzymatic method) of adult in- and outpatients in the same serum sample at the University Hospital Essen (Essen, Germany) between 2020-2022 were retrospectively evaluated. A Bland-Altman plot with 95% limits of agreement (LoAs) was used to assess the difference between the Jaffe and the enzymatic SCr (eSCr) method. We used the 2009 Chronic Kidney Disease Epidemiology Collaboration equation for determination of estimated glomerular filtration rate (eGFR) according to the Kidney Disease: Improving Global Outcomes guidelines. Results A total of 41 144 parallel SCr measurements were evaluated. On average, Jaffe SCr was 0.07 mg/dl higher than eSCr (LoA -0.12; 0.25 mg/dl). In 19% of all cases there was a different CKD stage when comparing eGFR between both SCr methods, of which 98% resulted in a more severe CKD stage determined with Jaffe SCr. In 1.6% of all cases Jaffe SCr was ≥0.3 mg/dl higher than eSCr. Conclusion The present study showed that methods of SCr measurement may affect both the diagnosis and staging of AKI and CKD. This must be taken into account when interpreting measurements of renal function in everyday clinical practice, but also when planning and comparing studies on renal diseases. One should therefore stay with one method for SCr measurement, preferably with the enzymatic method.
Collapse
Affiliation(s)
- Kristina Boss
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Susanne Stolpe
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen,Essen, Germany
| | - André Müller
- Department of Clinical Chemistry, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Bernd Wagner
- Department of Clinical Chemistry, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Marc Wichert
- Department of Clinical Chemistry, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Roland Assert
- Department of Clinical Chemistry, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lothar Volbracht
- Department of Clinical Chemistry, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen,Essen, Germany
| | - Bernd Kowall
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen,Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
6
|
Birkner S, Möhlendick B, Wilde B, Schoenfelder K, Boss K, Siffert W, Kribben A, Friebus-Kardash J. Single-Nucleotide Polymorphism in Genes Encoding G Protein Subunits GNB3 and GNAQ Increase the Risk of Cardiovascular Morbidity among Patients Undergoing Renal Replacement Therapy. Int J Mol Sci 2023; 24:15260. [PMID: 37894940 PMCID: PMC10607787 DOI: 10.3390/ijms242015260] [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: 09/13/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Single-nucleotide polymorphisms in G protein subunits are linked to an increased risk of cardiovascular events among the general population. We assessed the effects of GNB3 c.825C > T, GNAQ -695/-694GC > TT, and GNAS c.393C > T polymorphisms on the risk of cardiovascular events among 454 patients undergoing renal replacement therapy. The patients were followed up for a median of 4.5 years after the initiation of dialysis. Carriers of the TT/TT genotype of GNAQ required stenting because of coronary artery stenosis (p = 0.0009) and developed cardiovascular events involving more than one organ system (p = 0.03) significantly earlier and more frequently than did the GC/TT or GC/GC genotypes. Multivariate analysis found that the TT/TT genotype of GNAQ was an independent risk factor for coronary artery stenosis requiring stent (hazard ratio, 4.5; p = 0.001), cardiovascular events (hazard ratio, 1.93; p = 0.04) and cardiovascular events affecting multiple organs (hazard ratio, 4.9; p = 0.03). In the subgroup of male patients left ventricular dilatation with abnormally increased LVEDD values occurred significantly more frequently in TT genotypes of GNB3 than in CT/CC genotypes (p = 0.007). Our findings suggest that male dialysis patients carrying the TT genotype of GNB3 are at higher risk of left ventricular dilatation and that dialysis patients carrying the TT/TT genotype of GNAQ are prone to coronary artery stenosis and severe cardiovascular events.
Collapse
Affiliation(s)
- Simon Birkner
- Department of Nephrology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (S.B.); (B.W.); (K.S.); (K.B.); (A.K.)
| | - Birte Möhlendick
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany (W.S.)
| | - Benjamin Wilde
- Department of Nephrology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (S.B.); (B.W.); (K.S.); (K.B.); (A.K.)
| | - Kristina Schoenfelder
- Department of Nephrology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (S.B.); (B.W.); (K.S.); (K.B.); (A.K.)
| | - Kristina Boss
- Department of Nephrology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (S.B.); (B.W.); (K.S.); (K.B.); (A.K.)
| | - Winfried Siffert
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany (W.S.)
| | - Andreas Kribben
- Department of Nephrology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (S.B.); (B.W.); (K.S.); (K.B.); (A.K.)
| | - Justa Friebus-Kardash
- Department of Nephrology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (S.B.); (B.W.); (K.S.); (K.B.); (A.K.)
| |
Collapse
|
7
|
Engler H, Brinkhoff A, Wilde B, Kribben A, Rohn H, Witzke O, Schedlowski M, Benson S. Endotoxin-Induced Physiological and Psychological Sickness Responses in Healthy Humans: Insights into the Post-Acute Phase. Neuroimmunomodulation 2023; 30:268-276. [PMID: 37797587 PMCID: PMC10623394 DOI: 10.1159/000534444] [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: 05/27/2023] [Accepted: 10/02/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Experimental endotoxemia is a translational model of systemic inflammation that has contributed significantly to our current understanding of sickness behavior and inflammation-associated depression. Previous studies using this model revealed a strong association between cytokine levels, endocrine changes, and psychological sickness symptoms during the acute phase of inflammation. The objective of this randomized, double-blind, placebo-controlled crossover study was to gain insight into potential post-acute physiological and psychological consequences of endotoxin administration that may either persist or newly emerge between 24 and 72 h after injection. The main focus was on associations between serum levels of C-reactive protein (CRP) and affective symptoms as well as alterations in diurnal cortisol profile, the two key features of inflammation-associated depression. METHODS Healthy male volunteers (N = 18) received an injection of either endotoxin (0.8 ng/kg) or placebo on two separate but otherwise identical study days, 7 days apart. Blood and saliva samples were collected during acute and post-acute phases after injection to measure blood inflammatory markers (interleukin [IL]-6, IL-1 receptor antagonist [ra], CRP) and salivary cortisol levels. In addition, participants completed a comprehensive battery of questionnaires to assess physical and psychological sickness symptoms. RESULTS Endotoxin treatment induced a short-time rise in plasma IL-6 and a longer increase in IL-1ra. The increase in serum CRP was delayed compared to cytokines, peaking at 24 h and gradually decreasing until 72 h after injection. The inflammatory response was accompanied by bodily and psychological sickness symptoms which occurred only in the acute phase, whereas none of the symptoms persisted or recurred in the post-acute phase. Salivary cortisol levels were significantly increased during the acute phase and exhibited pronounced circadian changes. However, no significant differences in diurnal cortisol profiles were observed between placebo and endotoxin conditions on the days after treatment. CONCLUSION Our findings suggest that CRP, which is elevated in patients with inflammation-associated depression, does not appear to be responsible for depressive symptomatology. Moreover, a single inflammatory episode is not sufficient to alter diurnal cortisol profiles, as observed in inflammation-associated depression. In addition, the absence of persistent lipopolysaccharide-induced psychological and physiological changes beyond the acute phase further supports the safety of endotoxin administration in humans.
Collapse
Affiliation(s)
- Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexandra Brinkhoff
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hana Rohn
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Institute for Medical Education, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
8
|
Boss K, Paar M, Waterstradt K, Schnurr K, Ickerott P, Wieneke U, Spitthöver R, Oettl K, Kribben A. Albumin redox state of maintenance haemodialysis patients is positively altered after treatment. BMC Nephrol 2023; 24:273. [PMID: 37723426 PMCID: PMC10506191 DOI: 10.1186/s12882-023-03317-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND AND AIM Maintenance haemodialysis patients have increased morbidity and mortality which is mainly driven by an elevated inflammation level due to the uraemic milieu. A major part of this increased inflammation level is the degree of oxidative stress which can be assessed by albumin redox state (ARS). Aim of this study was to evaluate how the ARS is affected by a haemodialysis treatment and different dialyzer properties. METHODS ARS was determined before and after haemodialysis treatment by fractionating it into reduced human mercaptalbumin (HMA), reversibly oxidized human non-mercaptalbumin 1 (HNA-1), and irreversibly oxidized human non-mercaptalbumin 2 (HNA-2) by high-performance liquid chromatography. In healthy individuals, albumin circulates in the following proportions: HMA 70-80%, HNA-1 20-30% and HNA-2 2-5%. High flux (FX 100 [Fresenius Medical Care], BG 1.8 [Toray], Xevonta Hi 18 [B. Braun], CTA-2000 [Kawasumi]) and low flux FX10 [Fresenius Medical Care] dialyzers were used. RESULTS 58 patients (59% male, median age 68 years, median time on haemodialysis 32 month) were included in the study. Before haemodialysis treatment, HMA (median 55.9%, IQR 50.1-61.2%) was substantially lower than in healthy individuals. Accordingly, oxidized albumin fractions were above the level of healthy individuals (median HNA-1 38.5%, IQR 33.3-43.2%; median HNA-2 5.8%, IQR 5.1-6.7%). Before haemodialysis treatment HMA was significantly higher in patients usually treated with high flux membranes (p < 0.01). After haemodialysis treatment there was a significant increase of HMA and a decrease of HNA-1 and HNA-2 (p < 0.01). These effects were more pronounced in patients treated with high flux dialyzers (p < 0.01). There were no differences of ARS alteration with regard to the dialyzer´s sterilization mode or the presence of diabetes. CONCLUSION The study confirms that the ARS is positively altered by haemodialysis and shows for the first time that this effect depends on dialyzer properties.
Collapse
Affiliation(s)
- Kristina Boss
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, 45147, Essen, Germany.
| | - Margret Paar
- Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | | | | | - Philipp Ickerott
- Gemeinschaftspraxis für Nieren- und Hochdruckkrankheiten Essen-Steele, Essen, Germany
| | | | | | - Karl Oettl
- Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, 45147, Essen, Germany
| |
Collapse
|
9
|
Friebus-Kardash J, Kuang F, Peitz T, Hamdan TA, Eisenberger U, Boss K, Kribben A, Lang KS, Jahn M. Expression of Interferon Regulatory Factor 8 (IRF8) and Its Association with Infections in Dialysis Patients. Cells 2023; 12:1892. [PMID: 37508555 PMCID: PMC10378315 DOI: 10.3390/cells12141892] [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: 06/24/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Patients on dialysis have dysfunctions of innate and adaptive immune system responses. The transcriptional factor IRF8 (interferon regulatory factor 8) is primarily expressed in plasmacytoid cells (pDCs) and myeloid dendritic cells (mDCs), playing a crucial role in the maturation of dendritic cells, monocytes, and macrophages, and contributing to protection against bacterial infections. The current study analyzed the expression patterns of IRF8 and assessed its association with the risk of infections in 79 dialysis patients compared to 44 healthy controls. Different subsets of leukocytes and the intracellular expression of IRF8 were measured using flow cytometry. Compared to the healthy controls, the dialysis patients showed significantly reduced numbers of pDCs and significantly increased numbers of natural killer cells and classical and intermediate monocytes. The dialysis patients exhibited decreased numbers of IRF8-positive dendritic cells (pDC p < 0.001, mDC1 p < 0.001, mDC2 p = 0.005) and increased numbers of IRF8-positive monocytes (p < 0.001). IRF8 expression in pDC, mDC, and classical monocytes was lower in the dialysis patients than in the controls. Dialysis patients who required hospitalization due to infections within one year of follow-up displayed significantly reduced IRF8 expression levels in pDCs compared to patients without such infections (p = 0.04). Our results suggest that reduced IRF8 expression in pDCs is a potential risk factor predisposing dialysis patients to serious infections.
Collapse
Affiliation(s)
- Justa Friebus-Kardash
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Fei Kuang
- Institute of Immunology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Tobias Peitz
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Thamer A Hamdan
- Institute of Immunology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Kristina Boss
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Karl Sebastian Lang
- Institute of Immunology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| |
Collapse
|
10
|
Völker LA, Kaufeld J, Balduin G, Merkel L, Kühne L, Eichenauer DA, Osterholt T, Hägele H, Kann M, Grundmann F, Kolbrink B, Schulte K, Gäckler A, Kribben A, Boss K, Potthoff SA, Rump LC, Schmidt T, Mühlfeld AS, Schulmann K, Hermann M, Gaedeke J, Sauerland K, Bramstedt J, Hinkel UP, Miesbach W, Bauer F, Westhoff TH, Bruck H, Buxhofer-Ausch V, Müller TJ, Wendt R, Harth A, Schreiber A, Seelow E, Tölle M, Gohlisch C, Bieringer M, Geuther G, Jabs WJ, Fischereder M, von Bergwelt-Baildon A, Schönermarck U, Knoebl P, Menne J, Brinkkoetter PT. Impact of first-line use of caplacizumab on treatment outcomes in immune thrombotic thrombocytopenic purpura. J Thromb Haemost 2023; 21:559-572. [PMID: 36696206 DOI: 10.1016/j.jtha.2022.11.010] [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: 07/01/2022] [Revised: 11/14/2022] [Accepted: 11/23/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The von Willebrand factor-directed nanobody caplacizumab has greatly changed the treatment of immune thrombotic thrombocytopenic purpura (iTTP) in recent years. Data from randomized controlled trials established efficacy and safety. OBJECTIVES This study aims to address open questions regarding patient selection, tailoring of therapy duration, obstacles in prescribing caplacizumab in iTTP, effect on adjunct treatment, and outcomes in the real-world setting. METHODS We report retrospective, observational cohorts of 113 iTTP episodes treated with caplacizumab and 119 historical control episodes treated without caplacizumab. We aggregated data from the caplacizumab phase II/III trials and real-world data from France, the United Kingdom, Germany, and Austria (846 episodes, 396 treated with caplacizumab, and 450 historical controls). RESULTS Caplacizumab was efficacious in iTTP, independent of the timing of therapy initiation, but curtailed the time of active iTTP only when used in the first-line therapy within 72 hours after diagnosis and until at least partial ADAMTS13-activity remission. Aggregated data from multiple study populations showed that caplacizumab use resulted in significant absolute risk reduction of 2.87% for iTTP-related mortality (number needed to treat 35) and a relative risk reduction of 59%. CONCLUSION Caplacizumab should be used in first line and until ADAMTS13-remission, lowers iTTP-related mortality and refractoriness, and decreases the number of daily plasma exchange and hospital stay. This trial is registered at www. CLINICALTRIALS gov as #NCT04985318.
