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Lenz C, Slack MPE, Shea KM, Reinert RR, Taysi BN, Swerdlow DL. Long-Term effects of COVID-19: a review of current perspectives and mechanistic insights. Crit Rev Microbiol 2024; 50:315-328. [PMID: 37074754 DOI: 10.1080/1040841x.2023.2190405] [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: 01/05/2022] [Accepted: 02/25/2023] [Indexed: 04/20/2023]
Abstract
Although SARS-CoV-2, responsible for COVID-19, is primarily a respiratory infection, a broad spectrum of cardiac, pulmonary, neurologic, and metabolic complications can occur. More than 50 long-term symptoms of COVID-19 have been described, and as many as 80% of patients may develop ≥1 long-term symptom. To summarize current perspectives of long-term sequelae of COVID-19, we conducted a PubMed search describing the long-term cardiovascular, pulmonary, gastrointestinal, and neurologic effects post-SARS-CoV-2 infection and mechanistic insights and risk factors for the above-mentioned sequelae. Emerging risk factors of long-term sequelae include older age (≥65 years), female sex, Black or Asian race, Hispanic ethnicity, and presence of comorbidities. There is an urgent need to better understand ongoing effects of COVID-19. Prospective studies evaluating long-term effects of COVID-19 in all body systems and patient groups will facilitate appropriate management and assess burden of care. Clinicians should ensure patients are followed up and managed appropriately, especially those in at-risk groups. Healthcare systems worldwide need to develop approaches to follow-up and support patients recovering from COVID-19. Surveillance programs can enhance prevention and treatment efforts for those most vulnerable.
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Affiliation(s)
| | - Mary P E Slack
- Griffith University, School of Medicine and Dentistry, Griffith University Gold Coast campus, Queensland, Australia
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Reis F, Lenz C. Performance of Artificial Intelligence (AI)-Powered Chatbots in the Assessment of Medical Case Reports: Qualitative Insights From Simulated Scenarios. Cureus 2024; 16:e53899. [PMID: 38465163 PMCID: PMC10925004 DOI: 10.7759/cureus.53899] [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] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction With the expanding awareness and use of AI-powered chatbots, it seems possible that an increasing number of people could use them to assess and evaluate their medical symptoms. If chatbots are used for this purpose, that have not previously undergone a thorough medical evaluation for this specific use, various risks might arise. The aim of this study is to analyze and compare the performance of popular chatbots in differentiating between severe and less critical medical symptoms described from a patient's perspective and to examine the variations in substantive medical assessment accuracy and empathetic communication style among the chatbots' responses. Materials and methods Our study compared three different AI-supported chatbots - OpenAI's ChatGPT 3.5, Microsoft's Bing Chat, and Inflection's Pi AI. Three exemplary case reports for medical emergencies as well as three cases without an urgent reason for an emergency medical admission were constructed and analyzed. Each case report was accompanied by identical questions concerning the most likely suspected diagnosis and the urgency of an immediate medical evaluation. The respective answers of the chatbots were qualitatively compared with each other regarding the medical accuracy of the differential diagnoses mentioned and the conclusions drawn, as well as regarding patient-oriented and empathetic language. Results All examined chatbots were capable of providing medically plausible and probable diagnoses and classifying situations as acute or less critical. However, their responses varied slightly in the level of their urgency assessment. Clear differences could be seen in the level of detail of the differential diagnoses, the overall length of the answers, and how the chatbot dealt with the challenge of being confronted with medical issues. All given answers were comparable in terms of empathy level and comprehensibility. Conclusion Even AI chatbots that are not designed for medical applications already offer substantial guidance in assessing typical medical emergency indications but should always be provided with a disclaimer. In responding to medical queries, characteristic differences emerge among chatbots in the extent and style of their respective answers. Given the lack of medical supervision of many established chatbots, subsequent studies, and experiences are essential to clarify whether a more extensive use of these chatbots for medical concerns will have a positive impact on healthcare or rather pose major medical risks.
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Affiliation(s)
- Florian Reis
- Medical Affairs, Pfizer Pharma GmbH, Berlin, DEU
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Sommer P, Spitzer S, Brachmann J, Janssen G, Lenz C, Luik A, Sarver A, Szili-Torok T. Final results from the EU focal impulse and rotor modulation (E-FIRM) registry. Europace 2021. [DOI: 10.1093/europace/euab116.089] [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
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abbott
Background
The exact pathophysiology of how pulmonary vein (PV) triggers initiate or maintain episodes of atrial fibrillation (AF) has been elusive. Catheter ablation at relatively circumscribed areas of rapidly spinning rotors or very rapid focal impulse formation can significantly affect AF. Targeted ablation of these sources using Focal Impulse and Rotor Modulation (FIRM™) shows promise.
Purpose
To assess the safety and effectiveness of FIRM-guided procedures for the treatment of any type of symptomatic atrial fibrillation (AF).
Methods
Two hundred and ninety-nine subjects were enrolled in the E-FIRM Registry at 9 clinical sites in Germany and the Netherlands. Subjects were eligible if they had reported incidence of at least 2 documented episodes of symptomatic AF during the preceding 3 months and had failed at least Class I or III anti-arrhythmia drug. Data was collected at enrollment/baseline, procedure, and at 3-, 6-, and 12-month follow-up visits.
Results
A majority (59.5%, 178/299) had a history of previous ablation, 81.1% (133/164) in the left side, with an average of 1.5 ± 0.8 [range 0, 5] prior ablations. The primary safety endpoint was defined as freedom from procedure related Serious Adverse Events (SAEs) through 7-days and at 12-months. At 7-days, freedom from procedure related SAEs was 94.8% (257/271). At 12-months, freedom from procedure related SAEs was 84.4% (184/218). There were no deaths. Acute effectiveness success, defined as the elimination of all identified rotors, occurred in 64.0% (165/258) of treated patients. All patients for which data was reported had at least 1 rotor identified. The most common regions to find rotors were the lateral wall of the right atrium, the anterior/septal wall of the left atrium, and the posterior inferior region of the left atrium. 75.2% (194/258) of patients had at least one rotor identified in the right atrium, and 84.1% (217/258) of patients had at least one rotor identified in the left atrium. Success was defined as two sequential endpoints: single procedure freedom from AF recurrence at 3-months and single procedure freedom from AF recurrence. At 12-months, success was achieved in 46.4% (13/28) Paroxysmal, 42.9% (87/203) Persistent, and 0% (0/9) Long Standing AF subjects. Conclusions: Since acute success was reported as being achieved in only ∼2/3 of the treated subjects, it is possible that the full potential benefit of the FIRM-guided ablation was hidden in this evaluation of the full cohort. Considering the previous ablation and disease history of subjects, a single-procedure success rate at 12-months over 40% was considered a positive result. Based on these results, FIRM-guided RF ablation in conjunction with conventional RF ablation practices is both a safe and effective treatment strategy for patients with symptomatic AF.
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Affiliation(s)
- P Sommer
- Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - S Spitzer
- Praxis Klinik-Dresden, Dresden, Germany
| | | | - G Janssen
- Kardiologische Gemeinschaftspraxis am Park Sanssouci, Potsdam, Germany
| | - C Lenz
- UKB Berlin, Berlin, Germany
| | - A Luik
- Stadtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - A Sarver
- Abbott Laboratories, Plymouth, United States of America
| | - T Szili-Torok
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
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Proff J, Merkely B, Papp R, Lenz C, Nordbeck P, Butter CH, Meyerhoefer J, Doering M, Maccarter DJ, Ingel K, Thouet TH, Roser M. Closed loop stimulation in heart failure patients with severe chronotropic incompetence: responder versus non-responders. Europace 2021. [DOI: 10.1093/europace/euab116.442] [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
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Biotronik SE & Co. KG Woermannkehre 1 12359 Berlin
Background
The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. Rate-adaptive pacing (RAP) is an important treatment option for CI. However, only a proportion of HF patients treated with cardiac resynchronisation therapy (CRT) devices benefit from accelerometer-based RAP in terms of exercise tolerance, functional capacity, and quality of life (QoL). Further research is needed to identify patient characteristics predicting positive response to RAP, and to evaluate performance of alternative sensors such as closed loop stimulation (CLS) driven by cardiac impedance measurements. An optimal outcome measure is represented by ventilatory efficiency (VE) slope during cardio-pulmonary exercise test (CPX) because of superior prognostic value.
Purpose
The purpose of the BIO|Create pilot study was to assess the benefit of CLS in CRT patients with CI. In this predefined subanalysis, we identify predictors of positive response to CLS (reduction of VE slope by ≥5%) and compare study outcomes in responders vs non-responders.
Methods
The study enrolled CRT patients with NYHA class II or III and severe CI (<75% of age-predicted maximum heart rate [HR] or <50% of HR reserve utilised at end-exercise). Patients were randomised to DDD-CLS mode or to DDD pacing at 40 beats/min for 1 month, followed by crossover for another month. At 1- and 2-month follow-ups, exercise tolerance was assessed by treadmill CPX, functional capacity by 6-min walk test, and QoL by the EQ-5D-5L and Minnesota Living with HF (MLHFQ) questionnaires.
