@article{LinkerMagnusKornetal.2013, author = {Linker, Ralf A. and Magnus, Tim and Korn, Thomas and Kleinschnitz, Christoph and Meuth, Sven G.}, title = {Report on the 5'th scientific meeting of the "Verein zur F{\"o}rderung des Wissenschaftlichen Nachwuchses in der Neurologie" (NEUROWIND e.V.) held in Motzen, Germany, Oct. 25th - Oct. 27th, 2013}, series = {Experimental \& Translational Stroke Medicine}, volume = {5}, journal = {Experimental \& Translational Stroke Medicine}, number = {15}, doi = {10.1186/2040-7378-5-15}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-129230}, year = {2013}, abstract = {From october 25th - 27th 2013, the 5th NEUROWIND e.V. meeting was held in Motzen, Brandenburg, Germany. This year more than 60 doctoral students and postdocs from over 25 different groups working in German university hospitals or research institutes attended the meeting to discuss their latest findings in the fields of neuroimmunology, neurodegeneration and neurovascular research. All participants appreciated the stimulating environment in Motzen, Brandenburg, and people took the opportunity for scientific exchange, discussion about ongoing projects and already started further collaborations. Like in the previous years, the symposium was regarded as a very well organized platform to support research of young investigators in Germany. According to the major aim of NEUROWIND e.V. to support younger researchers in Germany the 3rd NEUROWIND YOUNG SCIENTIST AWARD for experimental neurology was awarded to Ruth Stassart working in the group of Klaus Armin Nave and Wolfgang Br{\"u}ck (MPI G{\"o}ttingen and Department of Neuropathology, G{\"o}ttingen Germany). The successful work was published in Nature Neuroscience entitled "A role for Swann cell-derived neuregulin-1 in remyelination". This outstanding paper deals with the function of Schwann cell neuregulin as an endogenous factor for myelin repair. The award is endowed with 20.000 Euro sponsored by Merck Serono GmbH, Darmstadt, Germany (unrestricted educational grant). This year's keynote lecture was given by Albert Ludolph, Head of the Department of Neurology at the University Clinic of Ulm. Dr. Ludolph highlighted the particular role of individual scientists for the development of research concepts in Alzheimer´s disease (AD) and frontotemporal dementia (FTD).}, language = {en} } @phdthesis{Hullin2016, author = {Hullin, Marcus}, title = {Zusammenhang zwischen Raumwahrnehmung, K{\"o}rperselbstgef{\"u}hl und Puppenhandillusion bei gesunden {\"A}lteren und Patienten mit kortikobasalem Syndrom}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-134291}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2016}, abstract = {Das K{\"o}rperselbstgef{\"u}hl (KSG) bezeichnet das Gef{\"u}hl, einen bestimmten K{\"o}r-perteil als dem eigenen K{\"o}rper zugeh{\"o}rig zu empfinden. Es erscheint stabil und nicht st{\"o}rbar, l{\"a}sst sich jedoch bei den meisten Menschen experimentell beein-flussen. Ein Beispiel hierf{\"u}r ist die Puppenhandillusion (PHI), bei der die nicht sichtbare eigene Hand des Probanden und eine sichtbare Plastikhand in glei-cher Stellung an den gleichen Fingerstellen synchron mit zwei Pinseln bestri-chen wird, wodurch die Wahrnehmung entsteht, die Plastikhand sei die eigene. Ver{\"a}nderungen des KSG k{\"o}nnen jedoch auch im Rahmen neurodegenerativer Erkrankungen vorkommen. So nimmt beim kortikobasalen Syndrom (CBS) etwa die H{\"a}lfte der Patienten im Krankheitsverlauf einen Arm und seine Bewegungen als fremd war ("Alien-limb"-Ph{\"a}nomen). Das CBS beginnt oft einseitig und ist durch eine rasch fortschreitende, akinetisch-rigide Parkinson-Symptomatik, aber auch durch kortikale Funktionsst{\"o}rungen gekennzeichnet, so dass es ne-ben einer St{\"o}rung des KSG auch zu einer St{\"o}rung der r{\"a}umlichen Aufmerk-samkeit (Hemineglect) kommt. Bislang wurde der Zusammenhang zwischen Raumwahrnehmung, KSG und PHI bei gesunden {\"a}lteren Menschen noch nicht systematisch untersucht. Ebenso wenig war bisher bekannt, inwieweit das KSG bei CBS-Patienten durch die PHI modulierbar ist. Wir untersuchten 65 gesunde {\"a}ltere Probanden (60 - 90 Jahre) ohne neurologi-sche Vorerkrankungen sowie zehn Patienten zwischen 59 und 77 Jahren mit wahrscheinlichem oder m{\"o}glichem CBS. Den kognitiven und orientierend seeli-schen Zustand eruierten wir mit Hilfe des PANDA- und des Uhrentests, die Raumwahrnehmung testeten wir mittels des Milner-Landmark-Tests sowie des Letter-Cancellation-Tests, das spontane K{\"o}rperselbstgef{\"u}hl wurde mittels eines Fragebogens erfasst. Der PHI-Versuch wurde mit synchroner sowie asynchro-ner taktiler Stimulation durchgef{\"u}hrt, das Auftreten eines Selbstgef{\"u}hls f{\"u}r die Plastikhand wurde subjektiv {\"u}ber spontane {\"A}ußerungen