TY  - JOUR
A1  - El-Helou, Sabine M.
A1  - Biegner, Anika-Kerstin
A1  - Bode, Sebastian
A1  - Ehl, Stephan R.
A1  - Heeg, Maximilian
A1  - Maccari, Maria E.
A1  - Ritterbusch, Henrike
A1  - Speckmann, Carsten
A1  - Rusch, Stephan
A1  - Scheible, Raphael
A1  - Warnatz, Klaus
A1  - Atschekzei, Faranaz
A1  - Beider, Renata
A1  - Ernst, Diana
A1  - Gerschmann, Stev
A1  - Jablonka, Alexandra
A1  - Mielke, Gudrun
A1  - Schmidt, Reinhold E.
A1  - Schürmann, Gesine
A1  - Sogkas, Georgios
A1  - Baumann, Ulrich H.
A1  - Klemann, Christian
A1  - Viemann, Dorothee
A1  - Bernuth, Horst von
A1  - Krüger, Renate
A1  - Hanitsch, Leif G.
A1  - Scheibenbogen, Carmen M.
A1  - Wittke, Kirsten
A1  - Albert, Michael H.
A1  - Eichinger, Anna
A1  - Hauck, Fabian
A1  - Klein, Christoph
A1  - Rack-Hoch, Anita
A1  - Sollinger, Franz M.
A1  - Avila, Anne
A1  - Borte, Michael
A1  - Borte, Stephan
A1  - Fasshauer, Maria
A1  - Hauenherm, Anja
A1  - Kellner, Nils
A1  - Müller, Anna H.
A1  - Ülzen, Anett
A1  - Bader, Peter
A1  - Bakhtiar, Shahrzad
A1  - Lee, Jae-Yun
A1  - Heß, Ursula
A1  - Schubert, Ralf
A1  - Wölke, Sandra
A1  - Zielen, Stefan
A1  - Ghosh, Sujal
A1  - Laws, Hans-Juergen
A1  - Neubert, Jennifer
A1  - Oommen, Prasad T.
A1  - Hönig, Manfred
A1  - Schulz, Ansgar
A1  - Steinmann, Sandra
A1  - Klaus, Schwarz
A1  - Dückers, Gregor
A1  - Lamers, Beate
A1  - Langemeyer, Vanessa
A1  - Niehues, Tim
A1  - Shai, Sonu
A1  - Graf, Dagmar
A1  - Müglich, Carmen
A1  - Schmalzing, Marc T.
A1  - Schwaneck, Eva C.
A1  - Tony, Hans-Peter
A1  - Dirks, Johannes
A1  - Haase, Gabriele
A1  - Liese, Johannes G.
A1  - Morbach, Henner
A1  - Foell, Dirk
A1  - Hellige, Antje
A1  - Wittkowski, Helmut
A1  - Masjosthusmann, Katja
A1  - Mohr, Michael
A1  - Geberzahn, Linda
A1  - Hedrich, Christian M.
A1  - Müller, Christiane
A1  - Rösen-Wolff, Angela
A1  - Roesler, Joachim
A1  - Zimmermann, Antje
A1  - Behrends, Uta
A1  - Rieber, Nikolaus
A1  - Schauer, Uwe
A1  - Handgretinger, Rupert
A1  - Holzer, Ursula
A1  - Henes, Jörg
A1  - Kanz, Lothar
A1  - Boesecke, Christoph
A1  - Rockstroh, Jürgen K.
A1  - Schwarze-Zander, Carolynne
A1  - Wasmuth, Jan-Christian
A1  - Dilloo, Dagmar
A1  - Hülsmann, Brigitte
A1  - Schönberger, Stefan
A1  - Schreiber, Stefan
A1  - Zeuner, Rainald
A1  - Ankermann, Tobias
A1  - Bismarck, Philipp von
A1  - Huppertz, Hans-Iko
A1  - Kaiser-Labusch, Petra
A1  - Greil, Johann
A1  - Jakoby, Donate
A1  - Kulozik, Andreas E.
