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Hecht, Markus ; Hahn, Dennis ; Wolber, Philipp ; Hautmann, Matthias Günther ; Reichert, Dietmar ; Weniger, Steffi ; Belka, Claus ; Bergmann, Tobias ; Göhler, Thomas ; Welslau, Manfred ; Große-Thie, Christina ; Guntinas-Lichius, Orlando ; Müller-von der Grün, Jens ; Balermpas, Panagiotis ; Orlowski, Katrin ; Messinger, Diethelm ; Stenzel, Karsten G. ; Fietkau, Rainer
Treatment options of locoregional recurrent head and neck squamous cell cancer (HNSCC) include both local strategies as surgery or re-radiotherapy and systemic therapy. In this prospective, multi-center, non-interventional study, patients were treated either with platinum-based chemotherapy and cetuximab (CT + Cet) or re-radiotherapy and cetuximab (RT + Cet). In the current analysis, progression-free survival (PFS) and overall survival (OS) were compared in patients with locoregional recurrence. Four hundred seventy patients were registered in 97 German centers. After exclusion of patients with distant metastases, a cohort of 192 patients was analyzed (129 CT + Cet, 63 RT + Cet). Radiotherapy was delivered as re-irradiation to 70% of the patients. The mean radiation dose was 51.8 Gy, whereas a radiation dose of ≥60 Gy was delivered in 33% of the patients. Chemotherapy mainly consisted of cisplatin/5-flurouracil (40%) or carboplatin/5-flurouracil (29%). The median PFS was 9.2 months in the RT + Cet group versus 5.1 months in the CT + Cet group (hazard ratio for disease progression or death, 0.40, 95% CI, 0.27–0.57, p < 0.0001). Median OS was 12.8 months in the RT + Cet group versus 7.9 months in the CT + Cet group (hazard ratio for death, 0.50, 95% CI, 0.33–0.75, p = 0.0008). In conclusion, radiotherapy combined with cetuximab improved survival compared to chemotherapy combined with cetuximab in locally recurrent HNSCC.
Müller-von der Grün, Jens ; Winkelmann, Anne Ria ; Rödel, Franz ; Balster, Sven ; Neumayer, Thomas Peter Michael ; Ghanaati, Shahram Michael ; Brandts, Christian Hubertus ; Burck, Iris ; Martin, Daniel ; Rödel, Claus ; Kesar, Nikolina ; Balermpas, Panagiotis
Background; Salivary gland carcinomas (SGC) cover a heterogeneous group of malignancies with a lack of data of high-level evidence.
Methods; Clinical data of 127 patients treated for SGC at a university cancer center between 2002 and 2017 were analyzed retrospectively. The association of clinicopathological characteristics, treatment modalities, adverse events, and outcome was assessed.
Results: Patients received surgery (n = 65), surgery followed by (chemo-)radiotherapy (n = 56), or primary (chemo-)radiotherapy (n = 6). Injury to the cranial nerves or their branches was the most frequent surgical complication affecting 40 patients (33.1%). Ten year overall and progression-free survival rates were 73.2% and 65.4%, respectively. Parotid tumor site, advanced tumor, and positive nodal stage remained independent negative prognostic factors for overall survival, loco-regional and distant tumor control in multivariate analysis.
Conclusions: Optimizing treatment strategies for SGC, depending on distinct clinicopathological factors, remains challenging due to the low incidence rates of the disease.
Miethke, Marcus ; Pieroni, Marco ; Weber, Karl Tilmann ; Brönstrup, Mark ; Hammann, Peter ; Halby, Ludovic ; Arimondo, Paola B. ; Glaser, Philippe ; Aigle, Bertrand ; Bode, Helge Björn ; Moreira, Rui ; Li, Yanyan ; Luzhetskyy, Andriy ; Medema, Marnix H. ; Pernodet, Jean-Luc ; Stadler, Marc ; Tormo, José Rubén ; Genilloud, Olga ; Truman, Andrew W. ; Weissman, Kira J. ; Takano, Eriko ; Sabatini, Stefano ; Stegmann, Evi ; Brötz, Heike ; Wohlleben, Wolfgang ; Seemann, Myriam ; Empting, Martin ; Hirsch, Anna K. H. ; Loretz, Brigitta ; Lehr, Claus-Michael ; Titz, Alexander ; Herrmann, Jennifer ; Jäger, Timo ; Alt, Silke ; Hesterkamp, Thomas ; Winterhalter, Mathias ; Schiefer, Andrea ; Pfarr, Kenneth ; Hoerauf, Achim ; Graz, Heather ; Graz, Michael ; Lindvall, Mika ; Ramurthy, Savithri ; Karlén, Anders ; Dongen, Maarten van ; Petkovic, Hrvoje ; Keller, Andreas ; Peyrane, Frédéric ; Donadio, Stefano ; Fraisse, Laurent ; Piddock, Laura J. V. ; Gilbert, Ian H. ; Moser, Heinz E. ; Müller, Rolf
An ever-increasing demand for novel antimicrobials to treat life-threatening infections caused by the global spread of multidrug-resistant bacterial pathogens stands in stark contrast to the current level of investment in their development, particularly in the fields of natural-product-derived and synthetic small molecules. New agents displaying innovative chemistry and modes of action are desperately needed worldwide to tackle the public health menace posed by antimicrobial resistance. Here, our consortium presents a strategic blueprint to substantially improve our ability to discover and develop new antibiotics. We propose both short-term and long-term solutions to overcome the most urgent limitations in the various sectors of research and funding, aiming to bridge the gap between academic, industrial and political stakeholders, and to unite interdisciplinary expertise in order to efficiently fuel the translational pipeline for the benefit of future generations.
