427 results on '"Alexander L. Gerbes"'
Search Results
2. p70 Ribosomal Protein S6 Kinase Is a Checkpoint of Human Hepatic Stellate Cell Activation and Liver Fibrosis in MiceSummary
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Florian P. Reiter, Liangtao Ye, Andrea Ofner, Tobias S. Schiergens, Andreas Ziesch, Lydia Brandl, Najib Ben Khaled, Simon Hohenester, Ralf Wimmer, Renate Artmann, Yulong He, Serene M.L. Lee, Doris Mayr, Changhua Zhang, Alexander L. Gerbes, Julia Mayerle, Gerald Denk, and Enrico N. De Toni
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Fibrosis ,Cirrhosis ,Chronic Liver Disease ,Transforming Growth Factor-β ,Platelet-Derived Growth Factor BB ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Progression of chronic liver disease (CLD) to liver cirrhosis and liver cancer is a major global cause of morbidity and mortality. Treatment options capable of inhibiting progression of liver fibrosis when etiological treatment of CLD is not available or fails have yet to be established. We investigated the role of serine/threonine kinase p70 ribosomal protein S6 kinase (p70S6K) as checkpoint of fibrogenesis in hepatic stellate cells (HSCs) and as target for the treatment of liver fibrosis. Approach & Results: Immunohistochemistry was used to assess p70S6K expression in liver resection specimen. Primary human or murine HSCs from wild-type or p70S6K–/– mice as well as LX-2 cells were used for in vitro experiments. Specific small interfering RNA or CEP-1347 were used to silence or inhibit p70S6K and assess its functional relevance in viability, contraction and migration assays, fluorescence-activated cell sorting, and Western blot. These results were validated in vivo by a chemical model of fibrogenesis using wild-type and p70S6K–/– mice. Expression of p70S6K was significantly increased in human cirrhotic vs noncirrhotic liver-tissue and progressively increased in vitro through activation of primary human HSCs. Conversely, p70S6K induced fibrogenic activation of HSCs in different models, including the small interfering RNA–based silencing of p70S6K in HSC lines, experiments with p70S6K–/– cells, and the pharmacological inhibition of p70S6K by CEP-1347. These findings were validated in vivo as p70S6K–/– mice developed significantly less fibrosis upon exposure to CCl4. Conclusions: We establish p70S6K as a checkpoint of fibrogenesis in vitro and in vivo and CEP-1347 as potential treatment option that can safely be used for long-term treatment.
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- 2022
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3. Drug‐Induced Liver Injury by Checkpoint Inhibitors: Benefit of a Causality Assessment Tool
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Sabine Weber, Andreas Benesic, Masatoshi Ishigami, and Alexander L. Gerbes
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2020
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4. Challenges and Future of Drug-Induced Liver Injury Research—Laboratory Tests
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Sabine Weber and Alexander L. Gerbes
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drug-induced liver injury ,hepatotoxicity ,biomarkers ,drug development ,adverse drug events ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Drug-induced liver injury (DILI) is a rare but potentially severe adverse drug event, which is also a major cause of study cessation and market withdrawal during drug development. Since no acknowledged diagnostic tests are available, DILI diagnosis poses a major challenge both in clinical practice as well as in pharmacovigilance. Differentiation from other liver diseases and the identification of the causative agent in the case of polymedication are the main issues that clinicians and drug developers face in this regard. Thus, efforts have been made to establish diagnostic testing methods and biomarkers in order to safely diagnose DILI and ensure a distinguishment from alternative liver pathologies. This review provides an overview of the diagnostic methods used in differential diagnosis, especially with regards to autoimmune hepatitis (AIH) and drug-induced autoimmune hepatitis (DI-AIH), in vitro causality methods using individual blood samples, biomarkers for diagnosis and severity prediction, as well as experimental predictive models utilized in pre-clinical settings during drug development regimes.
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- 2022
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5. Pretreatment with zinc protects Kupffer cells following administration of microbial products
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Jiang Zhang, Andreas Wieser, Hao Lin, Yuhui Fan, Hanwei Li, Tobias S. Schiergens, Julia Mayerle, Alexander L. Gerbes, and Christian J. Steib
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Primary non-parenchymal cell ,Spontaneous bacterial peritonitis ,Zinc ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Background: Systemic inflammation and severe fibrosis can reduce serum zinc levels, while zinc supplementation is reported to improve the prognosis of patients with chronic liver disease (CLD). Objectives: We aimed to investigate the clinical application of serum zinc in patients with CLD and the anti-infective mechanism of zinc supplementation. Methods: Based on the serum zinc level, 149 CLD patients were divided into 3 groups and their clinical parameters were compared. In in-vitro experiments, microbial isolates derived from patients were used to stimulate human liver non-parenchymal cells, and the zinc sulfate solution was added in certain experiments. The effect of zinc was compared by LDH and thromboxane A2 levels in the cell supernatant. Result: Compared with other groups, patients with low serum zinc levels had significantly higher C-reactive protein (CRP), total bilirubin, INR, creatinine, and MELD scores, while albumin and GOT levels were reduced. Only CRP and albumin were significantly correlated with serum zinc in both low and normal-zinc groups. Bacterial isolates significantly increased LDH levels in Kupffer cells (KCs) and stellate cells but had no effect on sinusoidal endothelial cells, whereas zinc pretreatment protected KCs but not stellate cells. Thromboxane A2 secreted by KCs can also be induced by bacterial stimulation, accompanied by increased gene expression of Myd88, MAPK and NF-kB, while zinc pretreatment can attenuate that. Conclusion: Serum zinc levels can be used to estimate infection and liver fibrosis in CLD patients. As a new antibacterial weapon, zinc supplementation acts on KCs through Myd88-MAPK related pathways.
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- 2020
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6. Data on chow, liver tissue and mitochondrial fatty acid compositions as well as mitochondrial proteome changes after feeding mice a western diet for 6â24 weeks
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Claudia Einer, Simon Hohenester, Ralf Wimmer, Lena Wottke, Renate Artmann, Sabine Schulz, Christian Gosmann, Alisha Simmons, Christin Leitzinger, Carola Eberhagen, Sabine Borchard, Sabine Schmitt, Stefanie M. Hauck, Christine von Toerne, Martin Jastroch, Ellen Walheim, Christian Rust, Alexander L. Gerbes, Bastian Popper, Doris Mayr, Max Schnurr, Angelika M. Vollmar, Gerald Denk, and Hans Zischka
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Science (General) ,Q1-390 - Abstract
The data presented in this article describe the fatty acid composition of chow, liver tissue and isolated liver mitochondria from mice fed for 6â24 weeks with a high caloric western diet (WD) in comparison to control diet (normal diet, ND). The fatty acid composition was measured via gas chromatography flame ionization detection (GC-FID). Moreover, WD-induced mitochondrial protein changes are presented in this work and were analyzed by mass spectrometry (LCâMS/MS). For further interpretation and discussion of the presented data please refer to the research article entitled âMitochondrial adaptation in steatotic miceâ (Einer et al., 2017) [1].
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- 2017
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7. Albumin Might Attenuate Bacteria-Induced Damage on Kupffer Cells for Patients with Chronic Liver Disease
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Hao Lin, Yuhui Fan, Andreas Wieser, Jiang Zhang, Ivonne Regel, Hanno Nieß, Julia Mayerle, Alexander L. Gerbes, and Christian J. Steib
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hepatic non-parenchymal cells ,albumin ,chronic liver diseases ,bacteria ,Cytology ,QH573-671 - Abstract
Chronic liver diseases (CLDs) are complex diseases that cause long-term inflammation and infection, which in turn accelerate their development. The usage of albumin in patients with CLDs has been debated for years. Human serum albumin (HSA) plays a key role in immunomodulation during the process of CLDs. The correlation between albumin and C-reactive protein (CRP) in CLD patients was analyzed by linear regression with the Pearson statistic. The damage of THP-1 and primary cells was evaluated by measuring the lactate dehydrogenase (LDH) in the supernatant. Immunofluorescence staining was performed to determine underlying pathways in Kupffer cells (KCs). Albumin negatively correlated with infection in patients with CLDs. In vitro experiments with THP-1 cells and KCs showed that albumin reduced LDH release after stimulation with bacterial products, while no differences in hepatic stellate cells (HSCs) and sinusoidal endothelial cells (SECs) were detected. Moreover, immunofluorescence staining revealed an increase of p-ERK and p-NF-kB p65 density after albumin treatment of KCs stimulated by bacterial products. In conclusion, albumin could assist CLD patients in alleviating inflammation caused by bacterial products and might be beneficial to patients with CLDs by securing KCs from bacteria-induced damage, providing a compelling rationale for albumin therapy in patients with CLDs.
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- 2021
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8. Ischemic Postconditioning (IPostC) Protects Fibrotic and Cirrhotic Rat Livers after Warm Ischemia
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Julia Schewe, Marie-Christine Makeschin, Ingrid Liss, Doris Mayr, Jiang Zhang, Andrej Khandoga, Simon Rothenfußer, Max Schnurr, Alexander L. Gerbes, and Christian J. Steib
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background. Decreased organ function following liver resection is a major clinical issue. The practical method of ischemic postconditioning (IPostC) has been studied in heart diseases, but no data exist regarding fibrotic livers. Aims. We aimed to determine whether IPostC could protect healthy, fibrotic, and cirrhotic livers from ischemia reperfusion injury (IRI). Methods. Fibrosis was induced in male SD rats using bile duct ligation (BDL, 4 weeks), and cirrhosis was induced using thioacetamide (TAA, 18 weeks). Fibrosis and cirrhosis were histologically confirmed using HE and EvG staining. For healthy, fibrotic, and cirrhotic livers, isolated liver perfusion with 90 min of warm ischemia was performed in three groups (each with n=8): control, IPostC 8x20 sec, and IPostC 4x60 sec. additionally, healthy livers were investigated during a follow-up study. Lactate dehydrogenase (LDH) and thromboxane B2 (TXB2) in the perfusate, as well as bile flow (healthy/TAA) and portal perfusion pressure, were measured. Results. LDH and TXB2 were reduced, and bile flow was increased by IPostC, mainly in total and in the late phase of reperfusion. The follow-up study showed that the perfusate derived from a postconditioned group had much less damaging potential than perfusate derived from the nonpostconditioned group. Conclusion. IPostC following warm ischemia protects healthy, fibrotic, and cirrhotic livers against IRI. Reduced efflux of TXB2 is one possible mechanism for this effect of IPostC and increases sinusoidal microcirculation. These findings may help to improve organ function and recovery of patients after liver resection.
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- 2019
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9. IL-18 But Not IL-1 Signaling Is Pivotal for the Initiation of Liver Injury in Murine Non-Alcoholic Fatty Liver Disease
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Simon Hohenester, Veronika Kanitz, Tobias Schiergens, Claudia Einer, Jutta Nagel, Ralf Wimmer, Florian P. Reiter, Alexander L. Gerbes, Enrico N. De Toni, Christian Bauer, Lesca Holdt, Doris Mayr, Christian Rust, Max Schnurr, Hans Zischka, Andreas Geier, and Gerald Denk
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NAFLD ,Western diet ,NLRP3 ,inflammasome ,interleukin 1 ,interleukin 18 ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Non-alcoholic fatty liver disease (NAFLD) is rising in prevalence, and a better pathophysiologic understanding of the transition to its inflammatory phenotype (NASH) is key to the development of effective therapies. To evaluate the contribution of the NLRP3 inflammasome and its downstream effectors IL-1 and IL-18 in this process, we applied the true-to-life “American lifestyle-induced obesity syndrome” (ALiOS) diet mouse model. Development of obesity, fatty liver and liver damage was investigated in mice fed for 24 weeks according to the ALiOS protocol. Lipidomic changes in mouse livers were compared to human NAFLD samples. Receptor knockout mice for IL-1 and IL-18 were used to dissect the impact of downstream signals of inflammasome activity on the development of NAFLD. The ALiOS diet induced obesity and liver steatosis. The lipidomic changes closely mimicked changes in human NAFLD. A pro-inflammatory gene expression pattern in liver tissue and increased serum liver transaminases indicated early liver damage in the absence of histological evidence of NASH. Mechanistically, Il-18r−/−- but not Il-1r−/− mice were protected from early liver damage, possibly due to silencing of the pro-inflammatory gene expression pattern. Our study identified NLRP3 activation and IL-18R-dependent signaling as potential modulators of early liver damage in NAFLD, preceding development of histologic NASH.