Collapse
Affiliation(s)
- Linus A Völker
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Cologne Cluster of Excellence on Cellular Stress Responses in Ageing-Associated Diseases, Cologne, Germany
| | - Jessica Kaufeld
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany
| | - Gesa Balduin
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lena Merkel
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lucas Kühne
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University of Cologne, Cologne, Germany
| | - Thomas Osterholt
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Hägele
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Kann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Cologne Cluster of Excellence on Cellular Stress Responses in Ageing-Associated Diseases, Cologne, Germany
| | - Franziska Grundmann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Benedikt Kolbrink
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Kevin Schulte
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anja Gäckler
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Kristina Boss
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian A Potthoff
- University Hospital Düsseldorf, Department of Nephrology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany, Germany
| | - Lars C Rump
- University Hospital Düsseldorf, Department of Nephrology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany, Germany
| | - Tilman Schmidt
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Anja S Mühlfeld
- Uniklinik RWTH Aachen, Department of Medicine, Division of Nephrology, Aachen, Germany
| | - Karsten Schulmann
- Klinik für Hämatologie, Onkologie Palliativmedizin und Stammzelltransplantation, Klinikum Hochsauerland GmbH, Walburga Krankenhaus Meschede, Meschede, Germany; MVZ Hochsauerland GmbH, Praxis für Hämatologie und Onkologie, Arnsberg, Germany
| | - Matthias Hermann
- Medizinische Klinik V, Hämatologie/Onkologie, Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg
| | - Jens Gaedeke
- Department of Nephrology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kristin Sauerland
- Klinik für Innere Medizin, Hämatologie/Onkologie, Stammzelltransplantation und Palliativmedizin, Johannesstift, Bielefeld, Germany
| | - Jörn Bramstedt
- Medizinische Klinik II Sektion Nephrologie, Klinikum Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Ulrich P Hinkel
- Klinik für Nephrologie, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
| | - Wolfgang Miesbach
- Department of Hemostaseology-Hemophilia Center, University Hospital Frankfurt, Frankfurt, Germany
| | - Frederic Bauer
- Medical Department I, Marien Hospital Herne, Ruhr-University Bochum, Germany
| | - Timm H Westhoff
- Medical Department I, Marien Hospital Herne, Ruhr-University Bochum, Germany
| | - Heike Bruck
- Medical Clinic III, Helios Hospital Krefeld, Krefeld, Germany
| | - Veronika Buxhofer-Ausch
- Department of Internal Medicine I with Hematology, Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria; Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Tobias J Müller
- Department of Neurology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Ralph Wendt
- Department of Infectious Diseases/Tropical Medicine, Nephrology/KfH Renal Unit and Rheumatology, St. Georg Hospital Leipzig, Germany
| | - Ana Harth
- Department of Nephrology, Transplantation, and Medical Intensive Care, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Adrian Schreiber
- Department of Nephrology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Experimental and Clinical Research Center, Charité, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Evelyn Seelow
- Department of Nephrology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Experimental and Clinical Research Center, Charité, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Markus Tölle
- Charité-Universitätsmedizin Berlin, Cooperate Member of Freie Universität and Humboldt Universität, Department of Nephrology and Medical Intensive Care, Berlin, Germany
| | - Christopher Gohlisch
- Charité-Universitätsmedizin Berlin, Cooperate Member of Freie Universität and Humboldt Universität, Department of Nephrology and Medical Intensive Care, Berlin, Germany
| | - Markus Bieringer
- Department of Cardiology and Nephrology, Helios Klinik Berlin-Buch, Berlin, Germany
| | - Gesa Geuther
- Nordbadpraxis München-Praxis für Innere Medizin, Schwerpunktpraxis für Hämatologie, Onkologie, HIV und Palliativmedizin, München, Germany
| | - Wolfram J Jabs
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Michael Fischereder
- Nephrology Division, Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | | | - Ulf Schönermarck
- Nephrology Division, Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Paul Knoebl
- Division of Hematology and Hemostasis, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Jan Menne
- KRH Klinikum Mitte-Location Siloah, Hannover, Germany
| | - Paul T Brinkkoetter
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Cologne Cluster of Excellence on Cellular Stress Responses in Ageing-Associated Diseases, Cologne, Germany.
| | | |
Collapse
|
11
|
Boss K, Kribben A. [Staging of kidney disease today and tomorrow]. Dtsch Med Wochenschr 2023; 148:331-334. [PMID: 36878233 DOI: 10.1055/a-1924-3921] [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: 03/08/2023]
Abstract
Since September 2022, there is a new, German-language glossary for the nomenclature of renal function and renal disease, aligned with international technical terms and KDIGO guidelines for a more precise and uniform description of the facts. Terms such as "renal disease," "renal insufficiency," or "acute renal failure" should be avoided and replaced with "disease" or "functional impairment."The KDIGO guideline recommends in patients with CKD stage G3a, in addition to the determination of serum creatinine, the additional determination of cystatin to confirm the CKD stage. A combination of serum creatinine and cystatin C to estimate GFR without taking into account the so-called race coefficient seems to be more accurate in African Americans than the previous eGFR formulas. However, there is no recommendation on this in international guidelines yet. For Caucasians, the formula does not change.Renal function impairment lasting more than 7 days but less than 3 months is called acute kidney disease (AKD). The AKD stage is the critical time window for therapeutic interventions to reduce the risk of progression in kidney disease.A future, expanded AKI definition incorporating biomarkers will allow patients to be divided into subclasses according to functional and structural limitations, thus mapping the two-dimensionality of AKI. By using artificial intelligence, large amounts of data from clinical parameters, blood and urine samples, histopathological and molecular markers (including proteomics and metabolomics data) can be used integratively for the graduation of CKD and thus contribute significantly to individualized therapy.
Collapse
Affiliation(s)
- Kristina Boss
- Klinik für Nephrologie, Universitätsklinikum Essen, Essen
| | | |
Collapse
|
12
|
Haidari Z, Leiler S, Mamdooh H, Fittkau M, Boss K, Tyczynski B, Thielmann M, Bagaev E, El Gabry M, Wendt D, Kribben A, Bertsch T, Ruhparwar A, Fischlein T, Kalisnik JM. Effect of intraoperative haemoadsorption therapy on cardiac surgery for active infective endocarditis with confirmed Staphylococcus aureus bacteraemia. Interdiscip Cardiovasc Thorac Surg 2023; 36:7008331. [PMID: 36802263 PMCID: PMC9931064 DOI: 10.1093/icvts/ivad010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Sepsis caused by infective endocarditis (IE), due to Staphylococcus aureus, is associated with significant morbidity and mortality. Blood purification using haemoadsorption (HA) may attenuate the inflammatory response. We investigated the effect of intraoperative HA on postoperative outcomes in S. aureus IE. METHODS Patients with confirmed S. aureus IE undergoing cardiac surgery were included in a dual-centre study between January 2015 and March 2022. Patients treated with intraoperative HA (HA group) were compared to patients not treated with HA (control group). The primary outcome was vasoactive-inotropic score within the first 72 h postoperatively and secondary outcomes were sepsis-related mortality (SEPSIS-3 definition) and overall mortality at 30 and 90 days. RESULTS No differences in baseline characteristics were observed between groups (haemoadsorption group, n = 75, control group, n = 55). Significantly decreased vasoactive-inotropic score was observed in the haemoadsorption group at all time points [6 h: 6.0 (0-17) vs 17 (3-47), P = 0.0014; 12 h: 2 (0-8.3) vs 5.9 (0-37), P = 0.0138; 24 h: 0 (0-5) vs 4.9 (0-23), P = 0.0064; 48 h: 0 (0-2.1) vs 0.1 (0-13), P = 0.0192; 72 h: 0 (0) vs 0 (0-5), P = 0.0014]. Importantly, sepsis-related mortality (8.0% vs 22.8%, P = 0.02) and 30-day (17.3% vs 32.7%, P = 0.03) and 90-day overall mortality (21.3% vs 40%, P = 0.03) were also significantly lower with haemoadsorption. CONCLUSIONS Intraoperative HA during cardiac surgery for S. aureus IE was associated with significantly lower postoperative vasopressor and inotropic requirements and resulted in lower sepsis-related and overall 30- and 90-day mortality. In this high-risk population, improved postoperative haemodynamic stabilization by intraoperative HA appears to improve survival and should be further tested in future randomized trials.
Collapse
Affiliation(s)
- Zaki Haidari
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Spela Leiler
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Hazem Mamdooh
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Matthias Fittkau
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Kristina Boss
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | | | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany,Cytosorbents Inc., Princeton, NJ, USA
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Jurij Matija Kalisnik
- Corresponding author. Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Germany. Tel: +49-911-398-5441; fax: +49-911-398-5443; e-mail: (J.M. Kalisnik)
| |
Collapse
|
13
|
Stille K, Kribben A, Herget-Rosenthal S. Incidence, severity, risk factors and outcomes of acute kidney injury in older adults: systematic review and meta-analysis. J Nephrol 2022; 35:2237-2250. [PMID: 35932418 DOI: 10.1007/s40620-022-01381-2] [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: 09/18/2021] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Old age was identified as a strong risk factor for acute kidney injury (AKI). Our objectives were to provide estimates of AKI, risk factors and outcomes in patients ≥ 75 years for whom data are scarce. METHODS Observational studies and randomized controlled trials between 2005 and 2021 with patients of mean or median age ≥ 75 years, reporting AKI according to current definitions. Data on AKI incidence, risk factors and mortality were analyzed separately in unselected (UC) and acute heart failure (AHF) cohorts. RESULTS Twenty-six observational studies and 4 randomized controlled trials with 51,111 UC and 25,414 AHF patients were included. Ages averaged 79.4 and 79.8 years, respectively. Pooled risk ratios (RRs) of AKI rates were 26.29% (95% confidence intervals (CI) 13.20-41.97) (UC) and 24.21% (95% CI 20.03-28.65) (AHF). In both cohorts, AKI was associated with decreased estimated glomerular filtration rate at baseline, chronic kidney disease (UC: RR 1.80 (95% CI 1.15-2.80), AHF: RR 1.51 (95% CI 1.26-1.95) and hypertension (UC: RR 1.30 (95% CI 1.09-1.56), AHF: RR 1.07 (95% CI 1.05-1.09). RRs of AKI in patients on renin-angiotensin-inhibitors were 0.87 (95% CI 0.78-0.97) and 0.88 (95% CI 0.78-0.98) in UC and AHF, respectively. AKI was consistently associated with increased risk of in-hospital mortality (UC: RR 3.15 (95% CI 2.28-4.35), AHF: RR 4.28 (95% CI 2.53-7.24). CONCLUSION AKI is frequent in patients ≥ 75 years. While reduced renal function at baseline, CKD and hypertension were associated with AKI development, renin-angiotensin-inhibitors may be protective. Older AKI patients showed higher short-term mortality rates.
Collapse
Affiliation(s)
- Kolja Stille
- Department of Medicine, Rotes Kreuz Krankenhaus, St. Pauli Deich 24, 28199, Bremen, Germany
| | - Andreas Kribben
- Department of Nephrology, Universitätsklinikum, Universität Duisburg-Essen, Essen, Germany
| | - Stefan Herget-Rosenthal
- Department of Medicine, Rotes Kreuz Krankenhaus, St. Pauli Deich 24, 28199, Bremen, Germany. .,Department of Nephrology, Universitätsklinikum, Universität Duisburg-Essen, Essen, Germany.
| |
Collapse
|
14
|
Peitz T, Möhlendick B, Eisenberger U, Siffert W, Heinemann FM, Kribben A, Friebus-Kardash J. CC Genotype of GNAS c.393C>T (rs7121) Polymorphism Has a Protective Effect against Development of BK Viremia and BKV-Associated Nephropathy after Renal Transplant. Pathogens 2022; 11:pathogens11101138. [PMID: 36297195 PMCID: PMC9609707 DOI: 10.3390/pathogens11101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
The GNAS gene encodes the alpha-subunit of the stimulatory G-protein (Gαs) in humans and mice. The single-nucleotide polymorphism of GNAS, c.393C>T, is associated with an elevated production of Gαs and an increased formation of cyclic adenosine monophosphate (cAMP). In the present study, we analyzed the effect of this GNAS polymorphism on a renal allograft outcome. We screened a cohort of 436 renal allograft recipients, who were retrospectively followed up for up to 5 years after transplant. GNAS genotypes were determined with polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) assays. The 393T allele was detected in 319 (73%) recipients (113 recipients with TT and 206 with CT genotype) and the CC genotype in 117 (27%). The CC genotype was associated with a significantly lower frequency of BK viremia (CC, 17 recipients (15%); T 84 (26%)); p = 0.01; TT, 27 vs. CC, 17, p = 0.07; TT, 27 vs. CT, 57, p = 0. 46; CT, 57 vs. CC, 17, p = 0.01) and BKV-associated nephropathy (CC, 3 recipients (3%); T, 27 (8%); p = 0.03; TT,10 vs. CC, 3, p = 0.04; TT, 10 vs. CT,17, p = 0.85; CT, 17 vs. CC,3, p = 0.04) after transplant. BKV-associated nephropathy-free survival was significantly better among CC genotype carriers than among T allele carriers (p = 0.043; TT vs. CC, p = 0.03; CT vs. CC, p = 0.04; TT vs. CT, p = 0.83). Multivariate analysis indicated an independent protective effect of the CC genotype against the development of both BK viremia (relative risk. 0.54; p = 0.04) and BKV-associated nephropathy after renal transplant (relative risk. 0.27; p = 0.036). The GNAS 393 CC genotype seems to protect renal allograft recipients against the development of BK viremia and BKV-associated nephropathy.