und einen etablierten Fragebogen, objektiv {\"u}ber den sog. propriozeptiven Drift der stimulierten Hand erfasst. Unter den Kontrollprobanden fanden sich 12\% mit einer wahrscheinlichen De-menz, wohingegen dies bei 80\% der CBS-Patienten der Fall war. Im Milner-Landmark-Test zeigte sich bei den Kontrollprobanden eine {\"U}bersch{\"a}tzung des rechten Segmentes einer mittig geteilten Linie, entsprechend einem milden Hemineglect, bei den CBS-Patienten konnte keine einheitliche Tendenz festge-stellt werden. Das spontane K{\"o}rperselbstgef{\"u}hl stellte sich bei nahezu allen Probanden als intakt dar, w{\"a}hrend sich bei vier Patienten mit CBS Hinweise auf aktuelle oder intermittierende St{\"o}rungen desselben ergaben. Die Puppenhandil-lusion war in der Gruppe gesunder {\"A}lterer bei synchroner Stimulation ausl{\"o}s-bar, nicht jedoch bei asynchroner Stimulation. Eine Lateralisierungstendenz zeigte sich nicht. Dar{\"u}ber hinaus konnte bei den Probanden eine positive Korre-lation zwischen dem propriozeptiven Drift der linken Hand nach synchroner Stimulation und dem Hemineglect nach links gefunden werden. Bei den CBS-Patienten fand sich unabh{\"a}ngig von der Stimulationsart (synchron oder asyn-chron) eine erh{\"o}hte Bereitschaft, die linke Puppenhand ins eigene K{\"o}rperbild zu integrieren. Das Auftreten der PHI bei gesunden {\"a}lteren Probanden ist vergleichbar mit den Daten j{\"u}ngerer Probandengruppen. Hinweise auf eine hemisph{\"a}rische Laterali-sierungstendenz der PHI ergaben sich nicht, jedoch scheint der in dieser Grup-pe festgestellte leichtgradige Hemineglect nach links den multisensorischen Prozess zu beeinflussen, eine k{\"u}nstliche Hand in das eigene K{\"o}rperschema zu integrieren. Bei den CBS-Patienten war die PHI unabh{\"a}ngig vom Stimulations-modus links besser ausl{\"o}sbar als rechts, was mit vorwiegend rechtshemisph{\"a}-rischen krankheitsbedingten Ver{\"a}nderungen des multisensorischen Integrati-onsprozesses vereinbar ist.}, subject = {Raumwahrnehmung}, language = {de} } @article{VolkmannAlbaneseAntoninietal.2013, author = {Volkmann, Jens and Albanese, Alberto and Antonini, Angelo and Chaudhuri, K. Ray and Clarke, Karl E. and de Bie, Rob M. A. and Deuschl, G{\"u}nther and Eggert, Karla and Houeto, Jean-Luc and Kulisevsky, Jaime and Nyholm, Dag and Odin, Per and Ostergaard, Karen and Poewe, Werner and Pollak, Pierre and Rabey, Jose Martin and Rascol, Olivier and Ruzicka, Evzen and Samuel, Michael and Speelman, Hans and Sydow, Olof and Valldeoriola, Francesc and van der Linden, Chris and Oertel, Wolfgang}, title = {Selecting deep brain stimulation or infusion therapies in advanced Parkinson's disease: an evidence-based review}, series = {Journal of Neurology}, volume = {260}, journal = {Journal of Neurology}, doi = {10.1007/s00415-012-6798-6}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-132373}, pages = {2701-2714}, year = {2013}, abstract = {Motor complications in Parkinson's disease (PD) result from the short half-life and irregular plasma fluctuations of oral levodopa. When strategies of providing more continuous dopaminergic stimulation by adjusting oral medication fail, patients may be candidates for one of three device-aided therapies: deep brain stimulation (DBS), continuous subcutaneous apomorphine infusion, or continuous duodenal/jejunal levodopa/carbidopa pump infusion (DLI). These therapies differ in their invasiveness, side-effect profile, and the need for nursing care. So far, very few comparative studies have evaluated the efficacy of the three device-aided therapies for specific motor problems in advanced PD. As a result, neurologists currently lack guidance as to which therapy could be most appropriate for a particular PD patient. A group of experts knowledgeable in all three therapies reviewed the currently available literature for each treatment and identified variables of clinical relevance for choosing one of the three options such as type of motor problems, age, and cognitive and psychiatric status. For each scenario, pragmatic and (if available) evidence-based recommendations are provided as to which patients could be candidates for either DBS, DLI, or subcutaneous apomorphine.