A1  - Metzler, Markus
A1  - Naumann-Bartsch, Nora
A1  - Sobik, Bettina
A1  - Graf, Norbert
A1  - Heine, Sabine
A1  - Kobbe, Robin
A1  - Lehmberg, Kai
A1  - Müller, Ingo
A1  - Herrmann, Friedrich
A1  - Horneff, Gerd
A1  - Klein, Ariane
A1  - Peitz, Joachim
A1  - Schmidt, Nadine
A1  - Bielack, Stefan
A1  - Groß-Wieltsch, Ute
A1  - Classen, Carl F.
A1  - Klasen, Jessica
A1  - Deutz, Peter
A1  - Kamitz, Dirk
A1  - Lassy, Lisa
A1  - Tenbrock, Klaus
A1  - Wagner, Norbert
A1  - Bernbeck, Benedikt
A1  - Brummel, Bastian
A1  - Lara-Villacanas, Eusebia
A1  - Münstermann, Esther
A1  - Schneider, Dominik T.
A1  - Tietsch, Nadine
A1  - Westkemper, Marco
A1  - Weiß, Michael
A1  - Kramm, Christof
A1  - Kühnle, Ingrid
A1  - Kullmann, Silke
A1  - Girschick, Hermann
A1  - Specker, Christof
A1  - Vinnemeier-Laubenthal, Elisabeth
A1  - Haenicke, Henriette
A1  - Schulz, Claudia
A1  - Schweigerer, Lothar
A1  - Müller, Thomas G.
A1  - Stiefel, Martina
A1  - Belohradsky, Bernd H.
A1  - Soetedjo, Veronika
A1  - Kindle, Gerhard
A1  - Grimbacher, Bodo
T1  - The German national registry of primary immunodeficiencies (2012-2017)
JF  - Frontiers in Immunology
N2  - Introduction: The German PID-NET registry was founded in 2009, serving as the first national registry of patients with primary immunodeficiencies (PID) in Germany. It is part of the European Society for Immunodeficiencies (ESID) registry. The primary purpose of the registry is to gather data on the epidemiology, diagnostic delay, diagnosis, and treatment of PIDs. 

Methods: Clinical and laboratory data was collected from 2,453 patients from 36 German PID centres in an online registry. Data was analysed with the software Stata® and Excel. 

Results: The minimum prevalence of PID in Germany is 2.72 per 100,000 inhabitants. Among patients aged 1-25, there was a clear predominance of males. The median age of living patients ranged between 7 and 40 years, depending on the respective PID. Predominantly antibody disorders were the most prevalent group with 57% of all 2,453 PID patients (including 728 CVID patients). A gene defect was identified in 36% of patients. Familial cases were observed in 21% of patients. The age of onset for presenting symptoms ranged from birth to late adulthood (range 0-88 years). Presenting symptoms comprised infections (74%) and immune dysregulation (22%). Ninety-three patients were diagnosed without prior clinical symptoms. Regarding the general and clinical diagnostic delay, no PID had undergone a slight decrease within the last decade. However, both, SCID and hyper IgE-syndrome showed a substantial improvement in shortening the time between onset of symptoms and genetic diagnosis. Regarding treatment, 49% of all patients received immunoglobulin G (IgG) substitution (70%-subcutaneous; 29%-intravenous; 1%-unknown). Three-hundred patients underwent at least one hematopoietic stem cell transplantation (HSCT). Five patients had gene therapy. 

Conclusion: The German PID-NET registry is a precious tool for physicians, researchers, the pharmaceutical industry, politicians, and ultimately the patients, for whom the outcomes will eventually lead to a more timely diagnosis and better treatment.
KW  - registry for primary immunodeficiency
KW  - primary immunodeficiency (PID)
KW  - German PID-NET registry
KW  - PID prevalence
KW  - European Society for Immunodeficiencies (ESID)
KW  - IgG substitution therapy
KW  - CVID
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-226629
VL  - 10
ER  - 
TY  - JOUR
A1  - Graus, Dorothea
A1  - Konrad, Kai R.
