@phdthesis{Kums2017, author = {Kums, Juliane}, title = {Entwicklung und Charakterisierung von \(Gaussia\) \(princeps\) Luziferase-Antik{\"o}rper-Fusionsproteinen}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-146777}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2017}, abstract = {Antik{\"o}rper, die Oberfl{\"a}chenantigene erkennen, sind sowohl in der Diagnostik als auch in der Therapie verschiedener Erkrankungen von enormer Bedeutung. Damit Antik{\"o}rper in diesen Bereichen eingesetzt werden k{\"o}nnen, ist es sehr wichtig, dass die Interaktion eines Antik{\"o}rpers oder auch eines Antik{\"o}rperkonjugats mit seinem Antigen oder Fc-Rezeptoren ausreichend charakterisiert wird. Hierf{\"u}r werden meist zellfreie Verfahren angewandt, wie die isotherme Titrationskalorimetrie oder die Oberfl{\"a}chenplasmonenresonanzspektroskopie. Diese unterliegen verschiedenen Limitationen, beispielsweise der Verf{\"u}gbarkeit von rekombinantem Antigen. Vor allem aber werden zellul{\"a}re Einfl{\"u}sse, die die Bindungseigenschaften der Antik{\"o}rper beeinflussen, nicht ber{\"u}cksichtigt. Aber auch die derzeit angewandten Verfahren f{\"u}r zellul{\"a}re Bindungsstudien k{\"o}nnen problematisch sein, da sie meist auf Antik{\"o}rpern basieren, die biochemisch markiert worden sind, was zu funktionellen Beeintr{\"a}chtigungen f{\"u}hren kann. Außerdem zeigen solche Antik{\"o}rper h{\"a}ufig keine einheitliche St{\"o}chiometrie der jeweiligen Reporterstoffe und die Reproduzierbarkeit des Markierungsverfahrens ist in den meisten F{\"a}llen nicht gew{\"a}hrleistet. Positionsspezifische Markierungen sind jedoch vergleichsweise sehr aufwendig. Um die genannten Probleme zu umgehen, wurden in der vorliegenden Arbeit am Beispiel des Fn14-spezifischen Antik{\"o}rpers 18D1 Antik{\"o}rper-Fusionsproteine hergestellt und charakterisiert, die an verschiedenen Positionen genetisch mit der Gaussia princeps Luziferase (GpL) fusioniert worden sind. Dabei zeigte sich, dass die Positionierung der Luziferase am C-Terminus der leichten Kette des Antik{\"o}rpers (GpL(CT-LC)) die Bindungseigenschaften der GpL-18D1-IgG1-Fusionsproteine an Fn14 und an die verschiedenen Fcγ-Rezeptoren (FcγR) nicht oder nur in geringem Umfang beeinflusst. Auch die agonistische Aktivit{\"a}t der GpL-18D1-IgG1-Fusionsproteine, welche abh{\"a}ngig ist von der Oligomerisierung {\"u}ber Protein G oder der FcγR-Bindung, wurde durch die GpL-Markierung nicht wesentlich beeinflusst. Diese Ergebnisse ließen sich am Bespiel von 18D1 ebenfalls auf die dimeren Antik{\"o}rper-Isotypen IgG2, mIgG1 und mIgG2A {\"u}bertragen. GpL-Fusionsproteine der Antik{\"o}rper E09-IgG1 (CD95-spezifisch), G28.5-IgG1 (CD40-spezifisch) und BHA10-IgG1 (LTβR-spezifisch) zeigten gleichfalls keine gravierenden Ver{\"a}nderungen der Bindungseigenschaften oder den funktionellen Eigenschaften, was f{\"u}r eine breite Anwendbarkeit von GpL-Antik{\"o}rper-Fusionsproteinen spricht. Zusammenfassend betrachtet zeigen die hier pr{\"a}sentierten Ergebnisse, dass die genetische Fusion der Gaussia princeps Luziferase an das C-terminale Ende der leichten Antik{\"o}rperkette eine sehr gute M{\"o}glichkeit darstellt, Antigen-Antik{\"o}rper-Interaktionen zu charakterisieren ohne dabei mit den Eigenschaften des Antik{\"o}rpers zu interferieren. Dabei besticht dieser Ansatz im Vergleich zu anderen g{\"a}ngigen Verfahren durch seine Reproduzierbarkeit, eine einfache Handhabung, geringe Kosten und eine extrem hohe Sensitivit{\"a}t. Außerdem k{\"o}nnte dieses Antik{\"o}rper-Fusionsproteinformat zuk{\"u}nftig auch in vielen Bereichen als Tracer eingesetzt werden mit dem Vorteil, dass keinerlei Radioaktivit{\"a}t ben{\"o}tigt werden w{\"u}rde.}, subject = {Luciferasen}, language = {de} } @article{KraftFleischerWiedmannetal.2017, author = {Kraft, Peter and Fleischer, Anna and Wiedmann, Silke and R{\"u}cker, Viktoria and Mackenrodt, Daniel and Morbach, Caroline and Malzahn, Uwe and Kleinschnitz, Christoph and St{\"o}rk, Stefan and Heuschmann, Peter U.