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- 2020
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10. Proteomics Analysis of Monocyte-Derived Hepatocyte-Like Cells Identifies Integrin Beta 3 as a Specific Biomarker for Drug-Induced Liver Injury by Diclofenac
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Diana Dragoi, Andreas Benesic, Garwin Pichler, Nils A. Kulak, Harald S. Bartsch, and Alexander L. Gerbes
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DILI ,biomarker ,proteomics ,drug-development ,monocyte-derived hepatocyte-like cells ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Idiosyncratic drug-induced liver injury (iDILI) is a major cause of acute liver failure resulting in liver transplantation or death. Prediction and diagnosis of iDILI remain a great challenge, as current models provide unsatisfying results in terms of sensitivity, specificity, and prognostic value. The absence of appropriate tools for iDILI detection also impairs the development of reliable biomarkers. Here, we report on a new method for identification of drug-specific biomarkers. We combined the advantages of monocyte-derived hepatocyte-like (MH) cells, able to mimic individual characteristics, with those of a novel mass spectrometry-based proteomics technology to assess potential biomarkers for Diclofenac-induced DILI. We found over 2,700 proteins differentially regulated in MH cells derived from individual patients. Herefrom, we identified integrin beta 3 (ITGB3) to be specifically upregulated in Diclofenac-treated MH cells from Diclofenac-DILI patients compared to control groups. Finally, we validated ITGB3 by flow cytometry analysis of whole blood and histological staining of liver biopsies derived from patients diagnosed with Diclofenac-DILI. In summary, our results show that biomarker candidates can be identified by proteomics analysis of MH cells. Application of this method to a broader range of drugs in the future will exploit its full potential for the development of drug-specific biomarkers. Data are available via ProteomeXchange with identifier PXD008918.
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- 2018
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11. High age and low sodium urine concentration are associated with poor survival in patients with hepatorenal syndrome
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Matthias Hinz, Alexander Wree, Christoph Jochum, Lars P. Bechmann, Fuat Saner, Alexander L. Gerbes, Guido Gerken, and A.l.i. Canbay, M.D.
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Terlipressin ,Urinary sodium ,Predictors of response and survival ,Overall mortality ,Specialties of internal medicine ,RC581-951 - Abstract
Background. Combination therapy with terlipressin and albumin substitution is considered a widely accepted treatment regimen for patients with hepatorenal syndrome (HRS). However, only half of the patients respond to treatment and to date albumin substitution and terlipressin therapy are among the most expensive medical treatments available for patients with liver diseases. Thus, we aimed to identify clinical and etiological parameters to predict treatment response and overall mortality in patients with HRS.Material and methods. We retrospectively evaluated 21 patients, 13 male/8 female, aged 43-72 years with HRS. Four patients were transplanted after following combination treatment. Terlipressin was administered by continuous intravenous perfusion (2–6 mg/d) and albumin drips (50 mg) were given daily. Treatment response was defined by a decrease in serum creatinine level to < 1.5 mg/dL or by a > 50% reduction of the baseline concentration.Results. 57% of the patients responded to treatment, which was associated with improved survival at day 60, compared to non-responders. However, the overall mortality was not different between the two groups. Median age of 63 years was a significant negative predictor for therapy response. High baseline urinary sodium levels were of prognostic value for survival. The Model of End stage Liver Disease score (MELD score) did not correlate with therapy response.Conclusion. In conclusion high age is a predictor of non-response. Low urinary sodium before treatment is associated with poor survival. Terli-pressin and albumin co-treatment is associated with increased two-months survival rate. This seemingly moderate extension in survival rate can, however, be decisive for obtaining liver transplantation.
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- 2013
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12. Relapse and Need for Extended Immunosuppression: Novel Features of Drug-Induced Autoimmune Hepatitis
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Sabine Weber and Alexander L. Gerbes
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Gastroenterology - Abstract
Background: Drug-induced autoimmune hepatitis (DI-AIH) has been proposed as a distinct phenotype of drug-induced liver injury (DILI), and frequently has been associated with specific drugs, such as minocycline and nitrofurantoin. However, no clear definition of DI-AIH has been established thus far. Objectives: We aimed to identify features distinguishing DI-AIH from DILI and idiopathic autoimmune hepatitis (AIH) in an attempt to further define a DI-AIH phenotype. Method: A cohort of 38 previously reported DILI and AIH patients who were prospectively recruited at our tertiary centre and who received corticosteroid was analysed regarding the phenotypical presentation and outcome of DI-AIH, DILI, and AIH. Results: AIH (n = 19), DILI (n = 8), and DI-AIH (n = 11) patients presented with similar clinical features at onset, with the only difference being a higher Roussel Uclaf Causality Assessment Method (RUCAM) score in the DILI and DI-AIH patients. Post-treatment AIH scores were lower and a more rapid decrease of alanine aminotransferase in the first week of corticosteroid treatment was observed in both DILI groups when compared to AIH patients, while no significant differences were observed between DI-AIH and DILI patients. Relapse occurred in DI-AIH but not in DILI patients (36% vs. 0%) with a more frequent need for long-term immunosuppression (27% vs. 13%). Conclusions: Our data show that relapse after cessation of corticosteroids and need for further immunosuppressive treatment does occur in a substantial proportion of DI-AIH patients. However, no other phenotypical differences between DILI due to agents commonly associated with DI-AIH and DILI due to other drugs were identified.
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- 2023
13. p70 Ribosomal Protein S6 Kinase Is a Checkpoint of Human Hepatic Stellate Cell Activation and Liver Fibrosis in Mice
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Najib Ben Khaled, Florian P. Reiter, Andreas Ziesch, Alexander L. Gerbes, Julia Mayerle, Gerald Denk, Liangtao Ye, Ralf Wimmer, Enrico N. De Toni, Renate Artmann, Tobias S. Schiergens, Doris Mayr, Simon Hohenester, Andrea Ofner, Serene M. L. Lee, Changhua Zhang, Yulong He, and Lydia Brandl
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Liver Cirrhosis ,Wt, wild-type ,Cirrhosis ,WST, water-soluble tetrazolium ,P70-S6 Kinase 1 ,RC799-869 ,Chronic liver disease ,PDGF, platelet-derived growth factor ,Chronic Liver Disease ,α-SMA, α-smooth muscle actin ,Mice ,Fibrosis ,TGF-β, transforming growth factor-β ,medicine ,Hepatic Stellate Cells ,Animals ,Humans ,p70S6K, p70 ribosomal protein S6 kinase ,Transforming Growth Factor-β ,Original Research ,Cell Proliferation ,Hepatology ,business.industry ,Platelet-Derived Growth Factor BB ,phHSC, primary human hepatic stellate cell ,Gastroenterology ,GFAP, glial fibrillary acidic protein ,Ribosomal Protein S6 Kinases, 70-kDa ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,Hepatic stellate cell activation ,HSC, hepatic stellate cell ,pmHSC, murine hepatic stellate cell ,siRNA, small interfering RNA ,Ribosomal protein s6 ,CLD, chronic liver disease ,Hepatic stellate cell ,Cancer research ,Liver cancer ,business ,NASH, nonalcoholic steatohepatitis ,Signal Transduction - Abstract
Background & Aims Progression of chronic liver disease (CLD) to liver cirrhosis and liver cancer is a major global cause of morbidity and mortality. Treatment options capable of inhibiting progression of liver fibrosis when etiological treatment of CLD is not available or fails have yet to be established. We investigated the role of serine/threonine kinase p70 ribosomal protein S6 kinase (p70S6K) as checkpoint of fibrogenesis in hepatic stellate cells (HSCs) and as target for the treatment of liver fibrosis. Approach & Results Immunohistochemistry was used to assess p70S6K expression in liver resection specimen. Primary human or murine HSCs from wild-type or p70S6K–/– mice as well as LX-2 cells were used for in vitro experiments. Specific small interfering RNA or CEP-1347 were used to silence or inhibit p70S6K and assess its functional relevance in viability, contraction and migration assays, fluorescence-activated cell sorting, and Western blot. These results were validated in vivo by a chemical model of fibrogenesis using wild-type and p70S6K–/– mice. Expression of p70S6K was significantly increased in human cirrhotic vs noncirrhotic liver-tissue and progressively increased in vitro through activation of primary human HSCs. Conversely, p70S6K induced fibrogenic activation of HSCs in different models, including the small interfering RNA–based silencing of p70S6K in HSC lines, experiments with p70S6K–/– cells, and the pharmacological inhibition of p70S6K by CEP-1347. These findings were validated in vivo as p70S6K–/– mice developed significantly less fibrosis upon exposure to CCl4. Conclusions We establish p70S6K as a checkpoint of fibrogenesis in vitro and in vivo and CEP-1347 as potential treatment option that can safely be used for long-term treatment., Graphical abstract
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- 2021
14. Novel predictors for liver transplantation or death in drug-induced acute liver failure
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Alexander L. Gerbes, Gerald Denk, Christine Woischke, and Sabine Weber
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Drug ,medicine.medical_specialty ,Orthotopic liver transplantation ,medicine.medical_treatment ,media_common.quotation_subject ,Liver transplantation ,Severity of Illness Index ,Gastroenterology ,End Stage Liver Disease ,Liver disease ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,media_common ,Liver injury ,Hepatology ,Receiver operating characteristic ,business.industry ,Liver failure ,Liver Failure, Acute ,medicine.disease ,Liver Transplantation ,Chemical and Drug Induced Liver Injury ,business ,Biomarkers - Abstract
Objective Drug-induced liver injury (DILI) is a leading cause of acute liver failure (ALF). Predictors for orthotopic liver transplantation (OLT) or death in drug-induced ALF (DI-ALF) are scarce. Methods In total 33 of 346 patients recruited for our prospective study on potentially hepatotoxic drugs had ALF. DILI diagnosis was based on Roussel Uclaf Causality Assessment Method (RUCAM) score and expert opinion. Area under the receiver operating characteristic (AUROC) curve, Youden's index and positive and negative likelihood ratios were calculated to identify the best performing predictive markers and scores for OLT or death. Results Poor outcome was associated with lower baseline platelet counts and cholinesterase (CHE) levels, higher International Normalized Ratio (INR) levels and Model for End-Stage Liver Disease (MELD) scores. Yet, AUROC reached a maximum of only 0.71-0.75 for either of those laboratory markers or the MELD score. Notably however, combinations of those scores were highly discriminatory, in particular INR/(CHE*platelet count) and MELD/(CHE*platelet count), showing an AUROC of 0.91, a positive likelihood ratios of 13.78 and a negative likelihood ratios of 0.08. Conclusion While baseline MELD score, INR, CHE, and platelet counts had limited potential to discriminate between DI-ALF with survival or poor outcome, their combinations were highly associated with OLT or death in patients with DI-ALF.
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- 2021
15. Liver Injury Associated with Metamizole Exposure: Features of an Underestimated Adverse Event
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Andreas Benesic, Jens Neumann, Alexander L. Gerbes, and Sabine Weber
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Male ,medicine.medical_specialty ,Necrosis ,Antinuclear antibody positivity ,Dipyrone ,Toxicology ,Gastroenterology ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Original Research Article ,Prospective Studies ,Adverse effect ,Prospective cohort study ,Pharmacology ,Liver injury ,business.industry ,Jaundice ,Liver Failure, Acute ,Metamizole ,medicine.disease ,Cohort ,Female ,medicine.symptom ,Chemical and Drug Induced Liver Injury ,business ,medicine.drug - Abstract
Introduction and Objective The potential of metamizole to cause drug-induced liver injury (DILI) has received increasing attention. We investigated the distinguishing features of a case series comprising 32 patients with suspected metamizole-induced DILI. Methods For the current analysis, 32 of 238 patients with DILI included in our prospective study on drugs potentially causing DILI were included. Diagnosis of DILI was based on expert opinion and RUCAM (Roussel Uclaf Causality Assessment Method) score and supported by an in vitro test using monocyte-derived hepatocyte-like cells. Results Suspected metamizole-DILI was characterised by a female predominance, hepatocellular pattern of injury, high proportion of antinuclear antibody positivity, and predominance of eosinophilic cell infiltration and necrosis in the histopathological analysis. With 22%, a high proportion of these metamizole-associated liver injury cases developed acute liver failure, which was characterised by a longer latency of metamizole use and more pronounced liver biochemistry abnormalities at onset and peak levels. Furthermore, jaundice was a common finding in the metamizole-associated liver injury cases with 66% presenting with peak bilirubin levels of 3 mg/dL or higher, which was associated with a worse outcome and a higher frequency of acute liver failure. Conclusions Our analysis of a well-characterised DILI cohort further supports the potential of metamizole causing DILI and provides important features for the establishment of a signature pattern of liver injury observed in patients treated with metamizole. Clinical Trial Registration ClinicalTrials.gov: NCT 02353455. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01049-z.