Collapse
Affiliation(s)
- Tobias Peitz
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Birte Möhlendick
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Winfried Siffert
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Falko Markus Heinemann
- Institute for Transfusion Medicine, Transplantation Diagnostics, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Justa Friebus-Kardash
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Correspondence: ; Tel.: +49-(0)-201-7236559; Fax: +49-(0)-201-7236907
| |
Collapse
|
15
|
Eckardt KU, Binet I, de Groot K, Floege J, Galle JC, Jordans I, Kribben A, Oberbauer R, Pavenstädt H, Rosenkranz A, Säemann M, Winkelmayer WC. [Nomenclature for kidney function and kidney diseases - Improving assessment and prognosis through precision and comprehensibility]. Dtsch Med Wochenschr 2022; 147:1398-1406. [PMID: 36174584 PMCID: PMC9592152 DOI: 10.1055/a-1908-5163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nierenkrankheiten stellen ein zunehmendes Gesundheitsproblem dar, dessen Eindämmung eine effektive Kommunikation zwischen den an Erfassung, Diagnostik und Therapie Beteiligten sowie den betroffenen Patientinnen und Patienten erfordert. Die Nomenklatur für Nierenfunktion und Nierenkrankheiten ist jedoch bislang nicht einheitlich. Die internationale, gemeinnützige Organisation Kidney Disease: Improving Global Outcomes (KDIGO) hat deshalb 2019 in einem Konsensus-Prozess ein englischsprachiges Glossar entwickelt, um die Begriffe zur Beschreibung von Nierenfunktion, Nierenstruktur und Nierenkrankheiten zu vereinheitlichen. Leitprinzipien bei der Entwicklung dieser Nomenklatur waren (1) Präzision, (2) Patientenzentrierung und (3) Konsistenz mit bisherigen KDIGO-Leitlinien. Das vorliegende Positionspapier beinhaltet eine deutsche Übersetzung dieses Glossars, die im Auftrag der nephrologischen Fachgesellschaften in Deutschland, Österreich und der Schweiz entwickelt wurde.
Collapse
Affiliation(s)
- Kai-Uwe Eckardt
- Medizinische Klinik m. S. Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin Berlin
| | - Isabelle Binet
- Klinik für Nephrologie und Transplantationsmedizin, Kantonsspital St. Gallen, St. Gallen, Schweiz und Schweizerische Nierenstiftung
| | - Kirsten de Groot
- Medizinische Klinik III für Nieren-, Bluthochdruck- und Rheumaerkrankungen am Klinikum Offenbach
| | - Jürgen Floege
- Medizinische Klinik II, Nephrologie und Klinische Immunologie, Uniklinik der RWTH Aachen
| | - Jan C Galle
- Klinik für Nephrologie und Dialyseverfahren, Klinikum Lüdenscheid
| | - Isabelle Jordans
- Bundesverband Niere e. V., Mainz und Patientenstiftung Aktion Niere
| | - Andreas Kribben
- Klinik für Nephrologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Rainer Oberbauer
- Klinik für Innere Medizin III - Abteilung für Nephrologie, Medizinische Universität Wien
| | - Hermann Pavenstädt
- Medizinische Klinik und Poliklinik D der Universitätsklinik Münster (UKM)
| | | | - Marcus Säemann
- 6. Med. Abt. mit Nephrologie & Dialyse, Klinik Ottakring, Wien
| | - Wolfgang C Winkelmayer
- Section of Nephrology, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
16
|
Heinemann FM, Lindemann M, Keles D, Witzke O, Kribben A, Baba HA, Becker JU, Heinold A, Horn PA, Eisenberger U. Cumulative mean fluorescent intensities of
HLA
specific antibodies predict antibody mediated rejections after kidney transplantation. HLA 2022; 100:553-562. [DOI: 10.1111/tan.14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Falko Markus Heinemann
- Institute for Transfusion Medicine University Duisburg‐Essen, University Hospital Essen Essen Germany
| | - Monika Lindemann
- Institute for Transfusion Medicine University Duisburg‐Essen, University Hospital Essen Essen Germany
| | - Deniz Keles
- Institute for Transfusion Medicine University Duisburg‐Essen, University Hospital Essen Essen Germany
- Department of Nephrology University Duisburg‐Essen, University Hospital Essen Essen Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre for Infectious Diseases University Duisburg‐Essen, University Hospital Essen Essen Germany
| | - Andreas Kribben
- Department of Nephrology University Duisburg‐Essen, University Hospital Essen Essen Germany
| | - Hideo Andreas Baba
- Institute of Pathology University Duisburg‐Essen, University Hospital Essen Essen Germany
| | | | - Andreas Heinold
- Institute for Transfusion Medicine University Duisburg‐Essen, University Hospital Essen Essen Germany
| | - Peter Alexander Horn
- Institute for Transfusion Medicine University Duisburg‐Essen, University Hospital Essen Essen Germany
| | - Ute Eisenberger
- Department of Nephrology University Duisburg‐Essen, University Hospital Essen Essen Germany
| |
Collapse
|
17
|
Haidari Z, Demircioglu E, Boss K, Tyczynski B, Thielmann M, Schmack B, Kribben A, Weymann A, El Gabry M, Ruhparwar A, Wendt D. Intraoperative hemoadsorption in high-risk patients with infective endocarditis. PLoS One 2022; 17:e0266820. [PMID: 35900987 PMCID: PMC9333242 DOI: 10.1371/journal.pone.0266820] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Postoperative sepsis is an important cause of morbidity and mortality in patients with infective endocarditis undergoing surgical therapy. Blood purification using hemoadsorption therapy shows promising results in the treatment of sepsis. In this study, the clinical effects of intraoperative hemoadsorption in high-risk patients with infective endocarditis were evaluated.
Methods
Eligible candidates were high-risk patients with infective endocarditis undergoing cardiac surgery between January 2014 and December 2019. Patients with intraoperative hemoadsorption (hemoadsorption) were compared to patients without hemoadsorption (control). The endpoints were the incidence of postoperative sepsis, sepsis-associated death and in-hospital mortality. Additionally, postoperative vasopressor need, systemic vascular resistance indices and Sequential Organ Failure Assessment (SOFA) scores were compared.
Results
After propensity score matching, 70 high-risk patients were included. Postoperative sepsis occurred in 14 patients in the hemoadsorption group and in 16 patients in the control group, p = 0.629. Four patients died due to postoperative sepsis in the hemoadsorption group, while 11 postoperative septic patients died in the control group, p = 0.041. In-hospital mortality was 34% in the hemoadsorption group versus 43% in the control group, p = 0.461. On ICU-admission and the first postoperative day, the cumulative vasopressor need was 0.17 versus 0.25 μg/kgBW/min, p = 0.123 and 0.06 versus 0.11 μg/kgBW/min, p = 0.037, and the systemic vascular resistance index was 1448 versus 941 dyn·s·cm-5, p = 0.013 and 1156 versus 858 dyn·s·cm-5, p = 0.110 in the hemoadsorption versus control group, respectively. Postoperative course of SOFA score normalized significantly (p = 0.01) faster in the hemoadsorption group.
Conclusions
In high-risk cardiac surgical patients with infective endocarditis, intraoperative hemoadsorption significantly reduced sepsis-associated mortality. Furthermore, intraoperative hemoadsorption resulted in significant faster recovery of hemodynamics and organ function. Intraoperative hemoadsorption seems to attenuate the severity of postoperative sepsis.
Collapse
Affiliation(s)
- Zaki Haidari
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
- * E-mail:
| | - Ender Demircioglu
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Kristina Boss
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | | | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, Essen, Germany
| |
Collapse
|
18
|
Boss K, Stettner M, Szepanowski F, Mausberg AK, Paar M, Pul R, Kleinschnitz C, Oettl K, Kribben A. Severe and long-lasting alteration of albumin redox state by plasmapheresis. Sci Rep 2022; 12:12165. [PMID: 35842435 PMCID: PMC9288533 DOI: 10.1038/s41598-022-16452-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022] Open
Abstract
Plasmapheresis (PE) is an established form of therapeutic apheresis (TA). Purpose of this longitudinal prospective single center study was to investigate the effect of PE on albumin redox state (ARS), as infusion of commercial albumin during PE may alter albumin oxidation which has an impact on its functional properties and oxidative stress level. 43 subjects with autoimmune-mediated neurological disorders were included. 20 subjects in the experimental group received five treatments of PE. 13 subjects received five treatments of immunoadsorption and 10 subjects received no TA as controls. ARS was determined before and after TA and 12 days after the last TA by fractionating it into human mercaptalbumin (HMA), human non-mercaptalbumin 1 (HNA-1), and human non-mercaptalbumin 2 (HNA-2) by high-performance liquid chromatography. Irreversibly oxidised HNA-2 increased over the course of five PE treatments from 2.8% (IQR 1.3–3.7%) to 13.6% (IQR 10.9–15.9) (P < 0.01) and remained elevated 12 days after the last PE procedure (7.7% IQR 7.1–10.5, P < 0.05). The study showed for the first time that PE exerts a severe and long-lasting alteration on ARS indicating a new adverse effect of PE, that may influence oxidative stress level.
Collapse
Affiliation(s)
- Kristina Boss
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, 45147, Essen, Germany.
| | - Mark Stettner
- Department of Neurology and Center for Translational Neuro- and Behavioural Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Fabian Szepanowski
- Department of Neurology and Center for Translational Neuro- and Behavioural Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Anne K Mausberg
- Department of Neurology and Center for Translational Neuro- and Behavioural Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Margret Paar
- Division of Physiological Chemistry, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Refik Pul
- Department of Neurology and Center for Translational Neuro- and Behavioural Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioural Sciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karl Oettl
- Division of Physiological Chemistry, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, 45147, Essen, Germany
| |
Collapse
|
19
|
Haase A, Yang D, Dolff S, Witzke O, Kribben A, Wilde B. MO247: Exogen ATP has a Suppressive Effect on CD4+-T-Cells In Aav-Patients And Healthy Controls. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac067.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Anti-neutrophil-cytoplasmatic-antibody-associated vasculitis (AAV) is a life-threatening autoimmune disease. It is a necrotizing vasculitis of small- and medium-sized vessels. T-cells play a pivotal role in pathogenesis and mediating damage in the vessels. Exogen ATP (adenosine triphosphate) is normally in a low nanomolar range. Under inflammatory conditions, various cells can release ATP to the extracellular department. In this case, ATP is a DAMP (damage-associated molecular pattern), but its effect on disease mechanisms in AAV is not well understood. It is the aim of the study to determine the effect of exogenous ATP on T-cells in healthy controls and AAV-patients.
METHOD
A total of 22 AAV-patients in remission and 13 healthy controls were recruited. Peripheral blood mononuclear cells (PBMC) were isolated and then labeled with a tracking dye. The PBMC were cultured for 3 days with different concentrations of ATP in presence or absence of anti-CD3/CD28 stimulation. After 3 days, the cells were restimulated with PMA/Ionomycin and Brefeldin A for 4 hours. Cytokine production and cell proliferation were assessed by flow cytometry. Baseline was defined as T-cell proliferation in absence of exogenous ATP. The fold change was calculated by: $\frac{{{\rm{T}} - {\rm{cell\ proliferation\ with\ ATP}}}}{{{\rm{T}} - {\rm{cell\ proliferation\ without\ ATP}}}}$ . The P-value for paired values was calculated by the Wilcoxon matched-pairs signed rank test. The P-value for unpaired groups was calculated by the Mann Whitney U-test.
RESULTS
The mean T-cell proliferation of CD4+-T-cells for healthy controls was significantly different comparing 0 µM ATP and 500 µM ATP (mean proliferated fraction, 0 µM ATP versus 500 µM ATP: 40.48% versu 22.58%, P = .0002). In presence of ATP, a suppression of T-cell proliferation was found in patients and healthy controls (patients versus healthy controls, fold change T-cell proliferation from baseline with 50 µM ATP: 0.81 ± 0.03 versus 0.79 ± 0.03, P = .60; 125 µM ATP: 0.75 ± 0.03 versus 0.70 ± 0.04, P = .38; 250 µM ATP: 0.68 ± 0.03 versus 0.59 ± 0.05, P = .17; 500 µM ATP: 0.53 ± 0.03 versus 0.54 ± 0.05, P = .77); the higher the concentration of ATP, the stronger the suppression of proliferation.
IFNγ+-CD4+-T-cells of healthy controls were also suppressed by exogenous ATP (0 µM ATP versus 500 µM ATP, CD4+ T-cells: %IFNγ+: 19.94% versus 10.59%, P = .0002). INFγ production by CD4+-T-cells was reduced after addition of ATP in both patients and healthy controls (patients versus healthy controls, fold change CD4+-IFNγ+ -T-cells from baseline with 50 µM ATP: 0.69 ± 0.04 versus 0.64 ± 0.04, P = 0.45; 125 µM ATP: 0.62 ± 0.04 versus 0.58 ± 0.04, P = .63; 250 µM ATP: 0.62 ± 0.04 versus 0.49 ± 0.04, P = .11; 500 µM ATP: 0.59 ± 0.05 versus 0.51 ± 0.05, P = .56).
CONCLUSION
Exogenous ATP induced suppression of T-cells in healthy controls and might be important for the maintenance of immunotolerance. DAMP-mediated inhibitory mechanisms were functional in AAV-patients in remission.
Collapse
Affiliation(s)
- Alexandra Haase
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dai Yang
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
20
|
Friebus-Kardash J, Nela E, Möhlendick B, Kribben A, Siffert W, Heinemann FM, Eisenberger U. Development of De Novo Donor-specific HLA Antibodies and AMR in Renal Transplant Patients Depends on CYP3A5 Genotype. Transplantation 2022; 106:1031-1042. [PMID: 34241984 PMCID: PMC9038248 DOI: 10.1097/tp.0000000000003871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The single-nucleotide polymorphism CYP3A5 rs776746 is related to a reduction in the metabolizing activity of the CYP3A5 enzyme. People carrying at least one copy of the wild-type allele, defined as CYP3A5 expressers, exhibit higher clearance and lower trough concentrations of tacrolimus than homozygous nonexpressers, and this difference may affect alloimmunization and allograft function. METHODS We retrospectively studied 400 kidney transplant recipients treated with a tacrolimus-based immunosuppression regimen to detect CYP3A5 genotype, de novo formation of HLA antibodies and donor-specific antibodies (DSAs), and clinical outcome up to 5 y after transplant. RESULTS We found that 69 (17%) of the 400 patients were CYP3A5 expressers. During the first 3 y after transplant, CYP3A5 expressers tended to have lower tacrolimus trough levels than nonexpressers, although their tacrolimus dosage was as much as 80% higher. De novo DSAs were found more frequently in CYP3A5 expressers than in nonexpressers (13/69 [19%] versus 33/331 [10%], P = 0.02). De novo DSA-free survival rates (P = 0.02) were significantly lower for expressers than for nonexpressers. CYP3A5 genotype had no effect on allograft failure, but CYP3A5 expressers exhibited a significantly higher frequency of antibody-mediated rejection. CYP3A5 expresser status was an independent risk factor for the development of de novo DSAs (relative risk, 2.34, P = 0.01). CONCLUSIONS Early detection of CYP3A5 expressers, enabling genotype-based dose adjustment of tacrolimus immediately after renal transplant, may be a useful strategy for reducing the risk of de novo DSA production and antibody-mediated rejection.