Results
Among 17 patients with full follow-up datasets, 8 (47%) were responders to CLS. Compared to non-responders, responders had larger left ventricular (LV) ejection fraction at baseline (46 ± 3 vs 36 ± 9 %; p = 0.0070), smaller end-diastolic (121 ± 34 vs 181 ± 41 ml; p = 0.0085) and end-systolic (65 ± 23 vs 114 ± 39 ml; p = 0.0076) LV volumes, and were predominantly in NYHA class II (p = 0.0498). For study outcomes, the mean difference between DDD-CLS and DDD-40 modes in responders vs non-responders was - 6.1 (-16.4%) vs +2.7 (+6.8%) for VE slope (both p < 0.05), +0.5 vs -0.2 ml/min (O2 uptake efficiency slope), +1.3 vs -0.3 ml/kg/min (peak O2 uptake), +1.4 vs -0.75 mmHg (end-exercise end-tidal CO2), 16 vs 7 m (6-min walk distance), 0.08 vs 0.06 (EQ-5D-5L index), 1.9 vs 0 (EQ-5D-5L scale), and -2.5 vs +1.75 (MLHFQ).
Conclusions
For the first time, predictors for positive outcome of RAP in CRT patients have been identified. Patients with less advanced HF were responders to RAP driven by CLS principle. In addition, a consistent increase in exercise and functional capacity and QoL in these patients could be achieved. In contrast, patients with advanced HF experienced worse exercise capacity and QoL during RAP, suggesting caution if RAP is desirable due to CI. Further clinical research is needed to evaluate if positive response to RAP can improve hard clinical outcomes.
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Affiliation(s)
- J Proff
- Charite Universitatsmedizin Berlin, Berlin, Germany
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - R Papp
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - C Lenz
- UKB Berlin, Berlin, Germany
| | - P Nordbeck
- University Hospital Wuerzburg, Wuerzburg, Germany
| | - CH Butter
- Brandenburg Heart Center, Bernau bei Berlin, Germany
| | - J Meyerhoefer
- Maria Heimsuchung Caritas-Clinic Pankow, Berlin, Germany
| | - M Doering
- Heart Center of Leipzig, Leipzig, Germany
| | - DJ Maccarter
- Castle Pines , Castle Point Circle, United States of America
| | - K Ingel
- Biotronik SE & Co. KG, Berlin, Germany
| | - TH Thouet
- Charite Universitatsmedizin Berlin, Berlin, Germany
| | - M Roser
- Charite Universitatsmedizin Berlin, Berlin, Germany
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5
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Proff J, Merkely B, Papp R, Lenz C, Nordbeck P, Butter C, Meyerhoefer J, MacCarter D, Thouet T, Roser M. Creation of physiologic rhythm by closed loop stimulation in heart failure patients with severe chronotropic incompetence: worldwide first results of a pilot study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI.
Purpose
This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients.
Methods
A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL.
Results
Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13).
Conclusion
First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG
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Affiliation(s)
- J Proff
- Charite Universitatsmedizin Berlin, Berlin, Germany
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - R Papp
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - C Lenz
- UKB Berlin, Berlin, Germany
| | - P.J Nordbeck
- University Hospital Wuerzburg, Wuerzburg, Germany
| | - C.H Butter
- Brandenburg Heart Center, Bernau bei Berlin, Germany
| | - J Meyerhoefer
- Maria Heimsuchung Caritas-Clinic Pankow, Berlin, Germany
| | - D MacCarter
- Shape Medical System Inc., Denver, United States of America
| | - T.H Thouet
- Charite Universitatsmedizin Berlin, Berlin, Germany
| | - M Roser
- Charite Universitatsmedizin Berlin, Berlin, Germany
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Schenk S, Terne A, Keweloh B, Lenz C, Zacharzowsky U, Fritzsche D. Combination of cryothermy with radiofrequency energy sources during hybrid atrial fibrillation ablation- impact on lesion quality and outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Whereas pulmonary vein isolation lays the groundwork of endocardial atrial fibrillation (AF) ablation, it leaves patients undertreated. Additional substrate modification of the left atrium is often required, but lesion gaps and non-transmurality limit restoration of sinus rhythm. Moreover, some low voltage areas and conduction abnormalities are located exclusively on the epicardial aspect, and endocardial ablation alone does not address these issues. Our hybrid endo-/epicardial ablation strategy overcomes all these shortcomings.
Purpose
To test if the combination of epicardial cryo and radiofrequency (RF) ablation (dual) further improves the quality of ablation lines, and if the combined endo-/epicardial ablation can treat intractable cases of AF.
Methods
Twenty-six patients (13 paroxysmal, 13 long-persistent; 20 patients with 1–5 prior endocardial AF ablations) first underwent epicardial, total thoracoscopic beating heart ablation (TTA). Lesion sets included bilateral PVI, left atrial appendage closure, as well as superior (roof) and inferior (floor) interpulmonary vein lines. Roof and floor lines were alternatingly ablated by dual energy or RF only. Three months post TTA, endocardial mapping with optional gap closure completed this two-stage hybrid concept.
Results
Intraoperatively, 24 of 40 (60%) previous left or right endocardial PVIs were found incomplete. Apart from two post-TTA pacemaker insertions and one mini-thoracotomy for bleeding, respectively, no major morbidity was observed during follow up. The full protocol of the hybrid concept was applied in 24 patients. Forty-five of 47 (96%) epicardial PVIs were found gap-less during endocardial mapping, and the remaining 2 PVIs were readily re-ablated. In contrast, only 32 of 46 (70%) roof and floor lines were complete, and endocardial touch up was required in one of three patients. Of note, dual energy lines were more likely to be complete than RF only lines (17 of 22, 77%, vs. 15 of 24, 62%; p NS). Among 19 patients with continuous monitoring, only 4 (21%) had any AF burden including two patients within blanking period and before endocardial gap closure. The remaining 7 patients without continuous monitoring never experienced any symptoms related to recurrent AF, and serial Holter EKG were without pathology.
Conclusions
Hybrid ablation and dual energy provides a strong armamentarium for extra-pulmonary venous triggers of AF. Linear ablation lines were more likely to be gap-less and transmural, if dual energy sources were used. Dual energy TTA is highly efficient to restore sinus rhythm in patients with prior failed endocardial AF ablation. However, one of three patients will require endocardial gap closure to realize the full benefit of our two-stage hybrid concept. Further study will evaluate if dual energy lines outside the box can improve outcome in these challenging cases of intractable AF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Schenk
- Sana-Heart Centre Cottbus, Cottbus, Germany
| | - A Terne
- Sana-Heart Centre Cottbus, Cottbus, Germany
| | - B Keweloh
- Hirslanden-Klinik im Park, Cardiology, Zurich, Switzerland
| | - C Lenz
- UKB Berlin, Cardiology, Berlin, Germany
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Barbarics B, Eildermann K, Kaderali L, Cyganek L, Paul T, Ströbel P, Urlaub H, Tirilomis T, Lenz C, Bohnenberger H. Proteomic Mapping of Atrial and Ventricular Protein Abundance in Patients with Aortic Valve Stenosis. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705541] [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: 10/24/2022]
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Klamt T, Schwarz M, Lenz C, Baccelliere L, Buongiorno D, Cichon T, DiGuardo A, Droeschel D, Gabardi M, Kamedula M, Kashiri N, Laurenzi A, Leonardis D, Muratore L, Pavlichenko D, Periyasamy AS, Rodriguez D, Solazzi M, Frisoli A, Gustmann M, Roßmann J, Süss U, Tsagarakis NG, Behnke S. Remote mobile manipulation with the centauro robot: Full‐body telepresence and autonomous operator assistance. J FIELD ROBOT 2019. [DOI: 10.1002/rob.21895] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tobias Klamt
- Autonomous Intelligent Systems University of Bonn Bonn Germany
| | - Max Schwarz
- Autonomous Intelligent Systems University of Bonn Bonn Germany
| | - Christian Lenz
- Autonomous Intelligent Systems University of Bonn Bonn Germany
| | | | | | - Torben Cichon
- Man‐Machine Interaction RWTH Aachen University Aachen Germany
| | - Antonio DiGuardo
- PERCRO Laboratory TeCIP Institute, Scuola Superiore Sant'Anna Pisa Italy
| | - David Droeschel
- Autonomous Intelligent Systems University of Bonn Bonn Germany
| | | | | | - Navvab Kashiri
- Department of Advanced Robotics Italian Institute of Technology Genoa Italy
| | - Arturo Laurenzi
- Department of Advanced Robotics Italian Institute of Technology Genoa Italy
| | - Daniele Leonardis
- PERCRO Laboratory TeCIP Institute, Scuola Superiore Sant'Anna Pisa Italy
| | - Luca Muratore
- Department of Advanced Robotics Italian Institute of Technology Genoa Italy
- School of Electrical and Electronic Engineering The University of Manchester Manchester Great Britain UK
| | | | | | - Diego Rodriguez
- Autonomous Intelligent Systems University of Bonn Bonn Germany
| | | | - Antonio Frisoli
- PERCRO Laboratory TeCIP Institute, Scuola Superiore Sant'Anna Pisa Italy
