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Muenster S, Zschernack V, Dierig B, Frede S, Baumgarten G, Coburn M, Putensen C, Weisheit CK. Vancomycin and daptomycin modulate the innate immune response in a murine model of LPS-induced sepsis. Int J Immunopathol Pharmacol 2021; 35:20587384211031373. [PMID: 34296627 PMCID: PMC8312155 DOI: 10.1177/20587384211031373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sepsis is a leading cause of death worldwide, despite the use of multimodal therapies. Common antibiotic regimens are being affected by a rising number of multidrug-resistant pathogens, and new therapeutic approaches are therefore needed. Antibiotics have immunomodulatory properties which appear to be beneficial in the treatment of sepsis. We hypothesized that the last-resort antibiotics vancomycin (VAN) and daptomycin (DMC) modulate cell migration, phagocytosis, and protein cytokine levels in a murine model of lipopolysaccharide (LPS)-induced sepsis. Ten to twelve-week-old C57BL/6 mice (n = 4-6 animals per group) were stimulated with LPS for 20 h, followed by the administration of VAN or DMC. The outcome parameters were leukocyte accumulation and effector function. Quantification of the immune cells in the peritoneal lavage was performed using flow cytometry analysis. Phagocytosis was measured using pHrodo E. coli BioParticles. The response of the cytokines TNFα, IL-6, and IL-10 was measured in vitro using murine peritoneal macrophages stimulated with LPS and VAN or DMC. VAN decreased both the peritoneal macrophage and the dendritic cell populations following LPS stimulation. DMC reduced the dendritic cell population in the peritoneal cavity in LPS-infected mice. Both antibiotics increased the phagocytic activity in peritoneal macrophages, but this effect was diminished in response to LPS. Phagocytosis of dendritic cells was increased in LPS-infected animals treated with VAN. VAN and DMC differently modulated the levels of pro-and anti-inflammatory cytokines. In a murine model of LPS-induced sepsis, VAN and DMC exhibit immunomodulatory effects on cells involved in innate immunity. The question of whether these antibiotics exhibit synergistic effects in the treatment of septic patients, beyond their bactericidal properties, should be further evaluated in future studies.
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Affiliation(s)
- Stefan Muenster
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Birte Dierig
- Department of Cardiac, Thoracic and Vascular Surgery, University Hospital Mainz, Mainz, Germany
| | - Stilla Frede
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care, Johanniter Krankenhaus, Bonn, Nordrhein-Westfalen, Germany
| | - Mark Coburn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Duerr GD, Wu S, Schneider ML, Marggraf V, Weisheit CK, Velten M, Verfuerth L, Frede S, Boehm O, Treede H, Dewald O, Baumgarten G, Kim SC. CpG postconditioning after reperfused myocardial infarction is associated with modulated inflammation, less apoptosis, and better left ventricular function. Am J Physiol Heart Circ Physiol 2020; 319:H995-H1007. [PMID: 32857588 DOI: 10.1152/ajpheart.00269.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Postconditioning attenuates inflammation and fibrosis in myocardial infarction (MI). The aim of this study was to investigate whether postconditioning with the cytosine-phosphate-guanine (CpG)-containing Toll-like receptor-9 (TLR9) ligand 1668-thioate (CpG) can modulate inflammation and remodeling in reperfused murine MI. Thirty minutes of left descending coronary artery (LAD) occlusion was conducted in 12-wk-old C57BL/6 mice. Mice were treated with CpG intraperitoneally 5 min before reperfusion. The control group received PBS; the sham group did not undergo ischemia. M-mode echocardiography (3, 7, and 28 days) and Millar left ventricular (LV) catheterization were performed (7 and 28 days) before the hearts were excised and harvested for immunohistochemical (6 h, 24 h, 3 days, 7 days, and 28 days), gene expression (6 h, 24 h, and 3 days; Taqman RT-qPCR), protein, and FACS analysis (24 h and 3 days). Mice treated with CpG showed significantly better LV function after 7 and 28 days of reperfusion. Protein and mRNA expressions of proinflammatory and anti-inflammatory cytokines were significantly induced after CpG treatment. Histology revealed fewer macrophages in CpG mice after 24 h, confirmed by FACS analysis with a decrease in both classically M1- and alternative M2a-monocytes. CpG treatment reduced apoptosis and cardiomyocyte loss and was associated with induction of adaptive mechanisms, e.g., of heme-oxigenase-1 and β-/α-myosin heavy chain (MHC) ratio. Profibrotic markers collagen type Iα (Col-Ια) and Col-III induction was abrogated in CpG mice, accompanied by fewer myofibroblasts. This led to the formation of a smaller scar. Differential matrix metalloproteinase (MMP)/tissue inhibitor of metalloproteinase (TIMP) expression contributed to attenuated remodeling in CpG, resulting in preserved cardiac function in a Toll-like receptor 1- and TLR9-dependent manner. Our study suggests a cardioprotective mechanism of CpG postconditioning, involving Toll-like receptor-driven modulation of inflammation. This is followed by attenuated remodeling and preserved LV function.NEW & NOTEWORTHY Cytosine-phosphate-guanine (CpG) postconditioning seems to mediate inflammation via Toll-like receptor-1 and Toll-like receptor-9 signaling. Enhanced cytokine and chemokine expressions are partly attenuated by IL-10 and matrix metalloproteinase-8 (MMP8) induction, being associated with lower macrophage infiltration and M1-monocyte differentiation. Furthermore, switch from α- to β-MHC and balanced MMP/TIMP expression led to lesser cardiomyocyte apoptosis, smaller scar size, and preserved cardiac function. Data of pharmacological postconditioning have been widely disappointing to date. Our study suggests a new pathway promoting myocardial postconditioning via Toll-like receptor activation.
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Affiliation(s)
- Georg Daniel Duerr
- Department of Cardiac Surgery, University Clinical Centre Bonn, Bonn, Germany
| | - Shuijing Wu
- Department of Anaesthesiology, University Clinical Centre Bonn, Bonn, Germany
| | - Max Lukas Schneider
- Department of Anaesthesiology, University Clinical Centre Bonn, Bonn, Germany
| | - Vanessa Marggraf
- Department of Anaesthesiology, University Clinical Centre Bonn, Bonn, Germany
| | | | - Markus Velten
- Department of Anaesthesiology, University Clinical Centre Bonn, Bonn, Germany
| | - Luise Verfuerth
- Department of Cardiac Surgery, University Clinical Centre Bonn, Bonn, Germany
| | - Stilla Frede
- Department of Anaesthesiology, University Clinical Centre Bonn, Bonn, Germany
| | - Olaf Boehm
- Department of Anaesthesiology, University Clinical Centre Bonn, Bonn, Germany
| | - Hendrik Treede
- Department of Cardiac Surgery, University Clinical Centre Bonn, Bonn, Germany
| | - Oliver Dewald
- Department of Cardiac Surgery, University Hospital of Oldenburg, Oldenburg, Germany
| | - Georg Baumgarten
- Department of Anaesthesiology, Johanniter-Krankenhaus Bonn, Bonn, Germany
| | - Se-Chan Kim
- Department of Anaesthesiology, University Clinical Centre Bonn, Bonn, Germany
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Boehm O, Rohner M, Ehrentraut H, Guenther U, Meyer R, Knuefermann P, Baumgarten G, Duerr GD, Velten M. Low-tidal-volume prevent ventilation induced inflammation in a mouse model of sepsis. Life Sci 2019; 240:117081. [PMID: 31756342 DOI: 10.1016/j.lfs.2019.117081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND GOAL OF THE STUDY Pulmonary inflammation, increased vascular permeability, and pulmonary edema, occur in response to primary pulmonary infections like pneumonia but are also evident in endotoxemia or sepsis. Mechanical ventilation augments pre-existing lung injury and inflammation resulting from exposure to microbial products. The objective of this study was to test the hypothesis that low-tidal-volume prevent ventilation induced lung injury in sepsis. MATERIALS AND METHODS 10-12-week-old male C57BL/6N-mice received an intraperitoneal (i.p.) injection with equipotent dosages of LPS, 1668-thioate, 1612-thioate, or PBS. 120 min after injection, mice were randomized to low- (LV, 7 ± 1 ml/kg) or high-tidal-volume (HV, 25 ± 1 ml/kg) ventilation. Hemodynamic and ventilatory parameters were recorded and inflammatory markers were analyzed form BAL that was generated after 90 minute ventilation. RESULTS AND DISCUSSION Arterial blood pressures declined during mechanical ventilation in all groups. pO2 decreased in LPS injected and CO2 increased in sham, LPS, and 1612-thioate administered mice at 45 min and in 1668-thioate injected mice after 90 minute LV ventilation compared to respective HV groups. BAL protein concentrations increased in HV ventilated and 1668- or 1612-thioat pre-treated mice. BAL TNF-α protein concentrations increased in both LPS- and 1668-thioate-injected and IL-1β protein concentrations only in LPS-injected and HV ventilated mice. Most notably, no increased protein concentrations were observed in any of the LV ventilated groups. CONCLUSION We conclude that low-tidal-volume ventilation may be a potential strategy for the prevention of ventilator induced lung injury in a murine model of systemic TLR agonist induced lung injury.
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Affiliation(s)
- Olaf Boehm
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University Medical Center, Bonn, Germany
| | - Marc Rohner
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University Medical Center, Bonn, Germany
| | - Heidi Ehrentraut
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University Medical Center, Bonn, Germany
| | - Ulf Guenther
- Department of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Klinikum Oldenburg, Medical Campus University of Oldenburg, Germany
| | - Rainer Meyer
- Institute of Physiology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | | | | | - Georg Daniel Duerr
- Department of Cardiac Surgery, Rheinische Friedrich-Wilhelms-University Medical Center, Bonn, Germany
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University Medical Center, Bonn, Germany.
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Westphal S, Stoppe C, Gruenewald M, Bein B, Renner J, Cremer J, Coburn M, Schaelte G, Boening A, Niemann B, Kletzin F, Roesner J, Strouhal U, Reyher C, Laufenberg-Feldmann R, Ferner M, Brandes IF, Bauer M, Kortgen A, Stehr SN, Wittmann M, Baumgarten G, Struck R, Meyer-Treschan T, Kienbaum P, Heringlake M, Schoen J, Sander M, Treskatsch S, Smul T, Wolwender E, Schilling T, Degenhardt F, Franke A, Mucha S, Tittmann L, Kohlhaas M, Fuernau G, Brosteanu O, Hasenclever D, Zacharowski K, Meybohm P. Genome-wide association study of myocardial infarction, atrial fibrillation, acute stroke, acute kidney injury and delirium after cardiac surgery - a sub-analysis of the RIPHeart-Study. BMC Cardiovasc Disord 2019; 19:26. [PMID: 30678657 PMCID: PMC6345037 DOI: 10.1186/s12872-019-1002-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/14/2019] [Indexed: 01/01/2023] Open
Abstract
Background The aim of our study was the identification of genetic variants associated with postoperative complications after cardiac surgery. Methods We conducted a prospective, double-blind, multicenter, randomized trial (RIPHeart). We performed a genome-wide association study (GWAS) in 1170 patients of both genders (871 males, 299 females) from the RIPHeart-Study cohort. Patients undergoing non-emergent cardiac surgery were included. Primary endpoint comprises a binary composite complication rate covering atrial fibrillation, delirium, non-fatal myocardial infarction, acute renal failure and/or any new stroke until hospital discharge with a maximum of fourteen days after surgery. Results A total of 547,644 genotyped markers were available for analysis. Following quality control and adjustment for clinical covariate, one SNP reached genome-wide significance (PHLPP2, rs78064607, p = 3.77 × 10− 8) and 139 (adjusted for all other outcomes) SNPs showed promising association with p < 1 × 10− 5 from the GWAS. Conclusions We identified several potential loci, in particular PHLPP2, BBS9, RyR2, DUSP4 and HSPA8, associated with new-onset of atrial fibrillation, delirium, myocardial infarction, acute kidney injury and stroke after cardiac surgery. Trial registration The study was registered with ClinicalTrials.gov NCT01067703, prospectively registered on 11 Feb 2010. Electronic supplementary material The online version of this article (10.1186/s12872-019-1002-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabine Westphal
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Stoppe
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen, University Aachen, Aachen, Germany
| | - Matthias Gruenewald
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Berthold Bein
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Asklepios Klinik St. Georg, Hamburg, Germany.,Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jochen Renner
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Mark Coburn
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen, University Aachen, Aachen, Germany
| | - Gereon Schaelte
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen, University Aachen, Aachen, Germany
| | - Andreas Boening
- Department of Cardiovascular Surgery, University of Giessen, Giessen, Germany
| | - Bernd Niemann
- Department of Cardiovascular Surgery, University of Giessen, Giessen, Germany
| | - Frank Kletzin
- Clinic of Anaesthesiology and Intensive Care Medicine, University Hospital Rostock, Rostock, Germany
| | - Jan Roesner
- Department of Anaesthesiology and Intensive Care, Suedstadt Hospital Rostock, Rostock, Germany
| | - Ulrich Strouhal
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Reyher
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Marion Ferner
- Department of Anesthesiology, Medical Center of Johannes Gutenberg-University, Mainz, Germany
| | - Ivo F Brandes
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Martin Bauer
- Department of Anaesthesiology and Intensive Care, Klinikum Region Hannover, Hannover, Germany
| | - Andreas Kortgen
- Department of Anaesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Sebastian N Stehr
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Maria Wittmann
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Baumgarten
- Department of Anaesthesiology and Intensive Care Medicine, Johanniter Hospital Bonn, Bonn, Germany
| | - Rafael Struck
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Tanja Meyer-Treschan
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Peter Kienbaum
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Matthias Heringlake
- Department of Anaesthesiology and Intensive Care Medicine, University Luebeck, Luebeck, Germany
| | - Julika Schoen
- Department of Anaesthesiology and Intensive Care Medicine, Hospital Neuruppin, Neuruppin, Germany
| | - Michael Sander
- Department of Anaesthesiology and Intensive Care, University of Giessen, Giessen, Germany
| | - Sascha Treskatsch
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Thorsten Smul
- Department of Anaesthesiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ewa Wolwender
- Department of Anaesthesiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Thomas Schilling
- Department of Anaesthesiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Frauke Degenhardt
- Institute of Clinical Molecular Biology, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Soeren Mucha
- Institute of Clinical Molecular Biology, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Lukas Tittmann
- Institute of Clinical Molecular Biology, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Madeline Kohlhaas
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Georg Fuernau
- University Heart Center Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Luebeck, Luebeck, Germany
| | - Oana Brosteanu
- Clinical Trial Centre, University Leipzig, Leipzig, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany.
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Hilbert T, Markowski P, Frede S, Boehm O, Knuefermann P, Baumgarten G, Hoeft A, Klaschik S. Synthetic CpG oligonucleotides induce a genetic profile ameliorating murine myocardial I/R injury. J Cell Mol Med 2018; 22:3397-3407. [PMID: 29671939 PMCID: PMC6010716 DOI: 10.1111/jcmm.13616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/26/2018] [Indexed: 12/13/2022] Open
Abstract
We previously demonstrated that pre‐conditioning with CpG oligonucleotide (ODN) 1668 induces quick up‐regulation of gene expression 3 hours post‐murine myocardial ischaemia/reperfusion (I/R) injury, terminating inflammatory processes that sustain I/R injury. Now, performing comprehensive microarray and biocomputational analyses, we sought to further enlighten the “black box” beyond these first 3 hours. C57BL/6 mice were pretreated with either CpG 1668 or with control ODN 1612, respectively. Sixteen hours later, myocardial ischaemia was induced for 1 hour in a closed‐chest model, followed by reperfusion for 24 hours. RNA was extracted from hearts, and labelled cDNA was hybridized to gene microarrays. Data analysis was performed with BRB ArrayTools and Ingenuity Pathway Analysis. Functional groups mediating restoration of cellular integrity were among the top up‐regulated categories. Genes known to influence cardiomyocyte survival were strongly induced 24 hours post‐I/R. In contrast, proinflammatory pathways were down‐regulated. Interleukin‐10, an upstream regulator, suppressed specifically selected proinflammatory target genes at 24 hours compared to 3 hours post‐I/R. The IL1 complex is supposed to be one regulator of a network increasing cardiovascular angiogenesis. The up‐regulation of numerous protective pathways and the suppression of proinflammatory activity are supposed to be the genetic correlate of the cardioprotective effects of CpG 1668 pre‐conditioning.