Collapse
Affiliation(s)
- Justa Friebus-Kardash
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ejona Nela
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Birte Möhlendick
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Winfried Siffert
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Falko Markus Heinemann
- Institute for Transfusion Medicine, Transplantation Diagnostics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
21
|
Ma X, Dai Y, Witzke O, Xu S, Lindemann M, Kribben A, Dolff S, Wilde B. Chloroquine Suppresses Effector B-Cell Functions and Has Differential Impact on Regulatory B-Cell Subsets. Front Immunol 2022; 13:818704. [PMID: 35211119 PMCID: PMC8860819 DOI: 10.3389/fimmu.2022.818704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Chloroquine (CQ) is approved for treatment of B-cell mediated diseases such as rheumatoid arthritis and systemic lupus erythematosus. However, the exact mode of action in these diseases has not been studied and it remains unclear which effect CQ has on B-cells. Thus, it was the aim of this study to investigate to which extent CQ affects functionality of effector and regulatory B-cell. Methods For this purpose, B-cells were isolated from peripheral blood of healthy controls and renal transplant patients. B-cells were stimulated in presence or absence of CQ and Interleukin-10 (IL-10) and Granzyme B (GrB) secretion were assessed. In addition, effector functions such as plasma cell formation, and Immunoglobulin G (IgG) secretion were studied. Results CQ suppressed Toll-Like-Receptor (TLR)-9 induced B-cell proliferation in a dose-dependent manner. IL-10pos regulatory B-cells were suppressed by CQ already at low concentrations whereas anti-IgG/IgM-induced GrB secreting regulatory B-cells were less susceptible. Plasma blast formation and IgG secretion was potently suppressed by CQ. Moreover, purified B-cells from renal transplant patients were also susceptible to CQ-induced suppression of effector B-cell functions as observed by diminished IgG secretion. Conclusion In conclusion, CQ had a suppressive effect on IL-10 regulatory B-cells whereas GrB secreting regulatory B-cells were less affected. Effector functions of B-cells such as plasma blast formation and IgG secretion were also inhibited by CQ. Effector B-cells derived from renal transplant patients already under immunosuppression could be suppressed by CQ. These findings may partly explain the clinical efficacy of CQ in B-cell mediated autoimmune diseases. The application of CQ in other disease contexts where suppression of effector B-cells could offer a benefit, such as renal transplantation, may hypothetically be advantageous.
Collapse
Affiliation(s)
- Xin Ma
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Nephrology, First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Yang Dai
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Shilei Xu
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
22
|
Boss K, Kribben A. [Treatment and progression management of acute kidney injury]. Dtsch Med Wochenschr 2022; 147:246-252. [PMID: 35226923 DOI: 10.1055/a-1557-6909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Acute kidney injury (AKI) represents one of the greatest global health challenges and is associated with high mortality. The often multifactorial etiology and complex pathophysiological mechanisms have so far hampered the development of causal therapeutic options. The treatment should be stage-adapted according to the current KDIGO guideline: avoid nephrotoxicity, optimize volume status and perfusion pressure, monitor serum creatinine, urine output and proteinuria. New insights into the influence of mitochondrial dysfunction and cellular senescence in AKI, well-defined study endpoints, and innovations through nanotechnology may enable targeted drug-based AKI therapy in the future. Especially the weeks following an AKI are a vulnerable phase and crucial for progression management.
Collapse
|
23
|
Jahn M, Korth J, Dorsch O, Anastasiou OE, Krawczyk A, Brochhagen L, van de Sand L, Sorge-Hädicke B, Tyczynski B, Witzke O, Dittmer U, Dolff S, Wilde B, Kribben A. Decline of Humoral Responses 6 Months after Vaccination with BNT162b2 (Pfizer–BioNTech) in Patients on Hemodialysis. Vaccines (Basel) 2022; 10:vaccines10020327. [PMID: 35214785 PMCID: PMC8878048 DOI: 10.3390/vaccines10020327] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
This study analyzed binding and neutralizing antibody titers up to 6 months after standard vaccination with BNT162b2 (two doses of 30 µg each) in SARS-CoV-2 naïve patients (n = 59) on hemodialysis. Humoral vaccine responses were measured before and 6, 12, and 24 weeks after the first vaccination. A chemiluminescent immunoassay (CLIA) was used to quantify SARS-CoV-2 IgG against the spike glycoprotein. SARS-CoV-2 neutralizing activity was tested against the wild-type virus. A multivariable binary regression model was used to identify risk factors for the absence of humoral immune responses at 6 months. At week 6, vaccine-specific seroconversion was detected in 96.6% of all patients with median anti-SARS-CoV-2 IgGs of 918 BAU/mL. At weeks 12 and 24, seroconversion rates decreased to 91.5% and 79.7%, and corresponding median binding antibody titers declined to 298 BAU/mL and 89 BAU/mL, respectively. Neutralizing antibodies showed a decay from 79.6% at week 6 to 32.8% at week 24. The risk factor with the strongest association for vanishing immune responses was low serum albumin (p = 0.018). Regarding vaccine-specific humoral responses 6 months after the standard BNT162b2 vaccination schedule, SARS-CoV-2 naïve patients receiving hemodialysis must be considered at risk of becoming infected with SARS-CoV-2 and being infectious.
Collapse
Affiliation(s)
- Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
- Correspondence:
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Oliver Dorsch
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Friesener Straße 37a, 96317 Kronach, Germany;
| | - Olympia Evdoxia Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Adalbert Krawczyk
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Leonie Brochhagen
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Lukas van de Sand
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Burkhard Sorge-Hädicke
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Alfried-Krupp-Str. 43, 45131 Essen, Germany;
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| |
Collapse
|
24
|
Jahn M, Raschidi L, Özçürümez MK, Arzideh F, Korth J, Kribben A, Canbay A, Katsounas A. Comparison of Mortality Prediction Scores in Intermediate-Care Patients with Liver Cirrhosis at a German University Transplant Centre: A Prospective Study. Dig Dis 2022; 41:96-106. [PMID: 35172311 DOI: 10.1159/000522595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Mortality prediction models help to extract and relate patient data upon admission to intensive or intermediate care units (ImCUs). Considering technical and economic healthcare developments, re-evaluations of score performances are required to warrant their validity. This study validates and compares established scoring systems in cirrhotic ImCU patients. METHODS Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) 2 and 3, Sepsis Organ Failure Assessment (SOFA), Mortality Probability Model at ICU admission (MPMo) II and III, Model for End stage Liver Disease (MELD), CLIF-Consortium Acute-on-Chronic Liver Failure (CLIF-C ACLF), CLIF-Consortium Acute Decompensation (CLIF-C AD), and Intermediate Care Unit Severity Score (ImCUSS) were calculated in patients with cirrhosis (n = 98) at ImCU admission. Discrimination performances were evaluated by area under the receiver operating characteristic curves (AUROCs), calibration performances with calibration belt plots, and their corresponding p values. RESULTS Overall, SAPS 3 and CLIF-C ACLF have shown the best 90-day mortality prediction outcomes with AUROCs of 0.825 and 0.783 along with calibration belt p values of 0.128 and 0.061, respectively. In a subgroup analysis of patients with acute-on-chronic liver failure (ACLF), expanded SAPS 2, SOFA, and SAPS 3 reached the best AUROCs, i.e., 0.760, 0.750, and 0.714, but none of the tested scores reached an acceptable calibration. CONCLUSION Ninety-day mortality risk prediction of the SAPS 3 and CLIF-C ACLF was accurate in our cohort of patients with liver cirrhosis admitted to ImCUs. A particular challenge remains that is the mortality prediction in patients with ACLF requiring ImCU-level care; here, further developments are needed to generate scores with acceptable predictive performances.
Collapse
Affiliation(s)
- Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lea Raschidi
- Department of Anesthesiology, Luisenhospital Aachen, Aachen, Germany
| | - Mustafa K Özçürümez
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
| | - Farhad Arzideh
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ali Canbay
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
| | - Antonios Katsounas
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
| |
Collapse
|
25
|
Koslik MA, Friebus-Kardash J, Heinemann FM, Kribben A, Bräsen JH, Eisenberger U. Differential Treatment Effects for Renal Transplant Recipients With DSA-Positive or DSA-Negative Antibody-Mediated Rejection. Front Med (Lausanne) 2022; 9:816555. [PMID: 35174191 PMCID: PMC8841765 DOI: 10.3389/fmed.2022.816555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/07/2022] [Indexed: 12/22/2022] Open
Abstract
Background Antibody-mediated rejection (ABMR) is the main cause of renal allograft loss. The most common treatment strategy is based on plasmapheresis plus the subsequent administration of intravenous immunoglobulin (IVIG). Unfortunately, no approved long-term therapy is available for ABMR. The current study was designed to analyze the effect of various ABMR treatment approaches on allograft survival and to compare treatment effects in the presence or absence of donor-specific antibodies (DSAs). Methods This single-center study retrospectively analyzed 102 renal allograft recipients who had biopsy-proven ABMR after transplant. DSA was detectable in 61 of the 102 patients. Initial standard treatment of ABMR consisted of plasmapheresis (PS) or immunoadsorption (IA), followed by a single course of IVIG. In case of nonresponse or recurrence, additional immunosuppressive medications, such as rituximab, bortezomib, thymoglobulin, or eculizumab, were administered. In a second step, persistent ABMR was treated with increased maintenance immunosuppression, long-term therapy with IVIG (more than 1 year), or both. Results Overall graft survival among transplant patients with ABMR was <50% after 3 years of follow-up. Compared to the use of PS/IA and IVIG alone, the use of additional immunosuppressive medications had no beneficial effect on allograft survival (p = 0.83). Remarkably, allografts survival rates were comparable between patients treated with the combination of PS/IA and IVIG and those treated with a single administration of IVIG (p = 0.18). Renal transplant patients with ABMR but without DSAs benefited more from increased maintenance immunosuppression than did DSA-positive patients with ABMR (p = 0.01). Recipients with DSA-positive ABMR exhibited significantly better allograft survival after long-term application of IVIG for more than 1 year than did recipients with DSA-negative ABMR (p = 0.02). Conclusions The results of our single-center cohort study involving kidney transplant recipients with ABMR suggest that long-term application of IVIG is more favorable for DSA-positive recipients, whereas intensification of maintenance immunosuppression is more effective for recipients with DSA-negative ABMR.
Collapse
Affiliation(s)
- Marius Andreas Koslik
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Justa Friebus-Kardash
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Falko Markus Heinemann
- Institute for Transfusion Medicine, Transplantation Diagnostics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Hinrich Bräsen
- Nephropathology Unit, Hannover Medical School, Institute of Pathology, Hanover, Germany
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- *Correspondence: Ute Eisenberger
| |
Collapse
|
26
|
Mülling N, Ter Huurne J, Kahl AL, Tokmak F, Spitthöver R, Kribben A, Reinhardt W. Predictive role of fluctuating biochemical parameters for mortality in hemodialysis patients. Ther Apher Dial 2022; 26:1137-1147. [PMID: 35038241 DOI: 10.1111/1744-9987.13798] [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: 11/04/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION High inflammation parameters like CRP and low albumin levels are considered as risk factors in CKD stage 5 patients. Due to dynamic changes in these parameters, there is evidence of an association between their variation and mortality in hemodialysis patients. METHODS We retrospectively analyzed 153 patients on chronic hemodialysis. Dialysis-specific biochemical parameters were measured at three-month intervals over a 42-month period. Fluctuations were calculated as the percentage change in two subsequent measurements. RESULTS Median age was 70 years. 41.10% of the patients died over the study period. Higher fluctuation rates in albumin and CRP were significantly associated with a higher mortality rate. Regression analysis revealed that only the fluctuations in albumin proved to be a predictive variable for the end point "death". If the fluctuation in albumin increases by 1%, the mortality risk rises by 22%. CONCLUSION Fluctuations in albumin are of predictive importance in patients on chronic hemodialysis.
Collapse
Affiliation(s)
- Nils Mülling
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Jan Ter Huurne
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Anna Lena Kahl
- Institute of Medical Psychology and Behavioral Immunobiology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Faruk Tokmak
- MVZ Gelsenkirchen-Buer, Ludwig-Erhard Str. 10, 45891, Gelsenkirchen, Germany
| | - Ralf Spitthöver
- Dialyse- und Lipidzentrum Nordrhein, Hindenburgstr. 27, 45127, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Walter Reinhardt
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| |
Collapse
|
27
|
Fu J, Lehmann CHK, Wang X, Wahlbuhl M, Allabauer I, Wilde B, Amon L, Dolff S, Cesnjevar R, Kribben A, Woelfle J, Rascher W, Hoyer PF, Dudziak D, Witzke O, Hoerning A. CXCR4 blockade reduces the severity of murine heart allograft rejection by plasmacytoid dendritic cell-mediated immune regulation. Sci Rep 2021; 11:23815. [PMID: 34893663 PMCID: PMC8664946 DOI: 10.1038/s41598-021-03115-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 11/08/2021] [Indexed: 12/20/2022] Open
Abstract
Allograft-specific regulatory T cells (Treg cells) are crucial for long-term graft acceptance after transplantation. Although adoptive Treg cell transfer has been proposed, major challenges include graft-specificity and stability. Thus, there is an unmet need for the direct induction of graft-specific Treg cells. We hypothesized a synergism of the immunotolerogenic effects of rapamycin (mTOR inhibition) and plerixafor (CXCR4 antagonist) for Treg cell induction. Thus, we performed fully-mismatched heart transplantations and found combination treatment to result in prolonged allograft survival. Moreover, fibrosis and myocyte lesions were reduced. Although less CD3+ T cell infiltrated, higher Treg cell numbers were observed. Noteworthy, this was accompanied by a plerixafor-dependent plasmacytoid dendritic cells-(pDCs)-mobilization. Furthermore, in vivo pDC-depletion abrogated the plerixafor-mediated Treg cell number increase and reduced allograft survival. Our pharmacological approach allowed to increase Treg cell numbers due to pDC-mediated immune regulation. Therefore pDCs can be an attractive immunotherapeutic target in addition to plerixafor treatment.