| | | | - Jürgen Roßmann
- Man‐Machine Interaction RWTH Aachen University Aachen Germany
| | - Uwe Süss
- Kerntechnische Hilfsdienst GmbH Karlsruhe Germany
| | | | - Sven Behnke
- Autonomous Intelligent Systems University of Bonn Bonn Germany
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Schwarz M, Droeschel D, Lenz C, Periyasamy AS, Puang EY, Razlaw J, Rodriguez D, Schüller S, Schreiber M, Behnke S. Team NimbRo at MBZIRC 2017: Autonomous valve stem turning using a wrench. J FIELD ROBOT 2018. [DOI: 10.1002/rob.21826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Max Schwarz
- Autonomous Intelligent Systems; University of Bonn; Bonn Germany
| | - David Droeschel
- Autonomous Intelligent Systems; University of Bonn; Bonn Germany
| | - Christian Lenz
- Autonomous Intelligent Systems; University of Bonn; Bonn Germany
| | | | | | - Jan Razlaw
- Autonomous Intelligent Systems; University of Bonn; Bonn Germany
| | - Diego Rodriguez
- Autonomous Intelligent Systems; University of Bonn; Bonn Germany
| | | | | | - Sven Behnke
- Autonomous Intelligent Systems; University of Bonn; Bonn Germany
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Abstract
BACKGROUND Recent evidence shows that the serotonin 2A receptor (5-hydroxytryptamine2A receptor, 5-HT2AR) is critically involved in the formation of visual hallucinations and cognitive impairments in lysergic acid diethylamide (LSD)-induced states and neuropsychiatric diseases. However, the interaction between 5-HT2AR activation, cognitive impairments and visual hallucinations is still poorly understood. This study explored the effect of 5-HT2AR activation on response inhibition neural networks in healthy subjects by using LSD and further tested whether brain activation during response inhibition under LSD exposure was related to LSD-induced visual hallucinations. METHODS In a double-blind, randomized, placebo-controlled, cross-over study, LSD (100 µg) and placebo were administered to 18 healthy subjects. Response inhibition was assessed using a functional magnetic resonance imaging Go/No-Go task. LSD-induced visual hallucinations were measured using the 5 Dimensions of Altered States of Consciousness (5D-ASC) questionnaire. RESULTS Relative to placebo, LSD administration impaired inhibitory performance and reduced brain activation in the right middle temporal gyrus, superior/middle/inferior frontal gyrus and anterior cingulate cortex and in the left superior frontal and postcentral gyrus and cerebellum. Parahippocampal activation during response inhibition was differently related to inhibitory performance after placebo and LSD administration. Finally, activation in the left superior frontal gyrus under LSD exposure was negatively related to LSD-induced cognitive impairments and visual imagery. CONCLUSION Our findings show that 5-HT2AR activation by LSD leads to a hippocampal-prefrontal cortex-mediated breakdown of inhibitory processing, which might subsequently promote the formation of LSD-induced visual imageries. These findings help to better understand the neuropsychopharmacological mechanisms of visual hallucinations in LSD-induced states and neuropsychiatric disorders.
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Affiliation(s)
- A Schmidt
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
| | - F Müller
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
| | - C Lenz
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
| | - P C Dolder
- Division of Clinical Pharmacology and Toxicology,Department of Biomedicine and Department of Clinical Research,University of Basel, University Hospital Basel,Basel,Switzerland
| | - Y Schmid
- Division of Clinical Pharmacology and Toxicology,Department of Biomedicine and Department of Clinical Research,University of Basel, University Hospital Basel,Basel,Switzerland
| | - D Zanchi
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
| | - U E Lang
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
| | - M E Liechti
- Division of Clinical Pharmacology and Toxicology,Department of Biomedicine and Department of Clinical Research,University of Basel, University Hospital Basel,Basel,Switzerland
| | - S Borgwardt
- Department of Psychiatry (UPK),University of Basel,Basel,Switzerland
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11
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Müller F, Lenz C, Dolder P, Lang U, Schmidt A, Liechti M, Borgwardt S. Increased thalamic resting-state connectivity as a core driver of LSD-induced hallucinations. Acta Psychiatr Scand 2017; 136:648-657. [PMID: 28940312 PMCID: PMC5698745 DOI: 10.1111/acps.12818] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE It has been proposed that the thalamocortical system is an important site of action of hallucinogenic drugs and an essential component of the neural correlates of consciousness. Hallucinogenic drugs such as LSD can be used to induce profoundly altered states of consciousness, and it is thus of interest to test the effects of these drugs on this system. METHOD 100 μg LSD was administrated orally to 20 healthy participants prior to fMRI assessment. Whole brain thalamic functional connectivity was measured using ROI-to-ROI and ROI-to-voxel approaches. Correlation analyses were used to explore relationships between thalamic connectivity to regions involved in auditory and visual hallucinations and subjective ratings on auditory and visual drug effects. RESULTS LSD caused significant alterations in all dimensions of the 5D-ASC scale and significantly increased thalamic functional connectivity to various cortical regions. Furthermore, LSD-induced functional connectivity measures between the thalamus and the right fusiform gyrus and insula correlated significantly with subjective auditory and visual drug effects. CONCLUSION Hallucinogenic drug effects might be provoked by facilitations of cortical excitability via thalamocortical interactions. Our findings have implications for the understanding of the mechanism of action of hallucinogenic drugs and provide further insight into the role of the 5-HT2A -receptor in altered states of consciousness.
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Affiliation(s)
- F. Müller
- Department of Psychiatry (UPK)University of BaselBaselSwitzerland
| | - C. Lenz
- Department of Psychiatry (UPK)University of BaselBaselSwitzerland
| | - P. Dolder
- Division of Clinical Pharmacology and ToxicologyDepartment of Biomedicine and Department of Clinical ResearchUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - U. Lang
- Department of Psychiatry (UPK)University of BaselBaselSwitzerland
| | - A. Schmidt
- Department of Psychiatry (UPK)University of BaselBaselSwitzerland
| | - M. Liechti
- Division of Clinical Pharmacology and ToxicologyDepartment of Biomedicine and Department of Clinical ResearchUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - S. Borgwardt
- Department of Psychiatry (UPK)University of BaselBaselSwitzerland
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12
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Wottawa M, Naas S, Böttger J, van Belle GJ, Möbius W, Revelo NH, Heidenreich D, von Ahlen M, Zieseniss A, Kröhnert K, Lutz S, Lenz C, Urlaub H, Rizzoli SO, Katschinski DM. Hypoxia-stimulated membrane trafficking requires T-plastin. Acta Physiol (Oxf) 2017; 221:59-73. [PMID: 28218996 DOI: 10.1111/apha.12859] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/09/2017] [Revised: 01/25/2017] [Accepted: 02/15/2017] [Indexed: 12/30/2022]
Abstract
AIM Traffic between the plasma membrane and the endomembrane compartments is an essential feature of eukaryotic cells. The secretory pathway sends cargoes from biosynthetic compartments to the plasma membrane. This is counterbalanced by a retrograde endocytic route and is essential for cell homoeostasis. Cells need to adapt rapidly to environmental challenges such as the reduction of pO2 which, however, has not been analysed in relation to membrane trafficking in detail. Therefore, we determined changes in the plasma membrane trafficking in normoxia, hypoxia, and after reoxygenation. METHODS Membrane trafficking was analysed by using the bulk membrane endocytosis marker FM 1-43, the newly developed membrane probe mCLING, wheat germ agglutinin as well as fluorescently labelled cholera toxin subunit B. Additionally, the uptake of specific membrane proteins was determined. In parallel, a non-biased SILAC screen was performed to analyse the abundance of membrane proteins in normoxia and hypoxia. RESULTS Membrane trafficking was increased in hypoxia and quickly reversed upon reoxygenation. This effect was independent of the hypoxia-inducible factor (HIF) system. Using SILAC technology, we identified that the actin-bundling protein T-plastin is recruited to the plasma membrane in hypoxia. By the use of T-plastin knockdown cells, we could show that T-plastin mediates the hypoxia-induced membrane trafficking, which was associated with an increased actin density in the cells as determined by electron microscopy. CONCLUSION Membrane trafficking is highly dynamic upon hypoxia. This phenotype is quickly reversible upon reoxygenation, which suggests that this mechanism participates in the cellular adaptation to hypoxia.