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Affiliation(s)
- Tobias Hilbert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Paul Markowski
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Stilla Frede
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Olaf Boehm
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Pascal Knuefermann
- Department of Anesthesiology and Intensive Care Medicine, Gemeinschaftskrankenhaus Bonn St. Elisabeth - St. Petrus - St. Johannes gGmbH, Bonn, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, Johanniter Hospital Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Sven Klaschik
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Meybohm P, Kohlhaas M, Stoppe C, Gruenewald M, Renner J, Bein B, Albrecht M, Cremer J, Coburn M, Schaelte G, Boening A, Niemann B, Sander M, Roesner J, Kletzin F, Mutlak H, Westphal S, Laufenberg-Feldmann R, Ferner M, Brandes IF, Bauer M, Stehr SN, Kortgen A, Wittmann M, Baumgarten G, Meyer-Treschan T, Kienbaum P, Heringlake M, Schoen J, Treskatsch S, Smul T, Wolwender E, Schilling T, Fuernau G, Bogatsch H, Brosteanu O, Hasenclever D, Zacharowski K. RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study: Myocardial Dysfunction, Postoperative Neurocognitive Dysfunction, and 1 Year Follow-Up. J Am Heart Assoc 2018; 7:e008077. [PMID: 29581218 PMCID: PMC5907591 DOI: 10.1161/jaha.117.008077] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 11/08/2017] [Accepted: 01/26/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Remote ischemic preconditioning (RIPC) has been suggested to protect against certain forms of organ injury after cardiac surgery. Previously, we reported the main results of RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study, a multicenter trial randomizing 1403 cardiac surgery patients receiving either RIPC or sham-RIPC. METHODS AND RESULTS In this follow-up paper, we present 1-year follow-up of the composite primary end point and its individual components (all-cause mortality, myocardial infarction, stroke and acute renal failure), in a sub-group of patients, intraoperative myocardial dysfunction assessed by transesophageal echocardiography and the incidence of postoperative neurocognitive dysfunction 5 to 7 days and 3 months after surgery. RIPC neither showed any beneficial effect on the 1-year composite primary end point (RIPC versus sham-RIPC 16.4% versus 16.9%) and its individual components (all-cause mortality [3.4% versus 2.5%], myocardial infarction [7.0% versus 9.4%], stroke [2.2% versus 3.1%], acute renal failure [7.0% versus 5.7%]) nor improved intraoperative myocardial dysfunction or incidence of postoperative neurocognitive dysfunction 5 to 7 days (67 [47.5%] versus 71 [53.8%] patients) and 3 months after surgery (17 [27.9%] versus 18 [27.7%] patients), respectively. CONCLUSIONS Similar to our main study, RIPC had no effect on intraoperative myocardial dysfunction, neurocognitive function and long-term outcome in cardiac surgery patients undergoing propofol anesthesia. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01067703.
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Affiliation(s)
- Patrick Meybohm
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Madeline Kohlhaas
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Stoppe
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Matthias Gruenewald
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Germany
| | - Jochen Renner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Germany
| | - Berthold Bein
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Germany
- Department of Anesthesiology and Intensive Care Medicine, Asklepios Hospital St. Georg Hamburg, Germany
| | - Martin Albrecht
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Germany
| | - Mark Coburn
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Gereon Schaelte
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Andreas Boening
- Department of Cardiovascular Surgery, University of Giessen, Germany
| | - Bernd Niemann
- Department of Cardiovascular Surgery, University of Giessen, Germany
| | - Michael Sander
- Department of Anesthesiology and Intensive Care, University of Giessen, Germany
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Jan Roesner
- Department of Anesthesiology and Intensive Care, Suedstadt Hospital Rostock, Germany
- Clinic of Anesthesiology and Intensive Care Medicine, University Hospital Rostock, Germany
| | - Frank Kletzin
- Clinic of Anesthesiology and Intensive Care Medicine, University Hospital Rostock, Germany
| | - Haitham Mutlak
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sabine Westphal
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Marion Ferner
- Department of Anesthesiology, Medical Center of Johannes Gutenberg-University, Mainz, Germany
| | - Ivo F Brandes
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Goettingen, Germany
| | - Martin Bauer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Goettingen, Germany
- Department of Anesthesiology and Intensive Care, Klinikum Region Hannover, Germany
| | - Sebastian N Stehr
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Germany
| | - Andreas Kortgen
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, Johanniter Hospital Bonn, Germany
| | - Tanja Meyer-Treschan
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Duesseldorf, Germany
| | - Peter Kienbaum
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Duesseldorf, Germany
| | - Matthias Heringlake
- Department of Anesthesiology and Intensive Care Medicine, University Luebeck, Germany
| | - Julika Schoen
- Department of Anesthesiology and Intensive Care Medicine, University Luebeck, Germany
- Department of Anesthesiology and Intensive Care Medicine, Hospital Neuruppin, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Thorsten Smul
- Department of Anesthesiology, University Hospital Wuerzburg, Germany
| | - Ewa Wolwender
- Department of Anesthesiology, University Hospital Wuerzburg, Germany
| | - Thomas Schilling
- Department of Anesthesiology, University Hospital Magdeburg, Germany
| | - Georg Fuernau
- University Heart Luebeck Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Hospital Schleswig-Holstein, Luebeck, Germany
| | | | | | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Germany
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
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Hilbert T, Dornbusch K, Baumgarten G, Hoeft A, Frede S, Klaschik S. Pulmonary vascular inflammation: effect of TLR signalling on angiopoietin/TIE regulation. Clin Exp Pharmacol Physiol 2017; 44:123-131. [PMID: 27712004 DOI: 10.1111/1440-1681.12680] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 09/13/2016] [Accepted: 09/30/2016] [Indexed: 12/27/2022]
Abstract
Increased pulmonary vascular resistance is a critical complication in sepsis. Toll-like receptor (TLR) as well as angiopoietin (ANG) signalling both contribute to the emergence of pulmonary arterial hypertension. We hypothesized that TLR stimulation by bacterial ligands directly affects expression and secretion of ligands and receptors of the angiopoietin/TIE axis. Microvascular endothelial (HPMEC) and smooth muscle cells (SMC) of pulmonary origin were incubated with thrombin and with ligands for TLR2, -4, -5, and -9. Expression and secretion of ANG1, -2, TIE2 and IL-8 were determined using quantitative real-time PCR and ELISA. TLR stimulation had no impact either on the expression of ANG2 and TIE2 in HPMEC or on that of ANG1 in SMC. However, overall levels of both released ANG1 and -2 were halved upon stimulation with the TLR9 ligand CpG, and ANG2 release was significantly enhanced by TLR4 activation when initially provoked by sequentially performed stimulation. Furthermore, enhanced ANG2 activity increased endothelial permeability, as demonstrated in an in vitro transwell assay. We conclude that sole TLR stimulation by bacterial ligands plays no significant role for altered expression and secretion of ANG1, -2 and TIE2 in human pulmonary vascular cells. The interplay between various stimuli is required to induce imbalances between ANG1 and -2.
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Affiliation(s)
- Tobias Hilbert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Kathrin Dornbusch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, Johanniter Hospital Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Stilla Frede
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Sven Klaschik
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Baehner T, Dewald O, Heinze I, Mueller M, Schindler E, Schirmer U, Baumgarten G, Hoeft A, Ellerkmann RK. The provision of pediatric cardiac anesthesia services in Germany: current status of structural and personnel organization. Paediatr Anaesth 2017; 27:801-809. [PMID: 28419616 DOI: 10.1111/pan.13153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anesthesia for pediatric cardiac surgery requires a high level of expert knowledge. There are currently no recommendations and standards for anesthetic management for congenital cardiac surgery in Germany. AIM The aim of the present study was to assess the current status of structural and personnel anesthetic standards at pediatric cardiac surgery centers in Germany. METHODS All cardiac surgical centers in Germany were reviewed for an active program for congenital heart surgery. Centers with an active program were invited to respond to an online survey. The questionnaire containing 55 items in 16 categories assessed current practice in pediatric cardiac anesthesia. RESULTS An active program for pediatric cardiac surgery was identified at 27 centers. The response rate to the survey was 96.3%. A specialized group of anesthesiologists for pediatric cardiac anesthesia was reported from 26 centers (92.3%). The mean size of this group was 4.8 anesthesiologists per center. However, the annual case load of centers and relative annual case load per specialized anesthesiologist varied considerably between 12.5 and 250. Nonanesthesiologists performed sedation and general anesthesia for diagnostic and therapeutic interventions outside the operating theater in children with congenital heart diseases in 24 centers (77%). Although special equipment, for example, pediatric TEE, near-infrared spectroscopy, and devices for mechanical auto transfusion were available in most centers, their routine use was not always part of standard operating procedures. The proposal for mean adequate training in pediatric cardiac anesthesia as estimated by the participating centers was 10.8 months. CONCLUSION The present study represents the current structural situation for anesthesia at German pediatric cardiac surgery centers.
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Affiliation(s)
- Torsten Baehner
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Oliver Dewald
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Ingo Heinze
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Matthias Mueller
- Pediatric Heart Centre, Justus-Liebig University, Giessen, Germany
| | - Ehrenfried Schindler
- Department of Pediatric Anesthesiology and Critical Care Medicine, Asklepios Children's Hospital Sankt Augustin, Sankt Augustin, Germany
| | - Uwe Schirmer
- Department of Anesthesiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Richard K Ellerkmann
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
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Struck R, Wittmann M, Recht T, Baumgarten G, Meybohm P, Müller A, Bagci S. Effect of remote ischemic preconditioning on the melatonin and antioxidative status: a pilot study in patients undergoing cardiac surgery. J Cardiovasc Surg (Torino) 2017; 58:909-915. [PMID: 28124514 DOI: 10.23736/s0021-9509.17.09736-1] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Remote ischemic preconditioning (RIPC), a phenomenon in which a transient ischemia applied to a nonvital tissue protects another organ or tissue from subsequent lethal ischemic injury, is reported to protect the myocardium to withstand a subsequent prolonged ischemic event in patients undergoing cardiac surgery with cardiopulmonary bypass. It remains unclear whether oxidative stress and endogenous antioxidant enzymes play a role in the mechanistic pathways of RIPC. The aim of the present study was to evaluate the effects of RIPC on oxidative stress and extracellular concentrations of melatonin, extracellular superoxide dismutase (eSOD) and extracellular glutathione peroxidase (eGPx) in patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS Thirty-two patients were randomly assigned to receive either RIPC (N.=15) or sham-RIPC (N.=17). Blood samples were collected immediately before and after RIPC and at the end of surgery. Melatonin levels were determined by radioimmunoassay. Plasma concentrations of eSOD, eGPx and 8-hydroxydeoxyguanosine (8-OhdG) as a marker of DNA oxidative stress were measured via ELISA. RESULTS We found that RIPC compared to Sham-RIPC independently predicted higher melatonin concentrations at the end of surgery. However, it had no effect on eSOD, eGPx, and DNA oxidative stress. eSOD levels significantly increased during CPB time, while systemic eGPx levels decreased. High baseline melatonin concentration independently predicted lower 8-OHdG levels at the end of surgery. CONCLUSIONS Our results suggest that extracellular antioxidative enzymes such as eSOD and eGPx as well as oxidative stress levels in the perioperative period do not play a predominant role in the mechanistic pathways of RIPC. RIPC modulates systemic melatonin concentrations but does not affect eSOD, eGPx and oxidative stress levels.
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Affiliation(s)
- Rafael Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Thomas Recht
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas Müller
- Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Soyhan Bagci
- Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany -
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10
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Riedel R, Schmieder A, Koster A, Kim S, Baumgarten G, Schewe JC. [Heparin-induced thrombocytopenia type II (HIT II) : A medical-economic view]. Med Klin Intensivmed Notfmed 2016; 112:334-346. [PMID: 28005139 DOI: 10.1007/s00063-016-0237-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 10/18/2016] [Accepted: 11/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the context of inpatient and increasingly ambulatory thrombosis prophylaxis, heparins have been recognised as standard therapy for decades. In addition to the therapeutic benefit, therapy with heparins also entails the risk of undesirable side effects, such as bleeding and thrombocytopenia. Heparin-induced thrombocytopenia (HIT II) is deemed a serious side effect. AIM In the following work, HIT II is subjected to a medico-economic consideration (treatment, pharmaceuticals, subsequent costs due to possible complications) and, with regard to a possible HIT II prophylaxis, aspects of increasingly respected patient safety are also considered. METHODS In the context of a literature search the active ingredients argatroban and danaparoid, which are approved for HIT II treatment, were evaluated. RESULTS HIT II - especially in combination with thromboembolic complications - represents a medical-economic burden for the hospital. Although this is only an orientation guide, it shows that HIT II syndrome is not adequately cost-covered by the G‑DRG system. An early thrombosis prophylaxis with argatroban/danaparoid for HIT II risk patients should therefore be taken into account for medical-related as well as patient safety-relevant aspects. According to experience, the pharmaceutical supply for these medically needed products (anticoagulants) should be ensured for reasons of patient safety. CONCLUSION The risk of an immunological response to heparin therapy is known. Within the context of increased patient safety, thrombosis prophylaxis should be issued with a risk-adjusted prophylaxis.
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Affiliation(s)
- R Riedel
- Institut für Medizinökonomie und Medizinische Versorgungsforschung, Rheinische Fachhochschule Köln gGmbH, Schaevenstr. 1 b, 50676, Köln, Deutschland.
| | - A Schmieder
- Studiengang MSc Medizinökonomie, Rheinische Fachhochschule Köln gGmbH, Köln, Deutschland
| | - A Koster
- Institut für Anästhesiologie, Herz- und Diabeteszentrum NRW (HDZ), Bad Oeynhausen, Deutschland
| | - S Kim
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - G Baumgarten
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - J C Schewe
- DESA, Operative Intensivmedizin, Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
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11
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Abstract
Although anesthesia-associated mortality has been significantly reduced down to 0.00068-0.00082% over the last decades, recent studies have revealed a high perioperative mortality of 0.8- 4%. Apart from anesthesia and surgery-induced major complications, perioperative mortality is primarily negatively influenced by individual patient comorbidities. These risk factors predispose for acute critical incidents (e.g., myocardial infarction); however, the majority of fatal complications are a result of slowly progressing conditions, particularly infections or the sequelae of systemic inflammation. This implicates a broad window of opportunity for the detection and treatment of slow-onset complications to improve the perioperative outcome. The term "failure to rescue" (FTR), i.e., the proportion of patients who die from major complications compared to the number of all patients with complications, has been introduced as a valid indicator for the quality of perioperative care. Growing evidence has already shown that FTR is an underestimated factor in perioperative medicine accounting for or at least being involved in the development of postoperative mortality. While the incidence of severe postoperative complications amazingly does not show much variation between hospitals, FTR shows significant differences implying a major potential for improvement. With 14 million surgical procedures per year in Germany, a postoperative mortality of approximately 1% and an avoidable FTR rate of 40% mean that there are an estimated 60,000 preventable deaths per year. Hence, in the future it will be imperative to (1) identify patients at risk, (2) to prevent the development of postoperative complications with the use of adequate adjunctive therapeutic strategies, (3) to establish surveillance and monitoring systems for the early detection of postoperative complications and (4) to treat postoperative complications efficiently and in time when they arise.