}, language = {en} } @article{GolombeckWessigMonoranuetal.2013, author = {Golombeck, Stefanie Kristin and Wessig, Carsten and Monoranu, Camelia-Maria and Sch{\"u}tz, Ansgar and Solymosi, Laszlo and Melzer, Niko and Kleinschnitz, Christoph}, title = {Fatal atypical reversible posterior leukoencephalopathy syndrome: a case report}, series = {Journal of Medical Case Reports}, volume = {7}, journal = {Journal of Medical Case Reports}, number = {14}, doi = {10.1186/1752-1947-7-14}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-129456}, year = {2013}, abstract = {Introduction: Reversible posterior leukoencephalopathy syndrome - a reversible subacute global encephalopathy clinically presenting with headache, altered mental status, visual symptoms such as hemianopsia or cortical blindness, motor symptoms, and focal or generalized seizures - is characterized by a subcortical vasogenic edema symmetrically affecting posterior brain regions. Complete reversibility of both clinical signs and magnetic resonance imaging lesions is regarded as a defining feature of reversible posterior leukoencephalopathy syndrome. Reversible posterior leukoencephalopathy syndrome is almost exclusively seen in the setting of a predisposing clinical condition, such as pre-eclampsia, systemic infections, sepsis and shock, certain autoimmune diseases, various malignancies and cytotoxic chemotherapy, transplantation and concomitant immunosuppression (especially with calcineurin inhibitors) as well as episodes of abrupt hypertension. We describe for the first time clinical, radiological and histological findings in a case of reversible posterior leukoencephalopathy syndrome with an irreversible and fatal outcome occurring in the absence of any of the known predisposing clinical conditions except for a hypertensive episode. Case presentation: A 58-year-old Caucasian woman presented with a two-week history of subacute and progressive occipital headache, blurred vision and imbalance of gait and with no evidence for raised arterial blood pressure during the two weeks previous to admission. Her past medical history was unremarkable except for controlled arterial hypertension. Cerebral magnetic resonance imaging demonstrated cortical and subcortical lesions with combined vasogenic and cytotoxic edema atypical for both venous congestion and arterial infarction. Routine laboratory and cerebrospinal fluid parameters were normal. The diagnosis of reversible posterior leukoencephalopathy syndrome was established. Within hours after admission the patient showed a rapidly decreasing level of consciousness, extension and flexion synergisms, bilaterally extensor plantar responses and rapid cardiopulmonary decompensation requiring ventilatory and cardiocirculatory support. Follow-up cerebral imaging demonstrated widespread and confluent cytotoxic edematous lesions in different arterial territories, global cerebral swelling, and subsequent upper and lower brainstem herniation. Four days after admission, the patient was declared dead because of brain death. Conclusion: This case demonstrates that fulminant and fatal reversible posterior leukoencephalopathy syndrome may occur spontaneously, that is, in the absence of any of the known predisposing systemic conditions.}, language = {en} } @article{EhlingGoebBittneretal.2013, author = {Ehling, Petra and G{\"o}b, Eva and Bittner, Stefan and Budde, Thomas and Ludwig, Andreas and Kleinschnitz, Christoph and Meuth, Sven G.}, title = {Ischemia-induced cell depolarization: does the hyperpolarization-activated cation channel HCN2 affect the outcome after stroke in mice?}, series = {Experimental \& Translational Stroke Medicine}, volume = {5}, journal = {Experimental \& Translational Stroke Medicine}, number = {16}, doi = {10.1186/2040-7378-5-16}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-129240}, year = {2013}, abstract = {Background Brain ischemia is known to include neuronal cell death and persisting neurological deficits. A lack of oxygen and glucose are considered to be key mediators of ischemic neurodegeneration while the exact mechanisms are yet unclear. In former studies the expression of two different two-pore domain potassium \((K_{2P})\) channels (TASK1, TREK1) were shown to ameliorate neuronal damage due to cerebral ischemia. In neurons, TASK channels carrying hyperpolarizing \(K^+\) leak currents, and the pacemaker channel HCN2, carrying depolarizing Ih, stabilize the membrane potential by a mutual functional interaction. It is assumed that this ionic interplay between TASK and HCN2 channels enhances the resistance of neurons to insults accompanied by extracellular pH shifts. Methods In C57Bl/6 (wildtype, WT), \(hcn2^{+/+}\) and \(hcn2^{-/-}\) mice we used an in vivo model of cerebral ischemia (transient middle cerebral artery occlusion (tMCAO)) to depict a functional impact of HCN2 in stroke formation. Subsequent analyses comprise behavioural tests and hcn2 gene expression assays. Results After 60 min of tMCAO induction in WT mice, we collected tissue samples at 6, 12, and 24 h after reperfusion. In the infarcted neocortex, hcn2 expression analyses revealed a nominal peak of hcn2 expression 6 h after reperfusion with a tendency towards lower expression levels with longer reperfusion times. Hcn2 gene expression levels in infarcted basal ganglia did not change after 6 h and 12 h. Only