Skip to main content
Erschienen in: Seminars in Immunopathology 5/2015

01.09.2015 | Review

Matrix remodeling in systemic sclerosis

verfasst von: Andrew Leask

Erschienen in: Seminars in Immunopathology | Ausgabe 5/2015

Einloggen, um Zugang zu erhalten

Abstract

Systemic sclerosis (SSc, scleroderma) is an often-fatal disease characterized by connective tissue fibrosis of skin and internal organs. In scleroderma, there is an excessive production and accumulation of extracellular matrix (ECM) components resulting from an increase in collagen synthesis and matrix stability. Understanding how this how excessive ECM is produced and remodeled may represent a novel therapeutic approach. In this review, the transcription factors and collagen-modifying enzymes underlying collagen overexpression and enhancing stability in SSc are discussed. Moreover, the role of matrix stiffness in promoting fibrosis via a feed-forward mechanism is discussed. Indeed, the emerging evidence is that enhanced ECM remodeling resulting in increased ECM stiffness may be sufficient in itself to sustain persistence fibrosis in SSc.
Literatur
1.
Zurück zum Zitat Kielty CM, Shuttleworth CA (1997) Microfibrillar elements of the dermal matrix. Microsc Res Tech 38(4):413–427CrossRefPubMed Kielty CM, Shuttleworth CA (1997) Microfibrillar elements of the dermal matrix. Microsc Res Tech 38(4):413–427CrossRefPubMed
2.
Zurück zum Zitat Yates CC, Hebda P, Wells A (2012) Skin wound healing and scarring: fetal wounds and regenerative restitution. Birth Defects Res C Embryo Today 96(4):325–333PubMedCentralCrossRefPubMed Yates CC, Hebda P, Wells A (2012) Skin wound healing and scarring: fetal wounds and regenerative restitution. Birth Defects Res C Embryo Today 96(4):325–333PubMedCentralCrossRefPubMed
3.
Zurück zum Zitat Krieg T, Takehara K (2009) Skin disease: a cardinal feature of systemic sclerosis. Rheumatology (Oxford) 48(Suppl 3):iii14-8 Krieg T, Takehara K (2009) Skin disease: a cardinal feature of systemic sclerosis. Rheumatology (Oxford) 48(Suppl 3):iii14-8
4.
Zurück zum Zitat Kirk TZ, Mark ME, Chua CC, Chua BH, Mayes MD (1995) Myofibroblasts from scleroderma skin synthesize elevated levels of collagen and tissue inhibitor of metalloproteinase (TIMP-1) with two forms of TIMP-1. J Biol Chem 270(7):3423–3428CrossRefPubMed Kirk TZ, Mark ME, Chua CC, Chua BH, Mayes MD (1995) Myofibroblasts from scleroderma skin synthesize elevated levels of collagen and tissue inhibitor of metalloproteinase (TIMP-1) with two forms of TIMP-1. J Biol Chem 270(7):3423–3428CrossRefPubMed
5.
Zurück zum Zitat Rajkumar VS, Howell K, Csiszar K, Denton CP, Black CM, Abraham DJ (2005) Shared expression of phenotypic markers in systemic sclerosis indicates a convergence of pericytes and fibroblasts to a myofibroblast lineage in fibrosis. Arthritis Res Ther 7(5):R1113–R1123PubMedCentralCrossRefPubMed Rajkumar VS, Howell K, Csiszar K, Denton CP, Black CM, Abraham DJ (2005) Shared expression of phenotypic markers in systemic sclerosis indicates a convergence of pericytes and fibroblasts to a myofibroblast lineage in fibrosis. Arthritis Res Ther 7(5):R1113–R1123PubMedCentralCrossRefPubMed