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Affiliation(s)
- M. Wottawa
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - S. Naas
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - J. Böttger
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - G. J. van Belle
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - W. Möbius
- Department of Neurogenetics; Max Planck Institute of Experimental Medicine; Göttingen Germany
- Center for Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB); Göttingen Germany
| | - N. H. Revelo
- Institute of Neuro- and Sensory Physiology; UMG, CNMPB; Göttingen Germany
| | - D. Heidenreich
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - M. von Ahlen
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - A. Zieseniss
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - K. Kröhnert
- Institute of Neuro- and Sensory Physiology; UMG, CNMPB; Göttingen Germany
| | - S. Lutz
- Institute of Pharmacology; UMG; Göttingen Germany
| | - C. Lenz
- Bioanalytical Mass Spectrometry; Max Planck Institute for Biophysical Chemistry; Göttingen Germany
- Bioanalytics Research Group; Institute of Clinical Chemistry; UMG; Göttingen Germany
| | - H. Urlaub
- Bioanalytical Mass Spectrometry; Max Planck Institute for Biophysical Chemistry; Göttingen Germany
- Bioanalytics Research Group; Institute of Clinical Chemistry; UMG; Göttingen Germany
| | - S. O. Rizzoli
- Institute of Neuro- and Sensory Physiology; UMG, CNMPB; Göttingen Germany
| | - D. M. Katschinski
- Institute of Cardiovascular Physiology; University Medical Center Göttingen (UMG); Göttingen Germany
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13
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Davis K, Lenz C, Houghton K, Kaye J. Clinical Outcomes of Crizotinib in Real-World Practice Settings for Patients with Advanced ALK-Positive Non–Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.01.168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Davis K, Lenz C, Houghton K, Kaye J. Real-World Clinical Outcomes of Crizotinib Treatment in ALK-Positive Non–Small Cell Lung Cancer Patients with Brain Metastases. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.01.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Schwarz M, Rodehutskors T, Droeschel D, Beul M, Schreiber M, Araslanov N, Ivanov I, Lenz C, Razlaw J, Schüller S, Schwarz D, Topalidou-Kyniazopoulou A, Behnke S. NimbRo Rescue: Solving Disaster-response Tasks with the Mobile Manipulation Robot Momaro. J FIELD ROBOT 2016. [DOI: 10.1002/rob.21677] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Max Schwarz
- Autonomous Intelligent Systems Group; University of Bonn; Bonn Germany
| | | | - David Droeschel
- Autonomous Intelligent Systems Group; University of Bonn; Bonn Germany
| | - Marius Beul
- Autonomous Intelligent Systems Group; University of Bonn; Bonn Germany
| | - Michael Schreiber
- Autonomous Intelligent Systems Group; University of Bonn; Bonn Germany
| | - Nikita Araslanov
- Autonomous Intelligent Systems Group; University of Bonn; Bonn Germany
| | - Ivan Ivanov
- Autonomous Intelligent Systems Group; University of Bonn; Bonn Germany
| | - Christian Lenz
- Autonomous Intelligent Systems Group; University of Bonn; Bonn Germany
| | - Jan Razlaw
- Autonomous Intelligent Systems Group; University of Bonn; Bonn Germany
| | | | - David Schwarz
- Autonomous Intelligent Systems Group; University of Bonn; Bonn Germany
| | | | - Sven Behnke
- Autonomous Intelligent Systems Group; University of Bonn; Bonn Germany
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Schwarz M, Beul M, Droeschel D, Schüller S, Periyasamy AS, Lenz C, Schreiber M, Behnke S. Supervised Autonomy for Exploration and Mobile Manipulation in Rough Terrain with a Centaur-Like Robot. Front Robot AI 2016. [DOI: 10.3389/frobt.2016.00057] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Harrisberger F, Smieskova R, Vogler C, Egli T, Schmidt A, Lenz C, Simon AE, Riecher-Rössler A, Papassotiropoulos A, Borgwardt S. Impact of polygenic schizophrenia-related risk and hippocampal volumes on the onset of psychosis. Transl Psychiatry 2016; 6:e868. [PMID: 27505231 PMCID: PMC5022088 DOI: 10.1038/tp.2016.143] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/25/2016] [Accepted: 06/05/2016] [Indexed: 12/12/2022] Open
Abstract
Alterations in hippocampal volume are a known marker for first-episode psychosis (FEP) as well as for the clinical high-risk state. The Polygenic Schizophrenia-related Risk Score (PSRS), derived from a large case-control study, indicates the polygenic predisposition for schizophrenia in our clinical sample. A total of 65 at-risk mental state (ARMS) and FEP patients underwent structural magnetic resonance imaging. We used automatic segmentation of hippocampal volumes using the FSL-FIRST software and an odds-ratio-weighted PSRS based on the publicly available top single-nucleotide polymorphisms from the Psychiatric Genomics Consortium genome-wide association study (GWAS). We observed a negative association between the PSRS and hippocampal volumes (β=-0.42, P=0.01, 95% confidence interval (CI)=(-0.72 to -0.12)) across FEP and ARMS patients. Moreover, a higher PSRS was significantly associated with a higher probability of an individual being assigned to the FEP group relative to the ARMS group (β=0.64, P=0.03, 95% CI=(0.08-1.29)). These findings provide evidence that a subset of schizophrenia risk variants is negatively associated with hippocampal volumes, and higher values of this PSRS are significantly associated with FEP compared with the ARMS. This implies that FEP patients have a higher genetic risk for schizophrenia than the total cohort of ARMS patients. The identification of associations between genetic risk variants and structural brain alterations will increase our understanding of the neurobiology underlying the transition to psychosis.
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Affiliation(s)
- F Harrisberger
- Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland,Psychiatric University Clinics, University of Basel, Basel, Switzerland,Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, Basel 4012, Switzerland. E-mail:
| | - R Smieskova
- Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland,Psychiatric University Clinics, University of Basel, Basel, Switzerland,Medical Image Analysis Centre, University Hospital Basel, Basel, Switzerland
| | - C Vogler
- Psychiatric University Clinics, University of Basel, Basel, Switzerland,Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - T Egli
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - A Schmidt
- King's College London, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - C Lenz
- Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - A E Simon
- Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Bruderholz, Switzerland
| | - A Riecher-Rössler
- Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland,Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - A Papassotiropoulos
- Psychiatric University Clinics, University of Basel, Basel, Switzerland,Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland,Transfaculty Research Platform, University of Basel, Basel, Switzerland,Department Biozentrum, Life Sciences Training Facility, University of Basel, Basel, Switzerland
| | - S Borgwardt
- Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland,Psychiatric University Clinics, University of Basel, Basel, Switzerland,Medical Image Analysis Centre, University Hospital Basel, Basel, Switzerland,King's College London, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK
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18
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Harrisberger F, Smieskova R, Schmidt A, Lenz C, Walter A, Wittfeld K, Grabe HJ, Lang UE, Fusar-Poli P, Borgwardt S. BDNF Val66Met polymorphism and hippocampal volume in neuropsychiatric disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2015; 55:107-18. [PMID: 25956254 DOI: 10.1016/j.neubiorev.2015.04.017] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [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: 12/06/2014] [Revised: 04/15/2015] [Accepted: 04/25/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is a neurotrophin involved in neurogenesis and synaptic plasticity in the central nervous system, especially in the hippocampus, and has been implicated in the pathophysiology of several neuropsychiatric disorders. Its Val66Met polymorphism (refSNP Cluster Report: rs6265) is a functionally relevant single nucleotide polymorphism affecting the secretion of BDNF and is implicated in differences in hippocampal volumes. METHODS This is a systematic meta-analytical review of findings from imaging genetic studies on the impact of the rs6265 SNP on hippocampal volumes in neuropsychiatric patients with major depressive disorder, anxiety, bipolar disorder or schizophrenia. RESULTS The overall sample size of 18 independent clinical cohorts comprised 1695 patients. Our results indicated no significant association of left (Hedge's g=0.08, p=0.12), right (g=0.07, p=0.22) or bilateral (g=0.07, p=0.16) hippocampal volumes with BDNF rs6265 in neuropsychiatric patients. There was no evidence for a publication bias or any demographic, clinical, or methodological moderating effects. Both Val/Val homozygotes (g=0.32, p=0.004) and Met-carriers (g=0.20, p=0.004) from the patient sample had significantly smaller hippocampal volumes than the healthy control sample with the same allele. The magnitude of these effects did not differ between the two genotypes. CONCLUSION This meta-analysis suggests that there is no association between this BDNF polymorphism and hippocampal volumes. For each BDNF genotype, the hippocampal volumes were significantly lower in neuropsychiatric patients than in healthy controls.
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Affiliation(s)
- F Harrisberger
- University of Basel, Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, 4056 Basel, Switzerland; University of Basel, Department of Clinical Research (DKF), 4031 Basel, Switzerland
| | - R Smieskova
- University of Basel, Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, 4056 Basel, Switzerland; University of Basel, Department of Clinical Research (DKF), 4031 Basel, Switzerland
| | - A Schmidt
- University of Basel, Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, 4056 Basel, Switzerland; University of Basel, Department of Clinical Research (DKF), 4031 Basel, Switzerland
| | - C Lenz
- University of Basel, Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, 4056 Basel, Switzerland; University of Basel, Department of Clinical Research (DKF), 4031 Basel, Switzerland
| | - A Walter
- University of Basel, Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, 4056 Basel, Switzerland; University of Basel, Department of Clinical Research (DKF), 4031 Basel, Switzerland
| | - K Wittfeld
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - H J Grabe
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany; Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Helios Hospital Stralsund, Stralsund, Germany
| | - U E Lang
- University of Basel, Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, 4056 Basel, Switzerland; University of Basel, Department of Clinical Research (DKF), 4031 Basel, Switzerland
| | - P Fusar-Poli
- King's College London, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, De Crespigny Park 16, SE58AF London, UK; OASIS Prodromal Team SLaM NHS Foundation Trust, London, UK
| | - S Borgwardt
- University of Basel, Department of Psychiatry (UPK), Wilhelm Klein-Strasse 27, 4056 Basel, Switzerland; University of Basel, Department of Clinical Research (DKF), 4031 Basel, Switzerland; King's College London, Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, De Crespigny Park 16, SE58AF London, UK.