at 24 h after reperfusion, hcn2 expression significantly decreases by ~55\%. However, 30 min of tMCAO in hcn2-/- as well as hcn2+/+ littermates induced similar infarct volumes. Behavioural tests for global neurological function (Bederson score) and motor function/coordination (grip test) were performed at day 1 after surgery. Again, we found no differences between the groups. Conclusions Here, we hypothesized that the absence of HCN2, an important functional counter player of TASK channels, affects neuronal survival during stroke-induced tissue damage. However, together with a former study on TASK3 these results implicate that both TASK3 and HCN2 which were supposed to be neuroprotective due to their pH-dependency, do not influence ischemic neurodegeneration during stroke in the tMCAO model.}, language = {en} } @phdthesis{Oehler2015, author = {Oehler, Steffen Claus}, title = {Deeskalation der Immuntherapie bei Patienten mit Multipler Sklerose}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-133666}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2015}, abstract = {Die vorliegende Arbeit ist die erste, die sich mit der Frage besch{\"a}ftigt, mit welcher zur Deeskalation eingesetzten Therapie nach Beendigung einer Eskalationstherapie mit Mitoxantron am besten Krankheitsstabilit{\"a}t erreicht werden kann bzw. ob Patienten-/Krankheitscharakteristika existieren, die eine bestimmte Nachfolge-Therapie favorisieren. Trotz neuer Behandlungsm{\"o}glichkeiten der hochaktiven MS mit Fingolimod, Natalizumab und Alemtuzumab hat Mitoxantron im klinischen Alltag nach wie vor einen hohen Stellenwert, so dass die Fragestellung dieser Studie weiter relevant ist. Es zeigten sich keine Patientencharakteristika, die auf eine erfolgsversprechende Therapie in der Deeskalationsphase nach Mitoxantron schließen ließen. Bei Patienten, bei denen w{\"a}hrend der Eskalation mit Mitoxantron die Dosis reduziert werden konnte, wurden w{\"a}hrend der Deeskalationstherapie ein stabilerer Verlauf und weniger Therapiewechsel beobachtet. Bei Patienten, die wegen einer rein chronischen Krankheitsprogredienz eskaliert wurden, trat eine Verschlechterung nach Deeskalation h{\"a}ufiger auf als bei denjenigen, welche wegen Schubaktivit{\"a}t eskaliert wurden. Die Aussagekraft der Daten wird durch die nur niedrige Anzahl der in diese Studie eingeschlossenen Patienten limitiert. Rekrutierungsprobleme stellten die Hauptursache f{\"u}r die geringe Anzahl der Studienteilnehmer dar.}, subject = {Multiple Sklerose}, language = {de} } @article{FluriHeinenKleinschnitz2013, author = {Fluri, Felix and Heinen, Florian and Kleinschnitz, Christoph}, title = {Intravenous Thrombolysis in a Stroke Patient Receiving Rivaroxaban}, series = {Cerebrovascular Disease Extra}, volume = {2013}, journal = {Cerebrovascular Disease Extra}, number = {3}, doi = {10.1159/000355839}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-128816}, pages = {153-155}, year = {2013}, abstract = {No abstract available.}, language = {en} } @article{WalterReilichThieleetal.2013, author = {Walter, Maggie C. and Reilich, Peter and Thiele, Simone and Schessl, Joachim and Schreiber, Herbert and Reiners, Karlheinz and Kress, Wolfram and M{\"u}ller-Reible, Clemens and Vorgerd, Matthias and Urban, Peter and Schrank, Bertold and Deschauer, Marcus and Schlotter-Weigel, Beate and Kohnen, Ralf and Lochm{\"u}ller, Hans}, title = {Treatment of dysferlinopathy with deflazacort: a double-blind, placebo-controlled clinical trial}, series = {Orphanet Journal of Rare Diseases}, volume = {8}, journal = {Orphanet Journal of Rare Diseases}, number = {26}, issn = {1750-1172}, doi = {10.1186/1750-1172-8-26}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-125663}, year = {2013}, abstract = {Background: Dysferlinopathies are autosomal recessive disorders caused by mutations in the dysferlin (DYSF) gene encoding the dysferlin protein. DYSF mutations lead to a wide range of muscular phenotypes, with the most prominent being Miyoshi myopathy (MM) and limb girdle muscular dystrophy type 2B (LGMD2B). Methods: We assessed the one-year-natural course of dysferlinopathy, and the safety and efficacy of deflazacort treatment in a double-blind, placebo-controlled cross-over trial. After one year of natural course without intervention, 25 patients with genetically defined dysferlinopathy were randomized to receive deflazacort and placebo for six months each (1 mg/kg/day in month one, 1 mg/kg every 2nd day during months two to six) in one of two treatment sequences. Results: During one year of natural course, muscle strength declined about 2\% as measured by CIDD (Clinical Investigation of Duchenne Dystrophy) score, and 76 Newton as measured by hand-held dynamometry. Deflazacort did not improve muscle strength. In contrast, there is a trend of worsening muscle strength under deflazacort treatment, which recovers after discontinuation of the study drug. During deflazacort treatment, patients showed a broad spectrum of steroid side effects. Conclusion: Deflazacort is not an effective therapy for dysferlinopathies, and off-label use is not warranted. This is an important finding, since steroid treatment should not be administered in patients with dysferlinopathy, who may be often misdiagnosed as polymyositis.