}, title = {Feasibility and diagnostic accuracy of point-of-care handheld echocardiography in acute ischemic stroke patients - a pilot study}, series = {BMC Neurology}, volume = {17}, journal = {BMC Neurology}, number = {159}, doi = {10.1186/s12883-017-0937-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158081}, year = {2017}, abstract = {Background: Standard echocardiography (SE) is an essential part of the routine diagnostic work-up after ischemic stroke (IS) and also serves for research purposes. However, access to SE is often limited. We aimed to assess feasibility and accuracy of point-of-care (POC) echocardiography in a stroke unit (SU) setting. Methods: IS patients were recruited on the SU of the University Hospital W{\"u}rzburg, Germany. Two SU team members were trained in POC echocardiography for a three-month period to assess a set of predefined cardiac parameters including left ventricular ejection fraction (LVEF). Diagnostic agreement was assessed by comparing POC with SE executed by an expert sonographer, and intraclass correlation coefficient (ICC) or kappa (κ) with 95\% confidence intervals (95\% CI) were calculated. Results: In the 78 patients receiving both POC and SE agreement for cardiac parameters was good, with ICC varying from 0.82 (95\% CI 0.71-0.89) to 0.93 (95\% CI 0.87-0.96), and κ from 0.39 (-95\% CI 0.14-0.92) to 0.79 (95\% CI 0.67-0.91). Detection of systolic dysfunction with POC echocardiography compared to SE was very good, with an area under the curve of 0.99 (0.96-1.00). Interrater agreement for LVEF measured by POC echocardiography was good with κ 0.63 (95\% CI 0.40-0.85). Conclusions: POC echocardiography in a SU setting is feasible enabling reliable quantification of LVEF and preliminary assessment of selected cardiac parameters that might be used for research purposes. Its potential clinical utility in triaging stroke patients who should undergo or do not necessarily require SE needs to be investigated in larger prospective diagnostic studies.}, language = {en} } @article{LaglerElMeseryKuebleretal.2017, author = {Lagler, Charlotte and El-Mesery, Mohamed and K{\"u}bler, Alexander Christian and M{\"u}ller-Richter, Urs Dietmar Achim and St{\"u}hmer, Thorsten and Nickel, Joachim and M{\"u}ller, Thomas Dieter and Wajant, Harald and Seher, Axel}, title = {The anti-myeloma activity of bone morphogenetic protein 2 predominantly relies on the induction of growth arrest and is apoptosis-independent}, series = {PLoS ONE}, volume = {12}, journal = {PLoS ONE}, number = {10}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158993}, pages = {e0185720}, year = {2017}, abstract = {Multiple myeloma (MM), a malignancy of the bone marrow, is characterized by a pathological increase in antibody-producing plasma cells and an increase in immunoglobulins (plasmacytosis). In recent years, bone morphogenetic proteins (BMPs) have been reported to be activators of apoptotic cell death in neoplastic B cells in MM. Here, we use bone morphogenetic protein 2 (BMP2) to show that the "apoptotic" effect of BMPs on human neoplastic B cells is dominated by anti-proliferative activities and cell cycle arrest and is apoptosis-independent. The anti-proliferative effect of BMP2 was analysed in the human cell lines KMS12-BM and L363 using WST-1 and a Coulter counter and was confirmed using CytoTox assays with established inhibitors of programmed cell death (zVAD-fmk and necrostatin-1). Furthermore, apoptotic activity was compared in both cell lines employing western blot analysis for caspase 3 and 8 in cells treated with BMP2 and FasL. Additionally, expression profiles of marker genes of different cell death pathways were analysed in both cell lines after stimulation with BMP2 for 48h using an RT-PCR-based array. In our experiments we observed that there was rather no reduction in absolute cell number, but cells stopped proliferating following treatment with BMP2 instead. The time frame (48-72 h) after BMP2 treatment at which a reduction in cell number is detectable is too long to indicate a directly BMP2-triggered apoptosis. Moreover, in comparison to robust apoptosis induced by the approved apoptotic factor FasL, BMP2 only marginally induced cell death. Consistently, neither the known inhibitor of apoptotic cell death zVAD-fmk nor the necroptosis inhibitor necrostatin-1 was able to rescue myeloma cell growth in the presence of BMP2.