Collapse
Affiliation(s)
- Jian Fu
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department for Pediatric and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany.,The Emergency and Trauma Center, The First Affiliated Hospital of Hai Nan Medical University, Haikou, China
| | - Christian H K Lehmann
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Research Module II, Hartmannstr. 14, 91052, Erlangen, Germany. .,Medical Immunology Campus and German Centre for Immuntherapy (Deutsches Zentrum für Immuntherapie-DZI) Erlangen, FAU Erlangen-Nürnberg, 91054, Erlangen, Germany.
| | - Xinning Wang
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Mandy Wahlbuhl
- Department for Pediatric and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Ida Allabauer
- Department for Pediatric and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lukas Amon
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Research Module II, Hartmannstr. 14, 91052, Erlangen, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, Universitätsmedizin Essen, University Duisburg-Essen, Essen, Germany
| | - Robert Cesnjevar
- Department of Pediatric Cardiac Surgery, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Cardiac Surgery, Universitäts-Kinderspital Zürich, Zurich, Switzerland
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Joachim Woelfle
- Department for Pediatric and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Wolfgang Rascher
- Department for Pediatric and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Peter F Hoyer
- Department of Pediatrics II, Pediatric Nephrology, Gastroenterology, Endocrinology and Transplant Medicine, Children's Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Diana Dudziak
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Research Module II, Hartmannstr. 14, 91052, Erlangen, Germany.,Medical Immunology Campus and German Centre for Immuntherapy (Deutsches Zentrum für Immuntherapie-DZI) Erlangen, FAU Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, Universitätsmedizin Essen, University Duisburg-Essen, Essen, Germany
| | - André Hoerning
- Department for Pediatric and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany. .,Department of Pediatrics II, Pediatric Nephrology, Gastroenterology, Endocrinology and Transplant Medicine, Children's Hospital Essen, University Duisburg-Essen, Duisburg, Germany.
| |
Collapse
|
28
|
Hoyer DP, Benkö T, Gallinat A, Lefering R, Kaths M, Kribben A, Korth J, Rauen U, Treckmann JW, Paul A. HTK-N as a new preservation solution for human kidney preservation: Results of a pilot randomized controlled clinical phase II trial in living donor transplantation. Clin Transplant 2021; 36:e14543. [PMID: 34813125 DOI: 10.1111/ctr.14543] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND HTK-N was developed based on the traditional HTK preservation solution, resulting in stronger protection against reactive oxygen species as well as better tolerance to hypothermia and ischemia. Aim of the present study was to compare HTK-N to HTK in clinical kidney transplantation demonstrating safety and non-inferiority. METHODS We performed a randomized controlled single blinded clinical phase II trial in patients undergoing living donor kidney transplantation. After retroperitoneoscopic nephrectomy kidneys were either perfused and stored with classical HTK solution or the new HTK-N solution. Primary endpoint was the glomerular filtration rate (eGFR according to CKD EPI) 3 months after transplantation. Secondary endpoints included graft and patient survival beside others. RESULTS The study included 42 patients, of which 22 were randomized in the HTK-N group and 20 in the HTK group. The primary end point showed a mean eGFR of 55.4 ± 14.0 ml/min/1.73 m2 in the HTK group compared to a GFR of 57.2 ± 16.7 ml/min/m2 in the HTK-N group (P = .72). Regarding secondary endpoints, there were no apparent differences. Posttransplant graft and patient survival was 100%. CONCLUSION This study is the first clinical application of HTK-N for kidney preservation and demonstrates non-inferiority compared to HTK in the setting of living donor kidney transplantation.
Collapse
Affiliation(s)
- Dieter P Hoyer
- General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Tamas Benkö
- General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Anja Gallinat
- General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Rolf Lefering
- Institute of Research in Operative Medicine, University Witten, Herdecke, Germany
| | - Moritz Kaths
- General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ursula Rauen
- Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany
| | - Juergen W Treckmann
- General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Andreas Paul
- General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany
| |
Collapse
|
29
|
Grube M, Weber F, Kahl AL, Kribben A, Mülling N, Reinhardt W. Effect of High Dose Active Vitamin D Therapy on the Development of Hypocalcemia After Subtotal Parathyroidectomy in Patients on Chronic Dialysis. Int J Nephrol Renovasc Dis 2021; 14:399-410. [PMID: 34795499 PMCID: PMC8594789 DOI: 10.2147/ijnrd.s334227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background The period after parathyroidectomy (PTx) in dialysis patients is characterized by periods of severe hypocalcemia. This study aims to investigate the effect of high doses of active vitamin D immediately after PTx on the development of hypocalcemia. Materials and Methods We retrospectively reviewed 111 patients with secondary hyperparathyroidism receiving subtotal PTx between 2010 and 2019. A high dose group “HDG” (n = 67) receiving 12 µg alfacalcidol in combination with 8.550 mg calcium acetate per day, which was then adapted according to lab values, was compared with a low dose group “LDG” (n = 44) receiving up to 4 µg alfacalcidol per day. The laboratory values were recorded up to ten weeks postoperatively. Results The assumed drops in parathyroid hormone (PTH) and calcium were observed in both groups after PTx. We observed significantly lower calcium values in the LDG between days 4 and 18 postoperatively than in the HDG (p < 0.001). The proportion of severe hypocalcemia after PTx (total calcium <1.5 mmol/l) in the HDG was 8.5% on day 1 and 47% on day 4 in the LDG. Intravenous calcium requirements were significantly lower in the HDG (7.6%) than in the LDG (45.7%; p = 0.001). Conclusion The period after PTx in dialysis patients is characterized by an expected drop in PTH and calcium within the first days. Ongoing high turnover is observed in the 2nd and 3rd week after PTx. Administering high doses of alfacalcidol combined with calcium acetate diminishes the episodes of severe hypocalcemia and the need for intravenous calcium.
Collapse
Affiliation(s)
- Malina Grube
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Frank Weber
- Department of General-, Visceral- and Transplantation Surgery, Section of Endocrine Surgery, University Hospital Essen, Essen, Germany
| | - Anna Lena Kahl
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Nils Mülling
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Walter Reinhardt
- Department of Nephrology, University Hospital Essen, Essen, Germany
| |
Collapse
|
30
|
Möhlendick B, Schönfelder K, Breuckmann K, Elsner C, Babel N, Balfanz P, Dahl E, Dreher M, Fistera D, Herbstreit F, Hölzer B, Koch M, Kohnle M, Marx N, Risse J, Schmidt K, Skrzypczyk S, Sutharsan S, Taube C, Westhoff TH, Jöckel KH, Dittmer U, Siffert W, Kribben A. ACE2 polymorphism and susceptibility for SARS-CoV-2 infection and severity of COVID-19. Pharmacogenet Genomics 2021; 31:165-171. [PMID: 34001841 PMCID: PMC8415730 DOI: 10.1097/fpc.0000000000000436] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The RNA virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for coronavirus disease 2019 (COVID-19). Cell entry is mediated by the human angiotensin-converting enzyme II (ACE2). ACE2 and its close homolog angiotensin-converting enzyme I (ACE) are currently discussed candidate genes, in which single-nucleotide polymorphisms (SNPs) could alter binding or entry of SARS-CoV-2 and enhance tissue damage in the lung or other organs. This could increase the susceptibility for SARS-CoV-2 infection and the severity of COVID-19. PATIENTS AND METHODS We performed genotyping of SNPs in the genes ACE2 and ACE in 297 SARS-CoV-2-positive and 253 SARS-CoV-2-negative tested patients. We analyzed the association of the SNPs with susceptibility for SARS-CoV-2 infection and the severity of COVID-19. RESULTS SARS-CoV-2-positive and SARS-CoV-2-negative patients did not differ regarding demographics and clinical characteristics. For ACE2 rs2285666, the GG genotype or G-allele was significantly associated with an almost two-fold increased SARS-CoV-2 infection risk and a three-fold increased risk to develop serious disease or COVID-19 fatality. In contrast, the ACE polymorphism was not related to infection risk or severity of disease. In a multivariable analysis, the ACE2 rs2285666 G-allele remained as an independent risk factor for serious disease besides the known risk factors male gender and cardiovascular disease. CONCLUSIONS In summary, our report appears to be the first showing that a common ACE2 polymorphism impacts the risk for SARS-CoV-2 infection and the course of COVID-19 independently from previously described risk factors.
Collapse
Affiliation(s)
| | | | | | - Carina Elsner
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen
| | - Nina Babel
- Center for Translational Medicine, Ruhr University Bochum, Herne
| | - Paul Balfanz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen
| | - Edgar Dahl
- RWTH Centralized Biomaterial Bank (RWTH cBMB), Medical Faculty
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, RWTH Aachen University, Aachen
| | | | - Frank Herbstreit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen
| | - Bodo Hölzer
- Department of Nephrology, Ruhr University Bochum, Herne
| | | | | | - Nikolaus Marx
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Aachen
| | | | - Karsten Schmidt
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen
| | - Sarah Skrzypczyk
- Center for Translational Medicine, Ruhr University Bochum, Herne
| | | | - Christian Taube
- Department of Pulmonary Medicine, Ruhrlandklinik, University Hospital Essen
| | | | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen
| | | | | |
Collapse
|
31
|
Lindemann M, Wilde B, Friebus-Kardash J, Gäckler A, Witzke O, Dittmer U, Horn PA, Kribben A, Mülling N, Eisenberger U. Comparison of Humoral and Cellular CMV Immunity in Patients Awaiting Kidney Transplantation. Diagnostics (Basel) 2021; 11:diagnostics11091688. [PMID: 34574029 PMCID: PMC8467335 DOI: 10.3390/diagnostics11091688] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/26/2021] [Accepted: 09/13/2021] [Indexed: 01/05/2023] Open
Abstract
Chronic kidney disease may alter antiviral T cell immunity. In the current study, we assessed in 63 patients prior to kidney transplantation how humoral and cellular immunity against cytomegalovirus (CMV) correlated using an interferon (IFN)-γ ELISpot (T-Track® CMV, Mikrogen, Neuried, Germany). The cohort comprised 24 patients with negative and 39 with positive CMV IgG. Whereas none of the patients with negative CMV IgG showed detectable responses to the T-Track® CMV, 26 out of 39 patients with positive CMV IgG had positive ELISpot responses. The median response to CMV pp65 in the CMV seronegative group was 0 spot forming units (SFU) per 200,000 PBMC (range 0–1) and in the seropositive group 43 SFU (range 0–750). Thus, 13 out of 39 patients with positive CMV serostatus (33%) had undetectable T cell immunity and may be at an increased risk of CMV reactivation. CMV pp65-specific ELISpot responses were 29.3-fold higher in seropositive patients with vs. without dialysis and 5.6-fold higher in patients with vs. without immunosuppressive therapy, but patients with dialysis and immunosuppressive therapy showed, as expected, lower responses to phytohemagglutinin, the positive control. This finding may be caused by (subclinical) CMV-DNAemia and a “booster” of CMV-specific T cells.
Collapse
Affiliation(s)
- Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
- Correspondence: ; Tel.: +49-201-723-4217
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.W.); (J.F.-K.); (A.G.); (A.K.); (N.M.); (U.E.)
| | - Justa Friebus-Kardash
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.W.); (J.F.-K.); (A.G.); (A.K.); (N.M.); (U.E.)
| | - Anja Gäckler
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.W.); (J.F.-K.); (A.G.); (A.K.); (N.M.); (U.E.)
| | - Oliver Witzke
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Essen-Duisburg, 45147 Essen, Germany;
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University Essen-Duisburg, 45147 Essen, Germany;
| | - Peter A. Horn
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.W.); (J.F.-K.); (A.G.); (A.K.); (N.M.); (U.E.)
| | - Nils Mülling
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.W.); (J.F.-K.); (A.G.); (A.K.); (N.M.); (U.E.)
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.W.); (J.F.-K.); (A.G.); (A.K.); (N.M.); (U.E.)
| |
Collapse
|
32
|
Dolff S, Korth J, Jahn M, Kribben A, Witzke O, Wilde B. Anti-SARS-CoV-2 T-cell Responses After mRNA Vaccination in Belatacept-treated Renal Transplant Patients. Transplantation 2021; 105:e99. [PMID: 33966023 DOI: 10.1097/tp.0000000000003812] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
33
|
Berliner C, Boss K, Pape A, Kribben A, Fendler W, Herrmann K. [Oldies (but Goldies): Peritoneal Scintigraphy in Chronic Peritoneal Dialysis Patients]. Nuklearmedizin 2021; 60:450-453. [PMID: 34433221 DOI: 10.1055/a-1542-6247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Kristina Boss
- Klinik für Nephrologie, Universitätsklinikum Essen, Germany
| | - Anke Pape
- Klinik für Nephrologie, Universitätsklinikum Essen, Germany
| | | | | | - Ken Herrmann
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Germany
| |
Collapse
|
34
|
Schönfelder K, Schuh H, Pfister F, Krämer J, Eisenberger U, Skuljec J, Hackert J, Ruck T, Pfeuffer S, Fleischer M, Gäckler A, Hagenacker T, Kribben A, Meuth SG, Kleinschnitz C, Pul R. Autoimmune glomerulonephritis in a multiple sclerosis patient after cladribine treatment. Mult Scler 2021; 27:1960-1964. [PMID: 34165361 PMCID: PMC8521349 DOI: 10.1177/13524585211022719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oral cladribine is an approved disease-modifying drug for the treatment of relapsing multiple sclerosis. In controlled clinical trials as well as in post marketing safety assessments, autoimmune conditions have not yet been reported as a specific side effect of cladribine. OBJECTIVE AND RESULTS Here, we report a case of anti-glomerular basement membrane antibody-mediated glomerulonephritis that occurred shortly after the fourth cladribine treatment cycle. CONCLUSION Neurologists should be attentive to the development of secondary autoimmunity in cladribine-treated patients.