}, language = {en} } @article{KarleSchueleKlebeetal.2013, author = {Karle, Kathrin N. and Sch{\"u}le, Rebecca and Klebe, Stephan and Otto, Susanne and Frischholz, Christian and Liepelt-Scarfone, Inga and Sch{\"o}ls, Ludger}, title = {Electrophysiological characterisation of motor and sensory tracts in patients with hereditary spastic paraplegia (HSP)}, series = {Orphanet Journal of Rare Diseases}, volume = {8}, journal = {Orphanet Journal of Rare Diseases}, number = {158}, issn = {1750-1172}, doi = {10.1186/1750-1172-8-158}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-124763}, year = {2013}, abstract = {Background: Hereditary spastic paraplegias (HSPs) are characterised by lower limb spasticity due to degeneration of the corticospinal tract. We set out for an electrophysiological characterisation of motor and sensory tracts in patients with HSP. Methods: We clinically and electrophysiologically examined a cohort of 128 patients with genetically confirmed or clinically probable HSP. Motor evoked potentials (MEPs) to arms and legs, somato-sensory evoked potentials of median and tibial nerves, and nerve conduction studies of tibial, ulnar, sural, and radial nerves were assessed. Results: Whereas all patients showed clinical signs of spastic paraparesis, MEPs were normal in 27\% of patients and revealed a broad spectrum with axonal or demyelinating features in the others. This heterogeneity can at least in part be explained by different underlying genotypes, hinting for distinct pathomechanisms in HSP subtypes. In the largest subgroup, SPG4, an axonal type of damage was evident. Comprehensive electrophysiological testing disclosed a more widespread affection of long fibre tracts involving peripheral nerves and the sensory system in 40\%, respectively. Electrophysiological abnormalities correlated with the severity of clinical symptoms. Conclusions: Whereas HSP is primarily considered as an upper motoneuron disorder, our data suggest a more widespread affection of motor and sensory tracts in the central and peripheral nervous system as a common finding in HSP. The distribution patterns of electrophysiological abnormalities were associated with distinct HSP genotypes and could reflect different underlying pathomechanisms. Electrophysiological measures are independent of symptomatic treatment and may therefore serve as a reliable biomarker in upcoming HSP trials.}, language = {en} } @article{AblinFitzcharlesBuskilaetal.2013, author = {Ablin, Jacob and Fitzcharles, Mary-Ann and Buskila, Dan and Shir, Yoram and Sommer, Claudia and H{\"a}user, Winfried}, title = {Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies}, series = {Evidence-Bayed Complementary and Alternative Medicine}, journal = {Evidence-Bayed Complementary and Alternative Medicine}, issn = {1741-427X}, doi = {10.1155/2013/485272}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-122235}, pages = {485272}, year = {2013}, abstract = {Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS). First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM) treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin) and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran) were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques).}, language = {en} } @article{HaeuserWalittFitzcharlesetal.2014, author = {H{\"a}user, Winfried and Walitt, Brian and Fitzcharles, Mary-Ann and Sommer, Claudia}, title = {Review of pharmacological therapies in fibromyalgia syndrome}, series = {Arthritis Research \& Therapy}, volume = {16}, journal = {Arthritis Research \& Therapy}, number = {201}, issn = {1465-9913}, doi = {10.1186/ar4441}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-121598}, year = {2014}, abstract = {This review addresses the current status of drug therapy for the management of fibromyalgia syndrome (FMS) and is based on interdisciplinary FMS management guidelines, meta-analyses of drug trial data, and observational studies. In the absence of a single gold-standard medication, patients are treated with a variety of drugs from different categories, often with limited evidence. Drug therapy is not mandatory for the management of FMS. Pregabalin, duloxetine, milnacipran, and amitriptyline are the current first-line prescribed agents but have had a mostly modest effect. With only a minority of patients expected to experience substantial benefit, most will discontinue therapy because of either a lack of efficacy or tolerability problems. Many drug treatments have undergone limited study and have had negative results. It is unlikely that these failed pilot trials will undergo future study. However, medications, though imperfect, will continue to be a component of treatment strategy for these patients. Both the potential for medication therapy to relieve symptoms and the potential to cause harm should be carefully considered in their administration.