A1  - Bemm, Felix
A1  - Nebioglu, Meliha Görkem Patir
A1  - Lorey, Christian
A1  - Duscha, Kerstin
A1  - Güthoff, Tilman
A1  - Herrmann, Johannes
A1  - Ferjani, Ali
A1  - Cuin, Tracey Ann
A1  - Roelfsema, M. Rob G.
A1  - Schumacher, Karin
A1  - Neuhaus, H. Ekkehard
A1  - Marten, Irene
A1  - Hedrich, Rainer
T1  - High V-PPase activity is beneficial under high salt loads, but detrimental without salinity
JF  - New Phytologist
N2  - The membrane-bound proton-pumping pyrophosphatase (V-PPase), together with the V-type H+-ATPase, generates the proton motive force that drives vacuolar membrane solute transport. Transgenic plants constitutively overexpressing V-PPases were shown to have improved salinity tolerance, but the relative impact of increasing PPi hydrolysis and proton-pumping functions has yet to be dissected.

For a better understanding of the molecular processes underlying V-PPase-dependent salt tolerance, we transiently overexpressed the pyrophosphate-driven proton pump (NbVHP) in Nicotiana benthamiana leaves and studied its functional properties in relation to salt treatment by primarily using patch-clamp, impalement electrodes and pH imaging.

NbVHP overexpression led to higher vacuolar proton currents and vacuolar acidification. After 3 d in salt-untreated conditions, V-PPase-overexpressing leaves showed a drop in photosynthetic capacity, plasma membrane depolarization and eventual leaf necrosis. Salt, however, rescued NbVHP-hyperactive cells from cell death. Furthermore, a salt-induced rise in V-PPase but not of V-ATPase pump currents was detected in nontransformed plants.

The results indicate that under normal growth conditions, plants need to regulate the V-PPase pump activity to avoid hyperactivity and its negative feedback on cell viability. Nonetheless, V-PPase proton pump function becomes increasingly important under salt stress for generating the pH gradient necessary for vacuolar proton-coupled Na+ sequestration.
KW  - cell death
KW  - plasma membrane voltage
KW  - proton pump currents
KW  - salt
KW  - vacuolar pH
KW  - vacuolar proton-ATPase (V-ATPase)
KW  - vacuolar proton-pyrophosphatase (V-PPase)
Y1  - 2018
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227553
VL  - 219
ER  - 
TY  - JOUR
A1  - Haberstumpf, Sophia
A1  - Forster, André
A1  - Leinweber, Jonas
A1  - Rauskolb, Stefanie
A1  - Hewig, Johannes
A1  - Sendtner, Michael
A1  - Lauer, Martin
A1  - Polak, Thomas
A1  - Deckert, Jürgen
A1  - Herrmann, Martin J.
T1  - Measurement invariance testing of longitudinal neuropsychiatric test scores distinguishes pathological from normative cognitive decline and highlights its potential in early detection research
JF  - Journal of Neuropsychology
N2  - Objective
Alzheimer’s disease (AD) is a growing challenge worldwide, which is why the search for early-onset predictors must be focused as soon as possible. Longitudinal studies that investigate courses of neuropsychological and other variables screen for such predictors correlated to mild cognitive impairment (MCI). However, one often neglected issue in analyses of such studies is measurement invariance (MI), which is often assumed but not tested for. This study uses the absence of MI (non-MI) and latent factor scores instead of composite variables to assess properties of cognitive domains, compensation mechanisms, and their predictability to establish a method for a more comprehensive understanding of pathological cognitive decline.
Methods
An exploratory factor analysis (EFA) and a set of increasingly restricted confirmatory factor analyses (CFAs) were conducted to find latent factors, compared them with the composite approach, and to test for longitudinal (partial-)MI in a neuropsychiatric test battery, consisting of 14 test variables. A total of 330 elderly (mean age: 73.78 ± 1.52 years at baseline) were analyzed two times (3 years apart).
