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International research group identifies three forms of disease progression for “acute decompensated liver cirrhosis”
FRANKFURT. When the body can no longer compensate the
gradual failure of the liver caused by liver cirrhosis, there is a high risk of
acute decompensated liver cirrhosis. In some patients this develops quickly
into an often deadly acute-on-chronic liver failure, in which other organs such
as the kidneys or brain fail. A study by an international team of researchers headed
by Professor Jonel Trebicka from the Frankfurt University Hospital and funded
by the foundation EF Clif, has discovered which patients are particularly at
risk. With their findings, the scientists have laid the foundation for the
development of preventive therapy to prevent acute-on-chronic liver failure.
The liver has many functions: it stores
nutrients and vitamins, produces dextrose, coagulation factors and hormones,
and breaks down toxins, drugs and alcohol. Chronic alcohol abuse, viruses or
other diseases can damage the liver and lead to chronic liver disease. Without
treatment, chronic liver disease leads to liver cirrhosis in the final stages,
in which liver tissue turns into connective tissue, making the liver
increasingly unable to carry out its functions. The result: the blood’s
clotting ability is impaired, toxic metabolic products are fortified, the liver
is not adequately supplied with blood and blood pressure rises in the portal
veins that supply the liver.
The body tries to compensate for the
reduced liver function. For example, new veins develop as alternative
circulation from the oesophagus, stomach and intestines which expand into varicose
veins. When the disease progresses to the point that this kind of compensation
is no longer possible – physicians speak of acute decompensated liver cirrhosis
– the situation becomes life-threatening: tissue fluid (ascites) collects in
the abdominal cavity, leading to bacterial infections and internal bleeding,
for example in the oesophagus. Difficulty concentrating, mood swings and
sleepiness are signs of a poisoning of the brain (hepatic encephalopathy) that
can result in a hepatic coma.
A European clinical study headed by
Professor Jonel Trebicka, and carried out under the umbrella of the European
Foundation for the Study of Chronic Liver Failure, has for the first time
identified three clinical course variations in patients admitted to the
hospital with acute decompensated cirrhosis.
1.
The first clinical course is characterised by high blood
inflammation values, indicating inflammatory reactions throughout the body.
Within three months after admission to the hospital, a number of body organs
fail: the acute decompensation becomes “acute-on-chronic liver failure” (ACLF).
The physicians therefore call this variation Pre-ACLF. More than half of
patients die from it; only a third survive after a year.
2.
Patients
with the second clinical course do
not develop ACLF and have moderate inflammation values. They suffer, however,
from significant hypertension in the portal vein. Approximately 20 percent die
within the following three months, another 15 percent over the course of the
following year. The physicians named this variation “instable decompensated
liver cirrhosis”.
3.
The
patients with the third clinical course exhibit
neither high inflammation values nor frequent complications. They do not
develop ACLF in the first three months. Within a year, however, one in ten
dies. The physicians call this variation “stable decompensated liver cirrhosis.“
Lead investigator Professor Jonel
Trebicka, gastroenterologist and hepatologist at Medical Clinic I of University Hospital Frankfurt explains: “We
are now working intensively on the development of new diagnostic options,
especially for the group of pre-ACLF patients, in order to identify this group
before admission to the hospital so that preventive measures can be implemented
early on. The development of preventive therapies for the often deadly ACLF is
one of our most important research goals in this context.”
Study co-author Professor Stefan Zeuzem, Dean
of the Faculty of Medicine and Director of Medical Clinic I at Frankfurt
University Hospital explains: “Liver diseases are one of the main focal points
of Medical Clinic I and we offer numerous specialised outpatient departments
for patients with acute and chronic liver diseases. So on the one hand we were
able to observe patients for the study. On the other hand, the research findings
on improving ACLF prevention and therapies will rapidly benefit all of our
patients.”
The research findings are part of a
European-wide study called PREDICT. The study observes the clinical course of
acute decompensated liver cirrhosis in order to find early indications for the
development of acute-on-chronic liver failures (ACLF). The study was funded by
the European Foundation for the Study of Chronic Liver Failure. 136 scientists
from 47 centres and institutions in 14 European countries are participating in
PREDICT.
Publication:
Jonel Trebicka, Javier Fernandez, Maria
Papp, Paolo Caraceni, Wim Laleman, Carmine Gambino, et al.: The PREDICT study uncovers three clinical
courses of acutely decompensated cirrhosis that have distinct pathophysiology.
Journal of Hepatology,
Further
information:
University Hospital Frankfurt, 51
Frankfurt
Medical Clinic I
Professor Jonel Trebicka
Section Translational Hepatology,
Medical Clinic I (Director: Professor Stefan
Zeuzem)
51/University Hospital
Frankfurt
Tel. +49 69 6301 80789 (Jennifer Biondo, secretarial
office)
Jonel.Trebicka@kgu.de.