}, language = {en} } @article{MencacciIsaiasReichetal.2014, author = {Mencacci, Niccol{\´o} E. and Isaias, Ioannis U. and Reich, Martin M. and Ganos, Christos and Plagnol, Vincent and Polke, James M. and Bras, Jose and Hersheson, Joshua and Stamelou, Maria and Pittman, Alan M. and Noyce, Alastair J. and Mok, Kin Y. and Opladen, Thomas and Kunstmann, Erdmute and Hodecker, Sybille and M{\"u}nchau, Alexander and Volkmann, Jens and Samnick, Samuel and Sidle, Katie and Nanji, Tina and Sweeney, Mary G. and Houlden, Henry and Batla, Amit and Zecchinelli, Anna L. and Pezzoli, Gianni and Marotta, Giorgio and Lees, Andrew and Alegria, Paulo and Krack, Paul and Cormier-Dequaire, Florence and Lesage, Suzanne and Brice, Alexis and Heutink, Peter and Gasser, Thomas and Lubbe, Steven J. and Morris, Huw R. and Taba, Pille and Koks, Sulev and Majounie, Elisa and Gibbs, J. Raphael and Singleton, Andrew and Hardy, John and Klebe, Stephan and Bhatia, Kailash P. and Wood, Nicholas W.}, title = {Parkinson's disease in GTP cyclohydrolase 1 mutation carriers}, series = {Brain}, volume = {137}, journal = {Brain}, number = {9}, doi = {10.1093/brain/awu179}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-121268}, pages = {2480-92}, year = {2014}, abstract = {GTP cyclohydrolase 1, encoded by the GCH1 gene, is an essential enzyme for dopamine production in nigrostriatal cells. Loss-of-function mutations in GCH1 result in severe reduction of dopamine synthesis in nigrostriatal cells and are the most common cause of DOPA-responsive dystonia, a rare disease that classically presents in childhood with generalized dystonia and a dramatic long-lasting response to levodopa. We describe clinical, genetic and nigrostriatal dopaminergic imaging ([(123)I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) tropane single photon computed tomography) findings of four unrelated pedigrees with DOPA-responsive dystonia in which pathogenic GCH1 variants were identified in family members with adult-onset parkinsonism. Dopamine transporter imaging was abnormal in all parkinsonian patients, indicating Parkinson's disease-like nigrostriatal dopaminergic denervation. We subsequently explored the possibility that pathogenic GCH1 variants could contribute to the risk of developing Parkinson's disease, even in the absence of a family history for DOPA-responsive dystonia. The frequency of GCH1 variants was evaluated in whole-exome sequencing data of 1318 cases with Parkinson's disease and 5935 control subjects. Combining cases and controls, we identified a total of 11 different heterozygous GCH1 variants, all at low frequency. This list includes four pathogenic variants previously associated with DOPA-responsive dystonia (Q110X, V204I, K224R and M230I) and seven of undetermined clinical relevance (Q110E, T112A, A120S, D134G, I154V, R198Q and G217V). The frequency of GCH1 variants was significantly higher (Fisher's exact test P-value 0.0001) in cases (10/1318 = 0.75\%) than in controls (6/5935 = 0.1\%; odds ratio 7.5; 95\% confidence interval 2.4-25.3). Our results show that rare GCH1 variants are associated with an increased risk for Parkinson's disease. These findings expand the clinical and biological relevance of GTP cycloydrolase 1 deficiency, suggesting that it not only leads to biochemical striatal dopamine depletion and DOPA-responsive dystonia, but also predisposes to nigrostriatal cell loss. Further insight into GCH1-associated pathogenetic mechanisms will shed light on the role of dopamine metabolism in nigral degeneration and Parkinson's disease.