Semrau, Sabine ; Gostian, Antoniu-Oreste ; Traxdorf, Thomas Maximilian ; Eckstein, Markus ; Rutzner, Sandra ; Müller-von der Grün, Jens ; Illmer, Thomas ; Hautmann, Matthias Günther ; Klautke, Gunther ; Laban, Simon Andreas ; Brunner, Thomas ; Tamaskovics, Bálint ; Frey, Benjamin ; Zhou, Jian-Guo ; Geppert, Carol-Immanuel ; Hartmann, Arndt ; Balermpas, Panagiotis ; Budach, Wilfried ; Gaipl, Udo ; Iro, Heinrich ; Fietkau, Rainer ; Hecht, Markus
Simple Summary: The study compares the effects on complete remission rate (CR) of a single dose of durvalumab/tremelimumab immediately after a single-cycle platinum and docetaxel as part of induction therapy for a controlled trial in head and neck cancer with chemotherapy alone from a historical collective. The CR rate was 60.3% after induction chemoimmunotherapy (ICIT; induction chemotherapy plus double immune checkpoint blockade) compared with 40.3% after induction chemotherapy (IC) alone. Patients with HPV-positive oropharyngeal cancer may benefit the most from additive double checkpoint inhibition, which is presumably due to the higher amount of infiltrating immune cells. Patients older than 60 years without HPV-positive oropharyngeal cancer are unlikely to benefit.
Abstract: To determine whether a single dose of double immune checkpoint blockade (induction chemoimmunotherapy (ICIT)) adds benefit to induction single-cycle platinum doublet (induction chemotherapy (IC)) in locally advanced head and neck squamous cell carcinoma (HNSCC), patients treated with cisplatin 30 mg/m2 d1-3 and docetaxel 75 mg/m2 d1 combined with durvalumab 1500 mg fixed dose d5 and tremelimumab 75 mg fixed dose d5 (ICIT) within the CheckRad-CD8 trial were compared with a retrospective cohort receiving the same chemotherapy (IC) without immunotherapy. The endpoint of this analysis was the complete response rate (CR). A total of 53 patients were treated with ICIT and 104 patients with IC only. CR rates were 60.3% for ICIT and 40.3% for IC (p = 0.018). In the total population (n = 157), the most important predictor to achieve a CR was treatment type (OR: 2.21 for ICIT vs. IC; p = 0.038, multivariate analysis). The most diverse effects in CR rates between ICIT and IC were observed in younger (age ≤ 60) patients with HPV-positive OPSCCs (82% vs. 33%, p = 0.176), while there was no difference in older patients without HPV-positive OPSCCs (53% vs. 48%). The analysis provides initial evidence that ICIT could result in higher CR rates than IC. Young patients with HPV-positive OPSCCs may have the greatest benefit from additional immune checkpoint inhibitors.
Liebers, Nora ; Düll, Johannes ; Fitzgerald, Donnacha ; Kerkhoff, Andrea ; Nörenberg, Daniel ; Käbisch, Eva ; Acker, Fabian ; Fuhrmann, Stephan ; Leng, Corinna ; Welslau, Manfred ; Chemnitz, Jens ; Middeke, Jan Moritz ; Weber, Thomas ; Holtick, Udo ; Trappe, Ralf Ulrich ; Pfannes, Roald ; Liersch, Rüdiger ; Spoer, Christian ; Fuxius, Stefan ; Gebauer, Niklas ; Caillé, Léandra ; Geer, Thomas ; Könecke, Christian ; Keller, Ulrich ; Claus, Rainer ; Mougiakakos, Dimitrios ; Mayer, Stephanie ; Hüttmann, Andreas ; Pott, Christiane ; Trummer, Arne ; Wulf, Gerald ; Brunnberg, Uta ; Bullinger, Lars ; Heß, Georg ; Müller-Tidow, Carsten ; Glaß, Bertram ; Lenz, Georg ; Dreger, Peter ; Dietrich, Sascha
The antibody-drug conjugate polatuzumab vedotin (pola) has recently been approved in combination with bendamustine and rituximab (pola-BR) for patients with refractory or relapsed (r/r) large B-cell lymphoma (LBCL). To investigate the efficacy of pola-BR in a real-world setting, we retrospectively analyzed 105 patients with LBCL who were treated in 26 German centers under the national compassionate use program. Fifty-four patients received pola as a salvage treatment and 51 patients were treated with pola with the intention to bridge to chimeric antigen receptor (CAR) T-cell therapy (n = 41) or allogeneic hematopoietic cell transplantation (n = 10). Notably, patients in the salvage and bridging cohort had received a median of 3 prior treatment lines. In the salvage cohort, the best overall response rate was 48.1%. The 6-month progression-free survival and overall survival (OS) was 27.7% and 49.6%, respectively. In the bridging cohort, 51.2% of patients could be successfully bridged with pola to the intended CAR T-cell therapy. The combination of pola bridging and successful CAR T-cell therapy resulted in a 6-month OS of 77.9% calculated from pola initiation. Pola vedotin-rituximab without a chemotherapy backbone demonstrated encouraging overall response rates up to 40%, highlighting both an appropriate alternative for patients unsuitable for chemotherapy and a new treatment option for bridging before leukapheresis in patients intended for CAR T-cell therapy. Furthermore, 7 of 12 patients with previous failure of CAR T-cell therapy responded to a pola-containing regimen. These findings suggest that pola may serve as effective salvage and bridging treatment of r/r LBCL patients.