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- 2021
16. Clinical features and evolution of bacterial infection-related acute-on-chronic liver failure
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Carlo Alessandria, Carmine Gambino, Javier Fernández, Hans Van Vlierberghe, Sophie Restellini, Marcos Girala, Luis Colombato, Tae Hee Lee, Nikolaos Pyrsopoulos, Eduardo Fassio, Sang Gyune Kim, Gisela Pinero, Paolo Caraceni, Shivaram Prasad Singh, Do Seon Song, Ji Won Park, Julio Vorobioff, Dong Joon Kim, C. Toledo, Aleksander Krag, Liane Rabinowich, Preetam Nath, Robert A. de Man, Elza Cotrim Soares, Xavier Verhelst, Tiago Sevá Pereira, Gustavo Romero, Macarena Simón-Talero, Sung Eun Kim, Michele Bartoletti, Alexander L. Gerbes, Sebastián Marciano, Tony Bruns, Hyoung Su Kim, Ki Tae Suk, Nicolas M. Intagliata, Annette Dam Fialla, Adrià Juanola, Manuela Merli, Rita de Cassia Ribeiro Barea, Laure Elkrief, Rakhi Maiwall, Laurentius A Lesmana, Pere Ginès, Vikas Gautam, E.L. Yoon, M. Marino, Paolo Angeli, Kalyan Ram Bhamidimarri, Victor Vargas, Virendra Singh, Juan Pablo Roblero, François Durand, Cosmas A. Rinaldi Lesmana, M. V. Maevskaya, Gustavo Navarro, Adrian Gadano, Florence Wong, Pramod Kumar, Tae Hun Kim, Daniela Campion, Salvatore Piano, Giacomo Zaccherini, Barbara Lattanz, Jae Seok Hwang, Sun Young Yim, Thomas D. Boyer, Jeong Han Kim, Carlos Brodersen, Wong F., Piano S., Singh V., Bartoletti M., Maiwall R., Alessandria C., Fernandez J., Soares E.C., Kim D.J., Kim S.E., Marino M., Vorobioff J., Barea R.D.C.R., Merli M., Elkrief L., Vargas V., Krag A., Singh S.P., Lesmana L.A., Toledo C., Marciano S., Verhelst X., Intagliata N., Rabinowich L., Colombato L., Kim S.G., Gerbes A., Durand F., Roblero J.P., Bruns T., Yoon E.L., Girala M., Pyrsopoulos N.T., Kim T.H., Yim S.Y., Juanola A., Gadano A., Angeli P., Bhamidimarri K., Boyer T.D., Brodersen C., Campion D., Caraceni P., de Man R.A., Fassio E., Fialla A.D., Gambino C., Gautam V., Gines P., Hwang J.S., Kim H.S., Kim J.H., Kumar P., Lattanz B., Lee T.H., Rinaldi Lesmana C.A., Maevskaya M., Nath P., Navarro G., Park J.-W., Pinero G., Restellini S., Romero G., Seva -Pereira T., Simon-Talero M., Song D.S., Suk K.T., Van Vlierberghe H., and Zaccherini G.
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Male ,0301 basic medicine ,Cirrhosis ,Organ Dysfunction Scores ,Antibiotic resistance ,medicine.medical_treatment ,Liver transplantation ,Severity of Illness Index ,0302 clinical medicine ,ACLF ,MDR ,Epidemiology ,Cross Infection ,Mortality rate ,Age Factors ,Bacterial Infections ,Middle Aged ,Prognosis ,Community-Acquired Infections ,Europe ,Hospitalization ,Female ,030211 gastroenterology & hepatology ,Alcohol-Related Disorders ,medicine.medical_specialty ,Sepsi ,India ,Risk Assessment ,Sepsis ,03 medical and health sciences ,Sex Factors ,Spontaneous bacterial peritonitis ,Internal medicine ,medicine ,Humans ,XDR ,Cirrhosi ,Hepatology ,business.industry ,Acute-On-Chronic Liver Failure ,medicine.disease ,Pneumonia ,030104 developmental biology ,antibiotic resistance ,liver transplantation ,sepsis ,business - Abstract
Background & Aims: Bacterial infections can trigger the development of organ failure(s) and acute-on-chronic liver failure (ACLF). Geographic variations in bacteriology and clinical practice could lead to worldwide differences in ACLF epidemiology, phenotypes and associated outcomes. Herein, we aimed to evaluate regional differences in bacterial infection-related ACLF in patients with cirrhosis admitted to hospital. Methods: This post hoc analysis included 1,175 patients with decompensated cirrhosis (with bacterial infection on admission or nosocomial infection) from 6 geographic regions worldwide. Clinical, laboratory and microbiological data were collected from the diagnosis of infection. Patients were followed-up for organ failure(s) and ACLF development according to the EASL-CLIF criteria from enrolment to discharge/death. Results: A total of 333 patients (28%) had ACLF at diagnosis of infection, while 230 patients developed ACLF after diagnosis of infection, resulting in an overall rate of bacterial infection related-ACLF of 48%, with rates differing amongst different geographic regions (38% in Southern Europe vs. 75% in the Indian subcontinent). Bacterial infection related-ACLF more frequently developed in younger patients (55 ± 13 vs. 58 ± 14 years), males (73% vs. 62%), patients with alcohol-related cirrhosis (59% vs. 45%) and those with a higher baseline MELD score (25 ± 11 vs. 16 ± 5) (all p
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- 2021
17. Sympathetic nervous activation, mitochondrial dysfunction and outcome in acutely decompensated cirrhosis: the metabolomic prognostic models (CLIF-C MET)
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Emmanuel Weiss, Carlos de la Peña-Ramirez, Ferran Aguilar, Juan-Jose Lozano, Cristina Sánchez-Garrido, Patricia Sierra, Pedro Izquierdo-Bueno Martin, Juan Manuel Diaz, François Fenaille, Florence A Castelli, Thierry Gustot, Wim Laleman, Agustín Albillos, Carlo Alessandria, Marco Domenicali, Paolo Caraceni, Salvatore Piano, Faouzi Saliba, Stefan Zeuzem, Alexander L Gerbes, Julia A Wendon, Christian Jansen, Wenyi Gu, Maria Papp, Raj Mookerjee, Carmine Gabriele Gambino, Cesar Jiménez, Ilaria Giovo, Giacomo Zaccherini, Manuela Merli, Antonella Putignano, Frank Erhard Uschner, Thomas Berg, Tony Bruns, Christian Trautwein, Alexander Zipprich, Rafael Bañares, José Presa, Joan Genesca, Victor Vargas, Javier Fernández, Mauro Bernardi, Paolo Angeli, Rajiv Jalan, Joan Claria, Christophe Junot, Richard Moreau, Jonel Trebicka, and Vicente Arroyo
- Subjects
cirrhosis ,liver failure ,Gastroenterology ,liver metabolism - Abstract
Background and aimsCurrent prognostic scores of patients with acutely decompensated cirrhosis (AD), particularly those with acute-on-chronic liver failure (ACLF), underestimate the risk of mortality. This is probably because systemic inflammation (SI), the major driver of AD/ACLF, is not reflected in the scores. SI induces metabolic changes, which impair delivery of the necessary energy for the immune reaction. This investigation aimed to identify metabolites associated with short-term (28-day) death and to design metabolomic prognostic models.MethodsTwo prospective multicentre large cohorts from Europe for investigating ACLF and development of ACLF, CANONIC (discovery, n=831) and PREDICT (validation, n=851), were explored by untargeted serum metabolomics to identify and validate metabolites which could allow improved prognostic modelling.ResultsThree prognostic metabolites strongly associated with death were selected to build the models. 4-Hydroxy-3-methoxyphenylglycol sulfate is a norepinephrine derivative, which may be derived from the brainstem response to SI. Additionally, galacturonic acid and hexanoylcarnitine are associated with mitochondrial dysfunction. Model 1 included only these three prognostic metabolites and age. Model 2 was built around 4-hydroxy-3-methoxyphenylglycol sulfate, hexanoylcarnitine, bilirubin, international normalised ratio (INR) and age. In the discovery cohort, both models were more accurate in predicting death within 7, 14 and 28 days after admission compared with MELDNa score (C-index: 0.9267, 0.9002 and 0.8424, and 0.9369, 0.9206 and 0.8529, with model 1 and model 2, respectively). Similar results were found in the validation cohort (C-index: 0.940, 0.834 and 0.791, and 0.947, 0.857 and 0.810, with model 1 and model 2, respectively). Also, in ACLF, model 1 and model 2 outperformed MELDNa 7, 14 and 28 days after admission for prediction of mortality.ConclusionsModels including metabolites (CLIF-C MET) reflecting SI, mitochondrial dysfunction and sympathetic system activation are better predictors of short-term mortality than scores based only on organ dysfunction (eg, MELDNa), especially in patients with ACLF.
- Published
- 2023
18. Erhöhte Leberwerte
- Author
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Alexander L. Gerbes, Gerald Denk, Hélène Bourhis, and Mark op den Winkel
- Subjects
medicine.medical_specialty ,Endocrinology ,Alanine transaminase ,biology ,business.industry ,Internal medicine ,medicine ,biology.protein ,Elevated liver enzymes ,General Medicine ,Aspartate Aminotransferases ,business - Published
- 2020
19. Antimitochondrial Rather than Antinuclear Antibodies Correlate with Severe Drug-Induced Liver Injury
- Author
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Alexander L. Gerbes, Andreas Benesic, Sabine Weber, Isabelle Rotter, and Marie-Luise Buchholtz
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Anti-nuclear antibody ,Bilirubin ,Gastroenterology ,Autoimmune Diseases ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Clinical significance ,Prospective Studies ,Prospective cohort study ,Aged ,Autoantibodies ,biology ,business.industry ,Autoantibody ,General Medicine ,Middle Aged ,Mitochondria ,Titer ,chemistry ,Antibodies, Antinuclear ,030220 oncology & carcinogenesis ,Cohort ,biology.protein ,030211 gastroenterology & hepatology ,Chemical and Drug Induced Liver Injury ,Antibody ,business - Abstract
Introduction: A proportion of patients with drug-induced liver injury (DILI) present with autoantibodies, which has led to the current concept of autoimmune-like DILI. However, no standardized definition exists and the clinical relevance has not been studied in detail yet. Methods: 143 patients with DILI enrolled in a prospective study were analyzed. DILI diagnosis was based on the monocyte-derived hepatocyte-like cell test and supported by Roussel Uclaf Causality Assessment Method (RUCAM) and expert adjudication. Testing for antinuclear antibodies (ANA) and antimitochondrial antibodies (AMA) was performed using immunofluorescence. ANA titers ≥1:100 were considered positive and ≥1:400 clinically relevant; AMA positivity was considered at titers ≥1:100. Results: 67% exhibited ANA ≥1:100 and 29% ANA ≥1:400; 10% were AMA positive. There was no significant correlation between the ANA titers and the causative drug, while AMA positive patients had taken nonsteroidal anti-inflammatory drugs more frequently. No difference was seen regarding clinical characteristics or laboratory parameters in patients with ANA ≥1:400, while patients with positive AMA presented with higher aminotransferases, bilirubin, and international normalized ratio. Significantly higher proportions of patients with ANA ≥1:400 or AMA positivity exhibited elevated immunoglobulin G levels. AMA positivity but not elevated ANA titers correlated with a higher proportion of Hy’s law positivity. Conclusion: A closer look in a causality proven DILI cohort provided no evidence that presence of ANA titers is specific for DILI by a certain medication. AMA rather than ANA positivity was related to a more pronounced liver injury.