6.
Zurück zum Zitat Fleischmajer R, Gay S, Meigel WN, Perlish JS (1978) Collagen in the cellular and fibrotic stages of scleroderma. Arthritis Rheum 21(4):418–428CrossRefPubMed Fleischmajer R, Gay S, Meigel WN, Perlish JS (1978) Collagen in the cellular and fibrotic stages of scleroderma. Arthritis Rheum 21(4):418–428CrossRefPubMed
7.
Zurück zum Zitat Scharffetter K, Lankat-Buttgereit B, Krieg T (1988) Localization of collagen mRNA in normal and scleroderma skin by in-situ hybridization. Eur J Clin Invest 18(1):9–17CrossRefPubMed Scharffetter K, Lankat-Buttgereit B, Krieg T (1988) Localization of collagen mRNA in normal and scleroderma skin by in-situ hybridization. Eur J Clin Invest 18(1):9–17CrossRefPubMed
8.
Zurück zum Zitat Varga J, Bashey RI (1995) Regulation of connective tissue synthesis in systemic sclerosis. Int Rev Immunol 12(2-4):187–199CrossRefPubMed Varga J, Bashey RI (1995) Regulation of connective tissue synthesis in systemic sclerosis. Int Rev Immunol 12(2-4):187–199CrossRefPubMed
9.
Zurück zum Zitat Saitta B, Gaidarova S, Cicchillitti L, Jimenez SA (2000) CCAAT binding transcription factor binds and regulates human COL1A1 promoter activity in human dermal fibroblasts: demonstration of increased binding in systemic sclerosis fibroblasts. Arthritis Rheum 43(10):2219–2229CrossRefPubMed Saitta B, Gaidarova S, Cicchillitti L, Jimenez SA (2000) CCAAT binding transcription factor binds and regulates human COL1A1 promoter activity in human dermal fibroblasts: demonstration of increased binding in systemic sclerosis fibroblasts. Arthritis Rheum 43(10):2219–2229CrossRefPubMed
10.
Zurück zum Zitat Bhattacharyya S, Sargent JL, Du P, Lin S, Tourtellotte WG, Takehara K, Whitfield ML, Varga J (2011) Egr-1 induces a profibrotic injury/repair gene program associated with systemic sclerosis. PLoS One 6(9):e23082PubMedCentralCrossRefPubMed Bhattacharyya S, Sargent JL, Du P, Lin S, Tourtellotte WG, Takehara K, Whitfield ML, Varga J (2011) Egr-1 induces a profibrotic injury/repair gene program associated with systemic sclerosis. PLoS One 6(9):e23082PubMedCentralCrossRefPubMed
11.
Zurück zum Zitat Fang F, Ooka K, Bhattacharyya S, Wei J, Wu M, Du P, Lin S, Del Galdo F, Feghali-Bostwick CA, Varga J (2011) The early growth response gene Egr2 (alias Krox20) is a novel transcriptional target of transforming growth factor-β that is up-regulated in systemic sclerosis and mediates profibrotic responses. Am J Pathol 178(5):2077–2090PubMedCentralCrossRefPubMed Fang F, Ooka K, Bhattacharyya S, Wei J, Wu M, Du P, Lin S, Del Galdo F, Feghali-Bostwick CA, Varga J (2011) The early growth response gene Egr2 (alias Krox20) is a novel transcriptional target of transforming growth factor-β that is up-regulated in systemic sclerosis and mediates profibrotic responses. Am J Pathol 178(5):2077–2090PubMedCentralCrossRefPubMed
12.
