@article{BelicPageLazariotouetal.2019, author = {Belic, Stanislav and Page, Lukas and Lazariotou, Maria and Waaga-Gasser, Ana Maria and Dragan, Mariola and Springer, Jan and Loeffler, Juergen and Morton, Charles Oliver and Einsele, Hermann and Ullmann, Andrew J. and Wurster, Sebastian}, title = {Comparative Analysis of Inflammatory Cytokine Release and Alveolar Epithelial Barrier Invasion in a Transwell® Bilayer Model of Mucormycosis}, series = {Frontiers in Microbiology}, volume = {9}, journal = {Frontiers in Microbiology}, doi = {10.3389/fmicb.2018.03204}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-252477}, year = {2019}, abstract = {Understanding the mechanisms of early invasion and epithelial defense in opportunistic mold infections is crucial for the evaluation of diagnostic biomarkers and novel treatment strategies. Recent studies revealed unique characteristics of the immunopathology of mucormycoses. We therefore adapted an alveolar Transwell® A549/HPAEC bilayer model for the assessment of epithelial barrier integrity and cytokine response to Rhizopus arrhizus, Rhizomucor pusillus, and Cunninghamella bertholletiae. Hyphal penetration of the alveolar barrier was validated by 18S ribosomal DNA detection in the endothelial compartment. Addition of dendritic cells (moDCs) to the alveolar compartment led to reduced fungal invasion and strongly enhanced pro-inflammatory cytokine response, whereas epithelial CCL2 and CCL5 release was reduced. Despite their phenotypic heterogeneity, the studied Mucorales species elicited the release of similar cytokine patterns by epithelial and dendritic cells. There were significantly elevated lactate dehydrogenase concentrations in the alveolar compartment and epithelial barrier permeability for dextran blue of different molecular weights in Mucorales-infected samples compared to Aspergillus fumigatus infection. Addition of monocyte-derived dendritic cells further aggravated LDH release and epithelial barrier permeability, highlighting the influence of the inflammatory response in mucormycosis-associated tissue damage. An important focus of this study was the evaluation of the reproducibility of readout parameters in independent experimental runs. Our results revealed consistently low coefficients of variation for cytokine concentrations and transcriptional levels of cytokine genes and cell integrity markers. As additional means of model validation, we confirmed that our bilayer model captures key principles of Mucorales biology such as accelerated growth in a hyperglycemic or ketoacidotic environment or reduced epithelial barrier invasion upon epithelial growth factor receptor blockade by gefitinib. Our findings indicate that the Transwell® bilayer model provides a reliable and reproducible tool for assessing host response in mucormycosis.}, language = {en} } @article{CarvalhoPereiraFernandesAraujoetal.2020, author = {Carvalho-Pereira, Joana and Fernandes, Filipa and Ara{\´u}jo, Ricardo and Springer, Jan and Loeffler, Juergen and Buitrago, Mar{\´i}a Jos{\´e} and Pais, C{\´e}lia and Sampaio, Paula}, title = {Multiplex PCR based strategy for detection of fungal pathogen DNA in patients with suspected invasive fungal infections}, series = {Journal of Fungi}, volume = {6}, journal = {Journal of Fungi}, number = {4}, issn = {2309-608X}, doi = {10.3390/jof6040308}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-219392}, year = {2020}, abstract = {A new and easy polymerase chain reaction (PCR) multiplex strategy, for the identification of the most common fungal species involved in invasive fungal infections (IFI) was developed in this work. Two panels with species-specific markers were designed, the Candida Panel for the identification of Candida species, and the Filamentous Fungi Panel for the identification of Aspergillus species and Rhizopusarrhizus. The method allowed the correct identification of all targeted pathogens using extracted DNA or by colony PCR, showed no cross-reactivity with nontargeted species and allowed identification of different species in mixed infections. Sensitivity reached 10 to 1 pg of DNA and was suitable for clinical samples from sterile sites, with a sensitivity of 89\% and specificity of 100\%. Overall, the study showed that the new method is suitable for the identification of the ten most important fungal species involved in IFI, not only from positive blood cultures but also from clinical samples from sterile sites. The method provides a unique characteristic, of seeing the peak in the specific region of the panel with the correct fluorescence dye, that aids the ruling out of unspecific amplifications. Furthermore, the panels can be further customized, selecting markers for different species and/or resistance genes.