}, language = {en} } @article{SeherLaglerStuehmeretal.2017, author = {Seher, Axel and Lagler, Charlotte and St{\"u}hmer, Thorsten and M{\"u}ller-Richter, Urs Dietmar Achim and K{\"u}bler, Alexander Christian and Sebald, Walter and M{\"u}ller, Thomas Dieter and Nickel, Joachim}, title = {Utilizing BMP-2 muteins for treatment of multiple myeloma}, series = {PLoS ONE}, volume = {12}, journal = {PLoS ONE}, number = {5}, doi = {10.1371/journal.pone.0174884}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158144}, pages = {e0174884}, year = {2017}, abstract = {Multiple myeloma (MM) represents a haematological cancer characterized by the pathological hyper proliferation of antibody-producing B-lymphocytes. Patients typically suffer from kidney malfunction and skeletal disorders. In the context of MM, the transforming growth factor β (TGFβ) member Activin A was recently identified as a promoter of both accompanying symptoms. Because studies have shown that bone morphogenetic protein (BMP)-2-mediated activities are counteracted by Activin A, we analysed whether BMP2, which also binds to the Activin A receptors ActRII and ActRIIB but activates the alternative SMAD-1/5/8 pathway, can be used to antagonize Activin A activities, such as in the context of MM. Therefore three BMP2 derivatives were generated with modified binding activities for the type II (ActRIIB) and/or type I receptor (BMPRIA) showing either increased or decreased BMP2 activity. In the context of MM these BMP2 muteins show two functionalities since they act as a) an anti-proliferative/apoptotic agent against neoplastic B-cells, b) as a bone-formation promoting growth factor. The molecular basis of both activities was shown in two different cellular models to clearly rely on the properties of the investigated BMP2 muteins to compete for the binding of Activin A to the Activin type II receptors. The experimental outcome suggests new therapeutic strategies using BMP2 variants in the treatment of MM-related pathologies.}, language = {en} } @article{KredelKunzmannSchlegeletal.2017, author = {Kredel, Markus and Kunzmann, Steffen and Schlegel, Paul-Gerhardt and W{\"o}lfl, Matthias and Nordbeck, Peter and B{\"u}hler, Christoph and Lotz, Christopher and Lepper, Philipp M. and Wirbelauer, Johannes and Roewer, Norbert and Muellenbach, Ralf M.}, title = {Double Peripheral Venous and Arterial Cannulation for Extracorporeal Membrane Oxygenation in Combined Septic and Cardiogenic Shock}, series = {American Journal of Case Reports}, volume = {18}, journal = {American Journal of Case Reports}, doi = {10.12659/AJCR.902485}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158193}, pages = {723-727}, year = {2017}, abstract = {Background: The use of venoarterial extracorporeal membrane oxygenation (va-ECMO) via peripheral cannulation for septic shock is limited by blood flow and increased afterload for the left ventricle. Case Report: A 15-year-old girl with acute myelogenous leukemia, suffering from severe septic and cardiogenic shock, was treated by venoarterial extracorporeal membrane oxygenation (va-ECMO). Sufficient extracorporeal blood flow matching the required oxygen demand could only be achieved by peripheral cannulation of both femoral arteries. Venous drainage was performed with a bicaval cannula inserted via the left V. femoralis. To accomplish left ventricular unloading, an additional drainage cannula was placed in the left atrium via percutaneous atrioseptostomy (va-va-ECMO). Cardiac function recovered and the girl was weaned from the ECMO on day 6. Successful allogenic stem cell transplantation took place 2 months later. Conclusions: In patients with vasoplegic septic shock and impaired cardiac contractility, double peripheral venoarterial extracorporeal membrane oxygenation (va-va-ECMO) with transseptal left atrial venting can by a lifesaving option.