Zurück zum Zitat Ponticos M, Papaioannou I, Xu S, Holmes AM, Khan K, Denton CP, Bou-Gharios G, Abraham DJ (2015) Failed degradation of JunB contributes to overproduction of type I collagen and development of dermal fibrosis in patients with systemic sclerosis. Arthritis Rheum 67(1):243–253CrossRef Ponticos M, Papaioannou I, Xu S, Holmes AM, Khan K, Denton CP, Bou-Gharios G, Abraham DJ (2015) Failed degradation of JunB contributes to overproduction of type I collagen and development of dermal fibrosis in patients with systemic sclerosis. Arthritis Rheum 67(1):243–253CrossRef
13.
Zurück zum Zitat Morris E, Chrobak I, Bujor A, Hant F, Mummery C, Ten Dijke P, Trojanowska M (2011) Endoglin promotes TGF-β/Smad1 signaling in scleroderma fibroblasts. Cell Physiol 226(12):3340–3348. doi:10.1002/jcp.22690 CrossRef Morris E, Chrobak I, Bujor A, Hant F, Mummery C, Ten Dijke P, Trojanowska M (2011) Endoglin promotes TGF-β/Smad1 signaling in scleroderma fibroblasts. Cell Physiol 226(12):3340–3348. doi:10.​1002/​jcp.​22690 CrossRef
14.
Zurück zum Zitat Ihn H, Yamane K, Asano Y, Jinnin M, Tamaki K (2006) Constitutively phosphorylated Smad3 interacts with Sp1 and p300 in scleroderma fibroblasts. Rheumatology (Oxford) 45(2):157–165CrossRef Ihn H, Yamane K, Asano Y, Jinnin M, Tamaki K (2006) Constitutively phosphorylated Smad3 interacts with Sp1 and p300 in scleroderma fibroblasts. Rheumatology (Oxford) 45(2):157–165CrossRef
15.
Zurück zum Zitat Ishida W, Mori Y, Lakos G, Sun L, Shan F, Bowes S, Josiah S, Lee WC, Singh J, Ling LE, Varga J (2006) Intracellular TGF-beta receptor blockade abrogates Smad-dependent fibroblast activation in vitro and in vivo. J Invest Dermatol 126(8):1733CrossRefPubMed Ishida W, Mori Y, Lakos G, Sun L, Shan F, Bowes S, Josiah S, Lee WC, Singh J, Ling LE, Varga J (2006) Intracellular TGF-beta receptor blockade abrogates Smad-dependent fibroblast activation in vitro and in vivo. J Invest Dermatol 126(8):1733CrossRefPubMed
16.
Zurück zum Zitat Chen Y, Shi-wen X, Eastwood M, Black CM, Denton CP, Leask A, Abraham DJ (2006) Contribution of activin receptor-like kinase 5 (transforming growth factor beta receptor type I) signaling to the fibrotic phenotype of scleroderma fibroblasts. Arthritis Rheum 54(4):1309–1316CrossRefPubMed Chen Y, Shi-wen X, Eastwood M, Black CM, Denton CP, Leask A, Abraham DJ (2006) Contribution of activin receptor-like kinase 5 (transforming growth factor beta receptor type I) signaling to the fibrotic phenotype of scleroderma fibroblasts. Arthritis Rheum 54(4):1309–1316CrossRefPubMed
17.
Zurück zum Zitat Ihn H, Tamaki K (2000) Increased phosphorylation of transcription factor Sp1 in scleroderma fibroblasts: association with increased expression of the type I collagen gene. Arthritis Rheum 43(10):2240–2247CrossRefPubMed Ihn H, Tamaki K (2000) Increased phosphorylation of transcription factor Sp1 in scleroderma fibroblasts: association with increased expression of the type I collagen gene. Arthritis Rheum 43(10):2240–2247CrossRefPubMed
18.
Zurück zum Zitat Kubo M, Czuwara-Ladykowska J, Moussa O, Markiewicz M, Smith E, Silver RM, Jablonska S, Blaszczyk M, Watson DK, Trojanowska M (2003) Persistent down-regulation of Fli1, a suppressor of collagen transcription, in fibrotic scleroderma skin. Am J Pathol 163(2):571–581PubMedCentralCrossRefPubMed Kubo M, Czuwara-Ladykowska J, Moussa O, Markiewicz M, Smith E, Silver RM, Jablonska S, Blaszczyk M, Watson DK, Trojanowska M (2003) Persistent down-regulation of Fli1, a suppressor of collagen transcription, in fibrotic scleroderma skin. Am J Pathol 163(2):571–581PubMedCentralCrossRefPubMed