}, language = {en} } @article{DixCzakaiSpringeretal.2016, author = {Dix, Andreas and Czakai, Kristin and Springer, Jan and Fliesser, Mirjam and Bonin, Michael and Guthke, Reinhard and Schmitt, Anna L. and Einsele, Hermann and Linde, J{\"o}rg and L{\"o}ffler, J{\"u}rgen}, title = {Genome-Wide Expression Profiling Reveals S100B as Biomarker for Invasive Aspergillosis}, series = {Frontiers in Microbiology}, journal = {Frontiers in Microbiology}, number = {7}, doi = {10.3389/fmicb.2016.00320}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-165386}, pages = {320}, year = {2016}, abstract = {Invasive aspergillosis (IA) is a devastating opportunistic infection and its treatment constitutes a considerable burden for the health care system. Immunocompromised patients are at an increased risk for IA, which is mainly caused by the species Aspergillus fumigatus. An early and reliable diagnosis is required to initiate the appropriate antifungal therapy. However, diagnostic sensitivity and accuracy still needs to be improved, which can be achieved at least partly by the definition of new biomarkers. Besides the direct detection of the pathogen by the current diagnostic methods, the analysis of the host response is a promising strategy toward this aim. Following this approach, we sought to identify new biomarkers for IA. For this purpose, we analyzed gene expression profiles of hematological patients and compared profiles of patients suffering from IA with non-IA patients. Based on microarray data, we applied a comprehensive feature selection using a random forest classifier. We identified the transcript coding for the S100 calcium-binding protein B (S100B) as a potential new biomarker for the diagnosis of IA. Considering the expression of this gene, we were able to classify samples from patients with IA with 82.3\% sensitivity and 74.6\% specificity. Moreover, we validated the expression of S100B in a real-time reverse transcription polymerase chain reaction (RT-PCR) assay and we also found a down-regulation of S100B in A. fumigatus stimulated DCs. An influence on the IL1B and CXCL1 downstream levels was demonstrated by this S100B knockdown. In conclusion, this study covers an effective feature selection revealing a key regulator of the human immune response during IA. S100B may represent an additional diagnostic marker that in combination with the established techniques may improve the accuracy of IA diagnosis.}, language = {en} } @article{KesselHogardtAspacheretal.2022, author = {Kessel, Johanna and Hogardt, Michael and Aspacher, Lukas and Wichelhaus, Thomas A. and Gerkrath, Jasmin and Rosenow, Emely and Springer, Jan and Rickerts, Volker}, title = {Exclusion of Mucorales co-infection in a patient with Aspergillus flavus sinusitis by fluorescence in situ hybridization (FISH)}, series = {Journal of Fungi}, volume = {8}, journal = {Journal of Fungi}, number = {3}, issn = {2309-608X}, doi = {10.3390/jof8030306}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-267208}, year = {2022}, abstract = {Invasive fungal infections are associated with increased mortality in hematological patients. Despite considerable advances in antifungal therapy, the evaluation of suspected treatment failure is a common clinical challenge requiring extensive diagnostic testing to rule out potential causes, such as mixed infections. We present a 64-year-old patient with secondary AML, diabetes mellitus, febrile neutropenia, and sinusitis. While cultures from nasal tissue grew Aspergillus flavus, a microscopic examination of the tissue was suggestive of concomitant mucormycosis. However, fluorescence in situ hybridization (FISH) using specific probes targeting Aspergillus and Mucorales species ruled out mixed infection. This was confirmed by specific qPCR assays amplifying the DNA of Aspergillus, but not of Mucorales. These results provided a rational basis for step-down targeted therapy, i.e., the patient received posaconazole after seven days of calculated dual therapy with liposomal amphotericin B and posaconazole. Despite clinical response to the antifungal therapy, he died due to the progression of the underlying disease within two weeks after diagnosis of fungal infection. Molecular diagnostics applied to tissue blocks may reveal useful information on the etiology of invasive fungal infections, including challenging situations, such as with mixed infections. A thorough understanding of fungal etiology facilitates targeted therapy that may improve therapeutic success while limiting side effects.