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Affiliation(s)
- O Boehm
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - M K A Pfeiffer
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - G Baumgarten
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - A Hoeft
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
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Gowran A, Kulikova T, Lewis FC, Foldes G, Fuentes L, Viiri LE, Spinelli V, Costa A, Perbellini F, Sid-Otmane C, Bax NAM, Pekkanen-Mattila M, Schiano C, Chaloupka A, Forini F, Sarkozy M, De Jager SCA, Vajen T, Glezeva N, Lee HW, Golovkin A, Kucera T, Musikhina NA, Korzhenkov NP, Santuchi MDEC, Munteanu D, Garcia RG, Ang R, Usui S, Kamilova U, Jumeau C, Aberg M, Kostina DA, Brandt MM, Muntean D, Lindner D, Sadaba R, Bacova B, Nikolov A, Sedmera D, Ryabov V, Neto FP, Lynch M, Portero V, Kui P, Howarth FC, Gualdoni A, Prorok J, Diolaiuti L, Vostarek F, Wagner M, Abela MA, Nebert C, Xiang W, Kloza M, Maslenko A, Grechanyk M, Bhattachariya A, Morawietz H, Babaeva AR, Martinez Sanchez SM, Krychtiuk KA, Starodubova J, Fiorelli S, Rinne P, Ozkaramanli Gur D, Hofbauer T, Starodubova J, Stellos K, Pinon P, Tsoref O, Thaler B, Fraga-Silva RA, Fuijkschot WW, Shaaban MNS, Matthaeus C, Deluyker D, Scardigli M, Zahradnikova A, Dominguez A, Kondrat'eva D, Sosorburam T, Murarikova M, Duerr GD, Griecsova L, Portnichenko VI, Smolina N, Duicu OANAM, Elder JM, Zaglia T, Lorenzon A, Ruperez C, Woudstra L, Suffee N, De Lucia C, Tsoref O, Russell-Hallinan A, Menendez-Montes I, Kapelko VI, Emmens RW, Hetman O, Van Der Laarse WJ, Goncharov S, Adao R, Huisamen B, Sirenko O, Kamilova U, Nassiri I, Tserendavaa SUMIYA, Yushko K, Baldan Martin M, Falcone C, Vigorelli V, Nigro P, Pompilio G, Stepanova O, Valikhov M, Samko A, Masenko V, Tereschenko S, Teoh T, Domenjo-Vila E, Theologou T, Field M, Awad W, Yasin M, Nadal-Ginard B, Ellison-Hughes GM, Hellen N, Vittay O, Harding SE, Gomez-Cid L, Fernandez-Santos ME, Suarez-Sancho S, Plasencia V, Climent A, Sanz-Ruiz R, Hedhammar M, Atienza F, Fernandez-Aviles F, Kiamehr M, Oittinen M, Viiri KM, Kaikkonen M, Aalto-Setala K, Diolaiuti L, Laurino A, Sartiani L, Vona A, Zanardelli M, Cerbai E, Failli P, Hortigon-Vinagre MP, Van Der Heyden M, Burton FL, Smith GL, Watson S, Scigliano M, Tkach S, Alayoubi S, Harding SE, Terracciano CM, Ly HQ, Mauretti A, Van Marion MH, Van Turnhout MC, Van Der Schaft DWJ, Sahlgren CM, Goumans MJ, Bouten CVC, Vuorenpaa H, Penttinen K, Sarkanen R, Ylikomi T, Heinonen T, Aalto-Setala K, Grimaldi V, Aprile M, Esposito R, Maiello C, Soricelli A, Colantuoni V, Costa V, Ciccodicola A, Napoli C, Rowe GC, Johnson K, Arany ZP, Del Monte F, D'aurizio R, Kusmic C, Nicolini G, Baumgart M, Groth M, Ucciferri N, Iervasi G, Pitto L, Pipicz M, Gaspar R, Siska A, Foldesi I, Kiss K, Bencsik P, Thum T, Batkai S, Csont T, Haan JJ, Bosch L, Brans MAD, Van De Weg SM, Deddens JC, Lee SJ, Sluijter JPG, Pasterkamp G, Werner I, Projahn D, Staudt M, Curaj A, Soenmez TT, Simsekyilmaz S, Hackeng TM, Von Hundelshausen P, Koenen RR, Weber C, Liehn EA, Santos-Martinez M, Medina C, Watson C, Mcdonald K, Gilmer J, Ledwidge M, Song SH, Lee MY, Park MH, Choi JC, Ahn JH, Park JS, Oh JH, Choi JH, Lee HC, Cha KS, Hong TJ, Kudryavtsev I, Serebryakova M, Malashicheva A, Shishkova A, Zhiduleva E, Moiseeva O, Durisova M, Blaha M, Melenovsky V, Pirk J, Kautzner J, Petelina TI, Gapon LI, Gorbatenko EA, Potolinskaya YV, Arkhipova EV, Solodenkova KS, Osadchuk MA, Dutra MF, Oliveira FCB, Silva MM, Passos-Silva DG, Goncalves R, Santos RAS, Da Silva RF, Gavrilescu CM, Paraschiv CM, Manea P, Strat LC, Gomez JMG, Merino D, Hurle MA, Nistal JF, Aires A, Cortajarena AL, Villar AV, Abramowitz J, Birnbaumer L, Gourine AV, Tinker A, Takamura M, Takashima S, Inoue O, Misu H, Takamura T, Kaneko S, Alieva TOHIRA, Mougenot N, Dufilho M, Hatem S, Siegbahn A, Kostina AS, Uspensky VE, Moiseeva OM, Kostareva AA, Malashicheva AB, Van Dijk CGM, Chrifi I, Verhaar MC, Duncker DJ, Cheng C, Sturza A, Petrus A, Duicu O, Kiss L, Danila M, Baczko I, Jost N, Gotzhein F, Schon J, Schwarzl M, Hinrichs S, Blankenberg S, Volker U, Hammer E, Westermann D, Martinez-Martinez E, Arrieta V, Fernandez-Celis A, Jimenez-Alfaro L, Melero A, Alvarez-Asiain V, Cachofeiro V, Lopez-Andres N, Tribulova N, Wallukat G, Knezl V, Radosinska J, Barancik M, Tsinlikov I, Tsinlikova I, Nicoloff G, Blazhev A, Pesevski Z, Kvasilova A, Stopkova T, Eckhardt A, Buffinton CM, Nanka O, Kercheva M, Suslova T, Gusakova A, Ryabova T, Markov V, Karpov R, Seemann H, Alcantara TC, Santuchi MDEC, Fonseca SG, Da Silva RF, Barallobre-Barreiro J, Oklu R, Fava M, Baig F, Yin X, Albadawi H, Jahangiri M, Stoughton J, Mayr M, Podliesna SP, Veerman CCV, Verkerk AOV, Klerk MK, Lodder EML, Mengarelli IM, Bezzina CRB, Remme CAR, Takacs H, Polyak A, Morvay N, Lepran I, Tiszlavicz L, Nagy N, Ordog B, Farkas A, Forster T, Varro A, Farkas AS, Jayaprakash P, Parekh K, Ferdous Z, Oz M, Dobrzynski H, Adrian TE, Landi S, Bonzanni M, D'souza A, Boyett M, Bucchi A, Baruscotti M, Difrancesco D, Barbuti A, Kui P, Takacs H, Oravecz K, Hezso T, Polyak A, Levijoki J, Pollesello P, Koskelainen T, Otsomaa L, Farkas AS, Papp JGY, Varro A, Toth A, Acsai K, Dini L, Mazzoni L, Sartiani L, Cerbai E, Mugelli A, Svatunkova J, Sedmera D, Deffge C, Baer C, Weinert S, Braun-Dullaeus RC, Herold J, Cassar AC, Zahra GZ, Pllaha EP, Dingli PD, Montefort SM, Xuereb RGX, Aschacher T, Messner B, Eichmair E, Mohl W, Reglin B, Rong W, Nitzsche B, Maibier M, Guimaraes P, Ruggeri A, Secomb TW, Pries AR, Baranowska-Kuczko M, Karpinska O, Kusaczuk M, Malinowska B, Kozlowska H, Demikhova N, Vynnychenko L, Prykhodko O, Grechanyk N, Kuryata A, Cottrill KA, Du L, Bjorck HM, Maleki S, Franco-Cereceda A, Chan SY, Eriksson P, Giebe S, Cockcroft N, Hewitt K, Brux M, Brunssen C, Tarasov AA, Davidov SI, Reznikova EA, Tapia Abellan A, Angosto Bazarra D, Pelegrin Vivancos P, Montoro Garcia S, Kastl SP, Pongratz T, Goliasch G, Gaspar L, Maurer G, Huber K, Dostal E, Pfaffenberger S, Oravec S, Wojta J, Speidl WS, Osipova I, Sopotova I, Eligini S, Cosentino N, Marenzi G, Tremoli E, Rami M, Ring L, Steffens S, Gur O, Gurkan S, Mangold A, Scherz T, Panzenboeck A, Staier N, Heidari H, Mueller J, Lang IM, Osipova I, Sopotova I, Gatsiou A, Stamatelopoulos K, Perisic L, John D, Lunella FF, Eriksson P, Hedin U, Zeiher A, Dimmeler S, Nunez L, Moure R, Marron-Linares G, Flores X, Aldama G, Salgado J, Calvino R, Tomas M, Bou G, Vazquez N, Hermida-Prieto M, Vazquez-Rodriguez JM, Amit U, Landa N, Kain D, Tyomkin D, David A, Leor J, Hohensinner PJ, Baumgartner J, Krychtiuk KA, Maurer G, Huber K, Baik N, Miles LA, Wojta J, Seeman H, Montecucco F, Da Silva AR, Costa-Fraga FP, Anguenot L, Mach FP, Santos RAS, Stergiopulos N, Da Silva RF, Kupreishvili K, Vonk ABA, Smulders YM, Van Hinsbergh VWM, Stooker W, Niessen HWM, Krijnen PAJ, Ashmawy MM, Salama MA, Elamrosy MZ, Juettner R, Rathjen FG, Bito V, Crocini C, Ferrantini C, Gabbrielli T, Silvestri L, Coppini R, Tesi C, Cerbai E, Poggesi C, Pavone FS, Sacconi L, Mackova K, Zahradnik I, Zahradnikova A, Diaz I, Sanchez De Rojas De Pedro E, Hmadcha K, Calderon Sanchez E, Benitah JP, Gomez AM, Smani T, Ordonez A, Afanasiev SA, Egorova MV, Popov SV, Wu Qing P, Cheng X, Carnicka S, Pancza D, Jasova M, Kancirova I, Ferko M, Ravingerova T, Wu S, Schneider M, Marggraf V, Verfuerth L, Frede S, Boehm O, Dewald O, Baumgarten G, Kim SC, Farkasova V, Gablovsky I, Bernatova I, Ravingerova T, Nosar V, Portnychenko A, Drevytska T, Mankovska I, Gogvadze V, Sejersen T, Kostareva A, Sturza A, Wolf A, Privistirescu A, Danila M, Muntean D, O ' Gara P, Sanchez-Alonso JL, Harding SE, Lyon AR, Prando V, Pianca N, Lo Verso F, Milan G, Pesce P, Sandri M, Mongillo M, Beffagna G, Poloni G, Dazzo E, Sabatelli P, Doliana R, Polishchuk R, Carnevale D, Lembo G, Bonaldo P, Braghetta P, Rampazzo A, Cairo M, Giralt M, Villarroya F, Planavila A, Biesbroek PS, Emmens RWE, Juffermans LJM, Van Der Wall AC, Van Rossum AC, Niessen JWM, Krijnen PAJ, Moor Morris T, Dilanian G, Farahmand P, Puceat M, Hatem S, Gambino G, Petraglia L, Elia A, Komici K, Femminella GD, D'amico ML, Pagano G, Cannavo A, Liccardo D, Koch WJ, Nolano M, Leosco D, Ferrara N, Rengo G, Amit U, Landa N, Kain D, Leor J, Neary R, Shiels L, Watson C, Baugh J, Palacios B, Escobar B, Alonso AV, Guzman G, Ruiz-Cabello J, Jimenez-Borreguero LJ, Martin-Puig S, Lakomkin VL, Lukoshkova EV, Abramov AA, Gramovich VV, Vyborov ON, Ermishkin VV, Undrovinas NA, Shirinsky VP, Smilde BJ, Woudstra L, Fong Hing G, Wouters D, Zeerleder S, Murk JL, Van Ham SM, Heymans S, Juffermans LJM, Van Rossum AC, Niessen JWM, Krijnen PAJ, Krakhmalova O, Van Groen D, Bogaards SJP, Schalij I, Portnichenko GV, Tumanovska LV, Goshovska YV, Lapikova-Bryhinska TU, Nagibin VS, Dosenko VE, Mendes-Ferreira P, Maia-Rocha C, Santos-Ribeiro D, Potus F, Breuils-Bonnet S, Provencher S, Bonnet S, Rademaker M, Leite-Moreira AF, Bras-Silva C, Lopes J, Kuryata O, Lusynets T, Alikulov I, Nourddine M, Azzouzi L, Habbal R, Tserendavaa SUMIYA, Enkhtaivan ODKHUU, Enkhtaivan ODKHUU, Shagdar ZORIGO, Shagdar ZORIGO, Malchinkhuu MUNKHZ, Malchinkhuu MUNLHZ, Koval S, Starchenko T, Mourino-Alvarez L, Gonzalez-Calero L, Sastre-Oliva T, Lopez JA, Vazquez J, Alvarez-Llamas G, Ruilope LUISM, De La Cuesta F, Barderas MG, Bozzini S, D'angelo A, Pelissero G. Poster session 3Cell growth, differentiation and stem cells - Heart511The role of the endocannabinoid system in modelling muscular dystrophy cardiac disease with induced pluripotent stem cells.512An emerging role of T lymphocytes in cardiac regenerative processes in heart failure due to dilated cardiomyopathy513Canonical wnt signaling reverses the ‘aged/senescent’ human endogenous cardiac stem cell phenotype514Hippo signalling modulates survival of human induced pluripotent stem cell-derived cardiomyocytes515Biocompatibility of mesenchymal stem cells with a spider silk matrix and its potential use as scaffold for cardiac tissue regeneration516A snapshot of genome-wide transcription in human induced pluripotent stem cell-derived hepatocyte-like cells (iPSC-HLCs)517Can NOS/sGC/cGK1 pathway trigger the differentiation and maturation of mouse embryonic stem cells (ESCs)?518Introduction of external Ik1 to human-induced pluripotent stem cell-derived cardiomyocytes via Ik1-expressing HEK293519Cell therapy of the heart studied using adult myocardial slices in vitro520Enhancement of the paracrine potential of human adipose derived stem cells when cultured as spheroid bodies521Mechanosensitivity of cardiomyocyte progenitor cells: the strain response in 2D and 3D environments522The effect of the vascular-like network on the maturation of the human induced pluripotent stem cell derived cardiomyocytes.Transcriptional control and RNA species - Heart525Gene expression regulation in heart failure: from pathobiology to bioinformatics526Human transcriptome in idiopathic dilated cardiomyopathy - a novel high throughput screening527A high-throghput approach unveils putative miRNA-mediated mitochondria-targeted cardioprotective circuits activated by T3 in the post ischemia reperfusion setting528The effect of uraemia on the expression of miR-212/132 and the calcineurin pathway in the rat heartCytokines and cellular inflammation - Heart531Lack of growth differentiation factor 15 aggravates adverse cardiac remodeling upon pressure-overload in mice532Blocking heteromerization of platelet chemokines ccl5 and cxcl4 reduces inflammation and preserves heart function after myocardial infarction533Is there an association between low-dose aspirin use and clinical outcome in HFPEF? Implications of modulating monocyte function and inflammatory mediator release534N-terminal truncated intracellular matrix metalloproteinase-2 expression in diabetic heart.535Expression of CD39 and CD73 on peripheral T-cell subsets in calcific aortic stenosis536Mast cells in the atrial myocardium of patients with atrial fibrillation: a comparison with patients in sinus rhythm539Characteristics of the inflammatory response in patients with coronary artery disease and arterial hypertension540Pro-inflammatory cytokines as cardiovascular events predictors in rheumatoid arthritis and asymptomatic atherosclerosis541Characterization of FVB/N murinic bone marrow-derived macrophage polarization into M1 and M2 phenotypes542The biological expression and thoracic anterior pain syndromeSignal transduction - Heart545The association of heat shock protein 90 and TGFbeta receptor I is involved in collagen production during cardiac remodelling in aortic-banded mice546Loss of the inhibitory GalphaO protein in the rostral ventrolateral medulla of the brainstem leads to abnormalities in cardiovascular reflexes and altered ventricular excitablitiy547Selenoprotein P regulates pressure overload-induced cardiac remodeling548Study of adenylyl cyclase activity in erythrocyte membranes in patients with chronic heart failure549Direct thrombin inhibitors inhibit atrial myocardium hypertrophy in a rat model of heart failure and atrial remodeling550Tissue factor / FVIIa transactivates the IGF-1R by a Src-dependent phosphorylation of caveolin-1551Notch signaling is differently altered in endothelial and smooth muscle cells of ascending aortic aneurysm patients552Frizzled 5 expression is essential for endothelial proliferation and migration553Modulation of vascular function and ROS production by novel synthetic benzopyran analogues in diabetes mellitusExtracellular matrix and fibrosis - Heart556Cardiac fibroblasts as inflammatory supporter cells trigger cardiac inflammation in heart failure557A role for galectin-3 in calcific aortic valve stenosis558Omega-3 polyunsaturated fatty acids- can they decrease risk for ventricular fibrillation?559Serum levels of elastin derived peptides and circulating elastin-antielastin immune complexes in sera of patients with coronary artery disease560Endocardial fibroelastosis is secondary to hemodynamic alterations in the chick model of hypoplastic left heart syndrome561Dynamics of serum levels of matrix metalloproteinases in primary anterior STEMI patients564Deletion of the alpha-7 nicotinic acetylcholine receptor changes the vascular remodeling induced by transverse aortic constriction in mice.565Extracellular matrix remodelling in response to venous hypertension: proteomics of human varicose veinsIon channels, ion exchangers and cellular electrophysiology - Heart568Microtubule-associated protein RP/EB family member 1 modulates sodium channel trafficking and cardiac conduction569Investigation of electrophysiological abnormalities in a rabbit athlete's heart model570Upregulation of expression of multiple genes in the atrioventricular node of streptozotocin-induced diabetic rat571miR-1 as a regulator of sinoatrial rhythm in endurance training adaptation572Selective sodium-calcium exchanger inhibition reduces myocardial dysfunction associated with hypokalaemia and ventricular fibrillation573Effect of racemic and levo-methadone on action potential of human ventricular cardiomyocytes574Acute temperature effects on the chick embryonic heart functionVasculogenesis, angiogenesis and arteriogenesis577Clinical improvement and enhanced collateral vessel growth after monocyte transplantation in mice578The role of HIF-1 alpha, VEGF and obstructive