Results
EFA revealed a four-factor model representing declarative memory, attention, working memory, and visual–spatial processing. Based on CFA, an accurate model was estimated across both measurement timepoints. Partial non-MI was found for parameters such as loadings, test- and latent factor intercepts as well as latent factor variances. The latent factor approach was preferable to the composite approach.
Conclusion
The overall assessment of non-MI latent factors may pose a possible target for this field of research. Hence, the non-MI of variances indicated variables that are especially suited for the prediction of pathological cognitive decline, while non-MI of intercepts indicated general aging-related decline. As a result, the sole assessment of MI may help distinguish pathological from normative aging processes and additionally may reveal compensatory neuropsychological mechanisms.
KW  - Alzheimer’s disease
KW  - early-onset predictors
KW  - mild cognitive impairment
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318932
VL  - 16
IS  - 2
SP  - 324
EP  - 352
ER  - 
TY  - JOUR
A1  - Herrmann, Anna
A1  - Herrmann, Matthias
A1  - Passlick, Bernward
A1  - Herth, Felix
A1  - Herrmann, Johannes
T1  - Cycling‐induced recurrent spontaneous pneumomediastinum and pneumopericardium in a young female patient
JF  - Clinical Case Reports
N2  - We present an exceptional case of recurrent cycling‐induced spontaneous pneumomediastinum and pneumopericardium in a female patient without any trauma. Radiological and endoscopic examinations were carried out to exclude other differential diagnoses. Decision for in‐hospital observation and conservative treatment was made. No symptoms were reported 12 months after return to sports activity.
KW  - Hamman's syndrome
KW  - spontaneous pneumomediastinum
KW  - spontaneous pneumopericardium
KW  - sport medicine
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-276465
VL  - 10
IS  - 3
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  - THES
A1  - Herrmann, Johannes Bernd
T1  - Rolle des Komplement C5a-Rezeptors 1 in der Pathophysiologie der Meningokokken-Sepsis
T1  - Role of complement C5a-Receptor 1 in Pathophysiology of Meningococcal Sepsis
N2  - Das bekapselte, Gram-negative, diplokokkenförmige Bakterium Neisseria meningitidis (Nme) ist ein asymptomatischer Kommensale des oberen Nasenrachenraums im Men-schen. Gerade bei Kindern ist es dem humanspezifischen Pathogen in seltenen Fällen möglich, in den Blutstrom einzuwandern und lebensbedrohliche Krankheitsbilder wie Meningoenzephalitis und Sepsis auszulösen, welche als „Invasive Meningokokkener-krankung“ (IMD) zusammengefasst werden. Jährlich ereignen sich weltweit bis zu 1,2 Mio Fälle von IMD, welche aufgrund des fulminanten Verlaufs und der hohen Letalität gefürchtet sind. In der Bekämpfung der Nme-Sepsis ist das humane Komplementsystem von entscheidender Bedeutung. Vor diesem Hintergrund ist die protektive Rolle des lytischen (Membranangriffskomplex MAK) und opsonisierenden Arms (Opsonine iC3b und C1q) der Komplementkaskade gut dokumentiert. Dagegen ist der Beitrag des in-flammatorischen Arms (Anaphylatoxine C3a und C5a) in der Nme-Sepsis bisher unklar. Aus diesem Grunde wurde mit dieser Arbeit die Rolle des inflammatorischen Arms an-hand des Komplement C5a-Rezeptors 1 (C5aR1) in der Pathophysiologie der Nme-Sepsis am Mausmodell untersucht. Nach Etablierung des murinen, intraperitonealen In-fektionsmodells konnte ein schädlicher Effekt des C5aR1 in der Nme-Sepsis beobachtet werden. Aus der Abwesenheit des C5aR1 resultierte eine höhere Überlebensrate, ein besserer klinischer Zustand, eine niedrigere Bakteriämie und niedrigere Konzentrationen der pro-inflammatorischen