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McGuire A, Martin M, Lenz C, Sollano JA. Treatment cost of non-small cell lung cancer in three European countries: comparisons across France, Germany, and England using administrative databases. J Med Econ 2015; 18:525-32. [PMID: 25802950 DOI: 10.3111/13696998.2015.1032974] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Lung cancer is a highly prevalent condition with non-small cell lung cancer (NSCLC), representing ∼ 80%. Given its high prevalence and poor survival rates, it is important to understand costs associated with NSCLC treatment. OBJECTIVES To carry out an incidence-based study in three European countries: France, Germany, and the UK, to estimate the cost of NSCLC treatment. METHODS Three similar administrative databases were accessed; Hospital Episode Statistics (England), Gesundheitsforen Leipzig (Germany), French Hospital Discharge system (France), using ICD-9/10 codes and treatment/surgery algorithms to identify NSCLC patients. An incidence population of NSCLC patients was obtained using an index year (ranging from 2007-2008), ensuring the absence of prior lung cancer (12-months). Data were extracted on treatment information, patient characteristics, and disease staging. Average NSCLC treatment costs were estimated by age and severity. For England, 20,081 patients were identified, for France, 15,061, and for Germany, 1038. RESULTS In-patient length of stay was 8.9, 8.7, and 10.1 days for France, England, and Germany, respectively, for the first year. Average total costs for the 2-year follow-up period for France, England, and Germany were €25,063, €17,777, and €32,500, respectively. Sub-group analyses showed higher costs for younger patients and those with metastatic disease. CONCLUSION Considerable differences in average treatment costs were observed. In-patient costs dominate in the first year of treatment in all countries. The study highlights the costly nature of NSCLC.
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Affiliation(s)
- A McGuire
- LSE, London, UK, and Mapi , Uxbridge , UK
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20
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Mcguire A, Martin M, Lenz C, Sollano J. The Cost of NSCLC Treatment in Three Countries: France, Germany and UK. Value Health 2014; 17:A628-A629. [PMID: 27202224 DOI: 10.1016/j.jval.2014.08.2243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Mcguire
- London School of Economics, London, UK
| | - M Martin
- OptumInsight, Uxbridge, Middlesex, UK
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21
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Voigt M, Fröhlich CW, Hüttel C, Kranke P, Mennen J, Boessneck O, Lenz C, Erbes T, Ernst J, Kerger H. Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia. Med Sci Monit 2013; 19:993-1000. [PMID: 24226381 PMCID: PMC3852368 DOI: 10.12659/msm.889597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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] [Indexed: 11/09/2022] Open
Abstract
Background This paper describes a randomized prospective study conducted in 308 patients undergoing caesarean section in spinal anaesthesia at a single hospital between 2010 and 2012 to find a suitable anti-emetic strategy for these patients. Material/Methods Spinal anesthesia was performed in left prone position, at L3/L4 with hyperbaric 0.5% Bupivacaine according to a cc/cm body height ratio. There were no opioids given peri-operatively. The patients received either no prophylaxis (Group I) or tropisetron and metoclopramide (Group II) or dimenhydrinate and dexamethasone (Group III), or tropisetron as a single medication (Group IV). The primary outcome was nausea and/or vomiting (NV) in the intraoperative, early (0–2 h) or late (2–24 h) postoperative period. Multivariate statistical analysis was conducted with a regression analysis and a backward elimination of factors without significant correlation. Results All prophylactic agents significantly reduced NV incidence intraoperatively. Relative risk reduction for NV by prophylaxis was most effective (59.5%) in Group II (tropisetron and metoclopramide). In Group III (dimenhydrinate and dexamethasone), NV risk was reduced by 29.9% and by 28.7% in Group IV (tropisetron mono-therapy). The incidence of NV in the early (0–2 h) and the late (2–24 h) postoperative period was low all over (7.8%), but the relative risk reduction of NV in the early postoperative period was 54.1% (Group IV), 45.1% (Group III), and 34.8% (Group II), respectively. In the late postoperative period, there was no significant difference between the 4 groups. Conclusions We recommend a prophylactic medication with tropisetron 2 mg and metoclopramide 20 mg for patients during caesarean section. These agents are safe, reasonably priced, and highly efficient in preventing nausea and vomiting.
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Abstract
Diagnostic testing has been improving the quality of cancer care. The dynamics of this field can be grasped through the application of innovation lifecycle models. Single testing, parallel testing and whole-genome sequencing are major technological evolutions. Given the increasing availability of biomarkers, the performance of single testing will be limited in the future, favoring the further implementation of parallel testing technologies. Whole-genome sequencing will lead to a further performance increase by introducing the era of genomic medicine. A broad adoption of presently available diagnostic technologies sets up the infrastructure for future technologies. The speed at which these technologies are introduced depends heavily on the regulatory and reimbursement environment, while their final diffusion is subject to pragmatic criteria such as user friendliness, perceived risk and perceived value added.
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Affiliation(s)
| | - Christian Lenz
- Global Health Economics & Outcomes Research, Pfizer Oncology, Linkstrasse 10, Berlin 10795, Germany
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23
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Smieskova R, Fusar-Poli P, Aston J, Simon A, Bendfeldt K, Lenz C, Stieglitz RD, McGuire P, Riecher-Rössler A, Borgwardt SJ. Insular volume abnormalities associated with different transition probabilities to psychosis. Psychol Med 2012; 42:1613-1625. [PMID: 22126702 PMCID: PMC3413195 DOI: 10.1017/s0033291711002716] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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: 08/02/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although individuals vulnerable to psychosis show brain volumetric abnormalities, structural alterations underlying different probabilities for later transition are unknown. The present study addresses this issue by means of voxel-based morphometry (VBM). METHOD We investigated grey matter volume (GMV) abnormalities by comparing four neuroleptic-free groups: individuals with first episode of psychosis (FEP) and with at-risk mental state (ARMS), with either long-term (ARMS-LT) or short-term ARMS (ARMS-ST), compared to the healthy control (HC) group. Using three-dimensional (3D) magnetic resonance imaging (MRI), we examined 16 FEP, 31 ARMS, clinically followed up for on average 3 months (ARMS-ST, n=18) and 4.5 years (ARMS-LT, n=13), and 19 HC. RESULTS The ARMS-ST group showed less GMV in the right and left insula compared to the ARMS-LT (Cohen's d 1.67) and FEP groups (Cohen's d 1.81) respectively. These GMV differences were correlated positively with global functioning in the whole ARMS group. Insular alterations were associated with negative symptomatology in the whole ARMS group, and also with hallucinations in the ARMS-ST and ARMS-LT subgroups. We found a significant effect of previous antipsychotic medication use on GMV abnormalities in the FEP group. CONCLUSIONS GMV abnormalities in subjects at high clinical risk for psychosis are associated with negative and positive psychotic symptoms, and global functioning. Alterations in the right insula are associated with a higher risk for transition to psychosis, and thus may be related to different transition probabilities.
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Affiliation(s)
- R. Smieskova
- Department of Psychiatry, University of Basel, Switzerland
- Medical Image Analysis Centre, University of Basel, Switzerland
| | - P. Fusar-Poli
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
| | - J. Aston
- Department of Psychiatry, University of Basel, Switzerland
| | - A. Simon
- Specialized Out-patient Service for Early Psychosis, Department of Psychiatry, Bruderholz, Switzerland
- University Hospital of Psychiatry, University of Bern, Switzerland
| | - K. Bendfeldt
- Medical Image Analysis Centre, University of Basel, Switzerland
| | - C. Lenz
- Radiological Physics, University Hospital Basel, Switzerland
| | | | - P. McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
| | | | - S. J. Borgwardt
- Department of Psychiatry, University of Basel, Switzerland
- Medical Image Analysis Centre, University of Basel, Switzerland
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
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Jones KB, Su L, Jin H, Lenz C, Randall RL, Underhill TM, Nielsen TO, Sharma S, Capecchi MR. SS18-SSX2 and the mitochondrial apoptosis pathway in mouse and human synovial sarcomas. Oncogene 2012; 32:2365-71, 2375.e1-5. [PMID: 22797074 DOI: 10.1038/onc.2012.247] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Synovial sarcoma is a deadly malignancy with limited sensitivity to traditional cytotoxic chemotherapy. SS18-SSX fusion oncogene expression characterizes human synovial sarcomas and drives oncogenesis in a mouse model. Elevated expression of BCL2 is considered a consistent feature of the synovial sarcoma expression profile. Our objective was to evaluate the expression of apoptotic pathway members in synovial sarcomas and interrogate the impact of modulating SS18-SSX expression on this pathway. We show in human and murine synovial sarcoma cells that SS18-SSX increases BCL2 expression, but represses other anti-apoptotic genes, including MCL1 and BCL2A1. This repression is achieved by directly suppressing expression via binding through activating transcription factor 2 (ATF2) to the cyclic adenosine monophosphate (AMP) response element (CRE) in the promoters of these genes and recruiting TLE1/Groucho. The suppression of these two anti-apoptotic pathways silences the typical routes by which other tumors evade BH3-domain peptidomimetic pharmacotherapy. We show that mouse and human synovial sarcoma cells are sensitive in vitro to ABT-263, a BH3-peptidomimetic, much more than the other tested cancer cell lines. ABT-263 also enhances the sensitivity of these cells to doxorubicin, a traditional cytotoxic chemotherapy used for synovial sarcoma. We also demonstrate the capacity of ABT-263 to stunt synovial sarcomagenesis in vivo in a genetic mouse model. These data recommend pursuit of BH3-peptidomimetic pharmacotherapy in human synovial sarcomas.