sleep apnoea in the development of coronary collateral circulation579Initiating cardiac repair with a trans-coronary sinus catheter intervention in an ischemia/reperfusion porcine animal model580Early adaptation of pre-existing collaterals after acute arteriolar and venular microocclusion: an in vivo study in chick chorioallantoic membraneEndothelium583EDH-type responses to the activator of potassium KCa2.3 and KCa3.1 channels SKA-31 in the small mesenteric artery from spontaneously hypertensive rats584The peculiarities of endothelial dysfunction in patients with chronic renocardial syndrome585Endothelial dysfunction, atherosclerosis of the carotid arteries and level of leptin in patient with coronary heart disease in combination with hepatic steatosis depend from body mass index.586Role of non-coding RNAs in thoracic aortic aneurysm associated with bicuspid aortic valve587Cigarette smoke extract abrogates atheroprotective effects of high laminar flow on endothelial function588The prognostic value of anti-connective tissue antibodies in coronary heart disease and asymptomatic atherosclerosis589Novel potential properties of bioactive peptides from spanish dry-cured ham on the endothelium.Lipids592Intermediate density lipoprotein is associated with monocyte subset distribution in patients with stable atherosclerosis593The characteristics of dyslipidemia in rheumatoid arthritisAtherosclerosis596Macrophages differentiated in vitro are heterogeneous: morphological and functional profile in patients with coronary artery disease597Palmitoylethanolamide promotes anti-inflammatory phenotype of macrophages and attenuates plaque formation in ApoE-/- mice598Amiodarone versus esmolol in the perioperative period: an in vitro study of coronary artery bypass grafts599BMPRII signaling of fibrocytes, a mesenchymal progenitor cell population, is increased in STEMI and dyslipidemia600The characteristics of atherogenesis and systemic inflammation in rheumatoid arthritis601Role of adenosine-to-inosine RNA editing in human atherosclerosis602Presence of bacterial DNA in thrombus aspirates of patients with myocardial infarction603Novel E-selectin binding polymers reduce atherosclerotic lesions in ApoE(-/-) mice604Differential expression of the plasminogen receptor Plg-RKT in monocyte and macrophage subsets - possible functional consequences in atherogenesis605Apelin-13 treatment enhances the stability of atherosclerotic plaques606Mast cells are increased in the media of coronary lesions in patients with myocardial infarction and favor atherosclerotic plaque instability607Association of neutrophil to lymphocyte ratio with presence of isolated coronary artery ectasiaCalcium fluxes and excitation-contraction coupling610The coxsackie- and adenovirus receptor (CAR) regulates calcium homeostasis in the developing heart611HMW-AGEs application acutely reduces ICaL in adult cardiomyocytes612Measuring electrical conductibility of cardiac T-tubular systems613Postnatal development of cardiac excitation-contraction coupling in rats614Role of altered Ca2+ homeostasis during adverse cardiac remodeling after ischemia/reperfusion615Experimental study of sarcoplasmic reticulum dysfunction and energetic metabolism in failing myocardium associated with diabetes mellitusHibernation, stunning and preconditioning618Volatile anesthetic preconditioning attenuates ischemic-reperfusion injury in type II diabetic patients undergoing on-pump heart surgery619The effect of early and delayed phase of remote ischemic preconditioning on ischemia-reperfusion injury in the isolated hearts of healthy and diabetic rats620Post-conditioning with 1668-thioate leads to attenuation of the inflammatory response and remodeling with less fibrosis and better left ventricular function in a murine model of myocardial infarction621Maturation-related changes in response to ischemia-reperfusion injury and in effects of classical ischemic preconditioning and remote preconditioningMitochondria and energetics624Phase changes in myocardial mitochondrial respiration caused by hypoxic preconditioning or periodic hypoxic training625Desmin mutations depress mitochondrial metabolism626Methylene blue modulates mitochondrial function and monoamine oxidases-related ROS production in diabetic rat hearts627Doxorubicin modulates the real-time oxygen consumption rate of freshly isolated adult rat and human ventricular cardiomyocytesCardiomyopathies and fibrosis630Effects of genetic or pharmacologic inhibition of the ubiquitin/proteasome system on myocardial proteostasis and cardiac function631Suppression of Wnt signalling in a desmoglein-2 transgenic mouse model for arrhythmogenic cardiomyopathy632Cold-induced cardiac hypertrophy is reversed after thermo-neutral deacclimatization633CD45 is a sensitive marker to diagnose lymphocytic myocarditis in endomyocardial biopsies of living patients and in autopsies634Atrial epicardial adipose tissue derives from epicardial progenitors635Caloric restriction ameliorates cardiac function, sympathetic cardiac innervation and beta-adrenergic receptor signaling in an experimental model of post-ischemic heart failure636High fat diet improves cardiac remodelling and function after extensive myocardial infarction in mice637Epigenetic therapy reduces cardiac hypertrophy in murine models of heart failure638Imbalance of the VHL/HIF signaling in WT1+ Epicardial Progenitors results in coronary vascular defects, fibrosis and cardiac hypertrophy639Diastolic dysfunction is the first stage of the developing heart failure640Colchicine aggravates coxsackievirus B3 infection in miceArterial and pulmonary hypertension642Osteopontin as a marker of pulmonary hypertension in patients with coronary heart disease combined with chronic obstructive pulmonary disease643Myocardial dynamic stiffness is increased in experimental pulmonary hypertension partly due to incomplete relaxation644Hypotensive effect of quercetin is possibly mediated by down-regulation of immunotroteasome subunits in aorta of spontaneously hypertensive rats645Urocortin-2 improves right ventricular function and attenuates experimental pulmonary arterial hypertension646A preclinical evaluation of the anti-hypertensive properties of an aqueous extract of Agathosma (Buchu)Biomarkers648The adiponectin level in hypertensive females with rheumatoid arthritis and its relationship with subclinical atherosclerosis649Markers for identification of renal dysfunction in the patients with chronic heart failure650cardio-hepatic syndromes in chronic heart failure: North Africa profile651To study other biomarkers that assess during myocardial infarction652Interconnections of apelin levels with parameters of lipid metabolism in hypertension patients653Plasma proteomics in hypertension: prediction and follow-up of albuminuria during chronic renin-angiotensin system suppression654Soluble RAGE levels in plasma of patients with cerebrovascular events. Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw150] [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: 11/12/2022] Open
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Boehm O, Baumgarten G, Hoeft A. Preoperative patient assessment: Identifying patients at high risk. Best Pract Res Clin Anaesthesiol 2016; 30:131-43. [DOI: 10.1016/j.bpa.2016.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/19/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
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Bode C, Fox M, Tewary P, Steinhagen A, Ellerkmann RK, Klinman D, Baumgarten G, Hornung V, Steinhagen F. Human plasmacytoid dentritic cells elicit a Type I Interferon response by sensing DNA via the cGAS-STING signaling pathway. Eur J Immunol 2016; 46:1615-21. [PMID: 27125983 DOI: 10.1002/eji.201546113] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 04/04/2016] [Accepted: 04/22/2016] [Indexed: 12/31/2022]
Abstract
Plasmacytoid dendritic cells (pDCs) are a major source of type I interferon (IFN) and are important for host defense by sensing microbial DNA via TLR9. pDCs also play a critical role in the pathogenesis of IFN-driven autoimmune diseases. Yet, this autoimmune reaction is caused by the recognition of self-DNA and has been linked to TLR9-independent pathways. Increasing evidence suggests that the cytosolic DNA receptor cyclic GMP-AMP (cGAMP) synthase (cGAS) is a critical component in the detection of pathogens and contributes to autoimmune diseases. It has been shown that binding of DNA to cGAS results in the synthesis of cGAMP and the subsequent activation of the stimulator of interferon genes (STING) adaptor to induce IFNs. Our results show that the cGAS-STING pathway is expressed and activated in human pDCs by cytosolic DNA leading to a robust type I IFN response. Direct activation of STING by cyclic dinucleotides including cGAMP also activated pDCs and knockdown of STING abolished this IFN response. These results suggest that pDCs sense cytosolic DNA and cyclic dinucleotides via the cGAS-STING pathway and that targeting this pathway could be of therapeutic interest.
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Affiliation(s)
- Christian Bode
- Department of Anesthesiology and Critical Care Medicine, University of Bonn, Bonn, Germany
| | - Mario Fox
- Department of Anesthesiology and Critical Care Medicine, University of Bonn, Bonn, Germany
| | - Poonam Tewary
- Laboratory of Experimental Immunology, Cancer Inflammation Program, Leidos Biomedical Research Inc, FNLCR, Frederick, MD, USA
| | - Almut Steinhagen
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Richard K Ellerkmann
- Department of Anesthesiology and Critical Care Medicine, University of Bonn, Bonn, Germany
| | - Dennis Klinman
- Cancer and Inflammation Program, Center for Cancer Research, NCI, Frederick, MD, USA
| | - Georg Baumgarten
- Department of Anesthesiology and Critical Care Medicine, University of Bonn, Bonn, Germany
| | - Veit Hornung
- Institute of Molecular Medicine, University of Bonn, Bonn, Germany
| | - Folkert Steinhagen
- Department of Anesthesiology and Critical Care Medicine, University of Bonn, Bonn, Germany
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Bualeong T, Kebir S, Hof D, Goelz L, Graewe M, Ehrentraut SF, Knuefermann P, Baumgarten G, Meyer R, Ehrentraut H. Tlr2 deficiency does not limit the development of left ventricular hypertrophy in a model of transverse aortic constriction induced pressure overload. J Negat Results Biomed 2016; 15:9. [PMID: 27109115 PMCID: PMC4843197 DOI: 10.1186/s12952-016-0050-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/30/2016] [Indexed: 01/04/2023] Open
Abstract
Background Toll-like receptors (TLRs) are involved in a variety of cardiovascular disorders, including septic cardiomyopathy, ischemia/reperfusion, heart failure, and cardiac hypertrophy. Previous research revealed that TLR4 promotes cardiac hypertrophy in vivo. Therefore, we investigated whether TLR2 is also involved in the development of cardiac hypertrophy. Methods Tlr2 deficient and wild type mice were subjected to transverse aortic constriction (TAC) or sham operation procedure. Left ventricular, heart and lung weights as well as hemodynamic parameters were determined after 3, 14 or 28 days. Real-time RT PCR was used to evaluate left ventricular gene expression. Protein content was determined via ELISA. Results TAC increased systolic left ventricular pressure, contraction and relaxations velocities as well as the heart weight in both genotypes. Tlr2 deficiency significantly enhanced cardiac hypertrophy after 14 and 28 days of TAC. Left ventricular end-diastolic pressure and heart rate increased in Tlr2−/− TAC mice only. Fourteen days of TAC led to a significant elevation of ANP, BNP, TGFβ and TLR4 mRNA levels in Tlr2−/− left ventricular tissue. Conclusion These data suggest that Tlr2 deficiency may promote the development of cardiac hypertrophy and ventricular remodeling after transverse aortic constriction.
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Affiliation(s)
- Tippaporn Bualeong
- Physiology Department, Medical Science Faculty, Naresuan University, Phitsanulok, 65000, Thailand.,Institute of Physiology II, University Hospital Bonn, Nussallee 11, 53115, Bonn, Germany
| | - Sied Kebir
- Institute of Physiology II, University Hospital Bonn, Nussallee 11, 53115, Bonn, Germany.,Department of Neurology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Dorothea Hof
- Institute of Physiology II, University Hospital Bonn, Nussallee 11, 53115, Bonn, Germany
| | - Lina Goelz
- Institute of Physiology II, University Hospital Bonn, Nussallee 11, 53115, Bonn, Germany.,Polyclinic of Orthodontics, University of Bonn, Welschnonnenstraße 17, 53111, Bonn, Germany
| | - Mathias Graewe
- Institute of Physiology II, University Hospital Bonn, Nussallee 11, 53115, Bonn, Germany
| | - Stefan Felix Ehrentraut
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Pascal Knuefermann
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Georg Baumgarten
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Rainer Meyer
- Institute of Physiology II, University Hospital Bonn, Nussallee 11, 53115, Bonn, Germany
| | - Heidi Ehrentraut
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
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Klauke N, Gräff I, Fleischer A, Boehm O, Guttenthaler V, Baumgarten G, Meybohm P, Wittmann M. Effects of prehospital hypothermia on transfusion requirements and outcomes: a retrospective observatory trial. BMJ Open 2016; 6:e009913. [PMID: 27029772 PMCID: PMC4823393 DOI: 10.1136/bmjopen-2015-009913] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Prehospital hypothermia is defined as a core temperature <36.0 °C and has been shown to be an independent risk factor for early death in patients with trauma. In a retrospective study, a possible correlation between the body temperature at the time of admission to the emergency room and subsequent in-hospital transfusion requirements and the in-hospital mortality rate was explored. SETTING This is a retrospective single-centre study at a primary care hospital in Germany. PARTICIPANTS 15,895 patients were included in this study. Patients were classified by admission temperature and transfusion rate. Excluded were ambulant patients and patients with missing data. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome values were length of stay (LOS) in days, in-hospital mortality, the transferred amount of packed red blood cells (PRBCs), and admission to an intensive care unit. Secondary influencing variables were the patient's age and the Glasgow Coma Scale. RESULTS In 22.85% of the patients, hypothermia was documented. Hypothermic patients died earlier in the course of their hospital stay than non-hypothermic patients (p<0.001). The administration of 1-3 PRBC increased the LOS significantly (p<0.001) and transfused patients had an increased risk of death (p<0.001). Prehospital hypothermia could be an independent risk factor for mortality (adjusted OR 8.521; p=0.001) and increases the relative risk for transfusion by factor 2.0 (OR 2.007; p=0.002). CONCLUSIONS Low body temperature at hospital admission is associated with a higher risk of transfusion and death. Hence, a greater awareness of prehospital temperature management should be established.