Collapse
Affiliation(s)
- Kristina Schönfelder
- Department of Nephrology, University Medicine Essen, Essen, Germany Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Helene Schuh
- Department of Neurology, University Medicine Essen, Essen, Germany/Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Frederick Pfister
- Department of Nephropathology, University Medicine Erlangen, Erlangen, Germany
| | - Julia Krämer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Ute Eisenberger
- Department of Nephrology, University Medicine Essen, Essen, Germany Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Jelena Skuljec
- Department of Neurology, University Medicine Essen, Essen, Germany/Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Jana Hackert
- Department of Neurology, University Medicine Essen, Essen, Germany/Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Tobias Ruck
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Steffen Pfeuffer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Michael Fleischer
- Department of Neurology, University Medicine Essen, Essen, Germany/Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Anja Gäckler
- Department of Nephrology, University Medicine Essen, Essen, Germany Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Tim Hagenacker
- Department of Neurology, University Medicine Essen, Essen, Germany/Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Medicine Essen, Essen, Germany Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, University Medicine Essen, Essen, Germany/Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Refik Pul
- Department of Neurology, University Medicine Essen, Essen, Germany/Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| |
Collapse
|
35
|
Brune B, Korth J, Dolff S, Wilde B, Siffert W, Kribben A, Witzke O. MO096ROLE OF THE ENDOTHELIN SYSTEM IN THE INTERACTIONS OF THE VASOPRESSOR SYSTEMS IN VIVO IN MEN - IMPORTANCE OF GENETIC HOST FACTORS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab106.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Arterial hypertension is one of the most common diseases of the cardiovascular system worldwide and is still the cause of most deaths in Germany. Data on interactions of the endothelin-system with the renin-angiotensin- and the sympathoadrenergic system in the regulation of systemic hemodynamics in humans are lacking. In our present investigation we study the effects of Endothelin A-, Alpha1- and Angiotensin II-type-1-receptor antagonization on the systemic pressor effects of intravenous Endothelin-1-application in young, healthy men. In addition, we analyzed the effects of the genetic variations of the GNB3 C825T-polymorphism on hemodynamic changes. GNB3 825CT/TT-allele-carriers are considered to have a higher risk for multiple diseases with structural, vascular degeneration, such as arterial hypertension, diabetes mellitus and obesity.
Method
21 healthy male volunteers were included in this double- blind, randomized, placebo-controlled cross-over study and were studied on four days. Endothelin-1 (ET-1) (0.5, 1, 2.5, 5 ng/kg/min for 20 min each) was given intravenous 2.0 hours after oral application of either placebo or Doxazosin, 3.5 hours after oral application of Candesartan (Candesartan 8 mg) or in the presence of a continuous infusion of the ET-A-selective antagonist BQ123 (60 μg/min). Blood pressure (BP) and heart rate (HR) were recorded and total peripheral resistance (TPR) was measured using impedance cardiography. ET-1-dose-response curves were analyzed with ANOVA. Data are presented as mean ± SD. Since we suspected an effect of the GNB3 C825T-polymorphism we divided the overall collective into 2 sub-collectives according to the GNB3 C825T-genotypes (n = 21, GNB3 825CC: n = 10, GNB3 825CT/TT: n = 11). Our analyses considered the overall collective and compared the sub-collectives intraday and interday.
Results
ET-1 increased systolic blood pressure (SBD) (p ≤ 0,01), diastolic blood pressure (DBD) and mean arterial pressure (MBP) as well as total peripheral resistance (TPR) (each p ≤ 0,001) with decreasing heart rate (HR5) (p ≤ 0,05). Elevation of blood pressure existed in both sub-collectives (GNB3 825CC: SBD & MBD: p ≤ 0,01, DBP & TPR: p ≤ 0,05, GNB3 825CT/TT: DBD, MBD & TPR: p ≤ 0,01, SBP p ≤ 0,05).
Antagonization of ETA-receptors reversed the effect in the overall collective as well as in the sub-collectives. Both, Doxazosin, as well as Candesartan led to a decrease in blood pressure, however, dose-response relationship was influenced more by doxazosin (DBD: p ≤ 0,001, MBD: p ≤ 0,01) than by candesartan (all values: p > 0,05). For both drugs, blood pressure and TPR remained elevated under maximum ET-1-application compared to baseline measurement. Blood pressure dependent heart rate changes were observed in the overall collective and in GNB3 825CC-allele-carriers under sole ET-1-therapy (p ≤ 0.05) (Fig. 1). Candesartan reversed the effect of ET-1 on the sub-collectives (p > 0.05). GNB3 825CT/TT-allele-carriers showed no reduction in heart rate under ET-1-application, but with accompanying candesartan therapy (p ≤ 0.01) (Fig. 2). The genotype collectives thus behaved oppositely to the drugs in this respect.
Conclusion
In summary, ET-1 increased systolic, diastolic and mean arterial blood pressure as well as systemic vascular resistance. Doxazosin, Candesartan and BQ123 led to a decrease in blood pressure. Blood pressure and TPR remained elevated under maximum ET-1 application plus Candesartan or Doxazosin. The heart rate changes of the genotype-separated sub-collectives were opposite when ET-1 was administered compared to ET-1 and Candesartan.
Collapse
Affiliation(s)
- Bastian Brune
- University Hospital Essen, Department of Trauma, Hand and Reconstructive Surgery, Essen, Germany
| | - Johannes Korth
- University Hospital Essen, Department of Nephrology, Essen, Germany
| | - Sebastian Dolff
- University Hospital Essen, Department of Infectious Diseases, West German Centre of Infectious Diseases, Essen, Germany
| | - Benjamin Wilde
- University Hospital Essen, Department of Nephrology, Essen, Germany
| | - Winfried Siffert
- University Hospital Essen, Institute for Pharmacogenetics, Essen, Germany
| | - Andreas Kribben
- University Hospital Essen, Department of Nephrology, Essen, Germany
| | - Oliver Witzke
- University Hospital Essen, Department of Infectious Diseases, West German Centre of Infectious Diseases, Essen, Germany
| |
Collapse
|
36
|
Riebeling T, Jamal K, Wilson R, Kolbrink B, von Samson-Himmelstjerna FA, Moerke C, Ramos Garcia L, Dahlke E, Michels F, Lühder F, Schunk D, Doldi P, Tyczynski B, Kribben A, Flüh C, Theilig F, Kunzendorf U, Meier P, Krautwald S. Primidone blocks RIPK1-driven cell death and inflammation. Cell Death Differ 2021; 28:1610-1626. [PMID: 33273695 PMCID: PMC7712602 DOI: 10.1038/s41418-020-00690-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 09/16/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
The receptor-interacting serine/threonine protein kinase 1 (RIPK1) is a key mediator of regulated cell death and inflammation. Recent studies suggest that RIPK1 inhibition would fundamentally improve the therapy of RIPK1-dependent organ damage in stroke, myocardial infarction, kidney failure, and systemic inflammatory response syndrome. Additionally, it could ameliorate or prevent multi-organ failure induced by cytokine release in the context of hyperinflammation, as seen in COVID-19 patients. Therefore, we searched for a RIPK1 inhibitor and present the aromatic antiepileptic and FDA-approved drug primidone (Liskantin®) as a potent inhibitor of RIPK1 activation in vitro and in a murine model of TNFα-induced shock, which mimics the hyperinflammatory state of cytokine release syndrome. Furthermore, we detected for the first time RIPK1 activation in the respiratory tract epithelium of hospitalized patients who tested positive for SARS-CoV-2 infection. Our data provide a strong rationale for evaluating the drug primidone in conditions of hyperinflammation in humans.
Collapse
Affiliation(s)
- Theresa Riebeling
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, 24105, Kiel, Germany
| | - Kunzah Jamal
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
- DDR Biology, Bioscience, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Rebecca Wilson
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
| | - Benedikt Kolbrink
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, 24105, Kiel, Germany
| | | | - Caroline Moerke
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, 24105, Kiel, Germany
| | - Laura Ramos Garcia
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
| | - Eileen Dahlke
- Institute of Anatomy, Christian-Albrechts-University Kiel, 24118, Kiel, Germany
| | - Friederike Michels
- Department of Neurosurgery, University Hospital Schleswig-Holstein, 24105, Kiel, Germany
| | - Fred Lühder
- Institute for Neuroimmunology and Multiple Sclerosis Research, University Medical Center Göttingen, 37075, Göttingen, Germany
| | - Domagoj Schunk
- Department of Emergency Medicine, University Hospital Schleswig-Holstein, 24105, Kiel, Germany
| | - Philipp Doldi
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University Munich, 81377, Munich, Germany
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University Hospital Schleswig-Holstein, 24105, Kiel, Germany
| | - Franziska Theilig
- Institute of Anatomy, Christian-Albrechts-University Kiel, 24118, Kiel, Germany
| | - Ulrich Kunzendorf
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, 24105, Kiel, Germany
| | - Pascal Meier
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK
| | - Stefan Krautwald
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, 24105, Kiel, Germany.
| |
Collapse
|
37
|
Korth J, Jahn M, Dorsch O, Anastasiou OE, Sorge-Hädicke B, Eisenberger U, Gäckler A, Dittmer U, Witzke O, Wilde B, Dolff S, Kribben A. Impaired Humoral Response in Renal Transplant Recipients to SARS-CoV-2 Vaccination with BNT162b2 (Pfizer-BioNTech). Viruses 2021; 13:v13050756. [PMID: 33923063 PMCID: PMC8146144 DOI: 10.3390/v13050756] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [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: 03/19/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/15/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has a major impact on transplant recipients, with mortality rates up to 20%. Therefore, the effect of established messenger RNA (mRNA)-based SARS-CoV-2 vaccines have to be evaluated for solid organ transplant patients (SOT) since they are known to have poor responses after vaccination. We investigated the SARS-CoV-2 immune response via SARS-CoV-2 IgG detection in 23 renal transplant recipients after two doses of the mRNA-based SARS-CoV-2 vaccine BNT162b2 following the standard protocol. The antibody response was evaluated once with an anti-SARS-CoV-2 IgG CLIA 15.8 +/− 3.0 days after the second dose. As a control, SARS-CoV-2 IgG was determined in 23 healthcare workers (HCW) and compared to the patient cohort. Only 5 of 23 (22%) renal transplant recipients were tested positive for SARS-CoV-2 IgG antibodies after the second dose of vaccine. In contrast, all 23 (100%) HCWs were tested positive for antibodies after the second dose. Thus, the humoral response of renal transplant recipients after two doses of the mRNA-based vaccine BNT162b2 (Pfizer-BioNTech, Kronach, Germany) is impaired and significantly lower compared to healthy controls (22% vs. 100%; p = 0.0001). Individual vaccination strategies might be beneficial in these vulnerable patients.
Collapse
Affiliation(s)
- Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
- Correspondence: ; Tel.: +49-201-723-84622
| | - Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
| | - Oliver Dorsch
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, KfH-Nierenzentrum Friesener Straße 37a, 96317 Kronach, Germany;
| | - Olympia Evdoxia Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Burkhard Sorge-Hädicke
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, KfH-Nierenzentrum Alfried-Krupp-Str. 43, 45131 Essen, Germany;
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
| | - Anja Gäckler
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (O.W.); (S.D.)
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (O.W.); (S.D.)
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.J.); (U.E.); (A.G.); (B.W.); (A.K.)
| |
Collapse
|
38
|
Korth J, Wilde B, Dolff S, Frisch J, Jahn M, Krawczyk A, Trilling M, Schipper L, Cordes S, Ross B, Lindemann M, Kribben A, Dittmer U, Witzke O, Herrmann A, Anastasiou OE. SARS-CoV-2 Seroprevalence in Healthcare Workers in Germany: A Follow-Up Study. Int J Environ Res Public Health 2021; 18:4540. [PMID: 33922895 PMCID: PMC8123190 DOI: 10.3390/ijerph18094540] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/14/2021] [Accepted: 04/21/2021] [Indexed: 12/19/2022]
Abstract
SARS-CoV-2 is a worldwide challenge for the medical sector. Healthcare workers (HCW) are a cohort vulnerable to SARS-CoV-2 infection due to frequent and close contact with COVID-19 patients. However, they are also well trained and equipped with protective gear. The SARS-CoV-2 IgG antibody status was assessed at three different time points in 450 HCW of the University Hospital Essen in Germany. HCW were stratified according to contact frequencies with COVID-19 patients in (I) a high-risk group with daily contacts with known COVID-19 patients (n = 338), (II) an intermediate-risk group with daily contacts with non-COVID-19 patients (n = 78), and (III) a low-risk group without patient contacts (n = 34). The overall seroprevalence increased from 2.2% in March-May to 4.0% in June-July to 5.1% in October-December. The SARS-CoV-2 IgG detection rate was not significantly different between the high-risk group (1.8%; 3.8%; 5.5%), the intermediate-risk group (5.1%; 6.3%; 6.1%), and the low-risk group (0%, 0%, 0%). The overall SARS-CoV-2 seroprevalence remained low in HCW in western Germany one year after the outbreak of COVID-19 in Germany, and hygiene standards seemed to be effective in preventing patient-to-staff virus transmission.
Collapse
Affiliation(s)
- Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (B.W.); (M.J.); (A.K.)
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (B.W.); (M.J.); (A.K.)
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (S.D.); (J.F.); (A.K.); (L.S.); (O.W.)
| | - Jasmin Frisch
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (S.D.); (J.F.); (A.K.); (L.S.); (O.W.)
| | - Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (B.W.); (M.J.); (A.K.)
| | - Adalbert Krawczyk
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (S.D.); (J.F.); (A.K.); (L.S.); (O.W.)
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (M.T.); (U.D.); (A.H.); (O.E.A.)
| | - Mirko Trilling
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (M.T.); (U.D.); (A.H.); (O.E.A.)
| | - Leonie Schipper
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (S.D.); (J.F.); (A.K.); (L.S.); (O.W.)
| | - Sebastian Cordes
- Department of Pneumology, University Hospital Essen, University of Duisburg-Essen, Tüschener Weg 40, 45239 Essen, Germany;
| | - Birgit Ross
- Hospital Hygiene, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany;
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (B.W.); (M.J.); (A.K.)