Mediatoren IL-6, CXCL-1 und TNF-α. Im Hinblick auf den zellulären Pathomechanismus sprechen Ergebnisse dieser Arbeit dafür, dass der C5aR1 primär eine gesteigerte Freisetzung inflammatorischer Mediatoren durch verschiedene Zellpopulationen triggert (Zytokinsturm), wodurch sekundär Zellparalyse, steigende Bakteriämie und höhere Letalität bedingt sind. Durch Depletionsversuche und Immun-fluoreszenzfärbungen konnte, unabhängig vom C5aR1, eine allgemein protektive Rolle von neutrophilen Granulozyten und Monozyten/Makrophagen in der Nme-Sepsis beo-bachtet werden. Darüber hinaus präsentierte sich der zyklische C5aR1-Antagonist PMX205 als erfolgsversprechende Therapieoption, um Parameter einer murinen Nme-Sepsis zu verbessern. Weitere Untersuchungen sind nötig, um die Wirksamkeit dieser Substanz in der humanen Nme-Sepsis zu erforschen. Zudem könnte das murine, intrape-ritoneale Infektionsmodell zur Klärung der Rolle des C5aR2 in der Nme-Sepsis genutzt werden.
N2  - The encapsulated, Gram-negative diplococcus Neisseria meningitidis (Nme) is an asymp-tomatic commensal in the human upper respiratory tract. In rare cases and especially in children, this human-specific pathogen is able to invade into the blood stream and cause life-threatening disorders like meningoencephalitis and septicemia, which are subsumed as „invasive meningococcal disease“ (IMD). The estimated number of cases is about 1.2 mio per year worldwide. IMD is greatly feared because of its fulminant progression and its high lethality. It is very well known, that the human complement system holds an essential role to fight meningococcal sepsis. In this context, the protective effects of the lytic (membrane attack complex MAC) and opsonizing branches (opsonines iC3b and C1q) are well established. On the contrary, very little is known about the contribution of the inflammatory branch (anaphylatoxines C3a and C5a) in meningococcal sepsis. Therefore, this work focused on the role of the C5a-Receptor 1 (C5aR1) in pathophysi-ology of meningococcal sepsis in a murine model. After having established the para-mount role of complement in murine intraperitoneal infection model, we could observe a detrimental effect of C5aR1 in Meningococcal sepsis. The absence of C5aR1 resulted in a higher overall survival, ameliorated clinical status, lower bacteremia and lower levels of the proinflammatory mediators IL-6, CXCL-1, TNF-α. Particularly with regard to results about the cellular pathomechanism, the C5aR1 seems to cause an increased re-lease of proinflammatory mediators (cytokine storm) exerted by various cell populations. As a consequence, cellular paralysis, increasing bacterial burden and higher lethality rate seems to occur. In reference to depletion experiments and immunofluorescence stain-ings, we could observe protective overall effects of neutrophils and mono-cytes/macrophages, uncorrelated to C5aR1 presence. Ultimately, the cyclic C5aR1-antagonist PMX205 appeared to be a promising option to improve parameters in murine meningococcal sepsis. Further experiments are required to examine the potential of this compound in human meningococcal sepsis. Moreover, the murine, intraperitoneal infec-tion model could be used to clarify the role of C5aR2 in meningococcal sepsis.
KW  - Komplement C5a
KW  - Neisseria meningitidis
KW  - Meningokokken-Sepsis
KW  - Komplement C5a Rezeptor 1
KW  - C5aR1-Antagonist
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-184533
ER  - 
TY  - JOUR
A1  - Herrmann, Johannes
A1  - Lotz, Christopher
A1  - Karagiannidis, Christian
A1  - Weber-Carstens, Steffen
A1  - Kluge, Stefan
A1  - Putensen, Christian
A1  - Wehrfritz, Andreas
A1  - Schmidt, Karsten
A1  - Ellerkmann, Richard K.