19.
Zurück zum Zitat Sandorfi N, Louneva N, Hitraya E, Hajnoczky G, Saitta B, Jimenez SA (2005) Inhibition of collagen gene expression in systemic sclerosis dermal fibroblasts by mithramycin. Ann Rheum Dis 64(12):1685–1691PubMedCentralCrossRefPubMed Sandorfi N, Louneva N, Hitraya E, Hajnoczky G, Saitta B, Jimenez SA (2005) Inhibition of collagen gene expression in systemic sclerosis dermal fibroblasts by mithramycin. Ann Rheum Dis 64(12):1685–1691PubMedCentralCrossRefPubMed
20.
Zurück zum Zitat Antoniv TT, De Val S, Wells D, Denton CP, Rabe C, de Crombrugghe B et al (2001) Characterization of an evolutionarily conserved far-upstream enhancer in the human α2(I) collagen (COL1A2) gene. J Biol Chem 276:21754–21764CrossRefPubMed Antoniv TT, De Val S, Wells D, Denton CP, Rabe C, de Crombrugghe B et al (2001) Characterization of an evolutionarily conserved far-upstream enhancer in the human α2(I) collagen (COL1A2) gene. J Biol Chem 276:21754–21764CrossRefPubMed
21.
Zurück zum Zitat Ponticos M, Harvey C, Ikeda T, Abraham D, Bou-Gharios G (2009) JunB mediates enhancer/promoter activity of COL1A2 following TGF-β induction. Nucleic Acids Res 37:5378–5389PubMedCentralCrossRefPubMed Ponticos M, Harvey C, Ikeda T, Abraham D, Bou-Gharios G (2009) JunB mediates enhancer/promoter activity of COL1A2 following TGF-β induction. Nucleic Acids Res 37:5378–5389PubMedCentralCrossRefPubMed
22.
Zurück zum Zitat Palumbo K, Zerr P, Tomcik M, Vollath S, Dees C, Akhmetshina A, Avouac J, Yaniv M, Distler O, Schett G, Distler JH (2011) The transcription factor JunD mediates transforming growth factor {beta}-induced fibroblast activation and fibrosis in systemic sclerosis. Ann Rheum Dis 70(7):1320–1326CrossRefPubMed Palumbo K, Zerr P, Tomcik M, Vollath S, Dees C, Akhmetshina A, Avouac J, Yaniv M, Distler O, Schett G, Distler JH (2011) The transcription factor JunD mediates transforming growth factor {beta}-induced fibroblast activation and fibrosis in systemic sclerosis. Ann Rheum Dis 70(7):1320–1326CrossRefPubMed
23.
Zurück zum Zitat Derijard B, Hibi M, Wu IH, Barrett T, Su B, Deng T, Karin M, Davis RJ (1994) JNK1: a protein kinase stimulated by UV light and Ha-Ras that binds and phosphorylates the c-Jun activation domain. Cell 76:1025–1037CrossRefPubMed Derijard B, Hibi M, Wu IH, Barrett T, Su B, Deng T, Karin M, Davis RJ (1994) JNK1: a protein kinase stimulated by UV light and Ha-Ras that binds and phosphorylates the c-Jun activation domain. Cell 76:1025–1037CrossRefPubMed
24.
Zurück zum Zitat Parapuram SK, Shi-wen X, Elliott C, Welch ID, Jones H, Baron M, Denton CP, Abraham DJ, Leask A (2011) Loss of PTEN expression by dermal fibroblasts causes skin fibrosis. J Invest Dermatol 131(10):1996–2003CrossRefPubMed Parapuram SK, Shi-wen X, Elliott C, Welch ID, Jones H, Baron M, Denton CP, Abraham DJ, Leask A (2011) Loss of PTEN expression by dermal fibroblasts causes skin fibrosis. J Invest Dermatol 131(10):1996–2003CrossRefPubMed
