Visual Universitätsmedizin Mainz

Boris Schnorbus, MD

Schnorbus, MD
Boris Schnorbus, MD
Position: Virchow Fellow,
Physician Cardiology I

boris.schnorbus@unimedizin-mainz.de
Further Information

Project description

1. EST- Studie

I am the study coordinator in the EST- study (Effects of clopidogrel vs prasugel vs ticagrelor on endothelial function, inflammatory and oxidative stress parameters and platelet function in patients undergoing coronary artery stenting. A randomised, prospective study) will be that of the trial coordinator. My responsibilities, under the supervision of Prof. Dr. Gori (principal investigator) include the preparation of the protocol, SOPs, the recruitment, education and coordination of trial staff, the preparation of CRFs. As a "spin-off" of this trial, we plan to conduct an invasive follow- up of these patients after one year in order to test, using optical coherence tomography, whether the treatment with different antiaggregants has an influence on the formation of in-stent neointima.

Overall, the goal of this Virchow fellowship position is to establish and facilitate the cooperation between the 2. Medical Department and the CTH providing access to patients for pre-clinical and pathophysiological studies in humans. This would allow concentrating studies of endothelial function testing, interventional studies and laboratory work (oxidative stress, inflammatory, platelet function, FACS). Prospectively, this centre could be integrated in the clinical studies module of the CTH. The close interaction between preclinical and clinical research in an interdisciplinary team will help improve the translational profile of our research.

 

2. The role of platelets, endothelial function and oxidative stress in ischemic coronary blood

One of my projects is addressed to the coronary slow flow phenomen. In up to 7% of the patients undergoing coronary angiography (typically for unstable angina or NSTEMI), the angiogram shows a slow progression of the contrast medium throughout the coronary tree in the absence of any stenosis. This phenomenon is most commonly seen in young men and smokers. Patients suffer from angina pectoris as if they had an epicardial coronary artery stenosis. Their prognosis is impaired. Therefore the disease is clinically relevant. Although the pathophysiology is not yet understood, our laboratory has made a number of observations in this field: as compared to patients with normal flow, coronary resistances are elevated in these patients; their endothelial function at rest (but not endothelial recruitability) is blunted, hematocrit is tendentially higher, and platelets are activated. These abnormalities have been described in detail in review papers from our laboratory. Endothelial dysfunction, myofiber hypertrophy, swelling and degeneration of endothelial cells, rheologic- factors (increased plasma viscosity), enhanced production of vasoconstrictors, platelet and leukocyte activation and oxidative stress seems to be have a central role in this phenomenon. To date, therapies have not been developed. We plan to develop a comprehensive program to study this phenomenon from the clinical and pathophysiological perspective. However, the term "slow flow" is not clearly defined: while some use a definition of TIMI 2 (ie a flow requiring more than 3 heart beats to reach the distal vessel) and classify patients in "normal" versus "slow flow", this binary classification in normal versus slow does not respect the complexity of coronary resistances. Therefore, in order to gain a more detailed insight into the prevalence of this phenomenon, we have initiated a registry enrolling all consecutive patients undergoing coronary angiography in our Institution. In this registry we plan to collect information on gender, age, cardiovascular risk factors, ECG, medications, medical history. Patients will be prospectively followed at 2, 5 and 10 years.

The Acute Coronary Syndrom (ACS) is still the main cause of death in the western countries. We plan to draw blood samples locally at the level of the coronary obstruction and to compare them with peripheral blood in order to gain more insight into the local processes occurring in the occluded artery. Therefore we plan the measurement of endothelial function, platelet function respectively – interaction in coronary blood in patients with an ACS.

 

Research Interests

  • Influence of P2Y12- Inhibitors on endothelial function, oxidative stress, inflammation and platelet function in patients undergoing coronary artery stenting
  • Hemodynamic study of the coronary slow flow- syndrome
  • The coroany slow flow- syndrome: Influence of platelet function/-interaction and inflammation

Research Funding

  • Inneruniversitäre Forschungsförderung (Stufe I)

Mentor

Mentors of the Virchow-Fellow are Professor Tommaso Gori, Professor of Translational Vascular Medicine, Department of Medicine 2 and PD Kerstin Jurk, Head of Laboratory "Platelet phenotype analysis" of the Center for Thrombosis and Hemostasis.

Team

  • Hannelore Seiler (study nurse)
  • Peter Weiß (doctoral candidate)
  • Florian Köhler (doctoral candidate)
  • Matthias Regh (doctoral candidate)

Curriculum vitae

1988- 1994

Anne- Frank Hauptschule Meggen, Lennestadt (Fachoberschulreife)

1994- 1997

Höhere Berufsfachschule für Technische Assistenten, Olsberg

1994- 1997

Abschluss Chemisch technischer Assistent, Fachhochschulreife

1997- 2005

Technical assistant at Forensic science Institute of Federal Criminal Police Office, Wiesbaden (acquired expertise in gaschromatography, mass spectrometry, pyrolysis, intrared spectroscopy)

2001- 2005

Abendgymnasium Wiesbaden (Abitur)

2005- 2011

Johannes Gutenberg- University of Mainz - State examination 05/2011

2007- 2010

Research assistant II. Medical Clinic, Department of Cardiology and Angiology, University Medical Center Mainz (PD Dr. med. Warnholtz): support of medical trials, laboratory work (photometry, ELISA)

2011

Doctoral thesis: Über den Effekt von Pentaerithrityltetranitrat auf kardiovaskuläre Biomarker und der Nitroglycerinabhängigen Dilatation bei Patienten mit koronarer Herzkrankheit (magna cum laude)

11/2011

Investigator in clinical trials course at IZKS Mainz

06/2011-06/2013

Chest Pain Unit, Department of Medicine II, Cardiology and Angiology, University Medical Center Mainz

07/2012-12/2012

Cardiac catheterization laboratory, Department of Medicine II, Cardiology and Angiology, University Medical Center Mainz

01/2013-06/2013

Station 4B, Department of Medicine II, Cardiology and Angiology, University Medical Center Mainz

since 07/2013

Chest Pain Unit, Department of Medicine II, Cardiology and Angiology, University Medical Center Mainz

References

  • Schnorbus B, Daiber A, Jurk K, Warnke S, König J, Krahn U, Lackner K, Münzel T, Gori T. Effects of clopidogrel, prasugrel and ticagrelor on endothelial function, inflammatory and oxidative stress parameters and platelet function in patients undergoing coronary artery stenting for an acute coronary syndrome. A randomised, prospective, controlled study. BMJ Open 4:e005268, 2014.