Wastewater provides indication of the degree of infection in population
FRANKFURT/AACHEN. Since the beginning of the pandemic, research groups have been working on methods to detect SARS-CoV-2 viruses in wastewater to be used to monitor the degree of COVID-19 transmission among the population. The idea is simple: since infected people shed SARS-CoV-2 viruses in their faeces, wastewater samples could give an indication of the infection numbers among all the residents connected to a wastewater treatment plant. Given sufficient sensitivity, these analyses could function as an early-warning system for authorities, allowing early detection of local case increases within the catchment area of a treatment plant.
A consortium of Frankfurt virologists,
ecotoxicologists and evolution researchers, and water researchers from Aachen
have now shown for the first time in Germany that SARS-CoV-2 genetic material
can be detected in treatment plants using modern molecular methods. Analyses revealed
3 to 20 gene equivalents per millilitre of raw wastewater in all nine treatment
plants tested during the first pandemic wave in April 2020. This concentration
level was also measured in studies in the Netherlands and the USA.
The researchers were astonished that older
retention samples from the years 2017 and 2018, before the outbreak of the
pandemic, also delivered signals. Extensive method validation revealed that the
gene primer erroneously registered not only SARS-CoV-2, but other non-disease
causing coronaviruses in wastewater as well. The current method, developed
specifically for SARS-CoV-2 in wastewater, has been confirmed through gene
sequencing.
The method can be now employed for what is
called wastewater-based epidemiology: the measured viral load of a treatment
plant allows conclusions on the number of COVID-19 infected individuals in the
catchment area. In the largest treatment plant, 1,037 acute cases were
estimated in the catchment area for a viral load of 6 trillion (6 x 1012)
gene equivalencies pro day; in smaller treatment plants with viral loads lower
by two orders of magnitude, 36 cases were estimated.
The sensitivity is sufficient as an early
warning system to indicate whether the action value of 50 incidents per 100,000
residents has been exceeded. Earlier hopes that the precision would be
sufficient to determine the estimated number infected people not reported
through laboratory diagnosis have not yet been fulfilled. However, the
scientists believe that further improvements in the methods are possible.
In vitro cell tests have shown that the
SARS-CoV-2 fragments verified in the wastewater are non-infectious. However, due
to the high loads and low retention capacity of conventional treatment plants,
the behaviour of SARS-CoV-2 in the water cycle should be investigated more
deeply. The authors of the study are working on making their knowledge
available for an application of the method soon, with the goal of achieving a
close cooperation between health ministries, environmental ministries,
treatment plant operators and professional associations.
The research team was formed on the
initiative of the non-profit Research Institute for Water and Waste Management
at RWTH Aachen (FiW), the Institute of Environmental Engineering at RWTH Aachen
(ISA), the Institute for Medical Virology at University Hospital Frankfurt (KGU)
and Department for Evolution Ecology and Environmental Toxicology at the
Institute of Ecology, Evolution and Diversity at 51 Frankfurt,
and is supported by six water boards in North Rhine-Westphalia, the LOEWE
Centre for Translational Biodiversity Genomics (TBG) and the University of
Saskatoon in Canada.
Publication: Sandra Westhaus,
Frank-Andreas Weber, Sabrina Schiwy, Volker Linnemann, Markus Brinkmann, Marek
Widera, Carola Greve, Axel Janke, Henner Hollert, Thomas Wintgens, Sandra
Ciesek. Detection
of SARS-CoV-2 in raw and treated wastewater in Germany – suitability for
COVID-19 surveillance and potential transmission risks. Science of the Total Environment. ,
Further
information
University Hospital Frankfurt
Institute for Medical Virology
Prof.
Dr. Sandra Ciesek through
University Hospital Frankfurt Press Office
Tel.
+49 69 6301 86442
kommunikation@kgu.de
Goethe
University Frankfurt
Institute of Ecology, Evolution and
Diversity
Dept. Evolution Ecology and Environmental
Toxicology
and LOEWE Centre for Translational Biodiversity
Genomics (TBG)
Prof. Dr. rer. nat.
Henner Hollert
hollert@bio.uni-frankfurt.de
Research Institute for Water and Waste
Management at RWTH Aachen (FiW)
Dr.
sc. Frank-Andreas Weber
weber@fiw.rwth-aachen.de
RWTH Aachen University
Institute of Environmental Engineering (ISA)
Univ.-Prof.
Dr.-Ing.
habil. Thomas Wintgens
wintgens@isa.rwth-aachen.de
78 million for 5-year project for the development of COVID-19 therapies
CARE (Corona Accelerated R&D in Europe),
supported by Europe’s Innovative Medicines Initiative (IMI), is the largest
undertaking of its kind dedicated to discovering and developing urgently needed
treatment options for COVID-19. The initiative is committed to a long-term
understanding of the disease and development of therapies for COVID-19 and
future coronavirus threats in addition to urgent efforts to repurpose existing
therapies as potential immediate response. The CARE consortium will accelerate
COVID-19 R&D by bringing together the leading expertise and projects of 37
teams from academic and non-profit research institutions and pharmaceutical
companies into a comprehensive drug discovery engine.
Complete news release here.