}, language = {en} } @article{BaurBuentemeyerMegerleetal.2017, author = {Baur, Johannes and B{\"u}ntemeyer, Tjark-Ole and Megerle, Felix and Deutschbein, Timo and Spitzweg, Christine and Quinkler, Marcus and Nawroth, Peter and Kroiss, Matthias and Germer, Christoph-Thomas and Fassnacht, Martin and Steger, Ulrich}, title = {Outcome after resection of Adrenocortical Carcinoma liver metastases: a retrospective study}, series = {BMC Cancer}, volume = {17}, journal = {BMC Cancer}, number = {522}, doi = {10.1186/s12885-017-3506-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-159409}, year = {2017}, abstract = {Background: Metastatic Adrenocortical Carcinoma (ACC) is a rare malignancy with a poor 5-year-survival rate (<15\%). A surgical approach is recommended in selected patients if complete resection of distant metastasis can be achieved. To date there are only limited data on the outcome after surgical resection of hepatic metastases of ACC. Methods: A retrospective analysis of the German Adrenocortical Carcinoma Registry was conducted. Patients with liver metastases of ACC but without extrahepatic metastases or incomplete tumour resection were included. Results: Seventy-seven patients fulfilled these criteria. Forty-three patients underwent resection of liver metastases of ACC. Complete tumour resection (R0) could be achieved in 30 (69.8\%). Median overall survival after liver resection was 76.1 months in comparison to 10.1 months in the 34 remaining patients with unresected liver metastases (p < 0.001). However, disease free survival after liver resection was only 9.1 months. Neither resection status (R0/R1) nor extent of liver resection were significant predictive factors for overall survival. Patients with a time interval to the first metastasis/recurrence (TTFR) of greater than 12 months or solitary liver metastases showed significantly prolonged survival. Conclusions: Liver resection in the case of ACC liver metastases can achieve long term survival with a median overall survival of more than 5 years, but disease free survival is short despite metastasectomy. Time to recurrence and single versus multiple metastases are predictive factors for the outcome.}, language = {en} } @article{SchmidFalterWeberetal.2017, author = {Schmid, Tobias and Falter, Lena and Weber, Sabine and M{\"u}ller, Nils and Molitor, Konstantin and Zeller, David and Weber-Steffens, Dorothea and Hehlgans, Thomas and Wajant, Harald and Mostb{\"o}ck, Sven and M{\"a}nnel, Daniela N.}, title = {Chronic inflammation increases the sensitivity of mouse Treg for TNFR2 costimulation}, series = {Frontiers in Immunology}, volume = {8}, journal = {Frontiers in Immunology}, doi = {10.3389/fimmu.2017.01471}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-173259}, year = {2017}, abstract = {TNF receptor type 2 (TNFR2) has gained attention as a costimulatory receptor for T cells and as critical factor for the development of regulatory T cells (Treg) and myeloid suppressor cells. Using the TNFR2-specific agonist TNCscTNF80, direct effects of TNFR2 activation on myeloid cells and T cells were investigated in mice. \(In\) \(vitro\), TNCscTNF80 induced T cell proliferation in a costimulatory fashion, and also supported \(in\) \(vitro\) expansion of Treg cells. In addition, activation of TNFR2 retarded differentiation of bone marrow-derived immature myeloid cells in culture and reduced their suppressor function. \(In\) \(vivo\) application of TNCscTNF80-induced mild myelopoiesis in na{\"i}ve mice without affecting the immune cell composition. Already a single application expanded Treg cells and improved suppression of CD4 T cells in mice with chronic inflammation. By contrast, multiple applications of the TNFR2 agonist were required to expand Treg cells in na{\"i}ve mice. Improved suppression of T cell proliferation depended on expression of TNFR2 by T cells in mice repeatedly treated with TNCscTNF80, without a major contribution of TNFR2 on myeloid cells. Thus, TNFR2 activation on T cells in na{\"i}ve mice can lead to immune suppression \(in\) \(vivo\). These findings support the important role of TNFR2 for Treg cells in immune regulation.