}, language = {en} } @article{LupianezVillaescusaCarvalhoetal.2016, author = {Lupia{\~n}ez, Carmen B. and Villaescusa, Maria T. and Carvalho, Agostinho and Springer, Jan and Lackner, Michaela and S{\´a}nchez-Maldonado, Jos{\´e} M. and Canet, Luz M. and Cunha, Cristina and Segura-Catena, Joana and Alcazar-Fuoli, Laura and Solano, Carlos and Fianchi, Luana and Pagano, Livio and Potenza, Leonardo and Aguado, Jos{\´e} M. and Luppi, Mario and Cuenca-Estrella, Manuel and Lass-Fl{\"o}rl, Cornelia and Einsele, Hermann and V{\´a}zquez, Lourdes and R{\´i}os-Tamayo, Rafael and Loeffler, J{\"u}rgen and Jurado, Manuel and Sainz, Juan}, title = {Common Genetic Polymorphisms within NF kappa B-Related Genes and the Risk of Developing Invasive Aspergillosis}, series = {Frontiers in Microbiology}, volume = {7}, journal = {Frontiers in Microbiology}, number = {1243}, doi = {10.3389/fmicb.2016.01243}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-165209}, year = {2016}, abstract = {Invasive Aspergillosis (IA) is an opportunistic infection caused by Aspergillus, a ubiquitously present airborne pathogenic mold. A growing number of studies suggest a major host genetic component in disease susceptibility. Here, we evaluated whether 14 single-nucleotide polymorphisms within NFκB1, NFκB2, RelA, RelB, Rel, and IRF4 genes influence the risk of IA in a population of 834 high-risk patients (157 IA and 677 non-IA) recruited through a collaborative effort involving the aspBIOmics consortium and four European clinical institutions. No significant overall associations between selected SNPs and the risk of IA were found in this large cohort. Although a hematopoietic stem cell transplantation (HSCT)-stratified analysis revealed that carriers of the IRF4rs12203592T/T genotype had a six-fold increased risk of developing the infection when compared with those carrying the C allele (ORREC = 6.24, 95\%CI 1.25-31.2, P = 0.026), the association of this variant with IA risk did not reach significance at experiment-wide significant threshold. In addition, we found an association of the IRF4AATC and IRF4GGTC haplotypes (not including the IRF4rs12203592T risk allele) with a decreased risk of IA but the magnitude of the association was similar to the one observed in the single-SNP analysis, which indicated that the haplotypic effect on IA risk was likely due to the IRF4rs12203592 SNP. Finally, no evidence of significant interactions among the genetic markers tested and the risk of IA was found. These results suggest that the SNPs on the studied genes do not have a clinically relevant impact on the risk of developing IA.}, language = {en} } @article{SchmidtEbnerRosenetal.2020, author = {Schmidt, Stefanie and Ebner, Friederike and Rosen, Kerstin and Kniemeyer, Olaf and Brakhage, Axel A. and L{\"o}ffler, J{\"u}rgen and Seif, Michelle and Springer, Jan and Schlosser, Josephine and Scharek-Tedin, Lydia and Scheffold, Alexander and Bacher, Petra and K{\"u}hl, Anja A. and R{\"o}sler, Uwe and Hartmann, Susanne}, title = {The domestic pig as human-relevant large animal model to study adaptive antifungal immune responses against airborne Aspergillus fumigatus}, series = {European Journal of Immunology}, volume = {50}, journal = {European Journal of Immunology}, number = {11}, doi = {10.1002/eji.201948524}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-216085}, pages = {1712 -- 1728}, year = {2020}, abstract = {Pulmonary mucosal immune response is critical for preventing opportunistic Aspergillus fumigatus infections. Although fungus-specific CD4\(^{+}\) T cells in blood are described to reflect the actual host-pathogen interaction status, little is known about Aspergillus-specific pulmonary T-cell responses. Here, we exploit the domestic pig as human-relevant large animal model and introduce antigen-specific T-cell enrichment in pigs to address Aspergillus-specific T cells in the lung compared to peripheral blood. In healthy, environmentally Aspergillus-exposed pigs, the fungus-specific T cells are detectable in blood in similar frequencies as observed in healthy humans and exhibit a Th1 phenotype. Exposing pigs to 10\(^{6}\) cfu/m\(^{3}\) conidia induces a long-lasting accumulation of Aspergillus-specific Th1 cells locally in the lung and also systemically. Temporary immunosuppression during Aspergillus-exposure showed a drastic reduction in the lung-infiltrating antifungal T-cell responses more than 2 weeks after abrogation of the suppressive treatment. This was reflected in blood, but to a much lesser extent. In conclusion, by using the human-relevant large animal model the pig, this study highlights that the blood clearly reflects the mucosal fungal-specific T-cell reactivity in environmentally exposed as well as experimentally exposed healthy pigs. But, immunosuppression significantly impacts the mucosal site in contrast to the initial systemic immune response.