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (M.T.); (U.D.); (A.H.); (O.E.A.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (S.D.); (J.F.); (A.K.); (L.S.); (O.W.)
| | - Anke Herrmann
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (M.T.); (U.D.); (A.H.); (O.E.A.)
| | - Olympia Evdoxia Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (M.T.); (U.D.); (A.H.); (O.E.A.)
| |
Collapse
|
39
|
Schönfelder K, Breuckmann K, Elsner C, Dittmer U, Fistera D, Herbstreit F, Risse J, Schmidt K, Sutharsan S, Taube C, Jöckel KH, Siffert W, Kribben A, Möhlendick B. Transmembrane serine protease 2 Polymorphisms and Susceptibility to Severe Acute Respiratory Syndrome Coronavirus Type 2 Infection: A German Case-Control Study. Front Genet 2021; 12:667231. [PMID: 33968142 PMCID: PMC8097083 DOI: 10.3389/fgene.2021.667231] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022] Open
Abstract
The transmembrane serine protease 2 (TMPRSS2) is the major host protease that enables entry of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) into host cells by spike (S) protein priming. Single nucleotide polymorphisms (SNPs) in the gene TMPRSS2 have been associated with susceptibility to and severity of H1N1 or H1N9 influenza A virus infections. Functional variants may influence SARS-CoV-2 infection risk and severity of Coronavirus disease 2019 (COVID-19) as well. Therefore, we analyzed the role of SNPs in the gene TMPRSS2 in a German case-control study. We performed genotyping of the SNPs rs2070788, rs383510, and rs12329760 in the gene TMPRSS2 in 239 SARS-CoV-2-positive and 253 SARS-CoV-2-negative patients. We analyzed the association of the SNPs with susceptibility to SARS-CoV-2 infection and severity of COVID-19. SARS-CoV-2-positive and SARS-CoV-2-negative patients did not differ regarding their demographics. The CC genotype of TMPRSS2 rs383510 was associated with a 1.73-fold increased SARS-CoV-2 infection risk, but was not correlated to severity of COVID-19. Neither TMPRSS2 rs2070788 nor rs12329760 polymorphisms were related to SARS-CoV-2 infection risk or severity of COVID-19. In a multivariable analysis (MVA), the rs383510 CC genotype remained an independent predictor for a 2-fold increased SARS-CoV-2 infection risk. In summary, our report appears to be the first showing that the intron variant rs383510 in the gene TMPRSS2 is associated with an increased risk to SARS-CoV-2 infection in a German cohort.
Collapse
Affiliation(s)
- Kristina Schönfelder
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Katharina Breuckmann
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carina Elsner
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - David Fistera
- Center of Emergency Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frank Herbstreit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Joachim Risse
- Center of Emergency Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Karsten Schmidt
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Winfried Siffert
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Birte Möhlendick
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
40
|
Jahn M, Korth J, Dorsch O, Anastasiou OE, Sorge-Hädicke B, Tyczynski B, Gäckler A, Witzke O, Dittmer U, Dolff S, Wilde B, Kribben A. Humoral Response to SARS-CoV-2-Vaccination with BNT162b2 (Pfizer-BioNTech) in Patients on Hemodialysis. Vaccines (Basel) 2021; 9:360. [PMID: 33918085 PMCID: PMC8070660 DOI: 10.3390/vaccines9040360] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/01/2021] [Accepted: 04/03/2021] [Indexed: 12/19/2022] Open
Abstract
mRNA-based SARS-CoV-2 vaccines offer a preventive strategy against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections that is of interest in the care of patients on hemodialysis (HDP). We measured humoral immune responses in 72 HDP after standard vaccination with two doses of the mRNA-based SARS-CoV-2 vaccine BNT162b2 (Pfizer-BioNTech). Antibody responses were evaluated with an anti-SARS-CoV-2 IgG ChemiLuminescent ImmunoAssay (CLIA) two weeks after the second dose. In addition, SARS-CoV-2 IgG was determined in a control of 16 healthy healthcare workers (HCW). The control group of HCW has shown a strong antibody response with a median (MD (Q1; Q3)) antibody titer of 800.0 AU/mL (520.5; 800.0). In comparison to HCW, HDP under 60 years of age responded equally (597.0 AU/mL (410.5; 800.0), p = 0.051). However, the antibody responses of the HDP negatively correlated with age (r2 = 0.2954 p < 0.0001), leading to significantly lower antibody titers in HDP over 60 years (280.0 AU/mL (45.7; 477.0), p < 0.0001). To thoroughly understand the immunogenicity of the new mRNA-based vaccines in HDP, longitudinal data on the effectiveness and durability of antibody responses are needed. Modifications of immunization schedules should be considered in HDP with low or without antibody responsiveness after standard vaccination to boost immune reactivity and prolong protective effects in these vulnerable patients.
Collapse
Affiliation(s)
- Michael Jahn
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
| | - Oliver Dorsch
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, KfH-Nierenzentrum Friesener Straße 37a, 96317 Kronach, Germany;
| | - Olympia Evdoxia Anastasiou
- Institute for Virology, University Hospital Essen, University Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Burkhard Sorge-Hädicke
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, KfH-Nierenzentrum Alfried-Krupp-Str. 43, 45131 Essen, Germany;
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
| | - Anja Gäckler
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (O.W.); (S.D.)
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (O.W.); (S.D.)
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
| |
Collapse
|
41
|
Wiechmann A, Wilde B, Tyczynski B, Amann K, Abdulahad WH, Kribben A, Lang KS, Witzke O, Dolff S. CD107a + (LAMP-1) Cytotoxic CD8 + T-Cells in Lupus Nephritis Patients. Front Med (Lausanne) 2021; 8:556776. [PMID: 33834029 PMCID: PMC8021690 DOI: 10.3389/fmed.2021.556776] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 02/22/2021] [Indexed: 01/07/2023] Open
Abstract
Cytotoxic CD8+ T-cells play a pivotal role in the pathogenesis of systemic lupus erythematosus (SLE). The aim of this study was to investigate the role of CD107a (LAMP-1) on cytotoxic CD8+ T-cells in SLE-patients in particular with lupus nephritis. Peripheral blood of SLE-patients (n = 31) and healthy controls (n = 21) was analyzed for the expression of CD314 and CD107a by flow cytometry. Kidney biopsies of lupus nephritis patients were investigated for the presence of CD8+ and C107a+ cells by immunohistochemistry and immunofluorescence staining. The percentages of CD107a+ on CD8+ T-cells were significantly decreased in SLE-patients as compared to healthy controls (40.2 ± 18.5% vs. 47.9 ± 15.0%, p = 0.02). This was even more significant in SLE-patients with inactive disease. There was a significant correlation between the percentages of CD107a+CD8+ T-cells and SLEDAI. The evaluation of lupus nephritis biopsies showed a significant number of CD107a+CD8+ T-cells mainly located in the peritubular infiltrates. The intrarenal expression of CD107a+ was significantly correlated with proteinuria. These results demonstrate that CD8+ T-cells of patients with systemic lupus erythematosus have an altered expression of CD107a which seems to be associated with disease activity. The proof of intrarenal CD107a+CD8+ suggests a role in the pathogenesis of lupus nephritis.
Collapse
Affiliation(s)
- Anika Wiechmann
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
| | - Bartosz Tyczynski
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
- Department of Medical Intensive Care I, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Kerstin Amann
- Department of Nephropathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Wayel H. Abdulahad
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Andreas Kribben
- Department of Nephrology, University Duisburg-Essen, Essen, Germany
| | - Karl Sebastian Lang
- Institute of Immunology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Duisburg-Essen, Essen, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
42
|
Cherneha M, Korth J, Kaulfuß M, Trilling M, Widera M, Rohn H, Dolff S, Babel N, Hoerning A, Kribben A, Witzke O. Reactivations of Latent Viral Infections Are Associated with an Increased Thr389 p70S6k Phosphorylation in Peripheral Lymphocytes of Renal Transplant Recipients. Viruses 2021; 13:v13030424. [PMID: 33800846 PMCID: PMC8000484 DOI: 10.3390/v13030424] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/21/2021] [Accepted: 03/03/2021] [Indexed: 01/19/2023] Open
Abstract
Reactivations of BK polyoma virus (BKPyV) and human cytomegalovirus (HCMV) frequently cause life- and graft-threatening complications after renal transplantation. Both viruses are dependent on the mTOR pathway for replication. In this study we investigated the association of viral replication with mTOR activity in peripheral lymphocytes of renal transplant recipients. A flow-cytometry based assay for the measurement of Thr389 p70S6k phosphorylation, a surrogate marker of the mTOR pathway was established. Forty-eight adult renal transplant recipients were recruited to measure p70S6k activity in their peripheral blood mononuclear cells. This data set in conjunction with information concerning previous replication of BKPyV and HCMV was examined for correlations. Episodes of BKPyV replication were significantly associated with increased p70S6k phosphorylation in CD4+ T lymphocytes (p = 0.0002) and CD19+ B lymphocytes (p = 0.0073). HCMV infection of patients with a high-risk HCMV constellation of donor and recipient (D+/R−) was associated with increased p70S6k phosphorylation in CD19+ B lymphocytes (p = 0.0325). These associations were found to be independent of the trough levels of the immunosuppressive drugs. Conclusion: P70S6k phosphorylation in peripheral lymphocytes is associated with BKPyV reactivations and to a lesser extent with HCMV infections in renal transplant recipients.
Collapse
Affiliation(s)
- Maxim Cherneha
- West German Centre of Infectious Diseases, Department of Infectious Diseases, Universitätsmedizin Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.K.); (H.R.); (S.D.); (O.W.)
- Correspondence: ; Tel.: +49-(0)-201-723-82552
| | - Johannes Korth
- Department of Nephrology, Universitätsmedizin Essen, University Duisburg-Essen, 45147 Essen, Germany; (J.K.); (A.K.)
| | - Meike Kaulfuß
- West German Centre of Infectious Diseases, Department of Infectious Diseases, Universitätsmedizin Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.K.); (H.R.); (S.D.); (O.W.)
| | - Mirko Trilling
- Institute for Virology, Universitätsmedizin Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.T.); (M.W.)
| | - Marek Widera
- Institute for Virology, Universitätsmedizin Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.T.); (M.W.)
| | - Hana Rohn
- West German Centre of Infectious Diseases, Department of Infectious Diseases, Universitätsmedizin Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.K.); (H.R.); (S.D.); (O.W.)
| | - Sebastian Dolff
- West German Centre of Infectious Diseases, Department of Infectious Diseases, Universitätsmedizin Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.K.); (H.R.); (S.D.); (O.W.)
| | - Nina Babel
- Medical Department I, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, 44625 Bochum, Germany;
| | - André Hoerning
- Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - Andreas Kribben
- Department of Nephrology, Universitätsmedizin Essen, University Duisburg-Essen, 45147 Essen, Germany; (J.K.); (A.K.)
| | - Oliver Witzke
- West German Centre of Infectious Diseases, Department of Infectious Diseases, Universitätsmedizin Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.K.); (H.R.); (S.D.); (O.W.)
| |
Collapse
|
43
|
Subburayalu J, Dolff S, Xu S, Sun M, Lindemann M, Heinold A, Heinemann FM, Tervaert JWC, Eisenberger U, Korth J, Brinkhoff A, Kribben A, Witzke O, Wilde B. Characterization of follicular T helper cells and donor-specific T helper cells in renal transplant patients with de novo donor-specific HLA-antibodies. Clin Immunol 2021; 226:108698. [PMID: 33639275 DOI: 10.1016/j.clim.2021.108698] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 12/21/2022]
Abstract
T follicular helper (TFH) cells are a heterogeneous subset of immunocompetent T helper (TH) cells capable of augmenting B cell responses in lymphoid tissues. In transplantation, exposure to allogeneic tissue activates TFH cells increasing the risk of the emergence of de novo donor-specific HLA-antibodies (dnDSA). These can cause antibody-mediated rejection (AMR) and allograft loss. Follicular regulatory T (TFR) cells counteract TFH cell activity. Here, we investigated the implications of TFH and TFR cells on dnDSA formation after renal transplantation (RTX). Considering TFH cells to be CXCR5+ and IL-21+, we found by flow cytometry that patients with dnDSA produced IL-21 more abundantly compared to healthy volunteers. In in vitro alloreactivity assays, patients with dnDSA featured an enhanced alloreactive TH cell pool in response to donor-specific HLA antigens. Besides, longitudinal investigations suggested enhanced alloreactivity shortly after transplantation increasing the risk of dnDSA development. Taken together, in spite of continuous immunosuppression we report a strong IL-21 response in TFH cells and an expanded reservoir of donor-specific memory TH cells in patients with dnDSA. This warrants further investigations if aberrant TFH cell activation may precede the formation of dnDSA promoting AMR.
Collapse
Affiliation(s)
- Julien Subburayalu
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Shilei Xu
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany; Department of General Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510530, China
| | - Ming Sun
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Andreas Heinold
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Falko M Heinemann
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Alexandra Brinkhoff
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany.
| |
Collapse
|
44
|
Fuhrmann V, Perez Ruiz de Garibay A, Faltlhauser A, Tyczynski B, Jarczak D, Lutz J, Weinmann-Menke J, Kribben A, Kluge S. Registry on extracorporeal multiple organ support with the advanced organ support (ADVOS) system: 2-year interim analysis. Medicine (Baltimore) 2021; 100:e24653. [PMID: 33607801 PMCID: PMC7899840 DOI: 10.1097/md.0000000000024653] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/10/2021] [Indexed: 12/31/2022] Open
Abstract
The objective of this registry is to collect data on real-life treatment conditions for patients for whom multiple organ dialysis with Advanced Organ Support (ADVOS) albumin hemodialysis is indicated.This registry was performed under routine conditions and without any study-specific intervention, diagnostic procedures, or assessments. Data on clinical laboratory tests, health status, liver function, vital signs, and examinations were collected (DRKS-ID: DRKS00017068). Mortality rates 28 and 90 days after the first ADVOS treatment, adverse events and ADVOS treatment parameters, including treatment abortions, were documented.This analysis was performed 2 years after the first patient was included on January 18, 2017. As of February 20, 2019, 4 clinical sites in Germany participated and enrolled 118 patients with a median age of 60 (IQR: 45, 69) of whom 70 were male (59.3%). Patients had a median SOFA Score of 14 (IQR: 11, 16) and a predicted mortality of 80%. The median number of failing organs was 3 (IQR: 2, 4).Four hundred twenty nine ADVOS treatments sessions were performed with a median duration of 17 hours (IQR: 6, 23). A 5.8% of the ADVOS sessions (25 of 429) were aborted due to device related errors, while 14.5% (62 of 429) were stopped for other reasons. Seventy nine adverse events were documented, 13 of them device related (all clotting, and all recovered without sequels).A significant reduction in serum creatinine (1.5 vs 1.2 mg/dl), blood urea nitrogen (24 vs 17 mg/dl) and bilirubin (6.9 vs 6.5 mg/dl) was observed following the first ADVOS treatment session. Blood pH, bicarbonate (HCO3-) and base excess returned to the physiological range, while partial pressure of carbon dioxide (pCO2) remained unchanged. At the time of the analysis, 28- and 90-day mortality were 60% and 65%, respectively, compared to an expected ICU-mortality rate of 80%. SOFA score was an independent predictor for outcome in a multivariable logistic regression analysis.The reported data show a high quality and completion of all participating centers. Data interpretation must be cautious due to the small number of patients, and the nature of the registry, without a control group. However, the data presented here show an improvement of expected mortality rates. Minor clotting events similar to other dialysis therapies occurred during the treatments.