}, language = {en} } @article{NiemannHuberWagneretal.2014, author = {Niemann, Axel and Huber, Nina and Wagner, Konstanze M. and Somandin, Christian and Horn, Michael and Lebrun-Julien, Fr{\´e}d{\´e}ric and Angst, Brigitte and Pereira, Jorge A. and Halfter, Hartmut and Welzl, Hans and Feltri, M. Laura and Wrabetz, Lawrence and Young, Peter and Wessig, Carsten and Toyka, Klaus V. and Suter, Ueli}, title = {The Gdap1 knockout mouse mechanistically links redox control to Charcot-Marie-Tooth disease}, series = {Brain}, volume = {137}, journal = {Brain}, number = {3}, doi = {10.1093/brain/awt371}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-120731}, pages = {668-82}, year = {2014}, abstract = {The ganglioside-induced differentiation-associated protein 1 (GDAP1) is a mitochondrial fission factor and mutations in GDAP1 cause Charcot-Marie-Tooth disease. We found that Gdap1 knockout mice (\(Gdap1^{-/-}\)), mimicking genetic alterations of patients suffering from severe forms of Charcot-Marie-Tooth disease, develop an age-related, hypomyelinating peripheral neuropathy. Ablation of Gdap1 expression in Schwann cells recapitulates this phenotype. Additionally, intra-axonal mitochondria of peripheral neurons are larger in \(Gdap1^{-/-}\) mice and mitochondrial transport is impaired in cultured sensory neurons of \(Gdap1^{-/-}\) mice compared with controls. These changes in mitochondrial morphology and dynamics also influence mitochondrial biogenesis. We demonstrate that mitochondrial DNA biogenesis and content is increased in the peripheral nervous system but not in the central nervous system of \(Gdap1^{-/-}\) mice compared with control littermates. In search for a molecular mechanism we turned to the paralogue of GDAP1, GDAP1L1, which is mainly expressed in the unaffected central nervous system. GDAP1L1 responds to elevated levels of oxidized glutathione by translocating from the cytosol to mitochondria, where it inserts into the mitochondrial outer membrane. This translocation is necessary to substitute for loss of GDAP1 expression. Accordingly, more GDAP1L1 was associated with mitochondria in the spinal cord of aged \(Gdap1^{-/-}\) mice compared with controls. Our findings demonstrate that Charcot-Marie-Tooth disease caused by mutations in GDAP1 leads to mild, persistent oxidative stress in the peripheral nervous system, which can be compensated by GDAP1L1 in the unaffected central nervous system. We conclude that members of the GDAP1 family are responsive and protective against stress associated with increased levels of oxidized glutathione.}, language = {en} } @article{UeceylerSommer2014, author = {{\"U}{\c{c}}eyler, Nurcan and Sommer, Claudia}, title = {High-Dose Capsaicin for the Treatment of Neuropathic Pain: What We Know and What We Need to Know}, series = {Pain and Therapy}, volume = {3}, journal = {Pain and Therapy}, number = {2}, issn = {2193-651X}, doi = {10.1007/s40122-014-0027-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-120669}, pages = {73-84}, year = {2014}, abstract = {Neuropathic pain is a frequent and disabling condition with diverse underlying etiologies and is often difficult to treat. Systemic drug treatment is often limited in efficacy. Furthermore, adverse effects may be a limiting factor when trying to reach the necessary dose. Analgesics that can be applied topically have the potential to largely overcome this problem. They may be of particular advantage in localized neuropathic pain syndromes such as postherpetic neuralgia or small fiber neuropathy. Capsaicin, the pungent component of chili peppers, is a natural ligand of the transient receptor potential vanilloid 1 channel and has long been used as topically applicable cream with concentrations of 0.025 to 0.075\%. In 2009, a high-concentration transdermal capsaicin 8\% patch (Qutenza ; Acorda Therapeutics, Inc., Ardsley, NY, USA; Astellas Pharma Europe Ltd., Chertsey, Surrey, UK) was introduced for the treatment of peripheral neuropathic pain syndromes other than of diabetic origin in adults. It has since been widely used in diverse neuropathic pain disorders. In this review article, we summarize current knowledge on Qutenza, its advantages and problems, and expose unmet needs.}, language = {en} } @article{HohmannMillesSchinkeetal.2014, author = {Hohmann, Christopher and Milles, Bianca and Schinke, Michael and Schroeter, Michael and Ulzheimer, Jochen and Kraft, Peter and Kleinschnitz, Christoph and Lehmann, Paul V. and Kuerten, Stefanie}, title = {Categorization of multiple sclerosis relapse subtypes by B cell profiling in the blood}, series = {Acta Neuropathologica Communications}, volume = {2}, journal = {Acta Neuropathologica Communications}, number = {138}, issn = {2051-5960}, doi = {10.1186/s40478-014-0138-2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-120580}, year = {2014}, abstract = {INTRODUCTION: B cells are attracting increasing attention in the pathogenesis of multiple sclerosis (MS). B cell-targeted therapies with monoclonal antibodies or plasmapheresis have been shown to be successful in a subset of patients. Here, patients with either relapsing-remitting (n = 24) or secondary progressive (n = 6) MS presenting with an acute clinical relapse were screened for their B cell reactivity to brain antigens and were re-tested three to nine months later. Enzyme-linked immunospot technique (ELISPOT) was used to identify brain-reactive B cells