- Published
- 2020
20. Monocyte-Derived Hepatocyte-Like Cell Test: A Novel Tool for in vitro Identification of Drug-Induced Liver Injury in Patients with Herbal or Dietary Supplements
- Author
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Henry Lik-Yuen Chan, Vincent Wai-Sun Wong, Alexander L. Gerbes, Sabine Weber, Andreas Benesic, and Grace Lai-Hung Wong
- Subjects
Drug ,Liver injury ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,Cell ,Gastroenterology ,Disease ,medicine.disease ,In vitro ,medicine.anatomical_structure ,Concomitant ,Hepatocyte ,Internal medicine ,medicine ,Medical prescription ,business ,media_common - Abstract
Background: Drug-induced liver injury caused by herbal and dietary supplements (HDS) has been an increasingly important phenomenon in recent years. Diagnosis is the major challenge. Definite causality assessment, especially in patients with concomitant prescription medicine or other potential causes of liver injury, can be impossible. Objectives: We investigated the usefulness of an in vitro test on the basis of peripheral monocytes of the individual patients in patients with acute liver injury consuming HDS. Method: Patients with acute liver injury who had been prospectively recruited by the University Hospital Munich (LMU, Munich) and the Chinese University of Hong Kong (CUHK) and who took at least 1 HDS were selected for this analysis. Diagnosis of drug-induced liver injury (DILI) was based on local expert adjudication, Roussel Uclaf Causality Assessment Method (RUCAM) score, and course of the disease and was supported by the monocyte-derived hepatocyte-like (MH) cell test. Results: We identified 47 patients with liver injury and intake of at least 1 HDS: 32 (68%) were diagnosed with DILI. HDS was determined as the causative agent in 28 out of those 32 patients. The MH cell test could correctly identify 29 out of those 32 DILI cases and showed false positive results in only 2 out of the 15 non-DILI patients. The MH cell test therefore reached a sensitivity and specificity of 90.6 and 86.7%, respectively, in patients with acute liver injury and HDS intake. Conclusions: Our data provide evidence that the MH cell test can be a useful tool to identify the role of HDS in causing DILI and therefore support causality assessment in patients consuming HDS.
- Published
- 2020
21. Kupffer cell activation by different microbial lysates: Toll‐like receptor‐2 plays pivotal role on thromboxane A 2 production in mice and humans
- Author
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Jiang Zhang, Andreas Wieser, Christian J. Steib, Moyan Hu, Hanwei Li, Ina‐Kristin Behrens, Tobias S. Schiergens, Hao Lin, and Alexander L. Gerbes
- Subjects
0301 basic medicine ,MAPK/ERK pathway ,Toll-like receptor ,Thromboxane ,Immunology ,Kupffer cell ,Pharmacology ,Biology ,03 medical and health sciences ,Thromboxane A2 ,chemistry.chemical_compound ,TLR2 ,030104 developmental biology ,0302 clinical medicine ,medicine.anatomical_structure ,chemistry ,medicine ,Immunology and Allergy ,Phosphorylation ,Secretion ,030215 immunology - Abstract
Thromboxane (TX) A2 has been identified as an important intrahepatic vasoconstrictor upon Kupffer cell (KC) activation during infections such as spontaneous bacterial peritonitis (SBP). The study aimed to investigate the role of TLRs in the TXA2 increase in liver nonparenchymal cells and their related mechanisms. Here, we identified TLR-2 as a common pathway for different microbials: microbial lysates including Gram-positive bacteria, Gram-negative bacteria, and fungi all increased TXA2 secretion via activation of TLR-2 in human KCs, accompanied by increased expression and phosphorylation of Myd88-related pathway. Of all TLR agonists, only TLR-1, -2, and -4 agonists increased TXA2 in human KCs. These results were further confirmed by mouse liver nonparenchymal cells. Comparing the effects of TLR-1, -2, and -4 antagonists, only TLR-2 antagonist showed inhibitory effects with all tested microbial lysates. Pretreatment with TLR-2 antagonist in human KCs blocked the secretion of IL-10, CXCL-10, TNF-α, and IL-6 induced by Gram-positive and Gram-negative bacterial stimulation. IL-23 and IL-1β were only induced by Gram-negative bacteria. Thus, TLR-2 might be a potential marker and an attractive target for future treatment of patients with SBP. In addition, IL-23 and IL-1β might distinguish early between Gram-positive and Gram-negative SBP.
- Published
- 2020
22. Metabolic implication of tigecycline as an efficacious second‐line treatment for sorafenib‐resistant hepatocellular carcinoma
- Author
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Helmut Pein, Alexander L. Gerbes, Johanna Pachmayr, Martin Müller, Martina Meßner, Simon Rothenfußer, Andreas Koeberle, Georg J. Arnold, Thomas Fröhlich, Angelika M. Vollmar, Alexandra K. Kiemer, Maximilian A. Ardelt, Sabine Schmitt, Carina Ortler, Lena Zobel, Petra Huber-Cantonati, Lars M. Koenig, and Hans Zischka
- Subjects
0301 basic medicine ,mitochondrial biogenesis ,Cell ,Apoptosis ,Mice, SCID ,Drug resistance ,Tigecycline ,Biochemistry ,antibiotics ,0302 clinical medicine ,Protein Synthesis Inhibitors ,Antibiotics ,Electron Acceptor Auxotrophy ,Mitochondrial Biogenesis ,Sorafenib Resistance ,Tumor Relapse ,tumor relapse ,Liver Neoplasms ,sorafenib resistance ,Sorafenib ,Mitochondria ,ddc ,medicine.anatomical_structure ,Hepatocellular carcinoma ,Female ,Biotechnology ,medicine.drug ,Carcinoma, Hepatocellular ,03 medical and health sciences ,Cell Line, Tumor ,Genetics ,medicine ,Animals ,Humans ,Adverse effect ,neoplasms ,Molecular Biology ,Cell Proliferation ,business.industry ,electron acceptor auxotrophy ,medicine.disease ,Xenograft Model Antitumor Assays ,digestive system diseases ,030104 developmental biology ,Mitochondrial biogenesis ,Drug Resistance, Neoplasm ,Cancer research ,Neoplasm Recurrence, Local ,business ,030217 neurology & neurosurgery ,Progressive disease - Abstract
Sorafenib represents the current standard of care for patients with advanced-stage hepatocellular carcinoma (HCC). However, acquired drug resistance occurs frequently during therapy and is accompanied by rapid tumor regrowth after sorafenib therapy termination. To identify the mechanism of this therapy-limiting growth resumption, we established robust sorafenib resistance HCC cell models that exhibited mitochondrial dysfunction and chemotherapeutic crossresistance. We found a rapid relapse of tumor cell proliferation after sorafenib withdrawal, which was caused by renewal of mitochondrial structures alongside a metabolic switch toward high electron transport system (ETS) activity. The translation-inhibiting antibiotic tigecycline impaired the biogenesis of mitochondrial DNA-encoded ETS subunits and limited the electron acceptor turnover required for glutamine oxidation. Thereby, tigecycline prevented the tumor relapse in vitro and in murine xenografts in vivo. These results offer a promising second-line therapeutic approach for advanced-stage HCC patients with progressive disease undergoing sorafenib therapy or treatment interruption due to severe adverse events.
- Published
- 2020
23. To Protect Fatty Livers from Ischemia Reperfusion Injury: Role of Ischemic Postconditioning
- Author
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Simon Rothenfußer, Andrej Khandoga, Marie-Christine Makeschin, Doris Mayr, Alexander L. Gerbes, Julia Schewe, Max Schnurr, Jiang Zhang, and Christian J. Steib
- Subjects
Male ,medicine.medical_specialty ,Ischemia–reperfusion injury ,Physiology ,Ischemia ,CCL2 ,Diet, High-Fat ,Rats, Sprague-Dawley ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,In vivo ,Internal medicine ,Lactate dehydrogenase ,medicine ,Animals ,Ischemic postconditioning ,Liver transplantation ,business.industry ,Fatty liver ,Gastroenterology ,medicine.disease ,Rats ,Fatty Liver ,Transplantation ,Endocrinology ,chemistry ,Reperfusion Injury ,030220 oncology & carcinogenesis ,Original Article ,030211 gastroenterology & hepatology ,business ,Reperfusion injury ,Perfusion - Abstract
Background The benefit of ischemic postconditioning (IPostC) might be the throttled inflow following cold ischemia. The current study investigated advantage and mechanisms of IPostC in healthy and fatty rat livers. Methods Male SD rats received a high-fat diet to induce fatty livers. Isolated liver perfusion was performed after 24 h ischemia at 4 °C as well as in vivo experiments after 90 min warm ischemia. The so-called follow-up perfusions served to investigate the hypothesis that medium from IPostC experiments is less harmful. Lactate dehydrogenase (LDH), transaminases, different cytokines, and gene expressions, respectively, were measured. Results Fatty livers showed histologically mild inflammation and moderate to severe fat storage. IPostC reduced LDH and TXB2 in healthy and fatty livers and increased bile flow. LDH, TNF-α, and IL-6 levels in serum decreased after warm ischemia + IPostC. The gene expressions of Tnf, IL-6, Ccl2, and Ripk3 were downregulated in vivo after IPostC. Conclusions IPostC showed protective effects after ischemia in situ and in vivo in healthy and fatty livers. Restricted cyclic inflow was an important mechanism and further suggested involvement of necroptosis. IPostC represents a promising and easy intervention to improve outcomes after transplantation. Electronic supplementary material The online version of this article (10.1007/s10620-020-06328-w) contains supplementary material, which is available to authorized users.
- Published
- 2020
24. Transjugular intrahepatic portosystemic shunt for patients with liver cirrhosis: survey evaluating indications, standardization of procedures and anticoagulation in 43 German hospitals
- Author
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Christian J. Steib, Hanwei Li, Alexander L. Gerbes, Jiang Zhang, Jens Ricke, Jonel Trebicka, Julia Mayerle, Carsten Meyer, and Alexander Zipprich
- Subjects
Liver Cirrhosis ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Portal venous pressure ,03 medical and health sciences ,0302 clinical medicine ,Hypertension, Portal ,Ascites ,medicine ,Humans ,Hepatic encephalopathy ,Contraindication ,Hepatology ,business.industry ,General surgery ,Gastroenterology ,Anticoagulants ,Reference Standards ,medicine.disease ,Clopidogrel ,Hospitals ,Treatment Outcome ,030220 oncology & carcinogenesis ,Hydrothorax ,030211 gastroenterology & hepatology ,Portasystemic Shunt, Transjugular Intrahepatic ,medicine.symptom ,business ,Transjugular intrahepatic portosystemic shunt ,medicine.drug - Abstract
Objectives Transjugular intrahepatic portosystemic shunt (TIPS) insertion is an established treatment to lower portal pressure. There are no obligatory evidence-based recommendations addressing procedure and anticoagulation. Therefore, a survey was performed to establish current practice at different German hospitals. Methods A three-page survey was sent out via postal mail to 76 different hospitals addressing the topics indication, contraindication, follow-up and anticoagulation. Results Forty-three hospitals completed the survey: the median number of TIPS/year was 28.6 ± 23. Ascites and hydrothorax were announced as the main indications. Bilirubin levels above 5 mg/dl, hepatic encephalopathy and cardiac disease were considered as absolute contraindications in most hospitals, but age was not. The biggest variations were reported with regard to anticoagulation after TIPS procedure. Four hospitals never used any anticoagulation; most hospitals reported the use of low molecular weight heparins for a period of days up to 4 weeks. But also aspirin or clopidogrel was used after TIPS insertion in eight different hospitals. Additionally, the standards for follow-up after TIPS insertion were different in the hospitals. Conclusions There is no consensus how to handle indication, contraindications and anticoagulation after the TIPS procedure. A national and international consensus is warranted to improve the outcome of TIPS patients and reduce secondary complications. In addition to compare results and efficacy in the future standard operation procedures as proposed here need to be put in place.
