TY - JOUR A1 - Notz, Quirin A1 - Schmalzing, Marc A1 - Wedekink, Florian A1 - Schlesinger, Tobias A1 - Gernert, Michael A1 - Herrmann, Johannes A1 - Sorger, Lena A1 - Weismann, Dirk A1 - Schmid, Benedikt A1 - Sitter, Magdalena A1 - Schlegel, Nicolas A1 - Kranke, Peter A1 - Wischhusen, Jörg A1 - Meybohm, Patrick A1 - Lotz, Christopher T1 - Pro- and Anti-Inflammatory Responses in Severe COVID-19-Induced Acute Respiratory Distress Syndrome—An Observational Pilot Study JF - Frontiers in Immunology N2 - Objectives The severity of Coronavirus Disease 2019 (COVID-19) is largely determined by the immune response. First studies indicate altered lymphocyte counts and function. However, interactions of pro- and anti-inflammatory mechanisms remain elusive. In the current study we characterized the immune responses in patients suffering from severe COVID-19-induced acute respiratory distress syndrome (ARDS). Methods This was a single-center retrospective study in patients admitted to the intensive care unit (ICU) with confirmed COVID-19 between March 14th and May 28th 2020 (n = 39). Longitudinal data were collected within routine clinical care, including flow-cytometry of lymphocyte subsets, cytokine analysis and growth differentiation factor 15 (GDF-15). Antibody responses against the receptor binding domain (RBD) of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Spike protein were analyzed. Results All patients suffered from severe ARDS, 30.8% died. Interleukin (IL)-6 was massively elevated at every time-point. The anti-inflammatory cytokine IL-10 was concomitantly upregulated with IL-6. The cellular response was characterized by lymphocytopenia with low counts of CD8+ T cells, natural killer (NK) and naïve T helper cells. CD8+ T and NK cells recovered after 8 to 14 days. The B cell system was largely unimpeded. This coincided with a slight increase in anti-SARS-CoV-2-Spike-RBD immunoglobulin (Ig) G and a decrease in anti-SARS-CoV-2-Spike-RBD IgM. GDF-15 levels were elevated throughout ICU treatment. Conclusions Massively elevated levels of IL-6 and a delayed cytotoxic immune defense characterized severe COVID-19-induced ARDS. The B cell response and antibody production were largely unimpeded. No obvious imbalance of pro- and anti-inflammatory mechanisms was observed, with elevated GDF-15 levels suggesting increased tissue resilience. KW - Coronavirus Disease 2019 KW - acute respiratory distress syndrome KW - Severe Acute Respiratory Syndrome Coronavirus 2 KW - cytokines KW - inflammation KW - growth differentiation factor 15 KW - immune response Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-212815 SN - 1664-3224 VL - 11 ER - TY - THES A1 - Schmid, Benedikt T1 - Molecular Signaling Mechanisms at the µ-Opioid Receptor T1 - Molekulare Signalmechanismen am µ-Opioidrezeptor N2 - To this day, opioids represent the most effective class of drugs for the treatment of severe pain. On a molecular level, all opioids in use today are agonists at the μ-opioid receptor (μ receptor). The μ receptor is a class A G protein-coupled receptor (GPCR). GPCRs are among the biological structures most frequently targeted by pharmaceuticals. They are membrane bound receptors, which confer their signals into the cell primarily by activating a variety of GTPases called G proteins. In the course of the signaling process, the μ receptor will be phosphorylated by GRKs, increasing its affinity for another entity of signaling proteins called β-arrestins (β-arrs). The binding of a β-arr to the activated μ receptor will end the G protein signal and cause the receptor to be internalized into the cell. Past research showed that the μ receptor’s G protein signal puts into effect the desired pain relieving properties of opioid drugs, whereas β-arr recruitment is more often linked to adverse effects like obstipation, tolerance, and respiratory depression. Recent work in academic and industrial research picked up on these findings and looked into the possibility of enhancing G protein signaling while suppressing β-arr recruitment. The conceptual groundwork of such approaches is the phenomenon of biased agonism. It appreciates the fact that different ligands can change the relative contribution of any given pathway to the overall downstream signaling, thus enabling not only receptor-specific but even pathway-specific signaling. This work examined the ability of a variety of common opioid drugs to specifically activate the different signaling pathways and quantify it by means of resonance energy transfer and protein complementation experiments in living cells. Phosphorylation of the activated receptor is a central step in the canonical GPCR signaling process. Therefore, in a second step, expression levels of the phosphorylating GRKs were enhanced in search for possible effects on receptor signaling and ligand bias. In short, detailed pharmacological profiles