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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.
In der vorligenden Arbeit wurden Vanadium-abhängige Bromidperoxidase- (VBPO-) Modelle zur stereoselektiven Synthese funktionalisierter O-Heterocyclen entwickelt, die durch Vanadium-katalysierte Oxygenierung von Bishomoallylalkoholen mechanistisch untersucht wurden. Weiterhin wurden Bromcyclisierungen von Bishomoallylalkoholen auf enzymatischem (VBPO), oxidativem und radikalischem Weg für Referenzprodukte einer neuen Variante der Bromcyclisierung durch Vanadium-katalysierte Bromidoxidation durchgeführt. Die Selektivitätsmuster aus den Synthesen ß-hydroxylierter und ß-bromierter Tetrahydrofurane wurden anschließend innerhalb einfacher Naturstoffsynthesen genutzt. Anhand eigener Vorarbeiten wurden neue Vanadium(V)-Komplexe aus Triethoxyvanadat mit tridentaten Schiffbaseliganden, basierend auf Salicylaldehyd und Aminoalkoholen mit strukturell unterschiedlichen Seitenketten in quantitativen Ausbeuten synthetisiert und charakterisiert (51V-NMR, UV und IR). In Test-Cyclisierungen unterschiedlicher Bishomoallylalkohole eignete sich VO(salin)(OEt) mit hohen Umsätzen und guten Regio- wie Stereoselektivitäten am besten. Die relative Geschwindigkeitskonstante (krel = 120±20) der Vanadium-katalysierten Oxidation des Testsystems konnte über Konkurrenzkinetik (Alkenol versus Alken) ermittelt werden und weist deutlich auf eine Bindung des Alkenols an Vanadium während der Oxidation hin. Um die Regio- und Stereoselektivitäten Vanadium-Schiffbase-katalysierter Oxidationen von Bishomoallylalkoholen verstehen zu können, wurden stereochemische Studien anhand des Testsystems durchgeführt. Dessen Oxidation wird demnach im selektivitätsbestimmenden Schritt dem Metallzentrum abgewandt in like-Position bevorzugt gebildet und führt zu dem cis-konfigurierten Tetrahydrofuran als Hauptprodukt. Im Folgenden wurden Vanadium-katalysierte Oxidationen unterschiedlich substituierter bishomoallylischer Alkohole durchgeführt, sämtliche Oxidationen führten regioselektiv zu Tetrahydrofuranen als Hauptprodukte, die Oxygenierung Dimethyl-substituierter Pentenole lieferte durch Substitution an C-1 selektiv cis-konfigurierte Tetrahydrofurane, 2-Substitution führte ebenso wie 3-Substitution zu trans-konfigurierte Oxolanen. Alkohole nicht aktivierter Olefine wurden in der Reihenfolge C-1 ? C-3 mit höherer Selektivität zu trans-konfigurierten Tetrahydrofuranen gebildet. Die Regio- und Stereoselektivitäten der radikalischen Bromcyclisierungen folgen den schon in früheren Arbeiten unserer Arbeitsgruppe aufgestellten Richtlinien (5-exo-trig; 2,5-trans, 2,4-cis und 2,3-trans). Die ionischen Bromcyclisierungen 5,5-dimethylierter Bishomoallyl-alkohole mittels NBS verliefen komplementär zu den Radikal-Cyclisierungen regioselektiv und in Abhängigkeit der Phenylsubstituenten an C-1 - C-3 stereoselektiv zu den 2,5-trans-, 3,5-cis- und 4,5-trans-konfigurierten Tetrahydropyranen. Aus der Bromcyclisierung prochiraler Pentenole in Gegenwart eines Acetonpulvers aus Ascophyllum nodosum (A.n.A.P.) konnte das b-bromierte Tetrahydrofuran racemisch in 87proz. Ausbeute erhalten werden. Ebensowenig führte der Einsatz chiraler Liganden in der Vanadium-katalysierten Oxygenierung prochiraler Penten-1-ole bei guten Ausbeuten (>80%) zu Enantiomeren-angereicherten Tatrahydrofuranen. Innerhalb einfacher Naturstoffsynthesen wurden cis-Pityol, Linalooloxid sowie (-)-epi-Bisabololoxid selektiv unter Standardbedingungen der Vanadium-Schiffbase-katalysierten Oxidationen mit VO(salin)(OEt) und TBHP dargestellt. Die Stereoselektivitäten steigen proportional zu dem Größenunterschied der Substituenten an Position 1 der Bishomoallylalkohole. Abschließend wurde durch Vanadium-katalysierte Bromidoxiadtion mit TBHP eine neue dreistufige Totalsynthese der vier "natürlichen" Muscarin-Isomere ausgearbeitet. Die Gesamtausbeuten dieser Synthesen liegen zwischen 3.0 und 19.9%.
Blood vessel organoids are an important in vitro model to understand the underlying mechanisms of human blood vessel development and for toxicity testing or high throughput drug screening. Here we present a novel, cost-effective, and easy to manufacture vascular organoid model. To engineer the organoids, a defined number of human induced pluripotent stem cells are seeded in non-adhesive agarose coated wells of a 96-well plate and directed towards a lateral plate mesoderm fate by activation of Wnt and BMP4 signaling. We observe the formation of a circular layer of angioblasts around days 5–6. Induced by VEGF application, CD31\(^+\) vascular endothelial cells appear within this vasculogenic zone at approximately day 7 of organoid culture. These cells arrange to form a primitive vascular plexus from which angiogenic sprouting is observed after 10 days of culture. The differentiation outcome is highly reproducible, and the size of organoids is scalable depending on the number of starting cells. We observe that the initial vascular ring forms at the interface between two cell populations. The inner cellular compartment can be distinguished from the outer by the expression of GATA6, a marker of lateral plate mesoderm. Finally, 14-days-old organoids were transplanted on the chorioallantois membrane of chicken embryos resulting in a functional connection of the human vascular network to the chicken circulation. Perfusion of the vessels leads to vessel wall maturation and remodeling as indicated by the formation of a continuous layer of smooth muscle actin expressing cells enwrapping the endothelium. In summary, our organoid model recapitulates human vasculogenesis, angiogenesis as well as vessel wall maturation and therefore represents an easy and cost-effective tool to study all steps of blood vessel development and maturation directly in the human setting without animal experimentation.