DGK and DZHK position paper on genome editing: basic science applications and future perspective
(2021)
Brandes, Ralf ; Dueck, Anne ; Engelhardt, Stefan ; Kaulich, Manuel ; Kupatt, Christian ; De Angelis, Maria Teresa ; Leisegang, Matthias ; Le Noble, Ferdinand ; Moretti, Alessandra ; Müller, Oliver J. ; Skryabin, Boris V. ; Thum, Thomas ; Wurst, Wolfgang
For a long time, gene editing had been a scientific concept, which was limited to a few applications. With recent developments, following the discovery of TALEN zinc-finger endonucleases and in particular the CRISPR/Cas system, gene editing has become a technique applicable in most laboratories. The current gain- and loss-of function models in basic science are revolutionary as they allow unbiased screens of unprecedented depth and complexity and rapid development of transgenic animals. Modifications of CRISPR/Cas have been developed to precisely interrogate epigenetic regulation or to visualize DNA complexes. Moreover, gene editing as a clinical treatment option is rapidly developing with first trials on the way. This article reviews the most recent progress in the field, covering expert opinions gathered during joint conferences on genome editing of the German Cardiac Society (DGK) and the German Center for Cardiovascular Research (DZHK). Particularly focusing on the translational aspect and the combination of cellular and animal applications, the authors aim to provide direction for the development of the field and the most frequent applications with their problems.
Peter, Antonia Sophia ; Roth, Edith ; Schulz, Sebastian R. ; Fraedrich, Kirsten ; Steinmetz, Tobit ; Damm, Dominik ; Hauke, Manuela ; Richel, Elie ; Müller-Schmucker, Sandra ; Habenicht, Katharina ; Eberlein, Valentina ; Issmail, Leila ; Uhlig, Nadja ; Dolles, Simon ; Grüner, Eva ; Peterhoff, David ; Ciesek, Sandra ; Hoffmann, Markus ; Pöhlmann, Stefan ; McKay, Paul F. ; Shattock, Robin J. ; Wölfel, Roman ; Socher, Eileen ; Wagner, Ralf ; Eichler, Jutta ; Sticht, Heinrich ; Schuh, Wolfgang ; Neipel, Frank ; Ensser, Armin ; Mielenz, Dirk Alexander ; Tenbusch, Matthias ; Winkler, Thomas H. ; Grunwald, Thomas ; Überla, Klaus Thomas ; Jäck, Hans-Martin
TRIANNI mice carry an entire set of human immunoglobulin V region gene segments and are a powerful tool to rapidly isolate human monoclonal antibodies. After immunizing these mice with DNA encoding the spike protein of SARS-CoV-2 and boosting with spike protein, we identified 29 hybridoma antibodies that reacted with the SARS-CoV-2 spike protein. Nine antibodies neutralize SARS-CoV-2 infection at IC50 values in the subnanomolar range. ELISA-binding studies and DNA sequence analyses revealed one cluster of three clonally related neutralizing antibodies that target the receptor-binding domain and compete with the cellular receptor hACE2. A second cluster of six clonally related neutralizing antibodies bind to the N-terminal domain of the spike protein without competing with the binding of hACE2 or cluster 1 antibodies. SARS-CoV-2 mutants selected for resistance to an antibody from one cluster are still neutralized by an antibody from the other cluster. Antibodies from both clusters markedly reduced viral spread in mice transgenic for human ACE2 and protected the animals from SARS-CoV-2-induced weight loss. The two clusters of potent noncompeting SARS-CoV-2 neutralizing antibodies provide potential candidates for therapy and prophylaxis of COVID-19. The study further supports transgenic animals with a human immunoglobulin gene repertoire as a powerful platform in pandemic preparedness initiatives.