of 17 opioid ligands were recorded. Comparison with known clinical properties of the compounds showed robust correlation of G protein activation efficacy and analgesic potency. Ligand bias (i.e. significant preference of any path- way over another by a given agonist) was found for a number of opioids in native HEK293 cells overexpressing μ receptor and β-arrs. Furthermore, overexpression of GRK2 was shown to fundamentally change β-arr pharmacodynamics of nearly all opioids. As a consequence, any ligand bias as detected earlier was abolished with GRK2 overexpression, with the exception of buprenorhin. In summary, the following key findings stand out: (1) Common opioid drugs exert biased agonism at the μ receptor to a small extent. (2) Ligand bias is influenced by expression levels of GRK2, which may vary between individuals, target tissues or even over time. (3) One of the opioids, buprenorhin, did not change its signaling properties with the overexpression of GRK2. This might serve as a starting point for the development of new opioids which could lack the ability of β-arr recruitment altogether and thus might help reduce adverse side effects in the treatment of severe pain. N2 - Nach wie vor stellen Opioide die wirkstärkste Gruppe von Medikamenten zu Behandlung starker Schmerzen dar. Auf molekularer Ebene sind alle heute gebräuchlichen Opioide Agonisten am μ-Opioidrezeptor. Der μ-Opioidrezeptor ist ein G-Protein-gekoppelter Rezeptor (GPCR) der Klasse A. GPCR zählen zu den häufigsten Zielstrukturen von Pharmaka. Sie sind membranständige Rezeptoren, die ihr Signal in erster Linie durch die Aktivierung von G-Proteine genannten GTPasen in die Zelle weiterleiten. Im Laufe des Signalprozesses wird der GPCR von GRK phosphoryliert, wodurch seine Affinität zu einer weiteren Gruppe von Signalproteinen, den sog. β-Arrestinen erhöht wird. Bindet ein β-Arrestin an den Rezeptor, beendet dies das G-Proteinsignal und veranlasst die Internalisierung des Rezeptors ins Zellinnere. Bisherige Forschung zeigte, dass das G-Proteinsignal des μ-Opioidrezeptors die erwünschte Schmerzlinderung vermittelt, wohingegen die Rekrutierung von β-Arrestin oftmals mit unerwünschten Wirkungen wie Obstipation, Toleranzentwicklung und Atemdepression in Verbindung gebracht wird. Neuere akademische und industrielle Forschung griff diese Erkenntnisse auf und erkundete die Möglichkeit, das G-Proteinsignal zu verstärken und zur gleichen Zeit die β-Arrestinrekrutierung zu inhibieren. Die theoretische Grundlage solcher Ansätze liegt im Konzept des biased agonism. Dieses berücksichtigt die Tatsache, dass verschiedene Liganden den Anteil eines bestimmten Signalweges am gesamten vom Rezeptor ausgehenden Signals beeinflussen kann und damit nicht nur rezeptor-, sondern sogar signalwegspezifische Signale möglich sein sollten. Die vorliegende Arbeit untersuchte eine Reihe von gängigen Opioiden auf ihre Fähigkeit hin, die einzelnen Signalwege spezifisch zu aktivieren und quantifizierte dies mit Methoden des Resonanzenergietransfers sowie der Proteinkomplementierung in lebenden Zellen. Die Phosphorylierung des Rezeptors ist ein zentrales Ereignis in der anerkannten Abfolge der Signalprozesse an GPCR. Daher wurde in einem weiteren Schritt die Expression der phosphorylierenden GRK erhöht und nach möglichen Auswirkungen auf die Selektivität der Signalwegaktivierung gesucht. Hierbei wurde detaillierte pharmakologische Profile von 17 Opioiden erstellt. Der Abgleich mit bekannten klinischen Wirkeigenschaften der Substanzen zeigte einen robusten Zusammenhang zwischen der Fähigkeit, G-Proteine zu aktivieren und der analgetischen Wirkstärke. Ligand bias, d.h. die signifikante Bevorzugung eines Signalweges gegenüber einem anderen durch einen Liganden, konnte für eine Reihe von Opioiden in lebenden HEK293-Zellen gezeigt werden, die den μ-Opioidrezeptor sowie β-Arrestine überexprimierten. Darüber hinaus konnte gezeigt werden, dass die zusätzliche Überexpression von GRK2 die pharmakodynamischen Eigenschaften nahezu aller Opioide grundlegend veränderte. In der Folge war jeder zuvor gezeigte ligand bias mit Ausnahme von Buprenorphin aufgehoben. Zusammenfassend stehen die folgenden drei Erkenntnisse im Vordergrund: (1) Gängige Opioide zeigen in einem gewissen Maß Selektivität zwischen den Signalwegen. (2) Ligand bias wird beeinflusst von GRK2-Expressionsleveln, welche zwischen Individuen, verschiedenen Gewebetypen oder auch im zeitlichen Verlauf variieren können. (3) Als einziges der untersuchten Opioide änderte Buprenorphin seine Signaleigenschaften durch die Überexpression von GRK2 nicht. Dies könnte als Anknüpfungspunkt in der Entwicklung neuer Opioide dienen, die keinerlei β-Arrestinrekrutierung bewirken und dadurch helfen könnten, unerwünschte Wirkungen in der Behandlung starker Schmerzen zu verhindern. KW - Opiatrezeptor KW - Opioide KW - G-Protein gekoppelte Rezeptoren KW - Pharmakodynamik KW - Arrestine KW - Rezeptorpharmakologie KW - biased agonism KW - signalling Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-176850 ER - TY - JOUR A1 - Herrmann, Johannes A1 - Adam, Elisabeth Hannah A1 - Notz, Quirin A1 - Helmer, Philipp A1 - Sonntagbauer, Michael A1 - Ungemach-Papenberg, Peter A1 - Sanns, Andreas A1 - Zausig, York A1 - Steinfeldt, Thorsten A1 - Torje, Iuliu A1 - Schmid, Benedikt A1 - Schlesinger, Tobias A1 - Rolfes, Caroline A1 - Reyher, Christian A1 - Kredel, Markus A1 - Stumpner, Jan A1 - Brack, Alexander A1 - Wurmb, Thomas A1 - Gill-Schuster, Daniel A1 - Kranke, Peter A1 - Weismann, Dirk A1 - Klinker, Hartwig A1 - Heuschmann, Peter A1 - Rücker, Viktoria A1 - Frantz, Stefan A1 - Ertl, Georg A1 - Muellenbach, Ralf Michael A1 - Mutlak, Haitham A1 - Meybohm, Patrick A1 - Zacharowski, Kai A1 - Lotz, Christopher T1 - COVID-19 Induced Acute Respiratory Distress Syndrome — A Multicenter Observational Study JF - Frontiers in Medicine N2 - Background: Proportions of patients dying from the coronavirus disease-19 (COVID-19) vary between different countries. We report the characteristics; clinical course and outcome of patients requiring intensive care due to COVID-19 induced acute respiratory distress syndrome (ARDS). Methods: This is a retrospective, observational multicentre study in five German secondary or tertiary care hospitals. All patients consecutively admitted to the intensive care unit (ICU) in any of the participating hospitals between March 12 and May 4, 2020 with a COVID-19 induced ARDS were included. Results: A total of 106 ICU patients were treated for COVID-19 induced ARDS, whereas severe ARDS was present in the majority of cases. Survival of ICU treatment was 65.0%. Median duration of ICU treatment was 11 days; median duration of mechanical ventilation was 9 days. The majority of ICU treated patients (75.5%) did not receive any antiviral or anti-inflammatory therapies. Venovenous (vv) ECMO was utilized in 16.3%. ICU triage with population-level decision making was not necessary at any time. Univariate analysis associated older age, diabetes mellitus or a higher SOFA score on admission with non-survival during ICU stay. Conclusions: A high level of care adhering to standard ARDS treatments lead to a good outcome in critically ill COVID-19 patients. KW - COVID-19 KW - ARDS (acute respiratory distress syndrome) KW - intensive care medicine KW - pandemia KW - Germany Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219834 SN - 2296-858X VL - 7 ER - TY - JOUR A1 - Schlesinger, Tobias A1 - Weißbrich, Benedikt A1 - Wedekink, Florian A1 - Notz, Quirin A1 - Herrmann, Johannes A1 - Krone, Manuel A1 - Sitter, Magdalena A1 - Schmid, Benedikt A1 - Kredel, Markus A1 - Stumpner, Jan A1 - Dölken, Lars A1 - Wischhusen, Jörg A1 - Kranke, Peter A1 - Meybohm, Patrick A1 - Lotz, Christpher T1 - Biodistribution and serologic response in SARS-CoV-2 induced ARDS: A cohort study JF - PLoS One N2 - Background The viral load and tissue distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain important questions. The current study investigated SARS-CoV-2 viral load, biodistribution and anti-SARS-CoV-2 antibody formation in patients suffering from severe corona virus disease 2019 (COVID-19) induced acute respiratory distress syndrome (ARDS). Methods This is a retrospective single-center study in 23 patients with COVID-19-induced ARDS. Data were collected within routine intensive care. SARS-CoV-2 viral load was assessed via reverse transcription quantitative polymerase chain reaction (RT-qPCR). Overall, 478 virology samples were taken. Anti-SARS-CoV-2-Spike-receptor binding domain (RBD) antibody detection of blood samples was performed with an enzyme-linked immunosorbent assay. Results Most patients (91%) suffered from severe ARDS during ICU treatment with a 30-day mortality of 30%. None of the patients received antiviral treatment. Tracheal aspirates tested positive for SARS-CoV-2 in 100% of the cases, oropharyngeal swabs only in 77%. Blood samples were positive in 26% of the patients. No difference of viral load was found in tracheal or blood samples with regard to 30-day survival or disease severity. SARS-CoV-2 was never found in dialysate. Serologic testing revealed significantly lower concentrations of SARS-CoV-2 neutralizing IgM and IgA antibodies in survivors compared to non-survivors (p = 0.009). Conclusions COVID-19 induced ARDS is accompanied by a high viral load of SARS-CoV-2 in tracheal aspirates, which remained detectable in the majority throughout intensive care treatment. Remarkably, SARS-CoV-2 RNA was never detected in dialysate even in patients with RNAemia. Viral load or the buildup of neutralizing antibodies was not associated with 30-day survival or disease severity. KW - viral load Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231348 VL - 15, 2020 IS - 11 ER -