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.
Post-fabrication formation of a proper vasculature remains an unresolved challenge in bioprinting. Established strategies focus on the supply of the fabricated structure with nutrients and oxygen and either rely on the mere formation of a channel system using fugitive inks or additionally use mature endothelial cells and/or peri-endothelial cells such as smooth muscle cells for the formation of blood vessels in vitro. Functional vessels, however, exhibit a hierarchical organization and multilayered wall structure that is important for their function. Human induced pluripotent stem cell-derived mesodermal progenitor cells (hiMPCs) have been shown to possess the capacity to form blood vessels in vitro, but have so far not been assessed for their applicability in bioprinting processes. Here, we demonstrate that hiMPCs, after formulation into an alginate/collagen type I bioink and subsequent extrusion, retain their ability to give rise to the formation of complex vessels that display a hierarchical network in a process that mimics the embryonic steps of vessel formation during vasculogenesis. Histological evaluations at different time points of extrusion revealed the initial formation of spheres, followed by lumen formation and further structural maturation as evidenced by building a multilayered vessel wall and a vascular network. These findings are supported by immunostainings for endothelial and peri-endothelial cell markers as well as electron microscopic analyses at the ultrastructural level. Moreover, endothelial cells in capillary-like vessel structures deposited a basement membrane-like matrix at the basal side between the vessel wall and the alginate-collagen matrix. After transplantation of the printed constructs into the chicken chorioallantoic membrane (CAM) the printed vessels connected to the CAM blood vessels and get perfused in vivo. These results evidence the applicability and great potential of hiMPCs for the bioprinting of vascular structures mimicking the basic morphogenetic steps of de novo vessel formation during embryogenesis.
Clinical and biological characteristics of medullary and extramedullary plasma cell dyscrasias
(2021)
Background: Extramedullary plasma cell (PC) disorders may occur as extramedullary disease in multiple myeloma (MM-EMD) or as primary extramedullary plasmocytoma (pEMP)/solitary osseous plasmocytoma (SOP). In this study, we aimed to obtain insights into the molecular mechanisms of extramedullary spread of clonal PC. Methods: Clinical and biological characteristics of 87 patients with MM-EMD (n = 49), pEMP/SOP (n = 20) and classical MM (n = 18) were analyzed by using immunohistochemistry (CXCR4, CD31, CD44 and CD81 staining) and cytoplasmic immunoglobulin staining combined with fluorescence in situ hybridization (cIg-FISH). Results: High expression of CD44, a cell-surface glycoprotein involved in cell-cell interactions, was significantly enriched in MM-EMD (90%) vs. pEMP/SOP (27%) or classical MM (33%) (p < 0.001). In addition, 1q21 amplification by clonal PC occurred at a similar frequency of MM-EMD (33%), pEMP/SOP (57%) and classical MM (44%). Conversely, del(17p13), t(4;14) and t(14;16) were completely absent in pEMP/SOP. Besides this, 1q21 amplification was identified in 64% of not paraskeletal samples from MM-EMD or pEMP compared to 9% of SOP or paraskeletal MM-EMD/pEMP and 44% of classical MM samples, respectively (p = 0.02). Conclusion: Expression of molecules involved in homing and cytogenetic aberrations differ between MM with or without EMD and pEMP/SOP.
Background: The primary aim of this study was to identify modifiable patient-related predictors of blood transfusions and perioperative complications in total hip and knee arthroplasty. Individual predictor-adjusted risks can be used to define preoperative treatment thresholds. Methods: We performed this retrospective monocentric study in orthopaedic patients who underwent primary total knee or hip arthroplasty. Multivariate logistic regression models were used to assess the predictive value of patient-related characteristics. Predictor-adjusted individual risks of blood transfusions and the occurrence of any perioperative adverse event were calculated for potentially modifiable risk factors. Results: 3754 patients were included in this study. The overall blood transfusion and complication rates were 4.8% and 6.4%, respectively. Haemoglobin concentration (Hb, p < 0.001), low body mass index (BMI, p < 0.001) and estimated glomerular filtration rate (eGFR, p = 0.004) were the strongest potentially modifiable predictors of a blood transfusion. EGFR (p = 0.001) was the strongest potentially modifiable predictor of a complication. Predictor-adjusted risks of blood transfusions and acute postoperative complications were calculated for Hb and eGFR. Hb = 12.5 g/dL, BMI = 17.6 kg/m\(^2\), and eGFR = 54 min/mL were associated, respectively, with a 10% risk of a blood transfusion, eGFR = 59 mL/min was associated with a 10% risk of a complication. Conclusion: The individual risks for blood transfusions and acute postoperative complications are strongly increased in patients with a low preoperative Hb, low BMI or low eGFR. We recommend aiming at a preoperative Hb ≥ 13g/dL, an eGFR ≥ 60 mL/min and to avoid a low BMI. Future studies must show if a preoperative increase of eGFR and BMI is feasible and truly beneficial.