}, language = {en} } @article{SpringerHeldMengolietal.2021, author = {Springer, Jan and Held, J{\"u}rgen and Mengoli, Carlo and Schlegel, Paul Gerhardt and Gamon, Florian and Tr{\"a}ger, Johannes and Kurzai, Oliver and Einsele, Hermann and Loeffler, Juergen and Eyrich, Matthias}, title = {Diagnostic performance of (1→3)-β-D-glucan alone and in combination with aspergillus PCR and galactomannan in serum of pediatric patients after allogeneic hematopoietic stem cell transplantation}, series = {Journal of Fungi}, volume = {7}, journal = {Journal of Fungi}, number = {3}, issn = {2309-608X}, doi = {10.3390/jof7030238}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-234179}, year = {2021}, abstract = {Data on biomarker-assisted diagnosis of invasive aspergillosis (IA) in pediatric patients is scarce. Therefore, we conducted a cohort study over two years including 404 serum specimens of 26 pediatric patients after allogeneic hematopoietic stem cell transplantation (alloSCT). Sera were tested prospectively twice weekly for Aspergillus-specific DNA, galactomannan (GM), and retrospectively for (1→3)-β-D-glucan (BDG). Three probable IA and two possible invasive fungal disease (IFD) cases were identified using the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSGERC) 2019 consensus definitions. Sensitivity and specificity for diagnosis of probable IA and possible IFD was 80\% (95\% confidential interval (CI): 28-99\%) and 55\% (95\% CI: 32-77\%) for BDG, 40\% (95\% CI: 5-85\%) and 100\% (95\% CI: 83-100\%) for GM, and 60\% (95\% CI: 15-95\%) and 95\% (95\% CI: 75-100\%) for Aspergillus-specific real-time PCR. However, sensitivities have to be interpreted with great caution due to the limited number of IA cases. Interestingly, the low specificity of BDG was largely caused by false-positive BDG results that clustered around the date of alloSCT. The following strategies were able to increase BDG specificity: two consecutive positive BDG tests for diagnosis (specificity 80\% (95\% CI: 56-94\%)); using an optimized cutoff value of 306 pg/mL (specificity 90\% (95\% CI: 68-99\%)) and testing BDG only after the acute posttransplant phase. In summary, BDG can help to diagnose IA in pediatric alloSCT recipients. However, due to the poor specificity either an increased cutoff value should be utilized or BDG results should be confirmed by an alternative Aspergillus assay.}, language = {en} } @article{SpringerWaltherRickertsetal.2019, author = {Springer, Jan and Walther, Grit and Rickerts, Volker and Hamprecht, Axel and Willinger, Birgit and Teschner, Daniel and Einsele, Hermann and Kurzai, Oliver and Loeffler, Juergen}, title = {Detection of Fusarium Species in Clinical Specimens by Probe-Based Real-Time PCR}, series = {Journal of Fungi}, volume = {5}, journal = {Journal of Fungi}, number = {4}, issn = {2309-608X}, doi = {10.3390/jof5040105}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-193111}, pages = {105}, year = {2019}, abstract = {The mold Fusarium is a ubiquitous fungus causing plant, animal and human infections. In humans, Fusarium spp. are the major cause of eye infections in patients wearing contact lenses or after local trauma. Systemic infections by Fusarium spp. mainly occur in immunosuppressed patients and can disseminate throughout the human body. Due to high levels of resistance to antifungals a fast identification of the causative agent is an urgent need. By using a probe-based real-time PCR assay specific for the genus Fusarium we analysed several different clinical specimens detecting Fusarium spp. commonly found in clinical samples in Germany. Also, a large collection of lung fluid samples of haematological patients was analysed (n = 243). In these, two samples (0.8\%) were reproducibly positive, but only one could be confirmed by sequencing. For this case of probable invasive fungal disease (IFD) culture was positive for Fusarium species. Here we describe a rapid, probe-based real-time PCR assay to specifically detect DNA from a broad range of Fusarium species and its application to clinically relevant specimens.