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Affiliation(s)
- K B Jones
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84112-5331, USA
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Vogt H, Ehmann I, Kremer M, Lenz C, Grab D. Kongenitale zystische adenomatoide Lungenmalformation (CCAML). Z Geburtshilfe Neonatol 2012. [DOI: 10.1055/s-0032-1309101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Finan M, Boudreaux C, Donnell R, Gates T, Klein M, Lenz C, Rocconi R. Capillary lymphatic space (CLS) invasion in robotic vs abdominal hysterectomy for endometrial cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lenz C, Klarhöfer M, Scheffler K. Feasibility of in vivo myelin water imaging using 3D multigradient-echo pulse sequences. Magn Reson Med 2011; 68:523-8. [PMID: 22213038 DOI: 10.1002/mrm.23241] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 08/10/2011] [Accepted: 09/08/2011] [Indexed: 11/12/2022]
Abstract
Quantitative myelin water imaging is able to show demyelinating processes and, therefore, provides insight into the pathology of white matter diseases such as multiple sclerosis. So far, mapping of the myelin water fraction most often was performed using single-slice multiecho spin-echo sequences. Recently, a different approach using two-dimensional multigradient-echo pulse sequences was suggested. In this work, a solution to three-dimensional in vivo myelin water fraction imaging is presented that applies multigradient-echo pulse sequences and uses non-negative least squares algorithms to analyze the multicomponent T*(2) decay. The suggested method offers not only whole brain coverage but also clinically practicable acquisition times. The obtained myelin water fraction values are low (6.9% for white matter) but are able to detect demyelination in multiple sclerosis lesions. However, the clinical application of the proposed method remains questionable, because further measurements that clarify the possibility of detecting ongoing processes in lesions are needed.
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Affiliation(s)
- C Lenz
- Department of Radiological Physics, University of Basel Hospital, Basel, Switzerland.
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Abstract
BACKGROUND Body image distortion is a key symptom of anorexia nervosa. In behavioral research two components of body image have been defined: attitudes towards the body and body size experience. Neuroimaging studies concerning own body image distortions in anorexia nervosa have revealed an inconsistent pattern of results and are constrained by the fact that no direct distinction between the different parts of body image has been made. METHOD The present study therefore set out to investigate the neural correlates of two parts of the own body image using functional magnetic resonance imaging (fMRI): satisfaction rating and size estimation for distorted own body photographs in patients with anorexia nervosa and controls. RESULTS Anorectic patients were less satisfied with their current body shape than controls. Patients further demonstrated stronger activation of the insula and lateral prefrontal cortex during the satisfaction rating of thin self-images. This indicates a stronger emotional involvement when patients are presented with distorted images close to their own ideal body size. Patients also overestimated their own body size. We were able to show complex differential modulations in activation of the precuneus during body size estimation in control and anorectic subjects. It could be speculated that a deficit in the retrieval of a multimodal coded body schema in precuneus/posterior parietal cortex is related to body size overestimation. CONCLUSIONS We were able to find specific behavioral responses and neural activation patterns for two parts of body image in anorexia nervosa and healthy controls. Thus, the present results underline the importance of developing research and therapeutic strategies that target the two different aspects of body image separately.
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Affiliation(s)
- H M Mohr
- Department of Biological Psychology, Institute of Psychology, Johann Wolfgang Goethe University, Frankfurt, Germany.
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Kruhøffer M, Voss T, Beller K, Scherer M, Cramer J, Deutschmann T, Homberg C, Schlumpberger M, Lenz C. Evaluation of the QIAsymphony SP Workstation for Magnetic Particle—Based Nucleic Acid Purification from Different Sample Types for Demanding Downstream Applications. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.jala.2009.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We evaluated automated nucleic acid (NA) extraction from a variety of different biological specimens using the QIAsymphony SP instrument. QIAsymphony DNA kits were used for DNA purification from human blood and from diverse human and animal tissue specimens. RNA was isolated from human blood stabilized in PAXgene Blood RNA tubes with the QIAsymphony PAXgene Blood RNA kit, and from human colon and bladder carcinoma biopsies using the QIAsymphony RNA kit. Photometric measurement, gel electrophoresis, and LabChip analysis on an Agilent 2100 Bioanalyzer (Agilent, Palo Alto, California) showed that the purified NAs were highly pure and intact, and that excellent yields were obtained. The DNA purified from blood and tissues performed well in single nucleotide polymorphism (SNP) array analysis, shown by call rates for the Affymetrix Genome-Wide Human 6.0 SNP arrays of > 99%. No significant differences were observed when array results of DNA purified either with magnetic particle technology or silica membrane technology were compared. The quality of the DNA allowed accurate allelic discrimination by TaqMan SNP PCR. Gene expression analyses of purified RNA either by “Human Endogenous Control Panel” TaqMan low-density array or on Affymetrix HG UI33 plus 2.0 GeneChips revealed high concordance between manually purified samples and those extracted on the QIAsymphony SP.
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Fortin T, Salvador A, Charrier JP, Lenz C, Bettsworth F, Lacoux X, Choquet-Kastylevsky G, Lemoine J. Multiple Reaction Monitoring Cubed for Protein Quantification at the Low Nanogram/Milliliter Level in Nondepleted Human Serum. Anal Chem 2009; 81:9343-52. [DOI: 10.1021/ac901447h] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- T. Fortin
- R&D Proteomique, bioMérieux SA, Marcy l’Etoile, France, UMR 5180 Sciences Analytiques, Université de Lyon, Lyon1, France, and PSM Support, Applied Biosystems, Darmstadt, Germany
| | - A. Salvador
- R&D Proteomique, bioMérieux SA, Marcy l’Etoile, France, UMR 5180 Sciences Analytiques, Université de Lyon, Lyon1, France, and PSM Support, Applied Biosystems, Darmstadt, Germany
| | - J. P. Charrier
- R&D Proteomique, bioMérieux SA, Marcy l’Etoile, France, UMR 5180 Sciences Analytiques, Université de Lyon, Lyon1, France, and PSM Support, Applied Biosystems, Darmstadt, Germany
| | - C. Lenz
- R&D Proteomique, bioMérieux SA, Marcy l’Etoile, France, UMR 5180 Sciences Analytiques, Université de Lyon, Lyon1, France, and PSM Support, Applied Biosystems, Darmstadt, Germany
| | - F. Bettsworth
- R&D Proteomique, bioMérieux SA, Marcy l’Etoile, France, UMR 5180 Sciences Analytiques, Université de Lyon, Lyon1, France, and PSM Support, Applied Biosystems, Darmstadt, Germany
| | - X. Lacoux
- R&D Proteomique, bioMérieux SA, Marcy l’Etoile, France, UMR 5180 Sciences Analytiques, Université de Lyon, Lyon1, France, and PSM Support, Applied Biosystems, Darmstadt, Germany
| | - G. Choquet-Kastylevsky
- R&D Proteomique, bioMérieux SA, Marcy l’Etoile, France, UMR 5180 Sciences Analytiques, Université de Lyon, Lyon1, France, and PSM Support, Applied Biosystems, Darmstadt, Germany
| | - J. Lemoine
- R&D Proteomique, bioMérieux SA, Marcy l’Etoile, France, UMR 5180 Sciences Analytiques, Université de Lyon, Lyon1, France, and PSM Support, Applied Biosystems, Darmstadt, Germany
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Abdrakhmanova A, Schlichting R, Hunter CL, Glueckmann M, Lenz C, Echeverri CJ, Soennichsen B, Jung A, Weiss-Haljiti C. RNAi and iTRAQ reagents united: targeted quantitation of siRNA-mediated protein silencing in human cells. Anal Bioanal Chem 2009; 395:773-85. [PMID: 19711061 DOI: 10.1007/s00216-009-3028-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 07/21/2009] [Accepted: 07/24/2009] [Indexed: 10/20/2022]
Abstract
Bridging the gap between functional genomics and traditional molecular cell biology is a challenge of the next decade. Here, we are aiming to find routines for targeted quantitation of protein silencing in response to RNAi based on complex cellular lysates. A workflow was established adapting siRNA treatment, processing the sample, generating isobaric iTRAQ-reagent-labeled peptides, and analyzing the sample applying MRM-based peptide quantitation to verify protein silencing on a 4000 QTRAP LC/MS/MS mass spectrometer. Subsequently, eight targets were analyzed, mostly with two siRNA designs. Although transcript and protein silencing correlated, the downregulation on the protein level was less pronounced. A time-course analysis of the chaperon HSPA9/mortalin indicated a delayed kinetic of protein versus transcript silencing. Further, the analysis of the functional response on the example of HSD17B4, a multifunctional enzyme essential to generate precursors for cholesterol biosynthesis, confirmed that strong silencing on the transcript level accompanied by moderate reduction of protein is sufficient to generate a physiological significant response. Fifty percent protein silencing resulted in a 3.5-fold induction of low-density lipoprotein and therefore cholesterol uptake in human liver cells. The established routines pave the way for the development of targeted protein quantitation assays suitable for target and biomarker validation.