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Affiliation(s)
- Nora Klauke
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Ingo Gräff
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Fleischer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Olaf Boehm
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Vera Guttenthaler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Patrick Meybohm
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Hilbert T, Duerr GD, Hamiko M, Frede S, Rogers L, Baumgarten G, Hoeft A, Velten M. Endothelial permeability following coronary artery bypass grafting: an observational study on the possible role of angiopoietin imbalance. Crit Care 2016; 20:51. [PMID: 26951111 PMCID: PMC4782352 DOI: 10.1186/s13054-016-1238-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/15/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Unresolved inflammation resulting in capillary leakage with endothelial barrier dysfunction is a major contributor to postoperative morbidity and mortality after coronary artery bypass graft (CABG). Angiopoietins (ANGs) are vascular growth factors, also mediating inflammation and disruption of the endothelium, thus inducing capillary leakage. We hypothesized that changes in the relative serum levels of ANG1 and ANG2 influence endothelial barrier function and perioperative morbidity after CABG. METHODS After approval and informed consent, serum samples (n = 28) were collected pre CABG surgery, 1, 6, and 24 h after aortic de-clamping. ANG1, ANG2, soluble ANG receptor TIE2 (sTIE2), and IL-6 serum concentrations were analyzed by ELISA. Human pulmonary microvascular endothelial cells (HPMECs) were incubated with patient serum and FITC-dextran permeability was assessed. Furthermore, ANG2 secretion of HPMECs was analyzed after incubation with IL-6-containing patient serum. RESULTS CABG induced an early and sustained increase of ANG2/ANG1 ratio (5-fold after 24 h compared to pre-surgery). These changes correlated with elevated serum lactate levels, fluid balance, as well as the duration of mechanical ventilation. Permeability of HPMECs significantly increased after incubation with post-surgery serum showing a marked shift of ANG2/ANG1 balance (18-fold) compared to serum with a less pronounced increase (6-fold). Furthermore, CABG resulted in increased IL-6 serum content. Pre-incubation with serum containing high levels of IL-6 amplified the ANG2 secretion by HPMECs; however, this was not influenced by blocking IL-6. CONCLUSIONS CABG affects the balance between ANG1 and ANG2 towards a dominance of the barrier-disruptive ANG2. Our data suggest that this ANG2/ANG1 imbalance contributes to an increased postoperative endothelial permeability, likewise being reflected by the clinical course. The results strongly suggest a biological effect of altered angiopoietin balance during cardiac surgery on endothelial permeability.
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Affiliation(s)
- Tobias Hilbert
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Georg Daniel Duerr
- Department of Cardiovascular Surgery, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Marwan Hamiko
- Department of Cardiovascular Surgery, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Stilla Frede
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Lynette Rogers
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
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Duerr G, Wu S, Schneider M, Marggraf V, Verfuerth L, Frede S, Boehm O, Dewald O, Baumgarten G, Kim S. Postconditioning with CpG-Containing TLR9 Ligand 1668-Thioate Attenuates Inflammatory Response and Remodeling Leading to Less Fibrosis and Better Left Ventricular Function in Murine Myocardial Infarction. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571720] [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: 10/22/2022]
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Spahn G, Stojanovic I, Müller-Obliers E, Aurich M, Baumgarten G, Plettenberg H, Kaschowitz T, Hoffmann M, Hofmann GO. [Characteristics of Focal Degenerative Cartilage Lesions in the Knee Joint. A Radiologic, Spectroscopic, Histological and Biochemical Study]. Sportverletz Sportschaden 2015; 29:209-18. [PMID: 26689188 DOI: 10.1055/s-0041-106952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to perform a macroscopic, spectroscopic and biochemical/histological examination of the defect margins of grade IIIb cartilage lesions in the patella, the medial femoral condyle, the corresponding articular surface and the remaining cartilage surfaces of the knee joint. Our null hypothesis was that there would be no difference in characteristics between the cartilage surrounding the defect, the corresponding articular surface and the remaining articular surfaces of the knee joint on the one hand and the cartilage within the defect on the other. METHOD The study included ten patients treated for focal cartilage lesions (ICRS classification grade IIIb) by autologous cartilage transplantation (ACT). All patients underwent a preoperative magnetic resonance imaging scan (1, 5 T). The articular cartilage lesions were classified pursuant to the recommendations of the International Cartilage Repair Society (ICRS). During the arthroscopic procedure, spectroscopic examinations were performed to measure the degree of cartilage degeneration in a total of 14 defined areas including the defect itself and the region of the defect margins. Biopsies for a histological and biochemical examination (collagen II, glycosaminoglycan, DNA) were taken from the centre of the defect and the defect margins that seemed to be intact on macroscopic examination. RESULTS All knee joints had focal grade IIIb cartilage lesions with an intact margin and an intact corresponding articular surface. The readings obtained on spectroscopic examination both in the defect, the apparently intact margins, the corresponding articular surface and all other examined areas of the knee suggested that severe degenerative changes had already occurred in the cartilage. The histological and biochemical examinations of the residual cartilage in the centre of the defect and the apparently intact margins revealed no significant differences. CONCLUSIONS Focal cartilage lesions frequently occur in the main weight-bearing zones of the patella and the medial femoral condyle. If they are the result of degenerative changes in the knee joint, the residual cartilage in the defect does not differ from the cartilage of the defect margins, the corresponding articular surface and the other cartilage surfaces. This leads to the conclusion that focal cartilage defects seen in degenerative joint damage are only one aspect of general joint degeneration.
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Affiliation(s)
- G Spahn
- Praxisklinik für Unfallchirurgie und Orthopädie Eisenach und Universitätsklinikum Jena
| | - I Stojanovic
- Radiologische Praxis am Sankt Georg Klinikum Eisenach
| | | | - M Aurich
- Sana Kliniken Leipziger Land GmbH, Borna
| | | | | | | | | | - G O Hofmann
- Universitätsklinikum Jena und BG-Unfallklinik "Bergmannstrost" Halle/Saale
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Eichhorn L, Murday AK, Kohnen B, Guttenthaler V, Türler A, Baumgarten G, Wittmann M. [Patient Satisfaction as a Measure of Quality of Patient Care - Comparison between a University Hospital and a General Hospital]. Gesundheitswesen 2015; 79:627-632. [PMID: 26671645 DOI: 10.1055/s-0041-110528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: The aim of the study was to compare the satisfaction of patients of a general hospital with a university hospital. A patient satisfaction index was calculated based on the assessed levels of satisfaction. In general, higher satisfaction could lead to increased competitiveness and improved cost efficiency for achieving profitability. Methods: The authors developed and administered a questionnaire on distinct parameters presumed to reflect the quality of the hospital stay to patients of a university hospital (University Hospital of Bonn, UKB, 1 224 beds) and a general hospital (Johanniterkrankenhaus, Bonn, JKH, 364 beds). Data were collected anonymously. Patient satisfaction and the relative importance of each parameter were assessed. The quotient of both parameters yields the patient satisfaction index (PZI). In order to account for possible differences in patient demands, statistical analysis was performed. Results: The demands and wishes, satisfaction and importance of the retrieved parameters did not differ significantly between the patients of the hospitals in any of aspects assessed (information, participation, contact and comfort during the hospital-stay). The study showed that communication and the contact to physicians and nurses was significantly more important for the patients than comfort (each p<0.001). The highest PZI were found in the categories entertainment (UKB 1.02; JKH 1.25) and contact to the nursing personnel (PZI UKB 0.94; PZI JKH 0.96). The standard of medical-technical care (UKB 0.93; JKH 0.95) was also highly ranked by patients of both hospitals. Needs for improvement related especially to the communication of errors (UKB 0.33; JKH 0.31). Discussion: Surveillance of patient wishes and criticism may result in a more patient-oriented care on a daily basis. Scrutinizing the resources employed may lead to more efficient use of resources and personnel and thus help cut costs and improve the attractiveness of hospitals.
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Affiliation(s)
- L Eichhorn
- Anästhesiologie, Universitätsklinikum Bonn
| | - A-K Murday
- Anästhesiologie, Universitätsklinikum Bonn
| | - B Kohnen
- Anästhesiologie, Universitätsklinikum Bonn
| | | | - A Türler
- Chirurgie, Johanniter Krankenhaus Bonn
| | | | - M Wittmann
- Anästhesiologie, Universitätsklinikum Bonn
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Memmert S, Gölz L, Pütz P, Jäger A, Deschner J, Appel T, Baumgarten G, Rath-Deschner B, Frede S, Götz W. Regulation of p53 under hypoxic and inflammatory conditions in periodontium. Clin Oral Investig 2015; 20:1781-9. [PMID: 26620730 DOI: 10.1007/s00784-015-1679-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Different studies suggest that inflammation as well as hypoxia leads to an increase of p53 protein levels. However, the implication of p53 during oral inflammatory processes is still unknown. The aim of this study was therefore to investigate the effect of hypoxia and inflammation on p53 regulation in human periodontium in vitro and in vivo. MATERIALS AND METHODS Under hypoxic and normoxic conditions, human primary periodontal ligament (PDL) fibroblasts (n = 9) were stimulated with lipopolysaccharides (LPS) from Porphyromonas gingivalis (P.g.), a periodontal pathogenic bacterium. After different time points, cell viability was tested; p53 gene expression, protein synthesis, and activation were measured using quantitative RT-PCR, immunoblotting, and immunofluorescence. Moreover, healthy and inflamed periodontal tissues were obtained from 12 donors to analyze p53 protein in oral inflammatory diseases by immunohistochemistry. RESULTS LPS-P.g. and hypoxia initially induced a significant upregulation of p53 mRNA expression and p53 protein levels. Nuclear translocation of p53 after inflammatory stimulation supported these findings. Hypoxia first enhanced p53 levels, but after 24 h of incubation, protein levels decreased, which was accompanied by an improvement of PDL cell viability. Immunohistochemistry revealed an elevation of p53 immunoreactivity in accordance to the progression of periodontal inflammation. CONCLUSIONS Our data indicate that p53 plays a pivotal role in PDL cell homeostasis and seems to be upregulated in oral inflammatory diseases. CLINICAL RELEVANCE Upregulation of p53 may promote the destruction of periodontal integrity. A possible relationship with carcinogenesis may be discussed.
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Affiliation(s)
- S Memmert
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, Faculty of Medicine, University of Bonn, Welschnonnenstr 17, 53111, Bonn, Germany. .,Section of Experimental Dento-Maxillo-Facial Medicine, Center of Dento-Maxillo-Facial Medicine, Faculty of Medicine, University of Bonn, Bonn, Germany.
| | - L Gölz
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, Faculty of Medicine, University of Bonn, Welschnonnenstr 17, 53111, Bonn, Germany
| | - P Pütz
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, Faculty of Medicine, University of Bonn, Welschnonnenstr 17, 53111, Bonn, Germany
| | - A Jäger
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, Faculty of Medicine, University of Bonn, Welschnonnenstr 17, 53111, Bonn, Germany
| | - J Deschner
- Section of Experimental Dento-Maxillo-Facial Medicine, Center of Dento-Maxillo-Facial Medicine, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - T Appel
- Clinic of Oral and Maxillofacial Surgery, Center of Dento-Maxillo-Facial Medicine, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - G Baumgarten
- Clinic and Polyclinic of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - B Rath-Deschner
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, Faculty of Medicine, University of Bonn, Welschnonnenstr 17, 53111, Bonn, Germany
| | - S Frede
- Clinic and Polyclinic of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - W Götz
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, Faculty of Medicine, University of Bonn, Welschnonnenstr 17, 53111, Bonn, Germany
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Ehrentraut H, Felix Ehrentraut S, Boehm O, El Aissati S, Foltz F, Goelz L, Goertz D, Kebir S, Weisheit C, Wolf M, Meyer R, Baumgarten G. Tlr4 Deficiency Protects against Cardiac Pressure Overload Induced Hyperinflammation. PLoS One 2015; 10:e0142921. [PMID: 26588247 PMCID: PMC4654478 DOI: 10.1371/journal.pone.0142921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/28/2015] [Indexed: 12/26/2022] Open
Abstract
Transverse aortic constriction provokes a pro-inflammatory reaction and results in cardiac hypertrophy. Endogenous ligands contribute to cardiac hypertrophy via toll-like receptor (TLR)-4 binding. A lack of TLR4 signaling diminishes hypertrophy and inflammation. Wild type mice undergoing aortic constriction respond to a lipopolysaccharide second-hit stimulus with hyperinflammation. The objective of this study was to assess whether other second-hit challenges utilizing TLR ligands provoke a comparable inflammatory reaction, and to find out whether this response is absent in TLR4 deficient mice. Assuming that cardiac stress alters the expression of pattern recognition receptors we analyzed the effects of transverse aortic constriction and second-hit virulence factor treatment on TLR expression, as well as cytokine regulation. Wild type and Tlr4-/- mice were subjected to three days of TAC and subsequently confronted with gram-positive TLR2 ligand lipoteichoic acid (LTA, 15 mg/g bodyweight) or synthetic CpG-oligodesoxynucleotide 1668 thioate (20 nmol/kg bodyweight, 30 min after D-galactosamin desensitization) signaling via TLR9. Hemodynamic measurements and organ preservation were performed 6 h after stimulation. Indeed, the study revealed a robust enhancement of LTA induced pattern recognition receptor and cytokine mRNA expression and a LTA-dependent reduction of hemodynamic pressure in TAC wild type mice. Second-Hit treatment with CpG-ODNs led to similar results. However, second-hit effects were abolished in Tlr4-/- mice. In total, these data indicate for the first time that cardiac stress increases the inflammatory response towards both, gram-negative and gram-positive, TLR ligands as well as bacterial DNA. The decrease of the inflammatory response upon TLR2 and -9 ligand challenge in TAC Tlr4-/- mice demonstrates that a lack of TLR4 signaling does not only prevent left ventricular hypertrophy but also protects the mice from a cardiac stress induced hyperinflammatory reaction.
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Affiliation(s)
- Heidi Ehrentraut
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Stefan Felix Ehrentraut
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Olaf Boehm
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Sakina El Aissati
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
- Marienhaus Klinikum, Bad Neuenahr-Ahrweiler, Germany
| | - Fabian Foltz
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
- Asklepios Klinik St. Augustin, Sankt Augustin, Germany
| | - Lina Goelz
- Polyclinic of Orthodontics, University of Bonn, Welschnonnenstraße 17, 53111, Bonn, Germany
- Institute of Physiology II, University Hospital Bonn, Nussallee 11, 53115, Bonn, Germany
| | - David Goertz
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
- Klinik für Orthopädie und Unfallchirurgie, HELIOS Medical Center Siegburg, Siegburg, Germany
| | - Sied Kebir
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
- Department of Neurology, University of Bonn Medical Center, Bonn, Germany
| | - Christina Weisheit
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Michael Wolf
- Polyclinic of Orthodontics, University of Bonn, Welschnonnenstraße 17, 53111, Bonn, Germany
- Institute of Physiology II, University Hospital Bonn, Nussallee 11, 53115, Bonn, Germany
| | - Rainer Meyer
- Institute of Physiology II, University Hospital Bonn, Nussallee 11, 53115, Bonn, Germany
| | - Georg Baumgarten
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
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Meybohm P, Bein B, Brosteanu O, Cremer J, Gruenewald M, Stoppe C, Coburn M, Schaelte G, Böning A, Niemann B, Roesner J, Kletzin F, Strouhal U, Reyher C, Laufenberg-Feldmann R, Ferner M, Brandes IF, Bauer M, Stehr SN, Kortgen A, Wittmann M, Baumgarten G, Meyer-Treschan T, Kienbaum P, Heringlake M, Schön J, Sander M, Treskatsch S, Smul T, Wolwender E, Schilling T, Fuernau G, Hasenclever D, Zacharowski K. A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery. N Engl J Med 2015; 373:1397-407. [PMID: 26436208 DOI: 10.1056/nejmoa1413579] [Citation(s) in RCA: 457] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Remote ischemic preconditioning (RIPC) is reported to reduce biomarkers of ischemic and reperfusion injury in patients undergoing cardiac surgery, but uncertainty about clinical outcomes remains. METHODS We conducted a prospective, double-blind, multicenter, randomized, controlled trial involving adults who were scheduled for elective cardiac surgery requiring cardiopulmonary bypass under total anesthesia with intravenous propofol. The trial compared upper-limb RIPC with a sham intervention. The primary end point was a composite of death, myocardial infarction, stroke, or acute renal failure up to the time of hospital discharge. Secondary end points included the occurrence of any individual component of the primary end point by day 90. RESULTS A total of 1403 patients underwent randomization. The full analysis set comprised 1385 patients (692 in the RIPC group and 693 in the sham-RIPC group). There was no significant between-group difference in the rate of the composite primary end point (99 patients [14.3%] in the RIPC group and 101 [14.6%] in the sham-RIPC group, P=0.89) or of any of the individual components: death (9 patients [1.3%] and 4 [0.6%], respectively; P=0.21), myocardial infarction (47 [6.8%] and 63 [9.1%], P=0.12), stroke (14 [2.0%] and 15 [2.2%], P=0.79), and acute renal failure (42 [6.1%] and 35 [5.1%], P=0.45). The results were similar in the per-protocol analysis. No treatment effect was found in any subgroup analysis. No significant differences between the RIPC group and the sham-RIPC group were seen in the level of troponin release, the duration of mechanical ventilation, the length of stay in the intensive care unit or the hospital, new onset of atrial fibrillation, and the incidence of postoperative delirium. No RIPC-related adverse events were observed. CONCLUSIONS Upper-limb RIPC performed while patients were under propofol-induced anesthesia did not show a relevant benefit among patients undergoing elective cardiac surgery. (Funded by the German Research Foundation; RIPHeart ClinicalTrials.gov number, NCT01067703.).