}, language = {en} } @article{SanchezMaldonadoMonizDiezterHorstetal.2020, author = {S{\´a}nchez-Maldonado, Jose Manuel and Mo{\~n}iz-D{\´i}ez, Ana and ter Horst, Rob and Campa, Daniele and Cabrera-Serrano, Antonio Jos{\´e} and Mart{\´i}nez-Bueno, Manuel and Garrido-Collado, Mar{\´i}a del Pilar and Hern{\´a}ndez-Mohedo, Francisca and Fern{\´a}ndez-Puerta, Laura and L{\´o}pez-Nevot, Miguel {\´A}ngel and Cunha, Cristina and Gonz{\´a}lez-Sierra, Pedro Antonio and Springer, Jan and Lackner, Michaela and Alcazar-Fuoli, Laura and Fianchi, Luana and Aguado, Jos{\´e} Mar{\´i}a and Pagano, Livio and L{\´o}pez-Fern{\´a}ndez, Elisa and Clavero, Esther and Potenza, Leonardo and Luppi, Mario and Moratalla, Lucia and Solano, Carlos and Sampedro, Antonio and Cuenca-Estrella, Manuel and Lass-Fl{\"o}rl, Cornelia and Canzian, Federico and Loeffler, Juergen and Li, Yang and Einsele, Hermann and Netea, Mihai G. and V{\´a}zquez, Lourdes and Carvalho, Agostinho and Jurado, Manuel and Sainz, Juan}, title = {Polymorphisms within the TNFSF4 and MAPKAPK2 loci influence the risk of developing invasive aspergillosis: a two-stage case control study in the context of the aspBIOmics consortium}, series = {Journal of Fungi}, volume = {7}, journal = {Journal of Fungi}, number = {1}, issn = {2309-608X}, doi = {10.3390/jof7010004}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-220107}, year = {2020}, abstract = {Here, we assessed whether 36 single nucleotide polymorphisms (SNPs) within the TNFSF4 and MAPKAPK2 loci influence the risk of developing invasive aspergillosis (IA). We conducted a two-stage case control study including 911 high-risk patients diagnosed with hematological malignancies that were ascertained through the aspBIOmics consortium. The meta-analysis of the discovery and replication populations revealed that carriers of the TNFSF4\(_{rs7526628T/T}\) genotype had a significantly increased risk of developing IA (p = 0.00022). We also found that carriers of the TNFSF4\(_{rs7526628T}\) allele showed decreased serum levels of TNFSF14 protein (p = 0.0027), and that their macrophages had a decreased fungicidal activity (p = 0.048). In addition, we observed that each copy of the MAPKAPK2\(_{rs12137965G}\) allele increased the risk of IA by 60\% (p = 0.0017), whereas each copy of the MAPKAPK2\(_{rs17013271T}\) allele was estimated to decrease the risk of developing the disease (p = 0.0029). Mechanistically, we found that carriers of the risk MAPKAPK2\(_{rs12137965G}\) allele showed increased numbers of CD38+IgM-IgD- plasmablasts in blood (p = 0.00086), whereas those harboring two copies of the allele had decreased serum concentrations of thymic stromal lymphopoietin (p = 0.00097). Finally, we also found that carriers of the protective MAPKAPK2\(_{rs17013271T}\) allele had decreased numbers of CD27-IgM-IgD- B cells (p = 0.00087) and significantly lower numbers of CD14+ and CD14+CD16- cells (p = 0.00018 and 0.00023). Altogether, these results suggest a role of the TNFSF4 and MAPKAPK2 genes in determining IA risk.}, language = {en} } @article{WhiteSpringerWiseetal.2022, author = {White, P. Lewis and Springer, Jan and Wise, Matt P. and Einsele, Hermann and L{\"o}ffler, Claudia and Seif, Michelle and Prommersberger, Sabrina and Backx, Matthijs and L{\"o}ffler, J{\"u}rgen}, title = {A clinical case of COVID-19-associated pulmonary aspergillosis (CAPA), illustrating the challenges in diagnosis (despite overwhelming mycological evidence)}, series = {Journal of Fungi}, volume = {8}, journal = {Journal of Fungi}, number = {1}, issn = {2309-608X}, doi = {10.3390/jof8010081}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-302438}, year = {2022}, abstract = {The COVID-19 pandemic has resulted in large numbers of patients requiring critical care management. With the established association between severe respiratory virus infection and invasive pulmonary aspergillosis (7.6\% for COVID-19-associated pulmonary aspergillosis (CAPA)), the pandemic places a significant number of patients at potential risk from secondary invasive fungal disease. We described a case of CAPA with substantial supporting mycological evidence, highlighting the need to employ strategic diagnostic algorithms and weighted definitions to improve the accuracy in diagnosing CAPA.}, language = {en} }