Innovative method opens up new perspectives for reconstructing climatic conditions of past eras
FRANKFURT. Corals and cave carbonates are important archives
of past climate. This is because the composition of these carbonate deposits can
reveal the temperatures that prevailed at the Earth’s surface at the time they formed.
An international team of geoscientists led by 51 Frankfurt,
Germany, has now developed a new method that makes it possible to identify whether
the composition of these deposits was exclusively controlled by temperature, or
if the formation process itself exerted an additional control. The new method allows
scientists to determine past Earth surface temperatures more reliably and to
study the processes involved in calcareous skeleton formation of modern and
extinct species. (Nature Communications, DOI
10.1038/s41467-020-17501-0)
Corals precipitate their calcareous skeletons
(calcium carbonate) from seawater. Over thousands of years, vast coral reefs
form due to the deposition of this calcium carbonate. During precipitation,
corals prefer carbonate groups containing specific variants of oxygen (chemical
symbol: O). For example, the lower the water temperature, the higher the
abundance of a heavy oxygen variant, known as isotope 18O, within
the precipitated carbonate. Unfortunately, the 18O abundance of the
seawater also influences the abundance of 18O in the calcium
carbonate – and the contribution of 18O from seawater cannot be
resolved when determining temperatures based on carbonate 18O
abundances alone.
A great step forward was the discovery
that the isotopic composition of the precipitated carbonate allows temperature
determinations independent of the composition of the water if the abundance of
a specific, very rare carbonate group is measured. This carbonate group
contains two heavy isotopes, a heavy carbon isotope (13C) and a
heavy oxygen isotope (18O) which are referred to as “clumped
isotopes”. Clumped isotopes are more abundant at lower temperatures.
However, even with this method there was
still a problem: The mineralization process itself can affect the incorporation
of heavy isotopes in the calcium carbonate (kinetic effects). If unidentified, the
bias introduced by such kinetic effects leads to inaccurate temperature
determinations. This particularly applies for climatic archives like corals and
cave carbonates.
An international research group led by
Professor Jens Fiebig at the Department of Geosciences at 51 Frankfurt
has now found a solution to this problem. They have developed a highly
sensitive method by which – in addition to the carbonate group containing 13C
and 18O – the abundance of another, even rarer carbonate group can
be determined with very high precision. This group also contains two heavy
isotopes, namely two heavy oxygen isotopes (18O).
If the theoretical abundances of these two
rare carbonate groups are plotted against each other in a graph, the influence
of the temperature is represented by a straight line. If, for a given sample,
the measured abundances of the two heavy carbonate groups produce a point away
from the straight line, this deviation is due to the influence of the
mineralization process.
David Bajnai, Fiebig’s former PhD student,
applied this method to various climatic archives. Among others, he examined various
coral species, cave carbonates and the fossil skeleton of a squid-like
cephalopod (belemnite).
Today, Dr. Bajnai is a post-doctoral
researcher at the University of Cologne. He explains: “We were able to show
that – in addition to temperature – the mechanisms of mineralization also
greatly affect the composition of many of the carbonates that we examined. In
the case of cave carbonates and corals, the observed deviations from the exclusive
temperature control confirm model calculations of the respective mineralization
processes conducted by Dr. Weifu Guo, our collaborator at the Woods Hole Oceanographic
Institution in the USA. The new method, for the first time, makes it possible
to quantitatively assess the influence of the mineralization process itself. This
way, the exact temperature of carbonate formation can be determined.”
Professor Jens Fiebig is convinced that the
new method holds great potential: “We will further validate our new method and
identify climatic archives that are particularly suitable for an accurate and
highly precise reconstruction of past Earth surface temperatures. We also intend
to use our method to study the effect that anthropogenic ocean acidification has
on carbonate mineralization, for instance in corals. The new method might even allow
us to estimate the pH values of earlier oceans.” If all this succeeds, the
reconstruction of environmental conditions that prevailed throughout Earth’s
history could be greatly improved, he adds.
Publication:
David Bajnai, Weifu Guo, Christoph Spötl,
Tyler B. Coplen, Katharina Methner, Niklas
Löffler, Emilija Krsnik, Eberhard
Gischler, Maximilian Hansen, Daniela Henkel, Gregory D. Price, Jacek Raddatz,
Denis Scholz, Jens Fiebig: Dual clumped
isotope thermometry resolves kinetic biases in carbonate formation temperatures,
Nature Communications, DOI 10.1038/s41467-020-17501-0,
Further
information:
Professor Jens Fiebig
Department of Geosciences
51 Frankfurt
Tel.: +49 (0) 69 798 40182
Jens.Fiebig@em.uni-frankfurt.de
Dr. David Bajnai
Institute of Geology and Mineralogy
University of Cologne
Tel.: +49 (0)221 470 89829
David.Bajnai@uni-koeln.de
Dr. Weifu Guo
Department of Geology and Geophysics
Woods Hole Oceanographic Institution
Woods Hole, MA
USA
Tel.:
+1 508 289 3380
wfguo@whoi.edu
How microbes in the primordial atmosphere obtained energy without oxygen