A1  - Oswald, Daniel
A1  - Lotz, Gösta
A1  - Zotzmann, Viviane
A1  - Moerer, Onnen
A1  - Kühn, Christian
A1  - Kochanek, Matthias
A1  - Muellenbach, Ralf
A1  - Gaertner, Matthias
A1  - Fichtner, Falk
A1  - Brettner, Florian
A1  - Findeisen, Michael
A1  - Heim, Markus
A1  - Lahmer, Tobias
A1  - Rosenow, Felix
A1  - Haake, Nils
A1  - Lepper, Philipp M.
A1  - Rosenberger, Peter
A1  - Braune, Stephan
A1  - Kohls, Mirjam
A1  - Heuschmann, Peter
A1  - Meybohm, Patrick
T1  - Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation
JF  - Critical Care
N2  - Background
Severe COVID-19 induced acute respiratory distress syndrome (ARDS) often requires extracorporeal membrane oxygenation (ECMO). Recent German health insurance data revealed low ICU survival rates. Patient characteristics and experience of the ECMO center may determine intensive care unit (ICU) survival. The current study aimed to identify factors affecting ICU survival of COVID-19 ECMO patients.
Methods
673 COVID-19 ARDS ECMO patients treated in 26 centers between January 1st 2020 and March 22nd 2021 were included. Data on clinical characteristics, adjunct therapies, complications, and outcome were documented. Block wise logistic regression analysis was applied to identify variables associated with ICU-survival.
Results
Most patients were between 50 and 70 years of age. PaO\(_{2}\)/FiO\(_{2}\) ratio prior to ECMO was 72 mmHg (IQR: 58–99). ICU survival was 31.4%. Survival was significantly lower during the 2nd wave of the COVID-19 pandemic. A subgroup of 284 (42%) patients fulfilling modified EOLIA criteria had a higher survival (38%) (p = 0.0014, OR 0.64 (CI 0.41–0.99)). Survival differed between low, intermediate, and high-volume centers with 20%, 30%, and 38%, respectively (p = 0.0024). Treatment in high volume centers resulted in an odds ratio of 0.55 (CI 0.28–1.02) compared to low volume centers. Additional factors associated with survival were younger age, shorter time between intubation and ECMO initiation, BMI > 35 (compared to < 25), absence of renal replacement therapy or major bleeding/thromboembolic events.
Conclusions
Structural and patient-related factors, including age, comorbidities and ECMO case volume, determined the survival of COVID-19 ECMO. These factors combined with a more liberal ECMO indication during the 2nd wave may explain the reasonably overall low survival rate. Careful selection of patients and treatment in high volume ECMO centers was associated with higher odds of ICU survival.
KW  - Covid-19
KW  - extracorporeal membrane oxygenation (ECMO)
KW  - intensive care unit
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299686
VL  - 26
IS  - 1
ER  - 
TY  - JOUR
A1  - Herrmann, Johannes
A1  - Muenstermann, Marcel
A1  - Strobel, Lea
A1  - Schubert-Unkmeir, Alexandra
A1  - Woodruff, Trent M.
A1  - Gray-Owen, Scott D.
A1  - Klos, Andreas
A1  - Johswich, Kay O.