Stürken, Christine ; Möbus, Volker ; Milde-Langosch, Karin ; Schmatloch, Sabine ; Fasching, Peter Andreas ; Rüschoff, Josef ; Stickeler, Elmar ; Henke, Rolf-Peter ; Denkert, Carsten Michael ; Hanker, Lars ; Schem, Christian ; Vladimirova, Valentina A. ; Karn, Thomas ; Nekljudova, Valentina ; Köhne, Claus-Henning ; Marmé, Frederik ; Schumacher, Udo ; Loibl, Sibylle ; Müller, Volkmar
Background: Breast cancer (BC) is the most frequent female cancer and preferentially metastasizes to bone. The transcription factor TGFB-induced factor homeobox 1 (TGIF) is involved in bone metabolism. However, it is not yet known whether TGIF is associated with BC bone metastasis or patient outcome and thus of potential interest. Methods: TGIF expression was analyzed by immunohistochemistry in 1197 formalin-fixed, paraffin-embedded tissue samples from BC patients treated in the GAIN (German Adjuvant Intergroup Node-Positive) study with two adjuvant dose-dense schedules of chemotherapy with or without bisphosphonate ibandronate. TGIF expression was categorized into negative/low and moderate/strong staining. Endpoints were disease-free survival (DFS), overall survival (OS) and time to primary bone metastasis as first site of relapse (TTPBM). Results: We found associations of higher TGIF protein expression with smaller tumor size (p= 0.015), well differentiated phenotype (p< 0.001) and estrogen receptor (ER)-positive BC (p< 0.001). Patients with higher TGIF expression levels showed a significantly longer disease-free (DFS: HR 0.75 [95%CI 0.59–0.95], log-rank p=0.019) and overall survival (OS: HR 0.69 [95%CI 0.50–0.94], log-rank p= 0.019), but no association with TTPBM (HR 0.77 [95%CI 0.51–1.16]; p= 0.213). Univariate analysis in molecular subgroups emphasized that elevated TGIF expression was prognostic for both DFS and OS in ER-positive BC patients (DFS: HR 0.68 [95%CI 0.51–0.91]; log-rank p= 0.009, interaction p= 0.130; OS: HR 0.60 [95%CI 0.41–0.88], log-rank p= 0.008, interaction p= 0.107) and in the HER2-negative subgroup (DFS:HR 0.67 [95%CI 0.50–0.88], log-rank p= 0.004, interaction p= 0.034; OS: HR 0.57 [95%CI 0.40–0.81], log-rank p= 0.002, interaction p= 0.015). Conclusions: Our results suggest that moderate to high TGIF expression is a common feature of breast cancer cells and that this is not associated with bone metastases as first site of relapse. However, a reduced expression is linked to tumor progression, especially in HER2-negative breast cancer.
Stürken, Christine ; Möbus, Volker ; Milde-Langosch, Karin ; Schmatloch, Sabine ; Fasching, Peter Andreas ; Rüschoff, Josef ; Stickeler, Elmar ; Henke, Rolf-Peter ; Denkert, Carsten Michael ; Hanker, Lars ; Schem, Christian ; Vladimirova, Valentina A. ; Karn, Thomas ; Nekljudova, Valentina ; Köhne, Claus-Henning ; Marmé, Frederik ; Schumacher, Udo ; Loibl, Sibylle ; Müller, Volkmar
Following publication of the original article, the authors noticed an incorrect affiliation for Christine Stürken and Udo Schumacher. The correct affiliations are as follows: Christine Stürken: Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Udo Schumacher: Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. The affiliations have been correctly published in this correction and the original article has been updated.
Wilde, Anne-Christin ; Lieb, Charlotte ; Leicht, Elise ; Greverath, Lena Maria ; Steinhagen, Lara Marleen ; Wald de Chamorro, Nina ; Petersen, Jörg ; Hofmann, Wolf-Peter ; Hinrichsen, Holger ; Heyne, Renate ; Berg, Thomas ; Naumann, Uwe ; Schwenzer, Jeannette ; Vermehren, Johannes ; Geier, Andreas ; Tacke, Frank ; Müller, Tobias
Background: Clinical practice guidelines for patients with primary biliary cholangitis (PBC) have been recently revised and implemented for well-established response criteria to standard first-line ursodeoxycholic acid (UDCA) therapy at 12 months after treatment initiation for the early identification of high-risk patients with inadequate treatment responses who may require treatment modification. However, there are only very limited data concerning the real-world clinical management of patients with PBC in Germany. Objective: The aim of this retrospective multicenter study was to evaluate response rates to standard first-line UDCA therapy and subsequent Second-line treatment regimens in a large cohort of well-characterized patients with PBC from 10 independent hepatological referral centers in Germany prior to the introduction of obeticholic acid as a licensed second-line treatment option. Methods: Diagnostic confirmation of PBC, standard first-line UDCA treatment regimens and response rates at 12 months according to Paris-I, Paris-II, and Barcelona criteria, the follow-up cut-off alkaline phosphatase (ALP) ≤ 1.67 × upper limit of normal (ULN) and the normalization of bilirubin (bilirubin ≤ 1 × ULN) were retrospectively examined between June 1986 and March 2017. The management and hitherto applied second-line treatment regimens in patients with an inadequate response to UDCA and subsequent response rates at 12 months were also evaluated. Results: Overall, 480 PBC patients were included in this study. The median UDCA dosage was 13.2 mg UDCA/kg bodyweight (BW)/d. Adequate UDCA treatment response rates according to Paris-I, Paris-II, and Barcelona criteria were observed in 91, 71.3, and 61.3% of patients, respectively. In 83.8% of patients, ALP ≤ 1.67 × ULN were achieved. A total of 116 patients (24.2%) showed an inadequate response to UDCA according to at least one criterion. The diverse second-line treatment regimens applied led to significantly higher response rates according to Paris-II (35 vs. 60%, p = 0.005), Barcelona (13 vs. 34%, p = 0.0005), ALP ≤ 1.67 × ULN and bilirubin ≤ 1 × ULN (52.1 vs. 75%, p = 0.002). The addition of bezafibrates appeared to induce the strongest beneficial effect in this cohort (Paris II: 24 vs. 74%, p = 0.004; Barcelona: 50 vs. 84%, p = 0.046; ALP < 1.67 × ULN and bilirubin ≤ 1 × ULN: 33 vs. 86%, p = 0.001). Conclusion: Our large retrospective multicenter study confirms high response rates following UDCA first-line standard treatment in patients with PBC and highlights the need for close monitoring and early treatment modification in high-risk patients with an insufficient response to UDCA since early treatment modification significantly increases subsequent response rates of these patients.