- Published
- 2019
25. Antifibrotic effects of hypocalcemic vitamin D analogs in murine and human hepatic stellate cells and in the CCl4 mouse model
- Author
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Enrico N. De Toni, Doris Mayr, Andreas Ziesch, Ivonne Regel, Renate Artmann, Simon Hohenester, Christian J. Steib, Michael Trauner, Liangtao Ye, Veronika Kanitz, Alexander L. Gerbes, Julia Mayerle, Gerald Denk, Florian Bösch, Florian P. Reiter, Ralf Wimmer, Graduate School, AGEM - Digestive immunity, and AGEM - Endocrinology, metabolism and nutrition
- Subjects
0301 basic medicine ,Paricalcitol ,biology ,Calcitriol ,Chemistry ,Alfacalcidol ,Cell Biology ,Transforming growth factor beta ,Pharmacology ,medicine.disease ,Pathology and Forensic Medicine ,03 medical and health sciences ,chemistry.chemical_compound ,030104 developmental biology ,0302 clinical medicine ,Fibrosis ,In vivo ,030220 oncology & carcinogenesis ,biology.protein ,medicine ,Vitamin D and neurology ,Hepatic stellate cell ,Molecular Biology ,medicine.drug - Abstract
Liver cirrhosis is a life-threatening consequence of liver fibrosis. The aim of this study was to investigate the antifibrotic potential of clinically available vitamin D analogs compared to that of calcitriol in vitro and in vivo. Murine hepatic stellate cells, Kupffer cells, and human LX-2 cells were treated with vitamin D analogs, and the profibrotic behavior of these cells was studied. In vivo liver fibrosis was induced using CCl4 until measurable fibrosis was established. Animals were then treated with calcitriol and paricalcitol. Vitamin D and its analogs showed antifibrotic effects in vitro. Treatment with active vitamin D (calcitriol, CAL) and its analogs reduced the protein expression of α-smooth muscle actin (α-SMA) in mHSC. In human LX-2 cells alfacalcidol reduced transforming growth factor-β (TGF-β) induced platelet-derived growth factor receptor-β protein expression and contractility while paricalcitol (PCT), in its equipotent dose to CAL, reduced TGF-β induced α-SMA protein expression, and ACTA2 and TGF-β mRNA expression. No effects of a treatment with vitamin D and its analogs were observed in Kupffer cells. In vivo, PCT-treated mice had significantly lower calcium levels than CAL-treated mice. CAL and PCT reduced the hepatic infiltration of CD11b-positive cells and alanine transaminase levels, while PCT but not CAL significantly inhibited fibrosis progression, with a favorable side effect profile in the CCl4 model. We conclude that hypocalcemic vitamin D analogs should be considered in future studies investigating vitamin D for the treatment of liver fibrosis.
- Published
- 2019
26. The effects of hepatic steatosis on thromboxane A2 induced portal hypertension
- Author
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Ujjwal M. Mahajan, Jiang Zhang, Alexander L. Gerbes, Julia Schewe, Hanwei Li, Christian J. Steib, and Marie Christine Makeschin
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Thromboxane ,03 medical and health sciences ,chemistry.chemical_compound ,Thromboxane A2 ,0302 clinical medicine ,Internal medicine ,medicine ,Hepatology ,business.industry ,Zymosan ,Kupffer cell ,Gastroenterology ,medicine.disease ,030104 developmental biology ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Portal hypertension ,lipids (amino acids, peptides, and proteins) ,030211 gastroenterology & hepatology ,Steatosis ,business ,Perfusion ,CD163 ,circulatory and respiratory physiology - Abstract
Introduction and aim Thromboxane (TX) A2 was identified as an important vasoconstrictor during Zymosan induced portal perfusion pressure (PP) increase. We aimed at investigating whether hepatic steatosis influences the extent of TXA2-induced portal hypertension. Materials and methods Sprague–Dawley rats were randomly divided into control and steatosis (induced by the special diet) groups. PP and TXB2 (stable degradation product of TXA2) in the perfusate were measured after in situ liver perfusion with Zymosan (150 μg/ml, 40–46 min) or U46619 (TXA2 analog, 0.1 μM/ml, 40–46 min). The number of Kupffer cell (KC) was measured by immunohistochemistry with CD163. Results Zymosan induced more TXB2 production and a higher PP increase in control group than in steatosis group despite more CD163 positive KCs in fatty livers. PP and TXB2 efflux revealed a strong correlation in control group and a moderate correlation in steatosis group. Contrary to the effect of Zymosan, U46619 induced a much higher PP increase in steatosis group than in control group. Conclusion Severe steatosis increased number of KCs, however, PP increase and TXB2 efflux caused by Zymosan infusion in fatty livers were lower than those in healthy livers. In contrast, TXA2 analog caused higher PP increase in fatty livers. Targeting the more sensitive response to TXA2 in fatty livers might be a potential therapy of severe steatosis.
- Published
- 2019
27. Drug-Induced Liver Injury (DILI): A Major Challenge
- Author
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Alexander L. Gerbes
- Subjects
Liver injury ,Drug ,business.industry ,media_common.quotation_subject ,General Medicine ,Pharmacology ,medicine.disease ,Liver ,Drug Discovery ,medicine ,Humans ,Chemical and Drug Induced Liver Injury ,business ,media_common - Published
- 2021
28. Biomarkers of idiosyncratic drug-induced liver injury (DILI) - a systematic review
- Author
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Francisco Javier Cubero, Alexander L. Gerbes, Guruprasad P. Aithal, Gerd A. Kullak-Ublick, Cristiana Freixo, Ismael Alvarez-Alvarez, Edmond Atallah, University of Zurich, and Aithal, Guruprasad P
- Subjects
Drug ,medicine.medical_specialty ,Drug-Related Side Effects and Adverse Reactions ,Adverse outcomes ,media_common.quotation_subject ,610 Medicine & health ,Toxicology ,Risk Factors ,medicine ,Humans ,Prospective Studies ,Intensive care medicine ,Methodological quality ,media_common ,Acute liver injury ,Liver injury ,Pharmacology ,business.industry ,3005 Toxicology ,General Medicine ,medicine.disease ,Transplantation ,3004 Pharmacology ,Liver ,10199 Clinic for Clinical Pharmacology and Toxicology ,Etiology ,Population study ,Chemical and Drug Induced Liver Injury ,business ,Biomarkers - Abstract
Introduction Idiosyncratic drug-induced liver injury (DILI) is an unpredictable event, and there are no specific biomarkers that can distinguish DILI from alternative explanations or predict its clinical outcomes. Areas covered This systematic review summarizes the available evidence for all biomarkers proposed to have a role in the diagnosis or prognosis of DILI. Following a comprehensive search, we included all types of studies in humans. We included DILI cases based on any threshold criteria but excluded intrinsic DILI, commonly caused by paracetamol overdose. We classified studies into diagnostic and prognostic categories and assessed their methodological quality. After reviewing the literature, 14 studies were eligible. Expert Opinion Diagnostic studies were heterogeneous with regard to the study population and outcomes measured. Prognostic models were developed by integrating novel biomarkers, risk scores, and traditional biomarkers, which increased their prognostic ability to predict death or transplantation by 6 months. This systematic review highlights the case of need for non-genetic biomarkers that distinguish DILI from acute liver injury related to alternative etiology. Biomarkers with the potential to identify serious adverse outcomes from acute DILI should be validated in independent prospective cohorts with a substantial number of cases.
- Published
- 2021
29. Marked Increase of Gamma-Glutamyltransferase as an Indicator of Drug-Induced Liver Injury in Patients without Conventional Diagnostic Criteria of Acute Liver Injury
- Author
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Sabine Weber, Alexander L. Gerbes, Gerald Denk, and Julian Allgeier
- Subjects
Acute liver injury ,Liver injury ,Drug ,medicine.medical_specialty ,biology ,business.industry ,media_common.quotation_subject ,Gastroenterology ,medicine.disease ,Internal medicine ,medicine ,biology.protein ,Surgery ,In patient ,Gamma-glutamyltransferase ,business ,media_common ,Research Article - Abstract
Introduction: Clinically significant drug-induced liver injury (DILI) is defined by elevations of alanine aminotransferase (ALT) ≥5 times the upper limit of normal (ULN), alkaline phosphatase (ALP) ≥2 × ULN, or ALT ≥3 × ULN and total bilirubin TBIL >2 × ULN. However, DILI might also occur in patients who do not reach those thresholds and still may benefit from discontinuation of medication. Methods: Fifteen patients recruited for our prospective study on potentially hepatotoxic drugs were included. DILI diagnosis was based on RUCAM (Roussel Uclaf Causality Assessment Method) score and expert opinion and was supported by an in vitro test using monocyte-derived hepatocyte-like (MH) cells. Results: Median RUCAM score was 6 (range 4–8), indicating that DILI was possible or probable in all cases. The predominant types of liver injury were mixed (60%) and cholestatic (40%). While no elevation above 2 × ULN of ALP and TBIL was observed, gamma-glutamyltransferase (GGT) above 2 × ULN was identified in 8 of the patients. Six of the 15 patients did not achieve full remission and showed persistent elevation of GGT, which was significantly associated with peak GGT elevation above 2 × ULN (p = 0.005). Conclusion: Here we present a case series of patients with liver enzyme elevation below the conventional thresholds who developed DILI with a predominant GGT elevation leading to drug withdrawal and/or chronic elevation of liver parameters, in particular of GGT. Thus, we propose that DILI should be considered in particular in cases with marked increase of GGT even if conventional DILI threshold levels are not reached, resulting in discontinuation of the causative drug and/or close monitoring of the patients.