T1  - Complement C5a receptor 1 exacerbates the pathophysiology of N. meningitidis sepsis and is a potential target for disease treatment
JF  - mBio
N2  - Sepsis caused by Neisseria meningitidis (meningococcus) is a rapidly progressing, life-threatening disease. Because its initial symptoms are rather unspecific, medical attention is often sought too late, i.e., when the systemic inflammatory response is already unleashed. This in turn limits the success of antibiotic treatment. The complement system is generally accepted as the most important innate immune determinant against invasive meningococcal disease since it protects the host through the bactericidal membrane attack complex. However, complement activation concomitantly liberates the C5a peptide, and it remains unclear whether this potent anaphylatoxin contributes to protection and/or drives the rapidly progressing immunopathogenesis associated with meningococcal disease. Here, we dissected the specific contribution of C5a receptor 1 (C5aR1), the canonical receptor for C5a, using a mouse model of meningococcal sepsis. Mice lacking C3 or C5 displayed susceptibility that was enhanced by >1,000-fold or 100-fold, respectively, consistent with the contribution of these components to protection. In clear contrast, C5ar1\(^{-/-}\) mice resisted invasive meningococcal infection and cleared N. meningitidis more rapidly than wild-type (WT) animals. This favorable outcome stemmed from an ameliorated inflammatory cytokine response to N. meningitidis in C5ar1\(^{-/-}\) mice in both in vivo and ex vivo whole-blood infections. In addition, inhibition of C5aR1 signaling without interference with the complement bactericidal activity reduced the inflammatory response also in human whole blood. Enticingly, pharmacologic C5aR1 blockade enhanced mouse survival and lowered meningococcal burden even when the treatment was administered after sepsis induction. Together, our findings demonstrate that C5aR1 drives the pathophysiology associated with meningococcal sepsis and provides a promising target for adjunctive therapy.

Importance:
The devastating consequences of N. meningitidis sepsis arise due to the rapidly arising and self-propagating inflammatory response that mobilizes antibacterial defenses but also drives the immunopathology associated with meningococcemia. The complement cascade provides innate broad-spectrum protection against infection by directly damaging the envelope of pathogenic microbes through the membrane attack complex and triggers an inflammatory response via the C5a peptide and its receptor C5aR1 aimed at mobilizing cellular effectors of immunity. Here, we consider the potential of separating the bactericidal activities of the complement cascade from its immune activating function to improve outcome of N. meningitidis sepsis. Our findings demonstrate that the specific genetic or pharmacological disruption of C5aR1 rapidly ameliorates disease by suppressing the pathogenic inflammatory response and, surprisingly, allows faster clearance of the bacterial infection. This outcome provides a clear demonstration of the therapeutic benefit of the use of C5aR1-specific inhibitors to improve the outcome of invasive meningococcal disease.
KW  - C5aR1
KW  - whole-blood model
KW  - Neisseria meningitidis
KW  - anaphylatoxins
KW  - complement system
KW  - inflammation
KW  - invasive disease
KW  - mouse model
KW  - neutrophils
KW  - sepsis
Y1  - 2018
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175792
VL  - 9
IS  - 1
ER  - 
TY  - JOUR
A1  - Herrmann, Johannes
A1  - Müller, Kerstin
A1  - Notz, Quirin
A1  - Hübsch, Martha
A1  - Haas, Kirsten
A1  - Horn, Anna
A1  - Schmidt, Julia
A1  - Heuschmann, Peter
A1  - Maschmann, Jens
A1  - Frosch, Matthias
A1  - Deckert, Jürgen
A1  - Einsele, Hermann
A1  - Ertl, Georg
A1  - Frantz, Stefan
A1  - Meybohm, Patrick
A1  - Lotz, Christopher
T1  - Prospective single-center study of health-related quality of life after COVID-19 in ICU and non-ICU patients
JF  - Scientific Reports
N2  - Long-term sequelae in hospitalized Coronavirus Disease 2019 (COVID-19) patients may result in limited quality of life. The current study aimed to determine health-related quality of life (HRQoL) after COVID-19 hospitalization in non-intensive care unit (ICU) and ICU patients. This is a single-center study at the University Hospital of Wuerzburg, Germany. Patients eligible were hospitalized with COVID-19 between March 2020 and December 2020. Patients were interviewed 3 and 12 months after hospital discharge. Questionnaires included the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L), patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder 7 scale (GAD-7), FACIT fatigue scale, perceived stress scale (PSS-10) and posttraumatic symptom scale 10 (PTSS-10). 85 patients were included in the study. The EQ5D-5L-Index significantly differed between non-ICU (0.78 ± 0.33 and 0.84 ± 0.23) and ICU (0.71 ± 0.27; 0.74 ± 0.2) patients after 3- and 12-months. Of non-ICU 87% and 80% of ICU survivors lived at home without support after 12 months. One-third of ICU and half of the non-ICU patients returned to work. A higher percentage of ICU patients was limited in their activities of daily living compared to non-ICU patients. Depression and fatigue were present in one fifth of the ICU patients. Stress levels remained high with only 24% of non-ICU and 3% of ICU patients (p = 0.0186) having low perceived stress. Posttraumatic symptoms were present in 5% of non-ICU and 10% of ICU patients. HRQoL is limited in COVID-19 ICU patients 3- and 12-months post COVID-19 hospitalization, with significantly less improvement at 12-months compared to non-ICU patients. Mental disorders were common highlighting the complexity of post-COVID-19 symptoms as well as the necessity to educate patients and primary care providers about monitoring mental well-being post COVID-19.