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Affiliation(s)
- Patrick Meybohm
- From the Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Frankfurt (P.M., U.S., C.R., K.Z.), the Departments of Anesthesiology and Intensive Care Medicine (P.M., B.B., M.G.) and Cardiovascular Surgery (J.C.), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Clinical Trial Center (O.B.), the Department of Internal Medicine/Cardiology, University of Leipzig Heart Center (G.F.), and Institute for Medical Informatics, Statistics, and Epidemiology (D.H.), University of Leipzig, Leipzig, the Department of Anesthesiology, University Hospital Aachen, Aachen (C.S., M.C., G.S.), the Department of Cardiovascular Surgery, University of Giessen, Giessen (A.B., B.N.), Clinic of Anesthesiology and Intensive Care Medicine, University Hospital Rostock, Rostock (J.R., F.K.), the Department of Anesthesiology, Medical Center of Johannes Gutenberg University, Mainz (R.L.-F., M.F.), the Department of Anesthesiology and Intensive Care Medicine, University Hospital Göttingen, Göttingen (I.F.B., M.B.), the Department of Anesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital, Jena (S.N.S., A.K.), the Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn (M.W., G.B.), the Department of Anesthesiology and Intensive Care Medicine, University Hospital Düsseldorf, Düsseldorf (T.M.-T., P.K.), the Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, Lübeck (M.H., J.S.), the Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin (M.S., S.T.), the Department of Anesthesiology, University Hospital Würzburg, Würzburg (T. Smul, E.W.), and the Department of Anesthesiology, University Hospital Magdeburg, Magdeburg (T. Schilling) - all in Germany
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Muenster S, Bode C, Diedrich B, Jahnert S, Weisheit C, Steinhagen F, Frede S, Hoeft A, Meyer R, Boehm O, Knuefermann P, Baumgarten G. Antifungal antibiotics modulate the pro-inflammatory cytokine production and phagocytic activity of human monocytes in an in vitro sepsis model. Life Sci 2015; 141:128-36. [PMID: 26382596 DOI: 10.1016/j.lfs.2015.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 03/27/2015] [Revised: 08/02/2015] [Accepted: 09/11/2015] [Indexed: 11/19/2022]
Abstract
AIMS The incidence of secondary systemic fungal infections has sharply increased in bacterial septic patients. Antimycotics exhibit immunomodulatory properties, yet these effects are incompletely understood in secondary systemic fungal infections following bacterial sepsis. We investigated a model of systemic inflammation to determine whether antimycotics (liposomal amphotericin B (L-AMB), itraconazol (ITC), and anidulafungin (ANI)) modulate the gene and protein expression as well as the phagocytic activity of lipopolysaccharide (LPS)-stimulated human monocytes. MAIN METHODS THP-1 monocytes were incubated with L-AMB, ITC or ANI and LPS. Gene expression levels of cytokines (TNF-<alpha>, IL-1<beta>, IL-6, and IL-10) were measured after 2h, 6h, and 24h. Cytokine protein levels were evaluated after 24h and phagocytic activity was determined following co-incubation with Escherichia coli. KEY FINDINGS All antimycotics differentially modulated the gene and protein expression of cytokines in sepsis-like conditions. In the presence of LPS, we identified L-AMB as immunosuppressive, whereas ITC demonstrated pro-inflammatory properties. Both compounds induced remarkably less phagocytosis. SIGNIFICANCE Our study suggests that antimycotics routinely used in septic patients alter the immune response in sepsis-like conditions by modulating cytokine gene and protein expression levels and phagocytic activity. Future treatment strategies should consider the immune status of the host and apply antimycotics accordingly in bacterial septic patients with secondary fungal infections.
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Affiliation(s)
- Stefan Muenster
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany.
| | - Christian Bode
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Britta Diedrich
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany; Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany
| | - Sebastian Jahnert
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christina Weisheit
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Folkert Steinhagen
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Stilla Frede
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Rainer Meyer
- Institute of Physiology II, University of Bonn, Bonn, Germany
| | - Olaf Boehm
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Pascal Knuefermann
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
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Soehle M, Dittmann A, Ellerkmann RK, Baumgarten G, Putensen C, Guenther U. Intraoperative burst suppression is associated with postoperative delirium following cardiac surgery: a prospective, observational study. BMC Anesthesiol 2015; 15:61. [PMID: 25928189 PMCID: PMC4419445 DOI: 10.1186/s12871-015-0051-7] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative delirium (POD) occurs frequently after cardiac surgery and is associated with increased morbidity and mortality. We analysed whether perioperative bilateral BIS monitoring may detect abnormalities before the onset of POD in cardiac surgery patients. Methods In a prospective observational study, 81 patients undergoing cardiac surgery were included. Bilateral Bispectral Index (BIS)-monitoring was applied during the pre-, intra- and postoperative period, and BIS, EEG Asymmetry (ASYM), and Burst Suppression Ratio (BSR) were recorded. POD was diagnosed according to the Confusion Assessment Method for the Intensive Care Unit, and patients were divided into a delirium and non-delirium group. Results POD was detected in 26 patients (32%). A trend towards a lower ASYM was observed in the delirium group as compared to the non-delirium group on the preoperative day (ASYM = 48.2 ± 3.6% versus 50.0 ± 4.7%, mean ± sd, p = 0.087) as well as before induction of anaesthesia, with oral midazolam anxiolysis (median ASYM = 49.5%, IQR [47.4;51.5] versus 50.6%, IQR [49.1;54.2], p = 0.081). Delirious patients remained significantly (p = 0.018) longer in a burst suppression state intraoperatively (107 minutes, IQR [47;170] versus 44 minutes, IQR [11;120]) than non-delirious patients. Receiver operating analysis revealed burst suppression duration (area under the curve = 0.73, p = 0.001) and BSR (AUC = 0.68, p = 0.009) as predictors of POD. Conclusions Intraoperative assessment of BSR may identify patients at risk of POD and should be investigated in further studies. So far it remains unknown whether there is a causal relationship or rather an association between intraoperative burst suppression and the development of POD. Trial registration clinicaltrials.gov NCT01048775
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Affiliation(s)
- Martin Soehle
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
| | | | - Richard K Ellerkmann
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
| | - Georg Baumgarten
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
| | - Christian Putensen
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
| | - Ulf Guenther
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
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Bode C, Muenster S, Diedrich B, Jahnert S, Weisheit C, Steinhagen F, Boehm O, Hoeft A, Meyer R, Baumgarten G. Linezolid, vancomycin and daptomycin modulate cytokine production, Toll-like receptors and phagocytosis in a human in vitro model of sepsis. J Antibiot (Tokyo) 2015; 68:485-90. [PMID: 25735844 PMCID: PMC4579589 DOI: 10.1038/ja.2015.18] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/14/2014] [Accepted: 12/19/2014] [Indexed: 01/19/2023]
Abstract
Conventional antibiotics exhibit immunomodulatory properties beneficial in the treatment of sepsis. Antibiotic-resistant Gram-positive bacteria have become a problem in sepsis therapy, giving rise to increased use of last-resort antibiotics; for example, linezolid (LIN), vancomycin (VAN) and daptomycin (DAP). As the immunomodulatory properties of these antibiotics in treating sepsis are unknown, this study examined the effect of VAN, LIN and DAP on the immune response under sepsis-like conditions in vitro. Lipopolysaccharide (LPS)-activated THP-1 monocytes were incubated with LIN, VAN or DAP. Gene expression of cytokines (TNFα, IL-1β, IL-6, IL-10) and Toll-like receptors (TLR1, 2, 4, 6, 7 and 9) was monitored and phagocytosis was determined following coincubation with E. coli. The antibiotics differentially modulated the gene expression of the investigated cytokines. While LIN and VAN upregulated the expression of all TLRs, DAP downregulated mRNA levels of TLR1, TLR2 and TLR6, which recognize pathogen-associated molecular patterns from Gram-positive bacteria. In addition, LIN inhibited, whereas VAN promoted the phagocytic activity of monocytes. Our results suggest that LIN and VAN possess pro-inflammatory properties, whereas DAP might reduce the immune response to Gram-positive bacteria in sepsis. Furthermore, VAN might be beneficial in the prevention of Gram-negative infections by increasing the phagocytosis of E. coli.
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Kim SC, Tran N, Schewe JC, Boehm O, Wittmann M, Graeff I, Hoeft A, Baumgarten G. Safety and economic considerations of argatroban use in critically ill patients: a retrospective analysis. J Cardiothorac Surg 2015; 10:19. [PMID: 25879883 PMCID: PMC4332969 DOI: 10.1186/s13019-015-0214-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/18/2015] [Indexed: 02/01/2023] Open
Abstract
Background Heparin-induced thrombocytopenia (HIT) causes thromboembolic complications which threaten life and limb. Heparin is administered to virtually every critically ill patient as a protective measure against thromboembolism. Argatroban is a promising alternative anticoagulant agent. However, a safe dose which still provides effective thromboembolic prophylaxis without major bleeding still needs to be identified. Methods Critically ill patients (n = 42) diagnosed with HIT at a tertiary medical center intensive care unit from 2005 to 2010 were included in this retrospective analysis. Patient records were perused for preexisting history of HIT, heparin dosage before HIT, argatroban dosage, number of transfusions required, thromboembolic complications and length of ICU stay (ICU LOS). Patients were allocated to Simplified Acute Physiology Scores above and below 30 (SAPS >30, SAPS <30), respectively. For calculations, patients (n = 19) without previous history of HIT were compared to patients (n = 23) with a history of HIT before initiation of argatroban. Results The mean initial argatroban dosage was below 0.4 mcg/kg/min regardless of SAPS score. Maintenance dosage had to be increased in patients with SAPS <30 to 0.54 ± 0.248 mcg/kg/min (p >0.05) to achieve effective anticoagulation. No thromboembolic complications were encountered. Argatroban had to be discontinued temporarily in 16 patients for a total of 57 times due to diagnostic or surgical procedures, supratherapeutic aPTT and bleeding without increasing the number of transfusions. A history of HIT was associated with a shorter ICU LOS and significantly reduced transfusion need when compared to patients with no history of HIT. Cost calculation favour argatroban due to increased transfusion needs during heparin administration and increase ICU LOS. Conclusion Argatroban can be used at doses < 0.4 mcg/kg/min without an increase in transfusion requirements and at a reduced overall treatment cost compared to heparin.
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Affiliation(s)
- Se-Chan Kim
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Nicole Tran
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Jens-Christian Schewe
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Olaf Boehm
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Ingo Graeff
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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Hohn A, Heising B, Hertel S, Baumgarten G, Hochreiter M, Schroeder S. Antibiotic consumption after implementation of a procalcitonin-guided antimicrobial stewardship programme in surgical patients admitted to an intensive care unit: a retrospective before-and-after analysis. Infection 2015; 43:405-12. [PMID: 25588968 DOI: 10.1007/s15010-014-0718-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 12/26/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyse antibiotic use density (AD)--World Health Organization defined daily doses/1,000 patient-days--before and after implementation of a local antimicrobial stewardship programme (ASP) in conjunction with a procalcitonin (PCT)-guided protocol in a surgical intensive care unit (ICU). METHODS In this retrospective observational study, data on 2,422 ICU patients between 2010 and 2012 were analysed. In 2011, an ASP in conjunction with a PCT protocol had been introduced into clinical practice. In a multivariate analysis, hospital mortality, length of stay (LOS) in hospital and ICU LOS were adjusted for effects from effective cost weight, gender, and age. AD and changes in the use of antibiotic classes were analysed. RESULTS AD decreased from 1,005.0 in 2010 to 791.9 in 2012 which is a total reduction of 21.2%. Consumption of aminoglycosides, cephalosporins and quinolones showed a marked reduction, whereas the use of penicillins did not change significantly. The multivariate models revealed no relevant changes in mortality rate, ICU LOS and hospital LOS. CONCLUSIONS Implementation of an ASP in conjunction with a PCT protocol in 2011 was associated with a marked decrease in total AD and led to a significant change in the spectrum of antibiotics. Clinical outcomes appeared to remain unchanged over the study period.
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Affiliation(s)
- A Hohn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany,
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Kim SC, Klebach C, Heinze I, Hoeft A, Baumgarten G, Weber S. The supraclavicular fossa ultrasound view for central venous catheter placement and catheter change over guidewire. J Vis Exp 2014. [PMID: 25548874 DOI: 10.3791/52160] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The supraclavicular fossa ultrasound view can be useful for central venous catheter (CVC) placement. Venipuncture of the internal jugular veins (IJV) or subclavian veins is performed with a micro-convex ultrasound probe, using a neonatal abdominal preset with a probe frequency of 10 Mhz at a depth of 10-12 cm. Following insertion of the guidewire into the vein, the probe is shifted to the right supraclavicular fossa to obtain a view of the superior vena cava (SVC), right pulmonary artery and ascending aorta. Under real-time ultrasound view, the guidewire and its J-tip is visualized and pushed forward to the lower SVC. Insertion depth is read from guidewire marks using central venous catheter. CVC is then inserted following skin and venous dilation. The supraclavicular fossa view is most suitable for right IJV CVC insertion. If other insertion sites are chosen the right supraclavicular fossa should be within the sterile field. Scanning of the IJVs, brachiocephalic veins and SVC can reveal significant thrombosis before venipuncture. Misplaced CVCs can be corrected with a change over guidewire technique under real-time ultrasound guidance. In conjunction with a diagnostic lung ultrasound scan, this technique has a potential to replace chest radiograph for confirmation of CVC tip position and exclusion of pneumothorax. Moreover, this view is of advantage in patients with a non-p-wave cardiac rhythm were an intra-cardiac electrocardiography (ECG) is not feasible for CVC tip position confirmation. Limitations of the method are lack of availability of a micro-convex probe and the need for training.
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Affiliation(s)
- Se-Chan Kim
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn;
| | - Christian Klebach
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn
| | - Ingo Heinze
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn
| | - Stefan Weber
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn
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31
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Weisheit C, Zhang Y, Faron A, Köpke O, Weisheit G, Steinsträsser A, Frede S, Meyer R, Boehm O, Hoeft A, Kurts C, Baumgarten G. Ly6C(low) and not Ly6C(high) macrophages accumulate first in the heart in a model of murine pressure-overload. PLoS One 2014; 9:e112710. [PMID: 25415601 PMCID: PMC4240580 DOI: 10.1371/journal.pone.0112710] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/14/2014] [Indexed: 01/13/2023] Open
Abstract
Cardiac tissue remodeling in the course of chronic left ventricular hypertrophy requires phagocytes which degrade cellular debris, initiate and maintain tissue inflammation and reorganization. The dynamics of phagocytes in left ventricular hypertrophy have not been systematically studied. Here, we characterized the temporal accumulation of leukocytes in the cardiac immune response by flow cytometry and fluorescence microscopy at day 3, 6 and 21 following transverse aortic constriction (TAC). Cardiac hypertrophy due to chronic pressure overload causes cardiac immune response and inflammation represented by an increase of immune cells at all three time points among which neutrophils reached their maximum at day 3 and macrophages at day 6. The cardiac macrophage population consisted of both Ly6Clow and Ly6Chigh macrophages. Ly6Clow macrophages were more abundant peaking at day 6 in response to pressure overload. During the development of cardiac hypertrophy the expression pattern of adhesion molecules was investigated by qRT-PCR and flow cytometry. CD11b, CX3CR1 and ICAM-1 determined by qRT-PCR in whole cardiac tissue were up-regulated in response to pressure overload at day 3 and 6. CD11b and CX3CR1 were significantly increased by TAC on the surface of Ly6Clow but not on Ly6Chigh macrophages. Furthermore, ICAM-1 was up-regulated on cardiac endothelial cells. In fluorescence microscopy Ly6Clow macrophages could be observed attached to the intra- and extra-vascular vessel-wall. Taken together, TAC induced the expression of adhesion molecules, which may explain the accumulation of Ly6Clow macrophages in the cardiac tissue, where these cells might contribute to cardiac inflammation and remodeling in response to pressure overload.