- Published
- 2021
30. COVID-19 and liver injury: hypoalbuminaemia and γGT should be observed at hospital admission
- Author
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Sabine Weber and Alexander L Gerbes
- Subjects
Gastroenterology - Published
- 2022
31. P041 Tandem mass tag-based quantitative proteomic profiling identifies novel putative serum biomarkers for the diagnosis of drug-induced liver injury in patients
- Author
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Raúl J. Andrade, Zhenyu Wang, Jane I. Grove, Shashi K. Ramaiah, Alexander L. Gerbes, Camilla Stephens, Andrew Fowell, Sabine Weber, Richard Virgen-Slane, Guido Stirnimann, Edmond Atallah, Einar Bjornsson, M. Isabel Lucena, James W. Dear, Hyder Hussaini, Vishal S. Vaidya, Ravi Kodihalli, Guruprasad P. Aithal, Robert A. Everley, Joel D. Federspiel, and Craig L. Hyde
- Subjects
Liver injury ,Drug ,Serum biomarkers ,Proteomic Profiling ,business.industry ,media_common.quotation_subject ,Cancer research ,Medicine ,In patient ,Tandem mass tag ,business ,medicine.disease ,media_common - Published
- 2021
32. Die pharmakologische Hemmung des Hippo-Signalweges reduziert die Entstehung der chronisch biliären Fibrose im Abcb4-/- Model durch eine Modulation der Aktivierung von hepatischen Sternzellen
- Author
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Alexander L. Gerbes, Andrea Ofner, Andreas Ziesch, Y He, Gerald Denk, Julia Mayerle, Khaled N Ben, Changhua Zhang, Tobias S. Schiergens, Doris Mayr, Ralf Wimmer, Florian P. Reiter, Hanno Nieß, Ujjwal M. Mahajan, E de Toni, Liangtao Ye, and Simon Hohenester
- Published
- 2021
33. Ashwagandha-Induced Liver Injury: Self-Reports on Commercial Websites as Useful Adjunct Tools for Causality Assessment
- Author
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Alexander L. Gerbes and Sabine Weber
- Subjects
Liver injury ,medicine.medical_specialty ,Hepatology ,business.industry ,Plant Extracts ,Gastroenterology ,MEDLINE ,medicine.disease ,Causality ,Adjunct ,Chemical and Drug Induced Liver Injury, Chronic ,medicine ,Humans ,Self Report ,Chemical and Drug Induced Liver Injury ,Intensive care medicine ,business - Published
- 2021
34. Drug-induced liver injury under immune checkpoint inhibitors – The challenge of causality assessment
- Author
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Alexander L. Gerbes, Sabine Weber, Kowcee Jalal, Hélène Bourhis, Andreas Benesic, and Masatoshi Ishigami
- Subjects
Drug ,Liver injury ,business.industry ,media_common.quotation_subject ,Immune checkpoint inhibitors ,Immunology ,Medicine ,business ,medicine.disease ,Causality ,media_common - Published
- 2021
35. Die Bedeutung des YAP-1/CTGF-Signalwegs für die Aktivierung von humanen hepatischen Sternzellen und für die Leberfibrogenese im Menschen
- Author
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Florian P. Reiter, Changhua Zhang, Alexander L. Gerbes, Julia Mayerle, Liangtao Ye, E de Toni, Tobias S. Schiergens, Doris Mayr, Gerald Denk, Renate Artmann, Y He, and Andreas Ziesch
- Published
- 2021
36. Presence and high titers of antinuclear antibodies do not correlate with clinical severity nor outcome in patients with drug-induced liver injury
- Author
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Alexander L. Gerbes, Isabelle Rotter, Andreas Benesic, Marie-Luise Buchholtz, and Sabine Weber
- Subjects
Liver injury ,Drug ,medicine.medical_specialty ,Anti-nuclear antibody ,business.industry ,media_common.quotation_subject ,medicine.disease ,Gastroenterology ,Titer ,Internal medicine ,Medicine ,In patient ,Clinical severity ,business ,media_common - Published
- 2021
37. Drug‐Induced Liver Injury by Checkpoint Inhibitors: Benefit of a Causality Assessment Tool
- Author
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Andreas Benesic, Sabine Weber, Alexander L. Gerbes, and Masatoshi Ishigami
- Subjects
Drug ,Liver injury ,Hepatology ,business.industry ,Immune checkpoint inhibitors ,media_common.quotation_subject ,MEDLINE ,Bioinformatics ,medicine.disease ,Causality ,Correspondence ,Medicine ,lcsh:Diseases of the digestive system. Gastroenterology ,lcsh:RC799-869 ,business ,media_common - Published
- 2020
38. Severe liver failure during SARS-CoV-2 infection
- Author
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Julia Mayerle, Sabine Weber, Michael Irlbeck, and Alexander L. Gerbes
- Subjects
0301 basic medicine ,Ramipril ,medicine.medical_specialty ,business.industry ,Gastroenterology ,Emergency department ,Azithromycin ,medicine.disease_cause ,medicine.disease ,Tazobactam ,03 medical and health sciences ,Liver disease ,030104 developmental biology ,0302 clinical medicine ,Hydrochlorothiazide ,Internal medicine ,medicine ,030211 gastroenterology & hepatology ,business ,medicine.drug ,Piperacillin ,Coronavirus - Abstract
We read with interest the recently described affections of the GI system in coronavirus disease (COVID-19).1 2 In addition to the effects on the gut, mild abnormalities in liver aminotransferase levels have been observed.3 4 We here report a previously non-described severe liver failure in a patient with COVID-19. A 65-year-old man was admitted to our emergency department with fever up to 40°C, dry cough and dyspnoea. The chest CT scan showed typical features of COVID-19, such as ground-glass opacities and peripheral consolidations. A throat swab confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Aminotransferase concentrations were slightly increased (alanine aminotransferase (ALT) 69 U/L and aspartate aminotransferase (AST) 92 U/L; upper limit of normal (ULN) ≤49 U/L). He had been receiving long-term treatment with hydrochlorothiazide and ramipril for arterial hypertension as sole medications and had no history of liver disease. The patient was admitted to the isolation ward and was given supplementary oxygen. He received piperacillin/tazobactam and azithromycin according to hospital standards, as well as paracetamol (1 g, up to two times per day). …
- Published
- 2020
39. Early ALT response to corticosteroid treatment distinguishes idiosyncratic drug‐induced liver injury from autoimmune hepatitis
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Andreas Benesic, Sabine Weber, Alexander L. Gerbes, and Isabelle Rotter
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Adult ,Male ,Drug ,medicine.medical_specialty ,media_common.quotation_subject ,Corticosteroid treatment ,Autoimmune hepatitis ,Severity of Illness Index ,Gastroenterology ,Diagnosis, Differential ,Young Adult ,Adrenal Cortex Hormones ,immune system diseases ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Alanine aminotransferase ,Aged ,media_common ,Acute liver injury ,Liver injury ,Hepatology ,business.industry ,Alanine Transaminase ,Middle Aged ,medicine.disease ,digestive system diseases ,Current analysis ,Hepatitis, Autoimmune ,Toxicity ,Female ,Chemical and Drug Induced Liver Injury ,business - Abstract
Background Drug‐induced liver injury (DILI) and idiopathic autoimmune hepatitis (AIH) are competing diagnoses in patients with acute liver injury (ALI) and drug intake. In absence of unequivocal markers, scores like RUCAM and AIH are used to distinguish both entities. However, in some cases the diagnosis remains ambiguous. Our aim was to identify a simple parameter to discriminate DILI and AIH shortly after starting corticosteroid treatment. Methods For the current analysis, 44 patients with ALI who took at least one drug and who received corticosteroids were included and comprised 22 DILI and 22 AIH cases. Scores of AIH and RUCAM were calculated at initial presentation, the final diagnosis was made from analysing the course of disease. Changes in the serum alanine aminotransferase (ALT) concentrations after starting corticosteroid treatment were determined and compared between the DILI and AIH groups. Results Fifty‐nine per cent of patients (n = 26) were correctly classified at presentation by AIH score and RUCAM respectively. However, in one‐third (n = 13) of the 44 patients, results were inconclusive and five other patients were misclassified. The decrease in ALT levels 1 week after the initiation of steroid therapy was significantly more pronounced in patients with the final diagnosis of DILI than in AIH patients (accuracy 77%). This difference was also observed in the 18 initially misclassified or inconclusive cases (accuracy 83%). Conclusion Short‐term response of ALT to corticosteroid therapy helps to differentiate DILI and AIH. This finding may be helpful in treatment decision for patients with inconclusive diagnostic scores.
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- 2019
40. Predictors of ribociclib-mediated antitumour effects in native and sorafenib-resistant human hepatocellular carcinoma cells
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Enrico N. De Toni, Tobias S. Schiergens, Timo Itzel, Liangtao Ye, Florian P. Reiter, Ralf Wimmer, Andreas Teufel, Matilde Pia Spampatti, Andrea Ofner, Simon Hohenester, Andreas Ziesch, Alexander L. Gerbes, Gerald Denk, Julia Mayerle, and S Munker
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0301 basic medicine ,Sorafenib ,Cancer Research ,Carcinoma, Hepatocellular ,Cell Survival ,Aminopyridines ,Antineoplastic Agents ,Apoptosis ,Retinoblastoma Protein ,03 medical and health sciences ,0302 clinical medicine ,Cyclin-dependent kinase ,Cell Line, Tumor ,Biomarkers, Tumor ,medicine ,Humans ,Viability assay ,RNA, Small Interfering ,neoplasms ,Cyclin-Dependent Kinase Inhibitor p16 ,Cell Proliferation ,biology ,Cell growth ,Liver Neoplasms ,Retinoblastoma protein ,Cyclin-Dependent Kinase 4 ,Cyclin-Dependent Kinase 6 ,General Medicine ,Cell cycle ,G1 Phase Cell Cycle Checkpoints ,digestive system diseases ,030104 developmental biology ,Oncology ,Drug Resistance, Neoplasm ,Purines ,030220 oncology & carcinogenesis ,Hepatocytes ,biology.protein ,Cancer research ,Molecular Medicine ,Cyclin-dependent kinase 6 ,G1 phase ,medicine.drug - Abstract
The cyclin-dependent kinases (CDKs) CDK4 and CDK6 are important regulators of the cell cycle and represent promising targets in cancer treatment. We aimed to investigate the relevance of CDK4/6 in the development of hepatocellular carcinoma (HCC) and the potential of ribociclib, a novel orally available CDK4/6 inhibitor, as a treatment for HCC. The effect of ribociclib was assessed in native and sorafenib-resistant HCC cell lines using viability assays, colony formation assays and FACS-based analyses. The expression of potential biomarkers of ribociclib response was assessed in cell lines and primary human hepatocytes using Western blotting. In addition, the prognostic relevance of the cyclin D-CDK4/6-retinoblastoma protein (Rb) pathway was assessed by analysing mRNA expression data from The Cancer Genome Atlas (TCGA). We found that ribociclib downregulated Rb and caused a profound loss of cell viability by inducing G1 cell cycle arrest in HCC cell lines exhibiting Rb-high/p16-low protein expression profiles, but not in Rb-low/p16-high cells, regardless their sensitivity to sorafenib. siRNA-based Rb silencing decreased cell proliferation, but did not diminish the sensitivity of HCC cells to ribociclib. Furthermore, we found that ribociclib synergized with sorafenib to cause cell death. mRNA analysis of primary human HCC specimens showed that CDK4 expression was correlated with patient survival and that the expression of Rb and the p16-encoding CDKN2A gene were inversely correlated. From our data we conclude that impairment of the cyclin D-CDK4/6-Rb pathway is a frequent feature of HCC and that it is associated with a unfavourable prognosis. We also found that ribociclib exhibits a preferential antineoplastic activity in Rb-high HCC cells. Our results warrant further investigation of Rb and p16 expression as markers of HCC sensitivity to ribociclib.
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- 2019
41. Leitlinienreport zur aktualisierten S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) zu Komplikationen der Leberzirrhose
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Alexander L. Gerbes, Petra Lynen Jansen, Julia Jungnitsch, Pia van Leeuwen, and Joachim Labenz
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Gynecology ,medicine.medical_specialty ,business.industry ,Gastroenterology ,Medicine ,business - Published
- 2019
42. Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) 'Komplikationen der Leberzirrhose'
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Deutsche Gesellschaft für Interventionelle Radiologie und minimal-invasive Therapie, A Zipprich, Reiner Wiest, Felix Gundling, Christian J. Steib, Deutsche Gesellschaft für Allgemein und Viszeralchirurgie, Jonel Trebicka, Joachim Labenz, Deutsche Gesellschaft für Nephrologie, Petra Lynen-Jansen, Alexander L. Gerbes, Matthias Dollinger, Axel Holstege, Beate Appenrodt, Bdp, V Bundesverband deutscher Pathologen e., and Veit Gülberg
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medicine.medical_specialty ,Evidence-based practice ,Cirrhosis ,business.industry ,MEDLINE ,Gastroenterology ,Guideline ,medicine.disease ,language.human_language ,German ,Patient support ,03 medical and health sciences ,0302 clinical medicine ,medicine ,language ,030211 gastroenterology & hepatology ,030212 general & internal medicine ,Intensive care medicine ,business ,Hepatic encephalopathy - Abstract
ZusammenfassungDie Leitlinie Komplikationen der Leberzirrhose der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) ersetzt die Leitlinie aus dem Jahr 2011. Sie basiert auf den Empfehlungen der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) für eine evidenzbasierte Konsensus-Leitlinie der Entwicklungsstufe S2k und wurde interdisziplinär unter Beteiligung aller relevanten Fachgesellschaften und der Patientenvertretung erstellt. Neben den in der Vorgängerversion behandelten Kapiteln Aszites, spontan bakterielle Peritonitis, hepatorenales Syndrom, hepatischer Hydrothorax und hepatopulmonales Syndrom wurden die Kapitel Diagnostik und Therapie der Hepatischen Enzephalopathie neu aufgenommen.
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- 2019
43. The PI3K inhibitor copanlisib synergizes with sorafenib to induce cell death in hepatocellular carcinoma
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Enrico N. De Toni, Florian P. Reiter, Andreas Ziesch, Julia Mayerle, Alexander L. Gerbes, and Liangtao Ye
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0301 basic medicine ,MAPK/ERK pathway ,Sorafenib ,Cancer Research ,Cell cycle checkpoint ,Immunology ,Cell ,lcsh:RC254-282 ,Article ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,chemistry.chemical_compound ,0302 clinical medicine ,Cyclin D1 ,medicine ,lcsh:QH573-671 ,Protein kinase B ,neoplasms ,PI3K/AKT/mTOR pathway ,Copanlisib ,business.industry ,lcsh:Cytology ,Cell Biology ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,female genital diseases and pregnancy complications ,digestive system diseases ,030104 developmental biology ,medicine.anatomical_structure ,chemistry ,030220 oncology & carcinogenesis ,Cancer research ,business ,medicine.drug - Abstract
Sorafenib, a multikinase inhibitor targeting the Ras/Raf/MAPK (mitogen-activated protein kinase) and vascular endothelial growth factor signaling pathways is an established treatment option for patients with advanced-stage hepatocellular carcinoma (HCC); however, despite its clinical benefit, chemoresistance and disease progression eventually occur almost invariably during treatment. Activation of the PI3K/AKT (phosphatidylinositol-3-kinase/serine/threonine kinase) pathway plays a role in the pathogenesis of HCC and may contribute to determine resistance to sorafenib. We thus evaluated in vitro the effects of the combination of sorafenib and copanlisib, a PI3K inhibitor recently approved for clinical use. The effects of copanlisib alone and in combination with sorafenib were assessed in several HCC cell lines by proliferation and colony formation assays, fluorescence-activated cell sorting analyses, and western blot. In addition, sorafenib-resistant cell clones were used. Copanlisib strongly reduced cell viability and colony formation in different native and sorafenib-resistant HCC cell lines by affecting cyclin D1/CDK4/6 signaling and causing cell cycle arrest. Elevation of phosphorylated (p)-AKT was observed upon incubation with sorafenib and was consistently found in six different unstimulated sorafenib-resistant cell clones. Copanlisib counteracted sorafenib-induced phosphorylation of p-AKT and synergistically potentiated its antineoplastic effect. In summary, copanlisib shows potent anticancer activity as a single agent and acts synergistically in combination with sorafenib in human HCC. Combination of sorafenib with copanlisib represents a rational potential therapeutic option for advanced HCC.