25.
Zurück zum Zitat Wang Y, Fan PS, Kahaleh B (2006) Association between enhanced type I collagen expression and epigenetic repression of the FLI1 gene in scleroderma fibroblasts. Arthritis Rheum 54(7):2271–2279CrossRefPubMed Wang Y, Fan PS, Kahaleh B (2006) Association between enhanced type I collagen expression and epigenetic repression of the FLI1 gene in scleroderma fibroblasts. Arthritis Rheum 54(7):2271–2279CrossRefPubMed
26.
Zurück zum Zitat Taniguchi T, Asano Y, Akamata K, Noda S, Takahashi T, Ichimura Y, Toyama T, Trojanowska M, Sato S (2015) Fibrosis, vascular activation, and immune abnormalities resembling systemic sclerosis in bleomycin-treated Fli-1-haploinsufficient mice. Arthritis Rheum 67(2):517–526CrossRef Taniguchi T, Asano Y, Akamata K, Noda S, Takahashi T, Ichimura Y, Toyama T, Trojanowska M, Sato S (2015) Fibrosis, vascular activation, and immune abnormalities resembling systemic sclerosis in bleomycin-treated Fli-1-haploinsufficient mice. Arthritis Rheum 67(2):517–526CrossRef
27.
Zurück zum Zitat Wu M, Melichian DS, de la Garza M, Gruner K, Bhattacharyya S, Barr L, Nair A, Shahrara S, Sporn PH, Mustoe TA, Tourtellotte WG, Varga J (2009) Essential roles for early growth response transcription factor Egr-1 in tissue fibrosis and wound healing. Am J Pathol 175(3):1041–1055. doi:10.2353/ajpath.2009.090241 PubMedCentralCrossRefPubMed Wu M, Melichian DS, de la Garza M, Gruner K, Bhattacharyya S, Barr L, Nair A, Shahrara S, Sporn PH, Mustoe TA, Tourtellotte WG, Varga J (2009) Essential roles for early growth response transcription factor Egr-1 in tissue fibrosis and wound healing. Am J Pathol 175(3):1041–1055. doi:10.​2353/​ajpath.​2009.​090241 PubMedCentralCrossRefPubMed
28.
Zurück zum Zitat van der Slot AJ, Zuurmond AM, Bardoel AF, Wijmenga C, Pruijs HE, Sillence DO, Brinckmann J, Abraham DJ, Black CM, Verzijl N, DeGroot J, Hanemaaijer R, TeKoppele JM, Huizinga TW, Bank RA (2003) Identification of PLOD2 as telopeptide lysyl hydroxylase, an important enzyme in fibrosis. J Biol Chem 278(42):40967–40972CrossRefPubMed van der Slot AJ, Zuurmond AM, Bardoel AF, Wijmenga C, Pruijs HE, Sillence DO, Brinckmann J, Abraham DJ, Black CM, Verzijl N, DeGroot J, Hanemaaijer R, TeKoppele JM, Huizinga TW, Bank RA (2003) Identification of PLOD2 as telopeptide lysyl hydroxylase, an important enzyme in fibrosis. J Biol Chem 278(42):40967–40972CrossRefPubMed
29.
Zurück zum Zitat Chanoki M, Ishii M, Kobayashi H, Fushida H, Yashiro N, Hamada T, Ooshima A (1995) Increased expression of lysyl oxidase in skin with scleroderma. Br J Dermatol 133(5):710–715CrossRefPubMed Chanoki M, Ishii M, Kobayashi H, Fushida H, Yashiro N, Hamada T, Ooshima A (1995) Increased expression of lysyl oxidase in skin with scleroderma. Br J Dermatol 133(5):710–715CrossRefPubMed
30.