Willems, Laurent Maximilian ; Rosenow, Felix ; Schubert-Bast, Susanne ; Kurlemann, Gerhard ; Zöllner, Johann Philipp ; Bast, Thomas ; Bertsche, Astrid ; Bettendorf, Ulrich ; Ebrahimi-Fakhari, Daniel ; Grau, Janina ; Hahn, Andreas ; Hartmann, Hans ; Hertzberg, Christoph ; Hornemann, Frauke ; Immisch, Ilka ; Jacobs-LeVan, Julia ; Klein, Karl Martin ; Klotz, Kerstin Alexandra ; Kluger, Gerhard ; Knake, Susanne ; Knuf, Markus ; Marquard, Klaus ; Mayer, Thomas ; Meyer, Sascha ; Muhle, Hiltrud ; Müller-Schlüter, Karen ; Podewils, Felix von ; Ruf, Susanne ; Sauter, Matthias ; Schäfer, Hannah ; Schlump, Jan-Ulrich ; Syrbe, Steffen ; Thiels, Charlotte ; Trollmann, Regina ; Wiemer-Kruel, Adelheid ; Wilken, Bernd ; Zukunft, Bianca ; Strzelczyk, Adam
Background: The approval of everolimus (EVE) for the treatment of angiomyolipoma (2013), subependymal giant cell astrocytoma (2013) and drug-refractory epilepsy (2017) in patients with tuberous sclerosis complex (TSC) represents the first disease-modifying treatment option available for this rare and complex genetic disorder. Objective: The objective of this study was to analyse the use, efficacy, tolerability and treatment retention of EVE in patients with TSC in Germany from the patient’s perspective. Methods: A structured cross-age survey was conducted at 26 specialised TSC centres in Germany and by the German TSC patient advocacy group between February and July 2019, enrolling children, adolescents and adult patients with TSC. Results: Of 365 participants, 36.7% (n = 134) reported the current or past intake of EVE, including 31.5% (n = 115) who were taking EVE at study entry. The mean EVE dosage was 6.1 ± 2.9 mg/m2 (median: 5.6 mg/m2, range 2.0–15.1 mg/m2) in children and adolescents and 4 ± 2.1 mg/m2 (median: 3.7 mg/m2, range 0.8–10.1 mg/m2) in adult patients. An early diagnosis of TSC, the presence of angiomyolipoma, drug-refractory epilepsy, neuropsychiatric manifestations, subependymal giant cell astrocytoma, cardiac rhabdomyoma and overall multi-organ involvement were associated with the use of EVE as a disease-modifying treatment. The reported efficacy was 64.0% for angiomyolipoma (75% in adult patients), 66.2% for drug-refractory epilepsy, and 54.4% for subependymal giant cell astrocytoma. The overall retention rate for EVE was 85.8%. The retention rates after 12 months of EVE therapy were higher among adults (93.7%) than among children and adolescents (88.7%; 90.5% vs 77.4% after 24 months; 87.3% vs 77.4% after 36 months). Tolerability was acceptable, with 70.9% of patients overall reporting adverse events, including stomatitis (47.0%), acne-like rash (7.7%), increased susceptibility to common infections and lymphoedema (each 6.0%), which were the most frequently reported symptoms. With a total score of 41.7 compared with 36.8 among patients not taking EVE, patients currently being treated with EVE showed an increased Liverpool Adverse Event Profile. Noticeable deviations in the sub-items ‘tiredness’, ‘skin problems’ and ‘mouth/gum problems’, which are likely related to EVE-typical adverse effects, were more frequently reported among patients taking EVE. Conclusions: From the patients’ perspective, EVE is an effective and relatively well-tolerated disease-modifying treatment option for children, adolescents and adults with TSC, associated with a high long-term retention rate that can be individually considered for each patient. Everolimus therapy should ideally be supervised by a centre experienced in the use of mechanistic target of rapamycin inhibitors, and adverse effects should be monitored on a regular basis.