KW  - health care
KW  - public health
KW  - quality of life
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357174
VL  - 13
ER  - 
TY  - JOUR
A1  - Herrmann, Johannes
A1  - Notz, Quirin
A1  - Schlesinger, Tobias
A1  - Stumpner, Jan
A1  - Kredel, Markus
A1  - Sitter, Magdalena
A1  - Schmid, Benedikt
A1  - Kranke, Peter
A1  - Schulze, Harald
A1  - Meybohm, Patrick
A1  - Lotz, Christopher
T1  - Point of care diagnostic of hypercoagulability and platelet function in COVID-19 induced acute respiratory distress syndrome: a retrospective observational study
JF  - Thrombosis Journal
N2  - Background
Coronavirus disease 2019 (COVID-19) associated coagulopathy (CAC) leads to thromboembolic events in a high number of critically ill COVID-19 patients. However, specific diagnostic or therapeutic algorithms for CAC have not been established. In the current study, we analyzed coagulation abnormalities with point-of-care testing (POCT) and their relation to hemostatic complications in patients suffering from COVID-19 induced Acute Respiratory Distress Syndrome (ARDS). Our hypothesis was that specific diagnostic patterns can be identified in patients with COVID-19 induced ARDS at risk of thromboembolic complications utilizing POCT.

Methods
This is a single-center, retrospective observational study. Longitudinal data from 247 rotational thromboelastometries (Rotem®) and 165 impedance aggregometries (Multiplate®) were analysed in 18 patients consecutively admitted to the ICU with a COVID-19 induced ARDS between March 12th to June 30th, 2020.

Results
Median age was 61 years (IQR: 51–69). Median PaO2/FiO2 on admission was 122 mmHg (IQR: 87–189), indicating moderate to severe ARDS. Any form of hemostatic complication occurred in 78 % of the patients with deep vein/arm thrombosis in 39 %, pulmonary embolism in 22 %, and major bleeding in 17 %. In Rotem® elevated A10 and maximum clot firmness (MCF) indicated higher clot strength. The delta between EXTEM A10 minus FIBTEM A10 (ΔA10) > 30 mm, depicting the sole platelet-part of clot firmness, was associated with a higher risk of thromboembolic events (OD: 3.7; 95 %CI 1.3–10.3; p = 0.02). Multiplate® aggregometry showed hypoactive platelet function. There was no correlation between single Rotem® and Multiplate® parameters at intensive care unit (ICU) admission and thromboembolic or bleeding complications.

Conclusions
Rotem® and Multiplate® results indicate hypercoagulability and hypoactive platelet dysfunction in COVID-19 induced ARDS but were all in all poorly related to hemostatic complications..
KW  - COVID-19
KW  - acute Respiratory Distress Syndrome
KW  - point of care testing
KW  - thromboelastometry
KW  - impedance aggregometry; WHOLE-BLOOD THROMBOELASTOMETRY; DEFINITION; DISEASE
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260739
VL  - 19
IS  - 1
ER  -