Zurück zum Zitat Hinz B (2009) Tissue stiffness, latent TGF-beta1 activation, and mechanical signal transduction: implications for the pathogenesis and treatment of fibrosis. Curr Rheumatol Rep 11(2):120–126CrossRefPubMed Hinz B (2009) Tissue stiffness, latent TGF-beta1 activation, and mechanical signal transduction: implications for the pathogenesis and treatment of fibrosis. Curr Rheumatol Rep 11(2):120–126CrossRefPubMed
31.
Zurück zum Zitat Eckes B, Zweers MC, Zhang ZG, Hallinger R, Mauch C, Aumailley M, Krieg T (2006) Mechanical tension and integrin alpha 2 beta 1 regulate fibroblast functions. J Investig Dermatol Symp Proc 11(1):66–72CrossRefPubMed Eckes B, Zweers MC, Zhang ZG, Hallinger R, Mauch C, Aumailley M, Krieg T (2006) Mechanical tension and integrin alpha 2 beta 1 regulate fibroblast functions. J Investig Dermatol Symp Proc 11(1):66–72CrossRefPubMed
32.
Zurück zum Zitat Chen Y, Shi-Wen X, van Beek J, Kennedy L, McLeod M, Renzoni EA, Bou-Gharios G, Wilcox-Adelman S, Goetinck PF, Eastwood M, Black CM, Abraham DJ, Leask A (2005) Matrix contraction by dermal fibroblasts requires transforming growth factor-beta/activin-linked kinase 5, heparan sulfate-containing proteoglycans, and MEK/ERK: insights into pathological scarring in chronic fibrotic disease. Am J Pathol 167(6):1699–1711PubMedCentralCrossRefPubMed Chen Y, Shi-Wen X, van Beek J, Kennedy L, McLeod M, Renzoni EA, Bou-Gharios G, Wilcox-Adelman S, Goetinck PF, Eastwood M, Black CM, Abraham DJ, Leask A (2005) Matrix contraction by dermal fibroblasts requires transforming growth factor-beta/activin-linked kinase 5, heparan sulfate-containing proteoglycans, and MEK/ERK: insights into pathological scarring in chronic fibrotic disease. Am J Pathol 167(6):1699–1711PubMedCentralCrossRefPubMed
33.
Zurück zum Zitat Asano Y, Ihn H, Jinnin M, Mimura Y, Tamaki K (2006) Involvement of alphavbeta5 integrin in the establishment of autocrine TGF-beta signaling in dermal fibroblasts derived from localized scleroderma. J Invest Dermatol 126(8):1761–1769CrossRefPubMed Asano Y, Ihn H, Jinnin M, Mimura Y, Tamaki K (2006) Involvement of alphavbeta5 integrin in the establishment of autocrine TGF-beta signaling in dermal fibroblasts derived from localized scleroderma. J Invest Dermatol 126(8):1761–1769CrossRefPubMed
34.
Zurück zum Zitat Shi-wen X, Renzoni EA, Kennedy L, Howat S, Chen Y, Pearson JD et al (2007) Endogenous endothelin-1 signaling contributes to type I collagen and CCN2 overexpression in fibrotic fibroblasts. Matrix Biol 26:625–632CrossRefPubMed Shi-wen X, Renzoni EA, Kennedy L, Howat S, Chen Y, Pearson JD et al (2007) Endogenous endothelin-1 signaling contributes to type I collagen and CCN2 overexpression in fibrotic fibroblasts. Matrix Biol 26:625–632CrossRefPubMed
35.
Zurück zum Zitat Shi-wen X, Thompson K, Khan K, Liu S, Murphy-Marshman H, Baron M, Denton CP, Leask A, Abraham DJ (2012) Focal adhesion kinase and reactive oxygen species contribute to the persistent fibrotic phenotype of lesional scleroderma fibroblasts. Rheumatology (Oxford) 51(12):2146–2154CrossRef Shi-wen X, Thompson K, Khan K, Liu S, Murphy-Marshman H, Baron M, Denton CP, Leask A, Abraham DJ (2012) Focal adhesion kinase and reactive oxygen species contribute to the persistent fibrotic phenotype of lesional scleroderma fibroblasts. Rheumatology (Oxford) 51(12):2146–2154CrossRef