Mikolas, Pavol ; Bröckel, Kyra ; Vogelbacher, Christoph ; Müller, Dirk K. ; Marxen, Michael ; Berndt, Christina ; Sauer, Cathrin ; Jung, Stine ; Fröhner, Juliane Hilde ; Fallgatter, Andreas J. ; Ethofer, Thomas ; Rau, Anne Katrin ; Kircher, Tilo ; Falkenberg, Dania Irina ; Lambert, Martin ; Kraft, Vivien ; Leopold, Karolina ; Bechdolf, Andreas ; Reif, Andreas ; Matura, Silke ; Stamm, Thomas ; Bermpohl, Felix ; Fiebig, Jana ; Juckel, Georg ; Flasbeck, Vera ; Correll, Christoph U. ; Ritter, Philipp Stefan ; Bauer, Michael ; Jansen, Andreas ; Pfennig, Andrea
In psychiatry, there has been a growing focus on identifying at-risk populations. For schizophrenia, these efforts have led to the development of early recognition and intervention measures. Despite a similar disease burden, the populations at risk of bipolar disorder have not been sufficiently characterized. Within the BipoLife consortium, we used magnetic resonance imaging (MRI) data from a multicenter study to assess structural gray matter alterations in N = 263 help-seeking individuals from seven study sites. We defined the risk using the EPIbipolar assessment tool as no-risk, low-risk, and high-risk and used a region-of-interest approach (ROI) based on the results of two large-scale multicenter studies of bipolar disorder by the ENIGMA working group. We detected significant differences in the thickness of the left pars opercularis (Cohen’s d = 0.47, p = 0.024) between groups. The cortex was significantly thinner in high-risk individuals compared to those in the no-risk group (p = 0.011). We detected no differences in the hippocampal volume. Exploratory analyses revealed no significant differences in other cortical or subcortical regions. The thinner cortex in help-seeking individuals at risk of bipolar disorder is in line with previous findings in patients with the established disorder and corresponds to the region of the highest effect size in the ENIGMA study of cortical alterations. Structural alterations in prefrontal cortex might be a trait marker of bipolar risk. This is the largest structural MRI study of help-seeking individuals at increased risk of bipolar disorder.
Müller, Michael ; Pawlowicz, Katarzyna ; Böhm, Myriam ; Hemkeppler, Eva ; Lwowski, Christoph Martin ; Hinzelmann, Lisa ; Shajari, Mehdi ; Kohnen, Thomas
Purpose: To compare the effective lens position (ELP), anterior chamber depth (ACD) changes, and visual outcomes in patients with and without pseudoexfoliation syndrome (PEX) after cataract surgery.
Design: Prospective, randomized, fellow-eye controlled clinical case series.
Methods: This prospective comparative case series enrolled 56 eyes of 56 consecutive patients with (n = 28) or without PEX (n = 28) and clinically significant cataract who underwent standard phacoemulsification and were implanted with single-piece acrylic posterior chamber intraocular lenses (IOLs). The primary outcome parameters were the ACD referring to the distance between the corneal anterior surface and the lens anterior surface, which is an indicator of the postoperative axial position of the IOL (the so-called ELP) and distance corrected visual acuity (DCVA).
Results: Before surgery, the ACD was 2.54 ± 0.42 mm in the PEX group and 2.53 ± 0.38 mm in the control group (p = 0.941). Postoperatively, the ACD was 4.29 ± 0.71 mm in the PEX group and 4.33 ± 0.72 mm in the normal group, respectively (p = 0.533). There was no significant difference in ACD changes between groups (PEX group: 1.75 ± 0.74 mm, control group: 1.81 ± 0.61 mm, p = 0.806) and DCVA pre- (p = 0.469) and postoperatively (PEX group: 0.11 ± 0.13 logMAR, control group: 0.09 ± 0.17 logMAR, p = 0.245) between groups.
Conclusion: Preoperative and postoperative ACD, as an indicator of ELP, between PEX eyes and healthy eyes after cataract surgery showed no significant difference. Phacoemulsification induced similar changes in eyes with PEX compared to healthy eyes.