}, language = {en} } @article{WiegeringRiegelWagneretal.2017, author = {Wiegering, Armin and Riegel, Johannes and Wagner, Johanna and Kunzmann, Volker and Baur, Johannes and Walles, Thorsten and Dietz, Ulrich and Loeb, Stefan and Germer, Christoph-Thomas and Steger, Ulrich and Klein, Ingo}, title = {The impact of pulmonary metastasectomy in patients with previously resected colorectal cancer liver metastases}, series = {PLoS ONE}, volume = {12}, journal = {PLoS ONE}, number = {3}, doi = {10.1371/journal.pone.0173933}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158036}, pages = {e0173933}, year = {2017}, abstract = {Background 40-50\% of patients with colorectal cancer (CRC) will develop liver metastases (CRLM) during the course of the disease. One third of these patients will additionally develop pulmonary metastases. Methods 137 consecutive patients with CRLM, were analyzed regarding survival data, clinical, histological data and treatment. Results were stratified according to the occurrence of pulmonary metastases and metastases resection. Results 39\% of all patients with liver resection due to CRLM developed additional lung metastases. 44\% of these patients underwent subsequent pulmonary resection. Patients undergoing pulmonary metastasectomy showed a significantly better five-year survival compared to patients not qualified for curative resection (5-year survival 71.2\% vs. 28.0\%; p = 0.001). Interestingly, the 5-year survival of these patients was even superior to all patients with CRLM, who did not develop pulmonary metastases (77.5\% vs. 63.5\%; p = 0.015). Patients, whose pulmonary metastases were not resected, were more likely to redevelop liver metastases (50.0\% vs 78.6\%; p = 0.034). However, the rate of distant metastases did not differ between both groups (54.5 vs.53.6; p = 0.945). Conclusion The occurrence of colorectal lung metastases after curative liver resection does not impact patient survival if pulmonary metastasectomy is feasible. Those patients clearly benefit from repeated resections of the liver and the lung metastases.}, language = {en} } @article{ZellerHeidemeierGrigoleitetal.2017, author = {Zeller, Daniel and Heidemeier, Anke and Grigoleit, G{\"o}tz Ulrich and M{\"u}llges, Wolfgang}, title = {Case report: subacute tetraplegia in an immunocompromised patient}, series = {BMC Neurology}, volume = {17}, journal = {BMC Neurology}, number = {31}, doi = {10.1186/s12883-017-0814-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157576}, year = {2017}, abstract = {Background: Clinical reasoning in Neurology is based on general associations which help to deduce the site of the lesion. However, even "golden principles" may occasionally be deceptive. Here, we describe the case of subacute flaccid tetraparesis due to motor cortical lesions. To our knowledge, this is the first report to include an impressive illustration of nearly symmetric motor cortical involvement of encephalitis on brain MRI. Case presentation: A 51 year old immunocompromized man developed a high-grade pure motor flaccid tetraparesis over few days. Based on clinical presentation, critical illness polyneuromyopathy was suspected. However, brain MRI revealed symmetrical hyperintensities strictly limited to the subcortical precentral gyrus. An encephalitis, possibly due to CMV infection, turned out to be the most likely cause. Conclusion: While recognition of basic clinical patterns is indispensable in neurological reasoning, awareness of central conditions mimicking peripheral nervous disease may be crucial to detect unsuspected, potentially treatable conditions.}, language = {en} }