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Affiliation(s)
- A Abdrakhmanova
- Applied Biosystems, Life Technologies, Frankfurter Strasse 129B, 64293, Darmstadt, Germany
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Waschke K, Quintet M, Kerger H, Lenz C. Oxygen-Carrying Blood Substitutes. Transfus Med Hemother 2009. [DOI: 10.1159/000223477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Moeller MM, Voelz J, Lenz C, Wicke J, Gradaus R, Neuzner J, Neuzner J. Right ventricular involvement in Takotsubo cardiomyopathy. Crit Care 2009. [PMCID: PMC4084044 DOI: 10.1186/cc7322] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fortin T, Salvador A, Charrier J, Lenz C, Lacoux G, Choquet-Kastylevsky G, Lemoine J. Robust and absolute quantitation of PSA in clinical human sera using Protein Reaction Monitoring (PRM). EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yang D, Lenz C, Togawa K, Lurje G, Pohl A, Manegold PC, Ning Y, Groshen SG, Lenz HJ. Age and ethnicity predict overall survival in patients with metastatic gastric cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Each organ possesses specific properties for controlling microvascular perfusion. Such specificity provides an opportunity to design transfusion fluids that target thrombo-embolic or vasospasm-induced ischemia in a particular organ or that optimize overall perfusion from systemic shock. The role of viscosity in the design of these fluids might be underestimated, because viscosity is rarely monitored or considered in critical care decisions. Studies linking viscosity-dependent changes of microvascular perfusion to outcome-relevant data suggest that whole blood viscosity is negligible as a determinant of microvascular perfusion under physiological conditions when autoregulation is effective. Because autoregulation is driven to maintain oxygen supply constant, the organism will compensate for changes in blood viscosity to sustain oxygen delivery. In contrast, under pathological conditions in the brain and elsewhere, increases of overall viscosity should be avoided - including all the situations where vascular autoregulatory mechanisms are inoperative due to ischemia, structural damage or physiologic dysfunction. As latter conditions are not to identify with high certainty, the risks that accompany therapeutic correction of blood viscosity are outweighing the benefits. The ability to bedside monitor blood viscosity and to link changes in viscosity to outcome parameters in various clinical conditions would provide more solid foundation for evidence-based clinical management.
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Affiliation(s)
- C Lenz
- Clinic of Anesthesiology and Critical Care Medicine, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
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Abstract
BACKGROUND The experience of our multidisciplinary team in surgical treatment of female-to-male trans-sexualism is presented, and our treatment concepts described in detail. In addition, our preferred technique of neourethra formation using a prefabricated free fibula flap is described. PATIENTS AND METHOD From 1996 to 2003, thirty-four patients underwent gender reassignment surgery as a staged procedure. The neourethra was constructed using an anterior vaginal flap and the prefabricated free fibular flap. RESULTS There were four complete losses of the prefabricated fibular flap (11.7%). The neourethra stricture rate was 20.5% and the fistula formation rate was 14.7%. In 82.3% of the patients, the ability to micturate while standing was achieved. CONCLUSION This modern concept reduces the complication rate and improves the quality of patient outcome.
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Affiliation(s)
- J Dabernig
- Abteilung für Hand-, Mikro- und Plastische Chirurgie, Amper-Kliniken AG, Klinikum Dachau, Dachau, Germany
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Dabernig J, Shilov B, Schumacher O, Turner AJ, Stirn N, Dabernig W, Lenz C, Schaff J. [The deepithelialized cross-finger flap: a good method for covering large dorsal finger defects]. Unfallchirurg 2006; 109:647-51. [PMID: 16874482 DOI: 10.1007/s00113-006-1087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Injuries to the dorsum of the finger are common. Combination with exposure of important deeper structures needs reconstruction with a flap. The deepithelialized cross-finger flap is a good possibility for covering large dorsal finger defects. PATIENTS AND METHODS From March 2003 to October 2003 six patients (two female, four male) underwent this procedure. RESULTS Neither flap loss nor infection was observed. All defects were covered adequately, and no donor site problems occurred. One week after flap division, the function of the involved finger joints had the same range of motion as the contralateral finger joints. CONCLUSION The deepithelialized cross-finger flap is a good and safe method for defect cover in large dorsal finger defects. The good postoperative range of motion supports the indication for this two-step reconstruction procedure.
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Affiliation(s)
- J Dabernig
- Abteilung für Hand-, Mikro- und Plastische Chirurgie, Amper-Kliniken AG, Klinikum Dachau.
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Michal M, Heidenreich T, Engelbach U, Lenz C, Overbeck G, Beutel M, Grabhorn R. Zum Zusammenhang von Depersonalisation, sozialen Ängsten und Scham–Übersicht, empirische Befunde und Diskussion der klinischen Relevanz. Psychother Psych Med 2006. [DOI: 10.1055/s-2006-934283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mohr HM, Grabhorn R, Lenz C. Untersuchung der neuronalen Korrelate des Körperbildes bei Anorexia nervosa mittels funktioneller Magnetresonanztomographie. Psychother Psychosom Med Psychol 2006. [DOI: 10.1055/s-2006-934284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Michal M, Engelbach U, Lenz C, Grabhorn R. Selbstwertregulation bei pathologischer Depersonalisation. Psychother Psychosom Med Psychol 2006. [DOI: 10.1055/s-2006-934282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dabernig J, Shilov B, Schumacher O, Lenz C, Dabernig W, Schaff J. Functional reconstruction of Achilles tendon defects combined with overlaying skin defects using a free tensor fasciae latae flap. J Plast Reconstr Aesthet Surg 2006; 59:142-7. [PMID: 16703858 DOI: 10.1016/j.bjps.2005.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present our experience in functional reconstruction of the Achilles tendon with large tissue defects following after trauma and infection. To cover the skin defect and to reconstruct the Achilles tendon we used the free tensor fasciae latae (TFL) flap. From 1997 to 2003 six males, ranging from 22 to 71 (average 38.6) years, underwent this reconstructive procedure. All of them had sustained a trauma with following loss of the tendon and of the overlying tissue. After initial debridements the reconstruction with a tensor fascia latae free flap was performed. To achieve a strong distal fascia lata attachment to the calcaneal bone, we developed a special method of fixation. After vertical osteotomy in the calcaneus the distal part of the fascia flap was introduced between the bone segments, which were fixed together with a spongiosa screw. For functional outcome, it was important to fix the foot in a 90 degrees position with tension on the vascularised fascia lata. The range of motion of the ankle of the reconstructed foot showed 93.7% in comparison to the normal foot. No flap failure occurred in any of the six patients. Simultaneous soft-tissue and function restoration of the foot with TFL free flap is in our opinion an optimal one-stage reconstructive procedure.
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Affiliation(s)
- J Dabernig
- Department of Hand-, Micro- and Plastic Surgery, Amper Kliniken AG, Klinikum Dachau, 85221 Dachau, Germany.
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Lenz C, Nackenhorst U. A Numerical Approach to Mechanosensation of Bone Tissue based on a Micromechanical Analysis of a Single Osteon. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/pamm.200410152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Frietsch T, Lenz C, Kuschinsky W, Waschke KE. Effects of chronic isovolaemic haemodilution on regional cerebral blood flow in conscious rats. Eur J Anaesthesiol 2004; 21:53-9. [PMID: 14768924 DOI: 10.1017/s0265021504001097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Acute isovolaemic haemodilution increases local and mean cerebral blood flow. It is not known whether a single haemodilution has a short-term effect only or whether it affects cerebral perfusion over a longer time period. In the present study, local and mean cerebral blood flow were determined in conscious rats after a 4, 24 and 48 h period following one-time haemodilution. METHODS Thirty-six rats were randomized to three untreated sham groups and three groups of haemodilution (4, 24 or 48 h, n = 6 for each group). Isovolaemic haemodilution with albumin 5% aimed to a target haematocrit of 0.2. Local cerebral blood flow was measured in 38 brain regions by the iodo-[14C]antipyrine method in conscious normothermic rats. RESULTS Isovolaemic haemodilution reduced haematocrit from 0.44 to 0.20. During the following 24 and 48 h periods, haematocrit remained low (0.22 and 0.21). Mean cerebral blood flow was similar in untreated sham groups (88 +/- 12 after 4 h, 92 +/- 11 after 24 h, 96 +/- 10 mL 100 g(-1) min(-1) after 48 h). Haemodilution increased mean cerebral blood flow after 4h (184 +/- 11 mL 100 g(-1) min(-1)), after 24h (153 +/- 13 mL 100 g(-1) min(-1)) and 48h (149 +/- 15 mL 100 g(-1) min(-1)) (P < or = 0.05). Local cerebral blood flow increased in all 38 structures after 4h haemodilution but decreased with time in six of 38 brain structures after 24h and in 15 regions after 48 h (P < or = 0.05). CONCLUSIONS A single one-time haemodilution increased mean cerebral blood flow for 2 days. However, local adaptation of cerebral blood flow to a chronic low haematocrit occurred but was heterogeneous within the brain.