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Affiliation(s)
- Christina Weisheit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Yunyang Zhang
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Anton Faron
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Odilia Köpke
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Gunnar Weisheit
- Geschwister-Scholl-Gymnasium, Academic High School Daun, Daun, Germany
| | - Arne Steinsträsser
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Stilla Frede
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Rainer Meyer
- Institute of Physiology II, University of Bonn, Bonn, Germany
| | - Olaf Boehm
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christian Kurts
- Institute of Experimental Immunology, University Hospital Bonn, Bonn, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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32
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Kim SC, Wu S, Fang X, Neumann J, Eichhorn L, Schleifer G, Boehm O, Meyer R, Frede S, Hoeft A, Baumgarten G, Knuefermann P. Postconditioning with a CpG containing oligodeoxynucleotide ameliorates myocardial infarction in a murine closed-chest model. Life Sci 2014; 119:1-8. [PMID: 25445440 DOI: 10.1016/j.lfs.2014.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 08/25/2014] [Accepted: 09/29/2014] [Indexed: 01/04/2023]
Abstract
AIMS Toll-like receptor (TLR)9 ligand CpG-oligodeoxynucleotide (CpG-ODN) exerts preconditioning in myocardial ischemia/reperfusion. We hypothesized a postconditioning effect of CpG-ODN in a murine closed-chest model of myocardial infarction. MATERIALS AND METHODS C57BL/6 (12 weeks, male, WT) mice were instrumented at the left anterior descending artery, then allowed 5d of recovery before 30 min ischemia. Treatments comprised: 1) PBS: 250 μl phosphate buffer solution intraperitoneally 5 min before reperfusion and 2) IPC (ischemic postconditioning): 3 twenty-second reperfusion and occlusion episodes at the end of ischemia 3) CpG-ODN: 1668 thioate 0.2 μmol/kg BW intraperitoneally 5 min before reperfusion. Infarct size was assessed via triphenyltetrazolium chloride (TTC) staining after 2 and 24h reperfusion. Myocardial mRNA-expression of cytokines was measured using real-time PCR after 2h reperfusion. Phosphatidylinositol-3 kinase (PI3K)-inhibitor wortmannin was injected intraperitoneally in WT 15 min before postconditioning and PBS in each group. Cardiac function in WT was assessed with a left-ventricular pressure-volume catheter at 24h reperfusion. KEY FINDINGS Following 30 min ischemia and 2h reperfusion, infarct size was diminished by 90% in WT postconditioned with CpG-ODN (2.4 ± 1.55 IS/AAR%) and IPC (1.98 ± 1.03 IS/AAR%) compared to PBS mice (23.2 ± 3.97 IS/AAR%). Infarct size increased following 24h reperfusion but the differences remained robust. Expression of TNF-α and IL-10 was increased in CpG-ODN. Wortmannin abolished the postconditioning effect of CpG-ODN and IPC. Ejection fraction and preload-recruitable stroke work were significantly greater in CpG-ODN mice. SIGNIFICANCE CpG-ODN confers postconditioning via activation of TLR9. Cardiac function is preserved following CpG-ODN postconditioning. The PI3K -inhibitor wortmannin attenuates CpG-ODN postconditioning.
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Affiliation(s)
- Se-Chan Kim
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, D-53115 Bonn, Germany.
| | - Shuijing Wu
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, D-53115 Bonn, Germany; Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiangming Fang
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Jens Neumann
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, D-53115 Bonn, Germany
| | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, D-53115 Bonn, Germany
| | - Grigorij Schleifer
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, D-53115 Bonn, Germany
| | - Olaf Boehm
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, D-53115 Bonn, Germany
| | - Rainer Meyer
- Institute of Physiology, University of Bonn, Nussallee 11, D-53115 Bonn, Germany
| | - Stilla Frede
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, D-53115 Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, D-53115 Bonn, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, D-53115 Bonn, Germany
| | - Pascal Knuefermann
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Str. 25, D-53115 Bonn, Germany
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Schiwon M, Weisheit C, Franken L, Gutweiler S, Dixit A, Meyer-Schwesinger C, Pohl JM, Maurice NJ, Thiebes S, Lorenz K, Quast T, Fuhrmann M, Baumgarten G, Lohse MJ, Opdenakker G, Bernhagen J, Bucala R, Panzer U, Kolanus W, Gröne HJ, Garbi N, Kastenmüller W, Knolle PA, Kurts C, Engel DR. Crosstalk between sentinel and helper macrophages permits neutrophil migration into infected uroepithelium. Cell 2014; 156:456-68. [PMID: 24485454 DOI: 10.1016/j.cell.2014.01.006] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/21/2013] [Accepted: 01/06/2014] [Indexed: 12/16/2022]
Abstract
The phagocytes of the innate immune system, macrophages and neutrophils, contribute to antibacterial defense, but their functional specialization and cooperation is unclear. Here, we report that three distinct phagocyte subsets play highly coordinated roles in bacterial urinary tract infection. Ly6C(-) macrophages acted as tissue-resident sentinels that attracted circulating neutrophils and Ly6C(+) macrophages. Such Ly6C(+) macrophages played a previously undescribed helper role: once recruited to the site of infection, they produced the cytokine TNF, which caused Ly6C(-) macrophages to secrete CXCL2. This chemokine activated matrix metalloproteinase-9 in neutrophils, allowing their entry into the uroepithelium to combat the bacteria. In summary, the sentinel macrophages elicit the powerful antibacterial functions of neutrophils only after confirmation by the helper macrophages, reminiscent of the licensing role of helper T cells in antiviral adaptive immunity. These findings identify helper macrophages and TNF as critical regulators in innate immunity against bacterial infections in epithelia.
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Affiliation(s)
- Marzena Schiwon
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany
| | - Christina Weisheit
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany; Clinic for Anesthesiology, University Clinic of Bonn, 53127 Bonn, Germany
| | - Lars Franken
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany
| | - Sebastian Gutweiler
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany
| | - Akanksha Dixit
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany
| | | | - Judith-Mira Pohl
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany
| | - Nicholas J Maurice
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany
| | - Stephanie Thiebes
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany
| | - Kristina Lorenz
- Institute of Pharmacology and Toxicology, University of Würzburg, 97078 Würzburg, Germany
| | - Thomas Quast
- Life and Medical Sciences Institute, Friedrich-Wilhelms-Universität, 53115 Bonn, Germany
| | - Martin Fuhrmann
- German Center for Neurodegenerative Diseases (DZNE), 53125 Bonn, Germany
| | - Georg Baumgarten
- Clinic for Anesthesiology, University Clinic of Bonn, 53127 Bonn, Germany
| | - Martin J Lohse
- Institute of Pharmacology and Toxicology, University of Würzburg, 97078 Würzburg, Germany
| | - Ghislain Opdenakker
- Laboratory of Immunobiology, Rega Institute for Medical Research, University of Leuven, 3000 KU Leuven, Belgium
| | - Jürgen Bernhagen
- Institute of Biochemistry and Molecular Cell Biology, RWTH Aachen University, 52062 Aachen, Germany
| | - Rick Bucala
- Yale University School of Medicine, New Haven, CT 06510, USA
| | - Ulf Panzer
- Medizinische Klinik III, University Clinic Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Waldemar Kolanus
- Life and Medical Sciences Institute, Friedrich-Wilhelms-Universität, 53115 Bonn, Germany
| | - Hermann-Josef Gröne
- Cellular and Molecular Pathology, German Cancer Research Center Heidelberg, 69120 Heidelberg, Germany
| | - Natalio Garbi
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany
| | - Wolfgang Kastenmüller
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany
| | - Percy A Knolle
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany
| | - Christian Kurts
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany.
| | - Daniel R Engel
- Institute of Experimental Immunology, University Clinic of Bonn, 53127 Bonn, Germany.
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Bode C, Diedrich B, Muenster S, Hentschel V, Weisheit C, Rommelsheim K, Hoeft A, Meyer R, Boehm O, Knuefermann P, Baumgarten G. Antibiotics regulate the immune response in both presence and absence of lipopolysaccharide through modulation of Toll-like receptors, cytokine production and phagocytosis in vitro. Int Immunopharmacol 2013; 18:27-34. [PMID: 24239744 DOI: 10.1016/j.intimp.2013.10.025] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 10/18/2013] [Accepted: 10/19/2013] [Indexed: 12/12/2022]
Abstract
The inflammatory response to pathogen-associated molecular patterns such as lipopolysaccharide (LPS) in sepsis is mediated via Toll-like receptors (TLRs). Since TLRs also trigger various immune functions, including phagocytosis, their modulation is a promising strategy in the treatment of sepsis. As antibiotics have immunomodulatory properties, this study examined the effect of commonly used classes of antibiotics on i) the expression of TLRs and cytokines and ii) the phagocytic activity under sepsis-like conditions in vitro. This was achieved by incubating THP-1 monocytes and peripheral blood mononuclear cells (PBMCs) obtained from patients after open-heart surgery with the addition of LPS and six key antibiotics (piperacillin, doxycycline, erythromycin, moxifloxacin or gentamicin). After 24h, mRNA levels of both cytokines (IL-1β, IL-6) and TLRs (1, 2, 4, and 6) were monitored and phagocytosis was determined following coincubation with Escherichia coli. Each antibiotic differentially regulated the gene expression of the investigated TLRs and cytokines in monocytes. Erythromycin, moxifloxacin and doxycyclin displayed the strongest effects and changed mRNA-levels of the investigated genes up to 5.6-fold. Consistent with this, antibiotics and, in particular, moxifloxacin, regulated the TLR-and cytokine expression in activated PBMCs obtained from patients after open-heart surgery. Furthermore, piperacillin, doxycyclin and moxifloxacin inhibited the phagocytic activity of monocytes. Our results suggest that antibiotics regulate the immune response by modulating TLR- and cytokine expression as well as phagocytosis under septic conditions. Moxifloxacin, doxycycline and erythromycin were shown to possess the strongest immunomodulatory effects and these antibiotic classes should be considered for future immunomodulatory studies in sepsis.
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Affiliation(s)
- Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
| | - Britta Diedrich
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany; Freiburg Institute for Advanced Studies-LifeNet, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Stefan Muenster
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Viktoria Hentschel
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christina Weisheit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Kuno Rommelsheim
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Rainer Meyer
- Institute of Physiology II, University of Bonn, Bonn, Germany
| | - Olaf Boehm
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Pascal Knuefermann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Hilbert T, Poth J, Frede S, Klaschik S, Hoeft A, Baumgarten G, Knuefermann P. Anti-atherogenic effects of statins: Impact on angiopoietin-2 release from endothelial cells. Biochem Pharmacol 2013; 86:1452-60. [PMID: 24041741 DOI: 10.1016/j.bcp.2013.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 01/30/2023]
Abstract
Beyond lipid lowering, statins are supposed to exert pleiotropic effects positively influencing the progression of atherosclerotic lesions. The development of such lesions is associated with increased release of angiopoietin-2 (Ang-2), an endothelial cell-specific protein growth factor stored in Weibel-Palade bodies (WPBs). The aim of our study was to examine whether statin pretreatment influences the release of Ang-2 from endothelial cells. Stimulation of HUVECs and HMVECs with PMA, thrombin or histamine resulted in significant release of Ang-2, as evidenced by ELISA. Pretreatment with simvastatin and mevastatin suppressed this release to basal level, while pravastatin had no effect. Simvastatin itself increased nitric oxide (NO, EC number 1.14.13.39) synthesis, measured by Griess reaction. Combining the statin pretreatment with the eNOS inhibitor L-NNA as well as bypassing the HMG-CoA reductase (EC number: 1.1.1.34) by adding mevalonic acid or geranyl pyrophosphate restored the exocytotic effect of PMA. Immunofluorescence microscopy showed that depletion of WPBs upon PMA stimulation ceased after pretreatment with simvastatin. This study demonstrates a potent suppressive effect of statins on the release of Ang-2 from endothelial cells. Regarding its harmful effects in the development of atherosclerotic lesions, our data provide further insight into the mechanisms of the anti-atherogenic potential of statins.
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Affiliation(s)
- Tobias Hilbert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany.
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Markowski P, Boehm O, Goelz L, Haesner AL, Ehrentraut H, Bauerfeld K, Tran N, Zacharowski K, Weisheit C, Langhoff P, Schwederski M, Hilbert T, Klaschik S, Hoeft A, Baumgarten G, Meyer R, Knuefermann P. Pre-conditioning with synthetic CpG-oligonucleotides attenuates myocardial ischemia/reperfusion injury via IL-10 up-regulation. Basic Res Cardiol 2013; 108:376. [PMID: 23929312 PMCID: PMC3778842 DOI: 10.1007/s00395-013-0376-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 12/10/2012] [Revised: 07/18/2013] [Accepted: 07/26/2013] [Indexed: 01/26/2023]
Abstract
The aim of the study was to investigate whether pre-conditioning with CpG-oligodeoxynucleotides (CpG-ODN) may change cardiac ischemia/reperfusion (I/R)-dependent inflammation and modulates infarct size and cardiac performance. WT and TLR9-deficient mice were pre-treated with 1668-, 1612- and H154-thioate or D-Gal as control. Priming with 1668-thioate significantly induced inflammatory mediators in the serum and a concomitant increase of immune cells in the blood and spleen of WT mice. Furthermore, it induced myocardial pattern recognition receptors and pro-inflammatory cytokines peaking 2 h after priming and a continuous increase of IL-10. 16 h after pre-conditioning, myocardial ischemia was induced for 1 h. Infarct size determined after 24 h of I/R was reduced by 75 % due to pre-conditioning with 1668-thioate but not in the other groups. During reperfusion, cytokine expression in 1668-thioate primed mice increased further with IL-10 exceeding the other mediators by far. These changes were observed neither in animals pre-treated with 1612- or H154-thioate nor in TLR9-deficient mice. The 1668-thioate-dependent increase of IL-10 was further supported by results of a micro-array analysis 3 h after begin of reperfusion. Block of IL-10 signaling increased I/R size and prevented influence of priming. In the group pre-treated with 1668-thioate, cardiac function was preserved 24 h, 14 days and 28 days after I/R, whereas animals without pre-conditioning exhibited impaired heart function 24 h and 14 days after I/R. The excessive 1668-thioate-dependent IL-10 up-regulation during pre-conditioning and after I/R seems to be the key factor for reducing infarct size and improving cardiac function. This is in agreement with the finding that IL-10 block prevents cardioprotection by pre-conditioning.
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Affiliation(s)
- P Markowski
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
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Hilbert T, Bongartz J, Weisheit C, Knüfermann P, Baumgarten G, Hoeft A, Poth JM. Beta2-adrenoceptor stimulation suppresses TLR9-dependent IFNA1 secretion in human peripheral blood mononuclear cells. PLoS One 2013; 8:e65024. [PMID: 23724117 PMCID: PMC3665595 DOI: 10.1371/journal.pone.0065024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 04/19/2013] [Indexed: 11/24/2022] Open
Abstract
Introduction IFNA1 (interferon alpha) is a key cytokine regulating the activity of numerous immune cells. Plasmacytoid dendritic cells (pDCs) as natural interferon-producing cells play critical roles as sensors of pathogens and link innate to adaptive immunity. CpG motifs within DNA sequences activating toll-like receptor 9 (TLR9) are the main stimuli eliciting IFNA1 secretion from pDCs. Adrenergic substances are capable of differentially modulating the response from various immune cells. Hence, the aim of this study was to examine how adrenoceptor stimulation influences TLR9-induced IFNA1 secretion from human pDCs. Methods PBMCs generated from human whole blood and pDCs enriched from buffy coats were stimulated with LPS and CpG-ODN 2336 in the presence or absence of epinephrine and different adrenoceptor antagonists. Secretion of TNF and IFNA1 was measured by ELISA. Flow cytometry was used to determine efficacy of pDC enrichment and adrenoceptor expression of PBMC subsets. The influence of modified IFNA1 secretion on NK cell activity was evaluated using a colorimetric tumor cell lysis assay. Results TLR9-induced IFNA1 secretion as well as TLR4-induced TNF secretion from PBMCs was dose-dependently attenuated by coincubation with epinephrine. Combination with different specific adrenoceptor antagonists revealed that this effect was mediated by the adrenoceptor β2 (ADRB2). Since flow cytometric analysis could exclude the presence of ADRB2 on pDCs, highly enriched pDCs lacked any visible impact of adrenoceptor stimulation on TLR9-induced IFNA1 release. Combination of pDCs with PBMCs restored the effect, even when they were separated by a permeable membrane. Suppression of TLR9-mediated IFNA1 secretion from PBMCs by adrenoceptor stimulation reduced the lytic activity of NK cells on K562 tumor cells. Conclusion We provide insights into the underlying mechanisms of the interrelation between immune responses and pharmacological agents widely used in clinical practice. Our results have implications for the future treatment of human patients, in which the endogenous immune response plays a pivotal role, such as during viral infections, inflammatory diseases and cancers.