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- 2019
44. Age independent survival benefit for patients with hepatocellular carcinoma (HCC) without metastases at diagnosis: a population-based study
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Helmut Friess, Jens Ricke, Wolfgang Schepp, Fabian Geisler, Jutta Engel, Ursula Ehmer, Julia Mayerle, Martin Fuchs, Anne Schlesinger-Raab, Alexander L. Gerbes, Enrico N. De Toni, P Paprottka, and Jens Werner
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Male ,Gadolinium DTPA ,Oncology ,medicine.medical_specialty ,Prognostic variable ,Carcinoma, Hepatocellular ,real-life-data ,Kaplan-Meier Estimate ,Disease ,survival ,Germany ,Internal medicine ,medicine ,Data Systems ,Humans ,Early Detection of Cancer ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Cause of death ,Aged, 80 and over ,Hepatology ,Relative survival ,business.industry ,Incidence ,Incidence (epidemiology) ,Liver Neoplasms ,Gastroenterology ,hepatocellular carcinoma ,Middle Aged ,Prognosis ,medicine.disease ,ddc ,Cancer registry ,Survival Rate ,Survival benefit ,Liver ,Hepatocellular carcinoma ,Female ,business ,tumor stage - Abstract
ObjectiveHepatocellular carcinoma (HCC) is a major cause of death worldwide and its incidence is expected to increase globally. Aim of this study was to assess whether the implementation of screening policies and the improvement of treatment options translated into a real-world survival benefit in HCC patients.Design4078 patients diagnosed with HCC between 1998 and 2016 from the Munich Cancer Registry were analysed. Tumour characteristics and outcome were analysed by time period and according to age and presence of metastases at diagnosis. Overall survival (OS) was analysed using Kaplan-Meier method and relative survival (RS) was computed for cancer-specific survival. Cox proportional hazard models were conducted to control for prognostic variables.ResultsWhile incidence of HCC remained substantially stable, tumours were diagnosed at increasingly earlier stages, although the median age at diagnosis increased. The 3 years RS in HCC improved from 19.8% in 1998–2002, 22.4% in 2003–2007, 30.6% in 2008–2012 up to 31.0% in 2013–2016. Median OS increased from 6 months in 1998–2002 to 12 months in 2008–2016. However, analysis according to the metastatic status showed that survival improved only in patients without metastases at diagnosis whereas the prognosis of patients with metastatic disease remained unchanged.ConclusionThese real-world data show that, in contrast to the current assumptions, the incidence of HCC did not increase in a representative German region. Earlier diagnosis, likely related to the implementation of screening programmes, translated into an increasing employment of effective therapeutic options and a clear survival benefit in patients without metastases at diagnosis, irrespective of age.
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- 2019
45. Inhibition of Cyclin‐Dependent Kinase 5: A Strategy to Improve Sorafenib Response in Hepatocellular Carcinoma Therapy
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Veronika Kanitz, Thorsten Lehr, Laura Posselt, Alexander L. Gerbes, Martin Müller, Simon Rothenfußer, Thomas Fröhlich, Lars M. König, Carina Atzberger, Emanuele Martini, Jan-Georg Wojtyniak, Georg J. Arnold, Stefan Zahler, Doris Mayr, Johanna Pachmayr, Melanie Ulrich, Dario Parazzoli, Petra Cantonati, Angelika M. Vollmar, Giorgio Scita, Maximilian A. Ardelt, and Martina Meßner
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0301 basic medicine ,Sorafenib ,Carcinoma, Hepatocellular ,Cellular homeostasis ,Small hairpin RNA ,Mice ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Growth factor receptor ,Liver Biology/Pathobiology ,Tumor Cells, Cultured ,medicine ,Animals ,Humans ,Dinaciclib ,Protein Kinase Inhibitors ,neoplasms ,Gene knockdown ,Hepatology ,business.industry ,Cyclin-dependent kinase 5 ,Liver Neoplasms ,Cyclin-Dependent Kinase 5 ,Original Articles ,medicine.disease ,digestive system diseases ,Treatment Outcome ,030104 developmental biology ,nervous system ,chemistry ,Hepatocellular carcinoma ,Cancer research ,Original Article ,Female ,030211 gastroenterology & hepatology ,business ,medicine.drug - Abstract
Therapeutic options for patients with advanced-stage hepatocellular carcinoma (HCC) are very limited. The only approved first-line treatment is the multi-tyrosine kinase inhibitor sorafenib, which shows low response rates and severe side effects. In particular, the compensatory activation of growth factor receptors leads to chemoresistance and limits the clinical impact of sorafenib. However, combination approaches to improve sorafenib have failed. Here we investigate the inhibition of cyclin-dependent kinase 5 (Cdk5) as a promising combination strategy to improve sorafenib response in HCC. Combination of sorafenib with Cdk5 inhibition (genetic knockdown by short hairpin RNA or CRISPR/Cas9 and pharmacologic inhibition) synergistically impaired HCC progression in vitro and in vivo by inhibiting both tumor cell proliferation and migration. Importantly, these effects were mediated by a mechanism for Cdk5: A liquid chromatography-tandem mass spectrometry-based proteomic approach revealed that Cdk5 inhibition interferes with intracellular trafficking, a process crucial for cellular homeostasis and growth factor receptor signaling. Cdk5 inhibition resulted in an accumulation of enlarged vesicles and respective cargos in the perinuclear region, considerably impairing the extent and quality of growth factor receptor signaling. Thereby, Cdk5 inhibition offers a comprehensive approach to globally disturb growth factor receptor signaling that is superior to specific inhibition of individual growth factor receptors. Conclusion: Cdk5 inhibition represents an effective approach to improve sorafenib response and to prevent sorafenib treatment escape in HCC. Notably, Cdk5 is an addressable target frequently overexpressed in HCC, and with Dinaciclib, a clinically tested Cdk5 inhibitor is readily available. Thus, our study provides evidence for clinically evaluating the combination of sorafenib and Dinaciclib to improve the therapeutic situation for patients with advanced-stage HCC.
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- 2018
46. Liver function test abnormalities at hospital admission are associated with severe course of SARS-CoV-2 infection: a prospective cohort study
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Alexander L. Gerbes, Johannes C. Hellmuth, Julia Mayerle, Sabine Weber, Clemens Scherer, and Maximilian Muenchhoff
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0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Severity of Illness Index ,law.invention ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Liver Function Tests ,law ,Risk Factors ,Internal medicine ,Severity of illness ,medicine ,Humans ,Aspartate Aminotransferases ,Prospective Studies ,Risk factor ,Prospective cohort study ,Aged ,Mechanical ventilation ,Aged, 80 and over ,medicine.diagnostic_test ,biology ,business.industry ,SARS-CoV-2 ,Liver Diseases ,Gastroenterology ,COVID-19 ,Alanine Transaminase ,gamma-Glutamyltransferase ,Middle Aged ,medicine.disease ,Intensive care unit ,Hospitalization ,030104 developmental biology ,Alanine transaminase ,biology.protein ,030211 gastroenterology & hepatology ,Female ,Liver function tests ,business ,Biomarkers - Abstract
ObjectiveLiver injury has frequently been reported in COVID-19 patients. The clinical relevance of liver injury related to SARS-CoV-2 infection remains unclear with a need for prospective studies on the impact of liver function test (LFT) abnormalities at baseline.DesignData of 217 patients without pre-existing liver disease prospectively included in the COVID-19 registry of the LMU university hospital were analysed in order to assess the association of abnormal LFT at admission and course of the disease. Severe course was defined as admission to the intensive care unit (ICU) or as COVID-19-related death.ResultsAbnormal LFT at baseline was present in 58% of patients, with a predominant elevation of aspartate aminotransferase (AST) (42%), gamma-glutamyltransferase (GGT) (37%) and alanine aminotransferase (ALT) (27%), hypoalbuminaemia was observed in 33%. Elevation of ALT and GGT, as well as hypoalbuminaemia, was associated with higher proportions of patients requiring ICU treatment and mechanical ventilation. After adjusting for age, gender and comorbidities, hypoalbuminaemia combined with abnormal AST or GGT at hospital admission was a highly significant independent risk factor for ICU admission (OR 46.22 and 38.8, respectively) and for a composite endpoint of ICU admission and/or COVID-19-related death (OR 42.0 and 26.9, respectively).ConclusionAbnormal LFTs at hospital admission, in particular GGT and albumin, are associated with a severe course of SARS-CoV-2 infection.