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Affiliation(s)
- T Frietsch
- Faculty of Clinical Medicine Mannheim, Department of Anesthesiology and Critical Care Medicine, University of Heidelberg, Germany.
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Resch A, Welsch R, Lenz C, Reitberger U, Monz B. Kosteneffektivitätsanalyse der Therapie der COPD mittels Tiotropium, Salmeterol und Ipratropium in Deutschland. Pneumologie 2004. [DOI: 10.1055/s-2004-819547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Weidemann W, Rossknecht E, Lenz C, Giesen C, Hanke H. Effects of testosterone in the vascular system – importance of non-classical hormone actions. Exp Clin Endocrinol Diabetes 2004. [DOI: 10.1055/s-2004-819055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Waschke KF, Riedel M, Lenz C, Albrecht DM, van Ackern K, Kuschinsky W. Regional Heterogeneity of Cerebral Blood Flow Response to Graded Pressure-Controlled Hemorrhage. ACTA ACUST UNITED AC 2004; 56:591-603. [PMID: 15128131 DOI: 10.1097/01.ta.0000075335.35705.e2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the regional distribution of cerebral blood flow (CBF) in nonanesthetized animals during periods of lowered blood pressure. The present investigation addresses the specific reaction patterns of local cerebral blood flow (LCBF) in comparison with mean CBF during graded pressure-controlled hemorrhagic shock in conscious rats. METHODS Conscious rats were subjected to graded pressure-controlled hemorrhage (to 85, 70, 55, or 40 mm Hg) by arterial blood withdrawal. After a period of 30 minutes, blood pressure was stabilized by withdrawal or reinfusion of blood. LCBF was determined autoradiographically by the iodo(14C)antipyrine method in 34 brain structures, and mean CBF was calculated and compared with the values of nonhemorrhaged control animals. RESULTS Mean CBF remained unchanged except for the group with the lowest blood pressure of 40 mm Hg (decrease in CBF of 28%). Otherwise, LCBF was increased in some brain structures at an unchanged mean CBF. Congruently, at 40 mm Hg, the decrease in mean CBF did not show up in all brain structures, the local pattern of CBF varying between an unchanged and a profoundly decreased CBF. The mean coefficient of variation of CBF was increased with the severity of hemorrhagic shock, which indicates an enhanced heterogeneity of CBF. CONCLUSION Because of the substantial heterogeneity in the responses of LCBF to pressure-controlled hemorrhage, autoregulation of CBF during pressure-controlled hemorrhagic shock has to be reconsidered on a regional basis.
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Affiliation(s)
- Klaus F Waschke
- Department of Anesthesiology, Faculty of Clinical Medicine, University of Heidelberg, Mannheim, Germany
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Secher T, Lenz C, Cazzamali G, Sørensen G, Williamson M, Hansen GN, Svane P, Grimmelikhuijzen CJ. Molecular cloning of a functional allatostatin gut/brain receptor and an allatostatin preprohormone from the silkworm Bombyx mori. J Biol Chem 2001; 276:47052-60. [PMID: 11590150 DOI: 10.1074/jbc.m106675200] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The cockroach-type or A-type allatostatins are inhibitory insect neuropeptides with the C-terminal sequence Tyr/Phe-X-Phe-Gly-Leu-NH(2). Here, we have cloned an A-type allatostatin receptor from the silkworm Bombyx mori (BAR). BAR is 361 amino acid residues long, has seven transmembrane domains, shows 60% amino acid residue identity with the first Drosophila allatostatin receptor (DAR-1), and 48% identity with the second Drosophila allatostatin receptor (DAR-2). The BAR gene has two introns and three exons. These two introns coincide with and have the same intron phasing as two introns in the DAR-1 and DAR-2 genes, showing that the three receptors are not only structurally but also evolutionarily related. Furthermore, we have cloned a Bombyx allatostatin preprohormone that contains eight different A-type allatostatins. Chinese hamster ovary cells permanently transfected with BAR DNA react on the addition of 4 x 10(-9)M Bombyx A-type allatostatins with a second messenger cascade (measured as bioluminescence), showing that BAR is a functional A-type allatostatin receptor. Southern blots suggest that Bombyx has at least one other BAR-related gene in addition to the BAR gene described in this paper. Northern blots and quantitative reverse transcriptase-polymerase chain reaction of different larval tissues show that BAR mRNA is mainly expressed in the gut and to a much lesser extent in the brain. To our knowledge, this is the first report on the molecular cloning and functional expression of an insect gut/brain peptide hormone receptor.
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MESH Headings
- Amino Acid Sequence
- Animals
- Blotting, Northern
- Blotting, Southern
- Bombyx
- Brain/metabolism
- CHO Cells
- Cloning, Molecular
- Cricetinae
- DNA, Complementary/metabolism
- Digestive System/metabolism
- Dose-Response Relationship, Drug
- Drosophila
- Drosophila Proteins
- Evolution, Molecular
- Exons
- Hormones/genetics
- Insect Proteins
- Introns
- Kinetics
- Molecular Sequence Data
- Neuropeptides
- Phylogeny
- Protein Precursors/genetics
- RNA, Messenger/metabolism
- Receptors, Cell Surface/chemistry
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/metabolism
- Receptors, G-Protein-Coupled
- Receptors, Neuropeptide
- Reverse Transcriptase Polymerase Chain Reaction
- Sequence Homology, Amino Acid
- Signal Transduction
- Tissue Distribution
- Transfection
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Affiliation(s)
- T Secher
- Department of Cell Biology, Zoological Institute, University of Copenhagen, Universitetsparken 15, DK-2100 Copenhagen, Denmark
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Lenz C, Waschke F. Artificial oxygen carriers and the cerebral circulation. Anasthesiol Intensivmed Notfallmed Schmerzther 2001; 36 Suppl 2:S110-3. [PMID: 11753713 DOI: 10.1055/s-2001-18202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- C Lenz
- Institut für Anästhesiologie und Operative Intensivmedizin, Fakultät für Klinische Medizin, Mannheim der Universität Heidelberg, Mannheim.
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Lenz C, Williamson M, Hansen GN, Grimmelikhuijzen CJ. Identification of four Drosophila allatostatins as the cognate ligands for the Drosophila orphan receptor DAR-2. Biochem Biophys Res Commun 2001; 286:1117-22. [PMID: 11527415 DOI: 10.1006/bbrc.2001.5475] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The allatostatins are generally inhibitory insect neuropeptides. The Drosophila orphan receptor DAR-2 is a G-protein-coupled receptor, having 47% amino acid residue identity with another Drosophila receptor, DAR-1 (which is also called dros. GPCR, or DGR) that was previously shown to be the receptor for an intrinsic Drosophila A-type (cockroach-type) allatostatin. Here, we have permanently expressed DAR-2 in CHO cells and found that it is the cognate receptor for four Drosophila A-type allatostatins, the drostatins-A1 to -A4. Of all the drostatins, drostatin-A4 (Thr-Thr-Arg-Pro-Gln-Pro-Phe-Asn-Phe-Gly-Leu-NH(2)) is the most effective in causing a second messenger cascade (measured as bioluminescence; threshold, 10(-9) M; EC(50), 10(-8) M), whereas the others are less effective and about equally potent (EC(50), 8 x 10(-8) M). Northern blots showed that the DAR-2 gene is expressed in embryos, larvae, pupae, and adult flies. In adult flies, the receptor is more strongly expressed in the thorax/abdomen than in the head parts, suggesting that DAR-2 is a gut receptor. This is confirmed by Northern blots from 3rd instar larvae, showing that the DAR-2 gene is mainly expressed in the gut and only very weakly in the brain. The Drosophila larval gut also contains about 20-30 endocrine cells, expressing the gene for the drostatins-A1 to -A4. We suggest, therefore, that DAR-2 mediates an allatostatin (drostatin)-induced inhibition of gut motility. This is the first report on the permanent and functional expression of a Drosophila gut neurohormone receptor.
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Affiliation(s)
- C Lenz
- Department of Cell Biology, Zoological Institute, University of Copenhagen, Universitetsparken 15, Copenhagen, DK-2100, Denmark
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