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Affiliation(s)
- Tobias Hilbert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
| | - Josef Bongartz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
| | - Christina Weisheit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
| | - Pascal Knüfermann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
| | - Jens M. Poth
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
- * E-mail:
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Baehner T, Guetgemann I, Heinze I, Hoeft A, Knuefermann P, Probst C, Baumgarten G. A rare case of direct tumor extension to the right ventricle. Ann Thorac Surg 2013; 95:706-7. [PMID: 23336886 DOI: 10.1016/j.athoracsur.2012.06.054] [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] [Received: 04/09/2012] [Revised: 06/09/2012] [Accepted: 06/27/2012] [Indexed: 11/25/2022]
Abstract
We report the case of a 72-year-old woman with signs of pulmonary embolism and right heart failure. Echocardiographic imaging and computed tomography revealed a mass within the inferior vena cava reaching from the head of the pancreas to the right ventricle. From standard imaging procedures and clinical findings alone, differentiation of a cardiac thrombus from a metastatic tumor mass was difficult. After resection of the intravascular tumor, histopathologic analysis confirmed a metastasis of primary ductal pancreatic adenocarcinoma. This is a report of a case of mucinous adenocarcinoma of the pancreas reaching the heart by continuous intravascular spreading.
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Affiliation(s)
- Torsten Baehner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
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Spahn G, Felmet G, Baumgarten G, Plettenberg H, Hoffmann M, Klinger HM, Hofmann GO. [Evaluation of cartilage degeneration by near infrared spectroscopy (NIRS): methodical description and systematic literature review]. Z Orthop Unfall 2013; 151:31-7. [PMID: 23329346 DOI: 10.1055/s-0032-1327873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Damage to hyaline cartilage is the most important pathophysiological tool in the development of osteoarthritis. Cartilage lesions are the most frequent pathological findings during arthroscopic operations. Arthroscopies as well as magnetic resonance tomography are gold standards for detection of cartilage lesions. But the arthroscopic evaluation of cartilage lesions is descriptive and subjective only. The surgeon is able to differentiate between intact cartilage surface, softening, superficial or deep fissure or flake and finally a complete defect. In routine arthroscopy the grading mostly is made by use of different scores [e.g. ICRS (International Cartilage Repair Society), Outerbridge, Insall, Jäger-Wirth or others]. Because the arthroscopic evaluation is subjective the reliability of this method is poor. Spectroscopic methods are established for evaluation of different tissue diseases in different indications. NIRS (near infrared spectroscopy) has become an important method for medical diagnostics in the last years. NIR is very energy-rich and suitable for glass fibre transport without relevant reduction. Insofar this technology may be ideal for endoscopic procedures. Our systematic literature review reveals that NIRS is a sufficient method for an objective diagnosis of cartilage lesions. In the current work we demonstrate an NIRS-based device for intraoperative, real-time cartilage evaluation. Furthermore, we discuss the possible clinical consequences from such measurements.
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Affiliation(s)
- G Spahn
- Unfallchirurgie und Orthopädie, Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach.
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Velten M, Duerr GD, Pessies T, Schild J, Lohner R, Mersmann J, Dewald O, Zacharowski K, Klaschik S, Hilbert T, Hoeft A, Baumgarten G, Meyer R, Boehm O, Knuefermann P. Priming with synthetic oligonucleotides attenuates pressure overload-induced inflammation and cardiac hypertrophy in mice. Cardiovasc Res 2012; 96:422-32. [PMID: 22977006 DOI: 10.1093/cvr/cvs280] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [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: 11/15/2022] Open
Abstract
AIMS Inflammation and Toll-like receptor (TLR) signalling have been linked to the development of cardiac hypertrophy following transverse aortic constriction (TAC). In the present study, we investigated whether pre-treatment with the synthetic TLR9 ligands 1668-thioate or 1612-thioate modulates the progression of TAC-induced cardiac inflammation and hypertrophy. METHODS AND RESULTS C57BL/6N-mice were pre-treated with 1668-thioate, 1612-thioate (0.25 nmol/g, i.p.), or phosphate-buffered saline 16 h prior to TAC or sham surgery. Heart-weight/body-weight ratio (HW/BW), cardiomyocyte cell size, cellular macrophage accumulation, myofibroblast differentiation, and collagen deposition were investigated for up to 28 days. Cardiac function was monitored using a pressure-volume catheter and M-mode echocardiography. Inflammatory gene expression in the heart was analysed via gene array, while the time course of mRNA expression of key inflammatory mediators was assessed via RT-qPCR. TAC increased the HW/BW ratio and cardiomyocyte cell size and induced macrophage accumulation, myofibroblast differentiation, and collagen deposition. These changes were accompanied by cardiac inflammation and a significant loss of left ventricular function. Pre-treatment with cytosine-phosphate-guanine (CpG)-containing 1668-thioate attenuated the inflammatory response, the progression of cardiac hypertrophy, and cardiac remodelling, which resulted in a prolonged preservation of left ventricular function. These changes were induced to a smaller extent by the use of the non-CG-containing oligodeoxynucleotide 1612-thioate. CONCLUSION Pre-treatment with 1668-thioate attenuated cardiac hypertrophy following pressure overload, possibly by modifying the hypertrophy-induced inflammatory response, thereby reducing cardiac growth and fibrosis as well as delaying loss of cardiac function.
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Affiliation(s)
- Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Sigmund-Freud-Strasse 25, Bonn D-53105, Germany
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Ehrentraut SF, Dörr A, Ehrentraut H, Lohner R, Lee SH, Hoeft A, Baumgarten G, Knuefermann P, Boehm O, Meyer R. Vascular dysfunction following polymicrobial sepsis: role of pattern recognition receptors. PLoS One 2012; 7:e44531. [PMID: 22970242 PMCID: PMC3436884 DOI: 10.1371/journal.pone.0044531] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 08/03/2012] [Indexed: 12/26/2022] Open
Abstract
AIMS Aim was to elucidate the specific role of pattern recognition receptors in vascular dysfunction during polymicrobial sepsis (colon ascendens stent peritonitis, CASP). METHODS AND RESULTS Vascular contractility of C57BL/6 (wildtype) mice and mice deficient for Toll-like receptor 2/4/9 (TLR2-D, TLR4-D, TLR9-D) or CD14 (CD14-D) was measured 18 h following CASP. mRNA expression of pro- (Tumor Necrosis Factor-α (TNFα), Interleukin (IL)-1β, IL-6) and anti-inflammatory cytokines (IL-10) and of vascular inducible NO-Synthase (iNOS) was determined using RT-qPCR. Wildtype mice exhibited a significant loss of vascular contractility after CASP. This was aggravated in TLR2-D mice, blunted in TLR4-D animals and abolished in TLR9-D and CD14-D animals. TNF-α expression was significantly up-regulated after CASP in wildtype and TLR2-D animals, but not in mice deficient for TLR4, -9 or CD14. iNOS was significantly up-regulated in TLR2-D animals only. TLR2-D animals showed significantly higher levels of TLR4, -9 and CD14. Application of H154-ODN, a TLR9 antagonist, attenuated CASP-induced cytokine release and vascular dysfunction in wildtype mice. CONCLUSIONS Within our model, CD14 and TLR9 play a decisive role for the development of vascular dysfunction and thus can be effectively antagonized using H154-ODN. TLR2-D animals are more prone to polymicrobial sepsis, presumably due to up-regulation of TLR4, 9 and CD14.
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Affiliation(s)
- Stefan Felix Ehrentraut
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Anne Dörr
- Institute of Physiology II, University of Bonn, Bonn, Germany
| | - Heidi Ehrentraut
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Ralph Lohner
- Institute of Physiology II, University of Bonn, Bonn, Germany
| | - Sun-Hee Lee
- Institute of Physiology II, University of Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Baumgarten
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Pascal Knuefermann
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Olaf Boehm
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Rainer Meyer
- Institute of Physiology II, University of Bonn, Bonn, Germany
- * E-mail:
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Kim SC, Boehm O, Meyer R, Hoeft A, Knüfermann P, Baumgarten G. A murine closed-chest model of myocardial ischemia and reperfusion. J Vis Exp 2012:e3896. [PMID: 22847277 DOI: 10.3791/3896] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Surgical trauma by thoracotomy in open-chest models of coronary ligation induces an immune response which modifies different mechanisms involved in ischemia and reperfusion. Immune response includes cytokine expression and release or secretion of endogenous ligands of innate immune receptors. Activation of innate immunity can potentially modulate infarct size. We have modified an existing murine closed-chest model using hanging weights which could be useful for studying myocardial pre- and postconditioning and the role of innate immunity in myocardial ischemia and reperfusion. This model allows animals to recover from surgical trauma before onset of myocardial ischemia. Volatile anesthetics have been intensely studied and their preconditioning effect for the ischemic heart is well known. However, this protective effect precludes its use in open chest models of coronary artery ligation. Thus, another advantage could be the use of the well controllable volatile anesthetics for instrumentation in a chronic closed-chest model, since their preconditioning effect lasts up to 72 hours. Chronic heart diseases with intermittent ischemia and multiple hit models are other possible applications of this model. For the chronic closed-chest model, intubated and ventilated mice undergo a lateral blunt thoracotomy via the 4th intercostal space. Following identification of the left anterior descending a ligature is passed underneath the vessel and both suture ends are threaded through an occluder. Then, both suture ends are passed through the chest wall, knotted to form a loop and left in the subcutaneous tissue. After chest closure and recovery for 5 days, mice are anesthetized again, chest skin is reopened and hanging weights are hooked up to the loop under ECG control. At the end of the ischemia/reperfusion protocol, hearts can be stained with TTC for infarct size assessment or undergo perfusion fixation to allow morphometric studies in addition to histology and immunohistochemistry.
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Affiliation(s)
- Se-Chan Kim
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Germany.
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Wittmann M, Boehm O, Thiessen N, Hoeft A, Knuefermann P, Baumgarten G. Studentische Evaluation der anästhesiologischen Lehre. Anaesthesist 2012; 61:588-90, 592-6. [DOI: 10.1007/s00101-012-2030-4] [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] [Received: 01/04/2012] [Revised: 02/29/2012] [Accepted: 04/10/2012] [Indexed: 11/30/2022]
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Ehrentraut H, Weber C, Ehrentraut S, Schwederski M, Boehm O, Knuefermann P, Meyer R, Baumgarten G. The toll-like receptor 4-antagonist eritoran reduces murine cardiac hypertrophy. Eur J Heart Fail 2011; 13:602-10. [PMID: 21613426 DOI: 10.1093/eurjhf/hfr035] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [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: 11/13/2022] Open
Abstract
AIMS Toll-like receptor 4 (TLR4) recognizes lipopolysaccharides and endogenous ligands released after organ injury. Deficiency of TLR4 attenuates the development of left ventricular hypertrophy after transverse aortic constriction (TAC) in mice. We hypothesized that application of the TLR4 antagonist eritoran may also reduce cardiac hypertrophy after TAC surgery. METHODS AND RESULTS A catheter was implanted into the jugular vein of C57BL/6 mice to allow repeated administration of eritoran (5 mg/kg body weight) or placebo. Three days after TAC or sham surgery, heart weights were determined and cardiac tissue underwent mRNA and protein quantification. The TAC placebo group exhibited a significant increase in left ventricular weight, left ventricular weight/tibia length, and left ventricular/body weight ratio compared with the sham and TAC eritoran groups. Natriuretic peptide mRNA was elevated significantly only in TAC placebo mice. Transverse aortic constriction surgery led to a distinct increase in interleukin (IL)-1β and IL-6 mRNA and protein expression in the placebo but not the eritoran group. In contrast, IL-10 was significantly increased in both eritoran groups independent from TAC. Matrix metalloproteinase zymographic activity was highest in TAC placebo animals. CONCLUSION Application of the TLR4 antagonist eritoran attenuates the development of cardiac hypertrophy possibly by a reduction in inflammatory and increase in anti-inflammatory cytokines.
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Affiliation(s)
- Heidi Ehrentraut
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
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Weber SU, Hammerstingl C, Mellert F, Baumgarten G, Putensen C, Knuefermann P. [Traumatic tricuspid valve insufficiency with right-to-left shunt: bridging using extracorporeal venovenous membrane oxygenation]. Anaesthesist 2011; 61:41-6. [PMID: 21901648 DOI: 10.1007/s00101-011-1934-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 06/14/2011] [Accepted: 07/22/2011] [Indexed: 11/25/2022]
Abstract
The case of a young male motor vehicle driver is reported who suffered multiple trauma in a car accident with pulmonary and cardiac contusions. In the course of severe pneumonia and traumatic tricuspid valve insufficiency a right-to-left shunt with refractory hypoxemia developed across a pre-existing atrial septal defect (ASD). The patient could be successfully treated by the combination of extracorporeal membrane oxygenation for bridging, interventional ASD occlusion and in the long-term by operative reconstruction of the tricuspid valve.
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Affiliation(s)
- S U Weber
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
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Wittmann M, Dewald D, Urbach H, Gast AS, Linnebank M, Baumgarten G, Knuefermann P, Hering R. Sinus venous thrombosis: a differential diagnosis of postpartum headache. Arch Gynecol Obstet 2011; 285:93-7. [DOI: 10.1007/s00404-011-1964-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 06/20/2011] [Indexed: 10/18/2022]
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Merz WM, Keyver-Paik MD, Baumgarten G, Lewalter T, Gembruch U. Spectrum of cardiovascular findings during pregnancy and parturition at a tertiary referral center. J Perinat Med 2011; 39:251-6. [PMID: 21501102 DOI: 10.1515/jpm.2011.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To analyze the spectrum of cardiovascular diseases occurring during pregnancy and delivery at a tertiary referral center. METHODS All patients presenting at our institution with pre-existing or first diagnosis of cardiac disease were recruited. Cardiac and obstetric complications and maternal and neonatal outcomes were recorded. RESULTS Fifty-two pregnancies in 49 women, including three pregnancy terminations were analyzed. Cardiac lesions were congenital in 26 (53.1%) and acquired in nine (18.4%); six patients (12.2%) had cardiomyopathies, eight (16.3%) ar-rhythmic conditions. A total of 42 women (85.7%) had a pre-existing cardiac condition and seven (14.3%) presented with first manifestation. Overall 22 cardiac complications occurred: five in pregnancy, eight around parturition, nine during follow-up. They included >1 New York Heart Association functional class deterioration (n=5), congestive heart failure/cardiomyopathy (n=5), valve replacement (n=4), sustained arrhythmia (n=3), cerebral insult, aortic dissection, transplantation (one case each), and death (n=2). Mean gestational age at delivery was 36+6. The cesarean section rate was 77.5%; 31.6% were performed for cardiac indications. Obstetric complications happened in 23 pregnancies (46.9%). There was no perinatal loss; cardiac defects were diagnosed in 9.3% (n=5) of offspring. CONCLUSION Cardiovascular diseases occurring during pregnancy and parturition comprise a heterogeneous spectrum of conditions. Established scores aid in the identification of high-risk patients; however, in our series 14.3% women had been healthy previously.
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Affiliation(s)
- Waltraut M Merz
- Department of Obstetrics and Prenatal Medicine, University Bonn Medical School, Bonn, Germany.
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Pabst S, Huss S, Zimmer S, Ghanem A, Nickenig G, Baumgarten G, Knüfermann P, Meyer R, Grohé C, Skowasch D. A new animal model in sarcoidosis. Pneumologie 2011. [DOI: 10.1055/s-0030-1270366] [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: 10/18/2022]
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49
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Gräff I, Wittmann M, Dahmen A, Goldschmidt B, Tenzer D, Glien P, Drehsen L, Link N, Hoeft A, Baumgarten G. Prozessoptimierung im interdisziplinären Notfallzentrum. Notf Rett Med 2011. [DOI: 10.1007/s10049-010-1286-y] [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: 10/18/2022]
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Schiller W, Muders T, Probst C, Vodermayer B, Rieke C, Baumgarten G, Schmid T. First in vivo results with the DLR-VAD in calves. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246910] [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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