Maier, Hannes ; Lenarz, Thomas ; Agha-Mir-Salim, Parwis ; Agterberg, Martijn J. H. ; Anagiotos, Andreas ; Arndt, Susan ; Ball, Geoffrey R. ; Bance, Manohar ; Barbara, Maurizio ; Baumann, Uwe ; Baumgartner, Wolfgang ; Bernardeschi, Daniele ; Beutner, Dirk ; Bosman, Arjan ; Briggs, Robert ; Busch, Susan ; Caversaccio, Marco ; Dahm, Markus ; Dalhoff, Ernst ; Devèze, Arnaud ; Ebrahimi-Madiseh, Azadeh ; Fraysse, Bernard ; Frenzel, Henning ; Gavilán, Javier ; Ghoncheh, Mohammad ; Håkansson, Bo E. V. ; Hodgetts, William ; Hol, Myrthe Karianne Sophie ; Holland, Julian ; Holmberg, Marcus ; Huber, Alexander ; Jenkins, Herman ; Katiri, Roulla ; Kheirkhah, Kiana ; Koitschev, Assen ; Kompis, Martin ; Lanting, Cris ; Lassaletta, Luis ; Lerut, Bob ; Leuwer, Rudolf ; Linder, Thomas ; Löwenheim, Hubert Martin ; Lustig, Lawrence ; Mandavia, Rishi ; Manrique, Manuel ; Jorge Humberto, Martins ; Mertens, Griet ; Mlynski, Robert Arndt ; Mojallal, Hamidreza ; Monini, Simonetta ; Monksfield, Peter ; Müller, Alexander ; Mylanus, Emmanuel ; Nakajima, Hideko Heidi ; Neudert, Marcus ; Offeciers, Erwin ; Pfiffner, Flurin ; Pietsch, Markus ; Plontke, Stefan K.-R. ; Prenzler, Nils Kristian ; Profant, Milan ; Rahne, Torsten ; Rajan, Gunesh ; Ratuszniak, Anna ; Raufer, Stefan ; Ray, Jaydip ; Reinfeldt, Sabine ; Röösli, Christof ; Rosenbom, Tove ; Salcher, Rolf Benedikt ; Schönermark, Matthias ; Schwab, Burkard ; Skarżyński, Henryk ; Skarżyński, Piotr H. ; Snapp, Hillary ; Sprinzl, Georg ; Spearman, Michael ; Stenfelt, Stefan ; Stieger, Christof ; Tringali, Stephane ; Truy, Eric ; Tysome, James ; Van de Heyning, Paul ; Verhaert, Nicolas ; Wesarg, Thomas ; Westerkull, Patrik ; Wollenberg, Barbara ; Zahnert, Thomas ; Zarowski, Andrzej ; Snik, Ad
Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-conduction devices and middle-ear implants have advantages but also limitations concerning complexity/invasiveness of the surgery, medical complications, and effectiveness. To counsel the patient, the clinician should have a good overview of the options with regard to safety and reliability as well as unequivocal technical performance data. The present consensus document is the outcome of an extensive iterative process including ENT specialists, audiologists, health-policy scientists, and representatives/technicians of the main companies in this field. This document should provide a first framework for procedures and technical characterization to enhance effective communication between these stakeholders, improving health care.
Activated SUMOylation restricts MHC class I antigen presentation to confer immune evasion in cancer
(2022)
Demel, Uta M. ; Böger, Marlitt ; Yousefian, Schayan ; Grunert, Corinna ; Zhang, Le ; Hotz, Paul W. ; Gottschlich, Adrian ; Köse, Hazal ; Isaakidis, Konstandina ; Vonficht, Dominik ; Grünschläger, Florian ; Rohleder, Elena ; Wagner, Kristina ; Dönig, Judith ; Igl, Veronika ; Brzezicha, Bernadette ; Baumgartner, Francis ; Habringer, Stefan ; Löber, Jens ; Chapuy, Björn ; Weidinger, Carl Thomas Maximilian ; Kobold, Sebastian ; Haas, Simon ; Busse, Antonia B. ; Müller, Stefan ; Wirth, Matthias ; Schick, Markus ; Keller, Ulrich
Activated SUMOylation is a hallmark of cancer. Starting from a targeted screening for SUMO-regulated immune evasion mechanisms, we identified an evolutionarily conserved function of activated SUMOylation, which attenuated the immunogenicity of tumor cells. Activated SUMOylation allowed cancer cells to evade CD8+ T cell–mediated immunosurveillance by suppressing the MHC class I (MHC-I) antigen-processing and presentation machinery (APM). Loss of the MHC-I APM is a frequent cause of resistance to cancer immunotherapies, and the pharmacological inhibition of SUMOylation (SUMOi) resulted in reduced activity of the transcriptional repressor scaffold attachment factor B (SAFB) and induction of the MHC-I APM. Consequently, SUMOi enhanced the presentation of antigens and the susceptibility of tumor cells to CD8+ T cell–mediated killing. Importantly, SUMOi also triggered the activation of CD8+ T cells and thereby drove a feed-forward loop amplifying the specific antitumor immune response. In summary, we showed that activated SUMOylation allowed tumor cells to evade antitumor immunosurveillance, and we have expanded the understanding of SUMOi as a rational therapeutic strategy for enhancing the efficacy of cancer immunotherapies.
Dávidová, Petra ; Müller, Michael ; Wenner, Yaroslava ; König, Clara ; Kenikstul, Ninel ; Kohnen, Thomas
Purpose: Filler injections for aesthetic purposes are very popular, but can have far-reaching and irreversible consequences. This report describes the course of a patient with devastating complications after glabellar hyaluronic acid injection, their pathomechanism, management and outcome.
Observations: A healthy, 43-year-old woman underwent her first hyaluronic acid injection in the glabella and went blind on her left eye immediately thereafter. Massaging of the injection area and observation were performed, before she presented with swelling of the left forehead and upper lid, ptosis, complete ophthalmoplegia and blindness in our hospital. Immediate massaging of the globe and systemic therapy including acetylsalicylic acid, tinzaparin sodium and cortisone was initiated and hyaluronidase injections in the injection area were performed. In the further course, the patient developed necrotic and hemorrhagic skin and mucosal lesions, lagophthalmos, anterior and posterior segment ischemia and globe hypotonia with consecutive globe deformation. In the follow-up of 2.5 months, lid swelling, lagophthalmos and ptosis resolved and keratopathy improved but blindness, skin lesions and strabismus with reduced eye motility were still present and madarosis and early enophthalmos were detected.