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- 2021
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47. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis
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William Bernal, Agustín Albillos, Alex Amoros, Wim Laleman, Michael Manns, Javier Martínez, Maximilian J. Brol, Pere Ginès, Alessandra Pohlmann, Joerg Tobiasch Moritz, Francois Smits, Elisabet Garcia-Lopez, Joan Clària, Jennifer Lehmann, Jonel Trebicka, Christoph Welsch, Vicente Arroyo, Richard Moreau, Tony Bruns, Monica Mesquita, Christian Jansen, Peter Jarcuska, Harald Rupprechter, Martin Janicko, Thierry Gustot, Macarena Simón-Talero, Giacomo Zaccherini, Cristina Ripoll, Luise Aamann, Oliviero Riggio, Martina Rizzo, Karen Vagner Danielsen, Javier Romaní Fernández, Jelte J Schaapman, Frank Erhard Uschner, Juan Acevedo, Miguel Á. Rodríguez, David Semela, Carlo Alessandria, Carmine Gambino, Lise Lotte Gluud, Paolo Caraceni, Emanuela Ciraci, István Altorjay, Cristina Solé, Salvatore Piano, Minneke J. Coenraad, Pierre Nahon, Haluk Tarik Kani, Faouzi Saliba, Agnese Antognoli, Andrea De Gottardi, Osman Ozdogan, Henning Grønbæk, Christian J. Steib, Anna Curto, Hans Van Vlierberghe, Manuel Romero-Gómez, T.M. Welzel, Roland Amathieu, Sylvie Tresson, Carla Pitarch, Frederik Nevens, Alexander Zipprich, Christian Trautwein, Ilaria Giovo, Victor Vargas, Laure Elkrief, Giorgio Maria Saracco, Johannes Chang, Mattias Mandorfer, Paul Horn, Thomas Berg, Nesrine Amari, Sara Mareso, Heinz Zoller, Osagie Akpata, Mária Papp, Adam Herber, Thomas Reiberger, Flemming Bendtsen, Elsa Solà, Ferran Aguilar, Jose Presa Ramos, Miriam Maschmeier, Tamas Tornai, Manuela Merli, Rajiv Jalan, Martina Gagliardi, Cornelius Engelmann, Rafael Bañares, Daniela Campion, Antonella Putignano, Natalie Van den Ende, Claire Francoz, Marco Pavesi, Paola Ponzo, Rita Garcia, Sven Francque, Vish Patel, Esau Moreno, Alessandra Brocca, Rudolf E. Stauber, Zsuzsanna Vitális, Rajeshwar P. Mookerjee, Ahmed Elsharkawy, Eleonora Bertoli, Michael Praktiknjo, Stephen D. Ryder, Cristina Sanchez, Boglarka Balogh, Debbie L. Shawcross, Manuel Tufoni, Paolo Angeli, Florian Rainer, Pavel Strnad, István Tornai, Edilmar Alvarado-Tapias, Alexander L. Gerbes, Didier Samuel, Maurizio Baldassarre, Cesar Jimenez, Stefan Zeuzem, Pietro Gatti, Germán Soriano, Robert Schierwagen, Ana Clemente, Mauro Bernardi, Daniel Markwardt, Trebicka, Jonel, Fernandez, Javier, Papp, Maria, Caraceni, Paolo, Laleman, Wim, Gambino, Carmine, Giovo, Ilaria, Uschner, Frank Erhard, Jansen, Christian, Jimenez, Cesar, Mookerjee, Rajeshwar, Gustot, Thierry, Albillos, Agustin, Bañares, Rafael, Jarcuska, Peter, Steib, Christian, Reiberger, Thoma, Acevedo, Juan, Gatti, Pietro, Shawcross, Debbie L, Zeuzem, Stefan, Zipprich, Alexander, Piano, Salvatore, Berg, Thoma, Bruns, Tony, Danielsen, Karen Vagner, Coenraad, Minneke, Merli, Manuela, Stauber, Rudolf, Zoller, Heinz, Ramos, José Presa, Solé, Cristina, Soriano, Germán, de Gottardi, Andrea, Gronbaek, Henning, Saliba, Faouzi, Trautwein, Christian, Kani, Haluk Tarik, Francque, Sven, Ryder, Stephen, Nahon, Pierre, Romero-Gomez, Manuel, Van Vlierberghe, Han, Francoz, Claire, Manns, Michael, Garcia-Lopez, Elisabet, Tufoni, Manuel, Amoros, Alex, Pavesi, Marco, Sanchez, Cristina, Praktiknjo, Michael, Curto, Anna, Pitarch, Carla, Putignano, Antonella, Moreno, Esau, Bernal, William, Aguilar, Ferran, Clària, Joan, Ponzo, Paola, Vitalis, Zsuzsanna, Zaccherini, Giacomo, Balogh, Boglarka, Gerbes, Alexander, Vargas, Victor, Alessandria, Carlo, Bernardi, Mauro, Ginès, Pere, Moreau, Richard, Angeli, Paolo, Jalan, Rajiv, Arroyo, Vicente, Banares, Rafael, Reiberger, Thomas, Shawcross, Debbie L., Berg, Thomas, Ramos, Jose Presa, Sole, Cristina, Soriano, German, Van Vlierberghe, Hans, Claria, Joan, Gines, Pere, Maschmeier, Miriam, Semela, David, Elkrief, Laure, Elsharkawy, Ahmed, Tornai, Tamas, Tornai, Istvan, Altorjay, Istvan, Antognoli, Agnese, Baldassarre, Maurizio, Gagliardi, Martina, Bertoli, Eleonora, Mareso, Sara, Brocca, Alessandra, Campion, Daniela, Saracco, Giorgio Maria, Rizzo, Martina, Lehmann, Jennifer, Pohlmann, Alessandra, Brol, Maximilian J., Chang, Johannes, Schierwagen, Robert, Sola, Elsa, Amari, Nesrine, Rodriguez, Miguel, Nevens, Frederik, Clemente, Ana, Janicko, Martin, Markwardt, Daniel, Mandorfer, Mattias, Welsch, Christoph, Welzel, Tanja M., Ciraci, Emanuela, Patel, Vish, Ripoll, Cristina, Herber, Adam, Horn, Paul, Bendtsen, Flemming, Gluud, Lise Lotte, Schaapman, Jelte, Riggio, Oliviero, Rainer, Florian, Moritz, Joerg Tobiasch, Mesquita, Monica, Alvarado-Tapias, Edilmar, Akpata, Osagie, Aamann, Luise, Samuel, Didier, Tresson, Sylvie, Strnad, Pavel, Amathieu, Roland, Simon-Talero, Macarena, Smits, Francois, van den Ende, Natalie, Martinez, Javier, Garcia, Rita, Rupprechter, Harald, Engelmann, Cornelius, and Ozdogan, Osman Cavit
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0301 basic medicine ,Liver Cirrhosis ,Male ,Cirrhosis ,Organ Dysfunction Scores ,acute complication ,Chronic liver disease ,Acute complications ,Non-elective admission ,Outcome ,Risk factors ,0302 clinical medicine ,Preventive Health Services ,Medicine and Health Sciences ,Gastro-entérologie ,risk factors ,610 Medicine & health ,Medical History Taking ,factors ,Toxic encephalopathy ,Bacterial Infections ,Middle Aged ,Prognosis ,Europe ,Cohort ,Disease Progression ,outcome ,030211 gastroenterology & hepatology ,Female ,medicine.symptom ,Needs Assessment ,Risk ,medicine.medical_specialty ,Alcoholic hepatitis ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Decompensation ,Medical history ,Inflammation ,Hepatology ,business.industry ,Hepatitis, Alcoholic ,Organ dysfunction ,Acute-On-Chronic Liver Failure ,chronic liver disease ,medicine.disease ,Precipitating Factors ,030104 developmental biology ,Human medicine ,business ,non-elective admission - Abstract
Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF phenotype (AD-ACLF) defined by organ failure(s). Precipitants may induce AD. This multicenter, prospective, observational PREDICT study (NCT03056612) analyzes and characterizes the precipitants leading to both of these AD phenotypes., info:eu-repo/semantics/published
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- 2021
48. Anschriften der Herausgeber und Autoren
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Reinhard Brunkhorst, Jürgen Schölmerich, Hans-Dieter Allescher, Thomas Berger, Peter Berlit, Franziska Bertram, Cornelius Bollheimer, Herbert Bruckmayer, Peter Brunotte, Roland Büttner, Klaus-Peter Czudaj, Dominic Dellweg, Matthias Dollinger, Dorothee Dorlars, Matthias Ebert, Matthias Eder, Esther Endlicher, Markus Fahlbusch, Peter Fickert, Gabriele Fluhr, Tobias Freundt, Baptist Gallwitz, Mirja Geelvink, Alexander L. Gerbes, Jens Gerth, Beate Gleissner, Thomas Glück, Stefan K. Gölder, Laura Gottschalk, Oliver Gross, Dietrich Gulba, Marianne Haag-Weber, Viola Hach-Wunderle, Michael Hamm, Thomas R.W. Herrmann, Walter Hermann, Felix J.F. Herth, Mirja Hickstein, Silke Hörnschemeyer-Decker, Axel Holstege, Oliver Kastrup, Ahmed A. Khattab, Jutta Keller, Philipp Klemm, Gunnar Klein, Stefan Köppen, Michael Kreuter, Markus A. Kuczyk, Frank Lammert, Ulf Landmesser, Thea Laurentius, Markus Lerch, Guntram Lock, J.-Matthias Löhr, Hans Peter Lorenzen, Gert Mayer, Stephanie Mayer, Julia Mayerle, Martina Mayr, Axel S. Merseburger, Gerhard A. Müller, Ulf Müller-Ladner, Karsten Müssig, Ralph Naumann, Michael Nebel, Jost Niedermeyer, Florian Obermeier, Peter Otto, Jens Panse, Klaus G. Parhofer, Susanne Petri, Michael Pfeifer, Antje Prasse, Ulrike Raap, Walter Reinisch, Gert Richardt, Katrin Richter-Bastian, Felix Rockmann, Bernd Salzberger, Tilman Sauerbruch, Philippe Schafhausen, Carsten Schmidt, Bernd Schönhofer, Friedrich Schorr, Christoph Schrader, Michael Schumann, Andreas Schwartz, Jochen Seufert, Britta Siegmund, Peter Simon, Peter Staib, Andreas Stallmach, Erwin Stark, Bernhard Steinhoff, Johannes Strunk, Ingo H. Tarner, Christian Teschendorf, Theodoros Thomas, Herbert Tilg, Ralph Tölg, Michael Trauner, Jenny Unterkofler, Peter Wagener, Manuel Wallbach, Thomas Weiss, Fritz von Weizsäcker, Martin Welker, Hans-Jürgen Welkoborsky, Tobias Welte, Burkhard Wiechens, Uwe Wiegand, Reiner Wiest, Jürgen Wilke, Ulrike Woenckhaus, Gunter Wolf, and Christian Wrede
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- 2021
49. Risk of recurrent hepatic encephalopathy in patients with liver cirrhosis : A German registry study
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H Mix, Maria von Karpowitz, Benjamin Seeliger, T.M. Welzel, Alexander L. Gerbes, Peter Buggisch, Daniel Markwardt, Heiner Wedemeyer, Heinz Hartmann, Kurt Grüngreiff, Maria M. Gabriel, Julia Kälsch, Karin Weissenborn, Gerald Kircheis, and Svenja Hardtke
- Subjects
Liver Cirrhosis ,medicine.medical_specialty ,Cirrhosis ,Psychometrics ,Medizin ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Internal medicine ,Statistical significance ,medicine ,Clinical endpoint ,Humans ,Prospective Studies ,Registries ,Risk factor ,Hepatic encephalopathy ,Hepatology ,business.industry ,Gastroenterology ,medicine.disease ,030220 oncology & carcinogenesis ,Hepatic Encephalopathy ,Cohort ,Quality of Life ,030211 gastroenterology & hepatology ,Observational study ,business - Abstract
BACKGROUND AND AIMS Patients with hepatic encephalopathy (HE) show low quality of life, recurrent hospitalizations and an increased mortality. We aimed to assess the natural course of patients after a recent episode of overt HE and to identify risk factors for HE recurrence in Germany. METHODS Fifteen sites took part in a prospective, observational study including patients with liver cirrhosis who had been hospitalized for HE within 3 months before recruitment. Clinical data, psychometric hepatic encephalopathy score (PHES) and critical flicker frequency were assessed quarterly for 1 year. Primary endpoint was HE recurrence requiring hospitalization, all-cause-mortality was treated as a competing risk factor. RESULTS From January 2014 to March 2016, a total of 115 patients were recruited. Overall 14 premature deaths were documented. For 78 subjects follow-up data were available in accordance with the protocol. After a median of 118 days, more than half of the per-protocol cohort was readmitted to hospital due to HE (N = 34) or died (N = 11). The risk for hospitalization was significantly increased in patients who had been recruited by liver transplant centers (P = 0.003), had had frequent HE relapses prior to recruitment (P =
- Published
- 2021
50. A Simple Prognostic Scoring System for Hepatocellular Carcinoma Treated with Selective Internal Radiation Therapy
- Author
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Manuel A de la Torre Aláez, Stephanie-Susanne Stecher, Hélène Bourhis, Enrico N. De Toni, Alexander L. Gerbes, Jens Ricke, Mark op den Winkel, Dorothea Nagel, Philip op den Winkel, Stephanie Hempe, Frank T. Kolligs, K.J. Paprottka, and Bruno Sangro
- Subjects
Oncology ,medicine.medical_specialty ,Scoring system ,Carcinoma, Hepatocellular ,business.industry ,Selective internal radiation therapy ,Hazard ratio ,Liver Neoplasms ,Gastroenterology ,General Medicine ,University hospital ,medicine.disease ,Prognosis ,Confidence interval ,Internal medicine ,Hepatocellular carcinoma ,Cohort ,medicine ,Humans ,business ,Median survival ,Neoplasm Staging ,Retrospective Studies - Abstract
Introduction: Selective internal radiation therapy (SIRT) is a local treatment option for patients with hepatocellular carcinoma (HCC). Its exact role next to other HCC therapies has yet to be defined. In order to identify patients most suitable for SIRT, a SIRT-specific prognostic score should be developed. Methods: A cohort of 72 SIRT patients treated at the University Hospital of Munich was retrospectively analyzed. The prognostic performance of 12 HCC staging systems and prognostic scores was assessed. Cox-regression analysis was used to identify independent prognostic factors, which formed the basis of the Munich-SIRT score (M-SIRT). All scores were ranked by calculating the c-Index and Akaike information criterion (AIC). External validation was performed in a cohort of 128 SIRT patients treated at the University Hospital of Pamplona, Spain. Results: median overall survival was 13 months (95% confidence interval 9.9–21.9). AFP (p = 0.005; hazard ratio [HR] 2.38), albumin (p < 0.001; HR 5.87), and alkaline phosphatase (p < 0.001; HR 8.38) were identified as independent prognostic factors. M-SIRT comprises 3 prognostic groups with a median survival of 38.9, 14.6, and 7.7 months, respectively (I vs. II: p = 0.003, II vs. III: p < 0.001). AIC (318) and concordance index (0.711) ranked M-SIRT superior to the established HCC staging systems, and the score successfully passed external validation in an independent SIRT cohort (I vs. II: p = 0.03; II vs. III: p = 0.007). Conclusion: Therapy-specific prognostic scores can facilitate treatment decisions and prognostication for HCC patients. Considering its performance in 200 SIRT patients, M-SIRT is a promising prognostic tool for HCC patients evaluated for SIRT.
- Published
- 2020
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