Collapse
Affiliation(s)
- Valentin Fuhrmann
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Intensivmedizin, Hamburg, Deutschland
- Universitätsklinikum Münster, Medizinische Klinik B für Gastroenterologie and Hepatologie, Münster
- Evangelisches Krankenhaus Duisburg-Nord, Klinik für Innere Medizin, Duisburg
| | | | | | | | - Dominik Jarczak
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Intensivmedizin, Hamburg, Deutschland
| | - Jens Lutz
- Gemeinschaftsklinikum Mittelrhein, Innere Medizin Nephrologie-Infektiologie, Koblenz
| | - Julia Weinmann-Menke
- Universitätsmedizin Mainz, I. Medizinische Klinik and Poliklinik, Mainz, Germany
| | | | - Stefan Kluge
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Intensivmedizin, Hamburg, Deutschland
| |
Collapse
|
45
|
Boss K, Kribben A, Tyczynski B. Pathological findings in rotation thromboelastometry associated with thromboembolic events in COVID-19 patients. Thromb J 2021; 19:10. [PMID: 33573670 PMCID: PMC7877314 DOI: 10.1186/s12959-021-00263-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Severe thromboembolic events are one of the major complications associated with COVID-19 infection, especially among critically ill patients. We analysed ROTEM measurements in COVID-19 patients with a severe disease course and in patients with severe sepsis. Methods In this study, data obtained by extended analysis of haemostasis with standard laboratory tests and thromboelastometry of 20 patients with severe course of COVID-19 were retrospectively analysed and compared with similar data from 20 patients with severe sepsis but no COVID-19. Results The thromboelastometry values obtained from 20 sepsis patients contained a maximum clot firmness above the normal range but among COVID-19 patients, hypercoagulability was much more pronounced, with significantly higher maximum clot firmness (FIBTEM: 38.4 ± 10.1 mm vs. 29.6 ± 10.8 mm; P = 0.012; EXTEM: 70.4 ± 10.4 mm vs. 60.6 ± 14.8 mm; P = 0.022). Additionally, fibrinogen levels were significantly higher among COVID-19 patients (757 ± 135 mg/dl vs. 498 ± 132 mg/dl, P < 0.0001). Furthermore, thromboelastometry showed fibrinolysis shutdown among COVID-19 patients with significantly lower maximum of lysis than among sepsis patients (EXTEM: 0.6 ± 1.2 % vs. 3.3 ± 3.7 %; P = 0.013). Seven of 20 COVID-19 patients experienced thromboembolic events, whereas no patient in the sepsis group experienced such events. Conclusions ROTEM analysis showed significantly different pathological findings characterized by hypercoagulability and fibrinolysis shutdown among COVID-19 patients with a severe disease course compared to patients with severe sepsis. These abnormalities seem to be associated with thromboembolic events.
Collapse
Affiliation(s)
- Kristina Boss
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Department of Medical Intensive Care I, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
46
|
Boss K, Jahn M, Wendt D, Haidari Z, Demircioglu E, Thielmann M, Ruhparwar A, Kribben A, Tyczynski B. Extracorporeal cytokine adsorption: Significant reduction of catecholamine requirement in patients with AKI and septic shock after cardiac surgery. PLoS One 2021; 16:e0246299. [PMID: 33556101 PMCID: PMC7870055 DOI: 10.1371/journal.pone.0246299] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/19/2021] [Indexed: 12/27/2022] Open
Abstract
Background Extracorporeal cytokine adsorption is an option in septic shock as an additional measure to treat a pathological immune response. Purpose of this study was to investigate the effects of extracorporeal cytokine adsorption on hemodynamic parameters in patients with acute kidney injury (AKI) on continuous renal replacement therapy (CRRT) and septic shock after cardiac surgery. Methods In this retrospective study, a total of 98 patients were evaluated. Hemoadsorption was performed by the CytoSorb® adsorber. In all patients cytokine adsorption was applied for at least 15 hours and at least one adsorber was used per patient. To compare cumulative inotrope need in order to maintain a mean arterial pressure (MAP) of ≥ 65 mmHg, we applied vasoactive score (VAS) for each patient before and after cytokine adsorption. A paired t-test has been performed to determine statistical significance. Results Before cytokine adsorption the mean VAS was 56.7 points. This was statistically significant decreased after cytokine adsorption (27.7 points, p< 0.0001). Before cytokine adsorption, the mean noradrenalin dose to reach a MAP of ≥ 65 mmHg was 0.49 μg/kg bw/min, the mean adrenalin dose was 0.12 μg/kg bw/min. After cytokine adsorption, significantly reduced catecholamine doses were necessary to maintain a MAP of ≥ 65 mmHg (0.24 μg/kg bw/min noradrenalin; p< 0.0001 and 0.07 μg/kg bw/min adrenalin; p < 0.0001). Moreover, there was a significant reduction of serum lactate levels after treatment (p< 0.0001). The mean SOFA-score for these patients with septic shock and AKI before cytokine adsorption was 16.7 points, the mean APACHE II-score was 30.2 points. The mean predicted in-hospital mortality rate based on this SOFA-score of 16.7 points was 77,0%, respectively 73,0% on APACHE II-score, while the all-cause in-hospital mortality rate of the patients in this study was 59.2%. Conclusion In patients with septic shock and AKI undergoing cardiac surgery, extracorporeal cytokine adsorption could significantly lower the need for postoperative inotropes. Additionally, observed versus SOFA- and APACHE II-score predicted in-hospital mortality rate was decreased.
Collapse
Affiliation(s)
- Kristina Boss
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- * E-mail:
| | - Michael Jahn
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart & Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Zaki Haidari
- Department of Thoracic and Cardiovascular Surgery, West German Heart & Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ender Demircioglu
- Department of Thoracic and Cardiovascular Surgery, West German Heart & Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart & Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart & Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
47
|
Boss K, Woywodt A, Kribben A, Mülling N, Becker S. Digitale Nephrologie. Nephrologe 2021; 16:57-61. [PMID: 33425034 PMCID: PMC7784214 DOI: 10.1007/s11560-020-00478-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 10/31/2022]
|
48
|
Hoyer DP, Dittmann S, Büscher A, Benkö T, Treckmann JW, Gallinat A, Kribben A, Paul A, Hoyer PF. Kidney transplantation with allografts from infant donors-Small organs, big value. Pediatr Transplant 2020; 24:e13794. [PMID: 32757309 DOI: 10.1111/petr.13794] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/04/2020] [Accepted: 06/28/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although infant organ donors remain a rare source of organs for transplantation, technical challenges have resulted in increased rates of complications and inferior graft function. The aim of the present study was to investigate the outcomes of kidneys procured from juvenile and infant donors. PATIENTS AND METHODS We evaluated all kidney transplants from deceased donors < 16 years of age performed at our center between 01/2008 and 08/2019. We defined three groups based on quartiles of donor body weight: <13 kg (infant donors), 13-40 kg (juvenile donors), and > 40 kg (standard criteria donors). Clinical characteristics and outcomes were compared between groups. RESULTS Ninety-two transplants were included in this study. Out of 92 recipients, there were 32 (34.8%) adult and 60 (65.2%) pediatric patients. All groups demonstrated excellent graft function and survival on both short and long-term follow-up. 1-year, 3-year, and 5-year graft survival rates for the standard criteria donor group were 100%, 95.2%, and 88.4%, respectively, compared with 95.8% for infant and 95% for juvenile donors at all times (P = .79). eGFR at 5 years was 98.9 ± 5.5, 74.1 ± 6.2, and 81.6 ± 6.9 mL/min/1.73 m2 for infant, juvenile, and standard criteria donors, respectively (P < .01). CONCLUSION Infant donor allografts can be transplanted with excellent long-term outcomes in both pediatric and adult recipients. Implanting them as single allografts onto pediatric candidates allows for the transplantation of two patients. As such, pediatric recipients should be prioritized for these donor organs.
Collapse
Affiliation(s)
- Dieter Paul Hoyer
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Susanne Dittmann
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Anja Büscher
- Pediatric Nephrology, University Hospital Essen, Essen, Germany
| | - Tamas Benkö
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | | | - Anja Gallinat
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Andreas Paul
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | | |
Collapse
|
49
|
Boss K, Wiegard-Szramek I, Dziobaka J, Kribben A, Dolff S. Intraperitoneal ampicillin treatment for peritoneal dialysis- related peritonitis with Listeria monocytogenes - a case report. BMC Nephrol 2020; 21:404. [PMID: 32948148 PMCID: PMC7501657 DOI: 10.1186/s12882-020-02068-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD)-related peritonitis is a rare but serious complication and is associated with increased morbidity and mortality rates. It is most commonly caused by Staphylococcus aureus or Staphylococcus epidermidis, but infection with Listeria monocytogenes may also occur. Recommendations for antibiotic treatment of a Listeria infection are currently based on a small number of case reports and suggest the administration of ampicillin. But unlike vancomycin or gentamicin, for ampicillin the route of application, the dosage, and the duration of treatment have not yet been established. We report a case in which PD-associated peritonitis due to Listeria infection was treated with ampicillin administered intravenously and intraperitoneally, separately and in combination. CASE PRESENTATION A 72-year-old man with chronic kidney disease stage 5 dialysis (CKDG5D) secondary to hypertension and diabetes was hospitalised in April 2020 because of PD-related peritonitis caused by a Listeria infection. In accordance with the results of resistance tests, the patient was treated with intravenous ampicillin at a dosage of 6 g twice daily. After initial treatment the leukocyte count in the PD effluent had decreased substantially, but it was permanently reduced only with the addition of intraperitoneal ampicillin (4 g daily). Efficient serum concentrations of ampicillin were determined for both routes of administration, intravenous and intraperitoneal. CONCLUSION This is the first case report demonstrating that PD-related peritonitis due to Listeria monocytogenes infection can be treated with intraperitoneal ampicillin and monitored by the determination of peripheral serum concentrations of ampicillin.
Collapse
Affiliation(s)
- Kristina Boss
- Department of Nephrology, University Hospital Essen, University-Duisburg Essen, 45147, Essen, Germany.
| | - Ina Wiegard-Szramek
- Department of Nephrology, University Hospital Essen, University-Duisburg Essen, 45147, Essen, Germany
| | - Jan Dziobaka
- Institute of Medical Microbiology, University Hospital Essen, University-Duisburg Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University-Duisburg Essen, 45147, Essen, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, University Hospital Essen, University-Duisburg Essen, Essen, Germany
| |
Collapse
|
50
|
Haase-Fielitz A, Elitok S, Schostak M, Ernst M, Isermann B, Albert C, Robra BP, Kribben A, Haase M. The Effects of Intensive Versus Routine Treatment in Patients with Acute Kidney Injury. Dtsch Arztebl Int 2020; 117:289-296. [PMID: 32530412 DOI: 10.3238/arztebl.2020.0289] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 10/17/2019] [Accepted: 02/10/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND In patients with acute kidney injury (AKI), specialized treatment-initiated in response to an early-warning system- may be beneficial compared with routine treatment. METHOD To explore effect estimators in a pilot trial (DRKS00010530), patients with AKI on regular wards of a university hospital were treated either in the usual way (control group) or more intensively (intervention group). The subjects were allotted randomly to the two treatment groups. The more intensive treatment consisted of an early warning system for a rise in the serum creatinine concentration, immediate consultation of a specialist, and the issuance of a patient kidney passport. The primary endpoint was recovery of renal function after AKI during the index hospitalization. Renal complications and process indicators were the secondary endpoints. RESULTS The proportion of patients whose renal function returned to baseline after AKI was 50% in the intervention group (N = 26) and 42% in the control group (N = 26) (odds ratio 1.4, 95% confidence interval [0.5; 4.0], p = 0.58). The calculated glomerular filtration rate went down, from hospital admission to discharge, by 3 mL/min/1.73 m2 (1st-3rd quartile: [6; -20]) in the intervention group and by 13 mL/min/1.73 m2 in the control group (1st-3rd quartile: [0; -25]; p = 0.09). Complications of AKI such as hyperkalemia, pulmonary edema, and renal acidosis were rarer in the intervention group (15% versus 39%; p = 0.03). In the intervention group, compared with the control group, the cause of AKI was identified more frequently (27% versus 4%; p = 0.05); drugs with relevance to the kidney were discontinued more frequently (65% versus 31%; p = 0.01); and the diagnosis of AKI was more frequently documented in the patient's chart (58% versus 37%; p = 0.03). CONCLUSION Specialized consultations supported by an early warning system for AKI seem to be beneficial for patients. The findings of this pilot trial should be verified in larger-scale randomized controlled trials.
Collapse
Affiliation(s)
- Anja Haase-Fielitz
- Department of Cardiology, Brandenburg Heart Center, Immanuel Hospital, Bernau; Brandenburg Medical School Theodor Fontane; Institute of Social Medicine and Health Systems Research, Magdeburg University, Magdeburg; Department of Nephrology and Endocrinology, Ernst von Bergmann Hospital, Potsdam; Department of Urology and Pediatric Urology, Magdeburg University Hospital, Magdeburg; Department of Orthopedics and Trauma Surgery, Ameos Hospital, Schönebeck; Institute of Laboratory Medicine, Leipzig University Hospital, Leipzig; Diaverum Renal Care Center Am Neuen Garten, Potsdam; Faculty of Medicine, Otto-von-Guericke University of Magdeburg; Department of Nephrology, Essen University Hospital, Essen
| | | | | | | | | | | | | | | | | |
Collapse
|