Conclusions and Importance: The outcome of ophthalmic artery occlusion after hyaluronic acid filler injection is poor. Sufficient knowledge about facial anatomy, the implementation of filler injections and the management of complications is essential for the practitioner. The patient should be clarified about potential and even rare risks of these procedures.
Höh, Robert Benedikt ; Wenzel, Mike ; Müller, Matthias ; Wittler, Clarissa ; Schlenke, Eva ; Hohenhorst, Jan L. ; Köllermann, Jens ; Steuber, Thomas ; Graefen, Markus ; Tilki, Derya ; Bernatz, Simon ; Karakiewicz, Pierre I. ; Preißer, Felix ; Becker, Andreas ; Kluth, Luis ; Mandel, Philipp ; Chun, Felix
Background: To test the impact of urethral sphincter length (USL) and anatomic variants of prostatic apex (Lee-type classification) in preoperative multiparametric magnet resonance imaging (mpMRI) on mid-term continence in prostate cancer patients treated with radical prostatectomy (RP). Methods: We relied on an institutional tertiary-care database to identify patients who underwent RP between 03/2018 and 12/2019 with preoperative mpMRI and data available on mid-term (>6 months post-surgery) urinary continence, defined as usage 0/1 (-safety) pad/24 h. Univariable and multivariable logistic regression models were fitted to test for predictor status of USL and prostatic apex variants, defined in mpMRI measurements. Results: Of 68 eligible patients, rate of mid-term urinary continence was 81% (n = 55). Median coronal (15.1 vs. 12.5 mm) and sagittal (15.4 vs. 11.1 mm) USL were longer in patients reporting urinary continence in mid-term follow-up (both p < 0.01). No difference was recorded for prostatic apex variants distribution (Lee-type) between continent vs. incontinent patients (p = 0.4). In separate multivariable logistic regression models, coronal (odds ratio (OR): 1.35) and sagittal (OR: 1.67) USL, but not Lee-type, were independent predictors for mid-term continence. Conclusion: USL, but not apex anatomy, in preoperative mpMRI was associated with higher rates of urinary continence at mid-term follow-up.
Beck, Michael ; Hartwich, Julius ; Eckstein, Markus ; Schmidt, Daniela ; Gostian, Antoniu-Oreste ; Müller, Sarina ; Rutzner, Sandra ; Gaipl, Udo Sebastian ; Müller-von der Grün, Jens ; Illmer, Thomas ; Hautmann, Matthias Günther ; Klautke, Gunther ; Döscher, Johannes ; Brunner, Thomas B. ; Tamaskovics, Bálint ; Hartmann, Arndt ; Iro, Heinrich ; Kuwert, Torsten ; Fietkau, Rainer ; Hecht, Markus ; Semrau, Sabine
Aim: In the CheckRad-CD8 trial patients with locally advanced head and neck squamous cell cancer are treated with a single cycle of induction chemo-immunotherapy (ICIT). Patients with pathological complete response (pCR) in the re-biopsy enter radioimmunotherapy. Our goal was to study the value of F-18-FDG PET/CT in the prediction of pCR after induction therapy.
Methods: Patients treated within the CheckRad-CD8 trial that additionally received FDG- PET/CT imaging at the following two time points were included: 3–14 days before (pre-ICIT) and 21–28 days after (post-ICIT) receiving ICIT. Tracer uptake in primary tumors (PT) and suspicious cervical lymph nodes (LN +) was measured using different quantitative parameters on EANM Research Ltd (EARL) accredited PET reconstructions. In addition, mean FDG uptake levels in lymphatic and hematopoietic organs were examined. Percent decrease (Δ) in FDG uptake was calculated for all parameters. Biopsy of the PT post-ICIT acquired after FDG-PET/CT served as reference. The cohort was divided in patients with pCR and residual tumor (ReTu).
Results: Thirty-one patients were included. In ROC analysis, ΔSUVmax PT performed best (AUC = 0.89) in predicting pCR (n = 17), with a decline of at least 60% (sensitivity, 0.77; specificity, 0.93). Residual SUVmax PT post-ICIT performed best in predicting ReTu (n = 14), at a cutpoint of 6.0 (AUC = 0.91; sensitivity, 0.86; specificity, 0.88). Combining two quantitative parameters (ΔSUVmax ≥ 50% and SUVmax PT post-ICIT ≤ 6.0) conferred a sensitivity of 0.81 and a specificity of 0.93 for determining pCR. Background activity in lymphatic organs or uptake in suspected cervical lymph node metastases lacked significant predictive value.
Conclusion: FDG-PET/CT can identify patients with pCR after ICIT via residual FDG uptake levels in primary tumors and the related changes compared to baseline. FDG-uptake in LN + had no predictive value.
Trial registry: ClinicalTrials.gov identifier: NCT03426657.