36.
Zurück zum Zitat Dooley A, Shi-Wen X, Aden N, Tranah T, Desai N, Denton CP, Abraham DJ, Bruckdorfer R (2010) Modulation of collagen type I, fibronectin and dermal fibroblast function and activity, in systemic sclerosis by the antioxidant epigallocatechin-3-gallate. Rheumatology (Oxford) 49(11):2024–2036CrossRef Dooley A, Shi-Wen X, Aden N, Tranah T, Desai N, Denton CP, Abraham DJ, Bruckdorfer R (2010) Modulation of collagen type I, fibronectin and dermal fibroblast function and activity, in systemic sclerosis by the antioxidant epigallocatechin-3-gallate. Rheumatology (Oxford) 49(11):2024–2036CrossRef
37.
Zurück zum Zitat Gerber EE, Gallo EM, Fontana SC et al (2014) Integrin-modulating therapy prevents fibrosis and autoimmunity in mouse models of scleroderma. Nature 503:126–130CrossRef Gerber EE, Gallo EM, Fontana SC et al (2014) Integrin-modulating therapy prevents fibrosis and autoimmunity in mouse models of scleroderma. Nature 503:126–130CrossRef
38.
Zurück zum Zitat Shiwen X, Stratton R, Nikitorowicz-Buniak J, Ahmed-Abdi B, Ponticos M, Denton C, Abraham D, Takahashi A, Suki B, Layne MD, Lafyatis R, Smith BD (2015) A role of myocardin related transcription factor-A (MRTF-A) in scleroderma related fibrosis. PLoS One 10(5):e0126015PubMedCentralCrossRefPubMed Shiwen X, Stratton R, Nikitorowicz-Buniak J, Ahmed-Abdi B, Ponticos M, Denton C, Abraham D, Takahashi A, Suki B, Layne MD, Lafyatis R, Smith BD (2015) A role of myocardin related transcription factor-A (MRTF-A) in scleroderma related fibrosis. PLoS One 10(5):e0126015PubMedCentralCrossRefPubMed
Metadaten
Titel
Matrix remodeling in systemic sclerosis
verfasst von
Andrew Leask
Publikationsdatum
01.09.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Seminars in Immunopathology / Ausgabe 5/2015
Print ISSN: 1863-2297
Elektronische ISSN: 1863-2300
DOI
https://doi.org/10.1007/s00281-015-0508-2

Weitere Artikel der Ausgabe 5/2015

Seminars in Immunopathology 5/2015 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Blutdrucksenkung könnte Uterusmyome verhindern

Frauen mit unbehandelter oder neu auftretender Hypertonie haben ein deutlich erhöhtes Risiko für Uterusmyome. Eine Therapie mit Antihypertensiva geht hingegen mit einer verringerten Inzidenz der gutartigen Tumoren einher.

„Jeder Fall von plötzlichem Tod muss obduziert werden!“

17.05.2024 Plötzlicher Herztod Nachrichten

Ein signifikanter Anteil der Fälle von plötzlichem Herztod ist genetisch bedingt. Um ihre Verwandten vor diesem Schicksal zu bewahren, sollten jüngere Personen, die plötzlich unerwartet versterben, ausnahmslos einer Autopsie unterzogen werden.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Schlechtere Vorhofflimmern-Prognose bei kleinem linken Ventrikel

17.05.2024 Vorhofflimmern Nachrichten

Nicht nur ein vergrößerter, sondern auch ein kleiner linker Ventrikel ist bei Vorhofflimmern mit einer erhöhten Komplikationsrate assoziiert. Der Zusammenhang besteht nach Daten aus China unabhängig von anderen Risikofaktoren.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.