in peripheral blood mononuclear cells (PBMC) directly ex vivo and after 96 h of polyclonal stimulation. Clinical severity of symptoms was determined using the Expanded Disability Status Scale (EDSS). RESULTS: Nine patients displayed B cells in the blood producing brain-specific antibodies directly ex vivo. Six patients were classified as B cell positive donors only after polyclonal B cell stimulation. In 15 patients a B cell response to brain antigens was absent. Based on the autoreactive B cell response we categorized MS relapses into three different patterns. Patients who displayed brain-reactive B cell responses both directly ex vivo and after polyclonal stimulation (pattern I) were significantly younger than patients in whom only memory B cell responses were detectable or entirely absent (patterns II and III; p = 0.003). In one patient a conversion to a positive B cell response as measured directly ex vivo and subsequently also after polyclonal stimulation was associated with the development of a clinical relapse. The evaluation of the predictive value of a brain antigen-specific B cell response showed that seven of eight patients (87.5\%) with a pattern I response encountered a clinical relapse during the observation period of 10 months, compared to two of five patients (40\%) with a pattern II and three of 14 patients (21.4\%) with a pattern III response (p = 0.0005; hazard ratio 6.08 (95\% confidence interval 1.87-19.77). CONCLUSIONS: Our data indicate actively ongoing B cell-mediated immunity against brain antigens in a subset of MS patients that may be causative of clinical relapses and provide new diagnostic and therapeutic options for a subset of patients.}, language = {en} } @article{FluriFleischerKleinschnitz2015, author = {Fluri, Felix and Fleischer, Michael and Kleinschnitz, Christoph}, title = {Accidental Thrombolysis in a Stroke Patient Receiving Apixaban}, series = {Cerebrovascular Diseases Extra}, volume = {5}, journal = {Cerebrovascular Diseases Extra}, doi = {10.1159/000375181}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-126326}, pages = {55-56}, year = {2015}, abstract = {No abstract available.}, language = {en} } @article{KraftDrechslerSchuhmannetal.2015, author = {Kraft, Peter and Drechsler, Christiane and Schuhmann, Michael K. and Gunreben, Ignaz and Kleinschnitz, Christoph}, title = {Characterization of Peripheral Immune Cell Subsets in Patients with Acute and Chronic Cerebrovascular Disease: A Case-Control Study}, series = {International Journal of Molecular Science}, volume = {16}, journal = {International Journal of Molecular Science}, number = {10}, doi = {10.3390/ijms161025433}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-126319}, pages = {25433-25449}, year = {2015}, abstract = {Immune cells (IC) play a crucial role in murine stroke pathophysiology. However, data are limited on the role of these cells in ischemic stroke in humans. We therefore aimed to characterize and compare peripheral IC subsets in patients with acute ischemic stroke/transient ischemic attack (AIS/TIA), chronic cerebrovascular disease (CCD) and healthy volunteers (HV). We conducted a case-control study of patients with AIS/TIA (n = 116) or CCD (n = 117), and HV (n = 104) who were enrolled at the University Hospital W{\"u}rzburg from 2010 to 2013. We determined the expression and quantity of IC subsets in the three study groups and performed correlation analyses with demographic and clinical parameters. The quantity of several IC subsets differed between the AIS/TIA, CCD, and HV groups. Several clinical and demographic variables independently predicted the quantity of IC subsets in patients with AIS/TIA. No significant changes in the quantity of IC subsets occurred within the first three days after AIS/TIA. Overall, these findings strengthen the evidence for a pathophysiologic role of IC in human ischemic stroke and the potential use of IC-based biomarkers for the prediction of stroke risk. A comprehensive description of IC kinetics is crucial to enable the design of targeted treatment strategies.}, language = {en} } @article{HohnmannMillesSchinkeetal.2014, author = {Hohnmann, Christopher and Milles, Bianca and Schinke, Michael and Schroeter, Michael and Ulzheimer, Jochen and Kraft, Peter and Kleinschnitz, Christoph and Lehmann, Paul V. and Kuerten, Stefanie}, title = {Categorization of multiple sclerosis relapse subtypes by B cell profiling in the blood}, series = {Acta Neuropathologica Communications}, volume = {2}, journal = {Acta Neuropathologica Communications}, number = {138}, doi = {10.1186/s40478-014-0138-2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-126124}, year = {2014}, abstract = {Introduction B cells are attracting increasing attention in the pathogenesis of multiple sclerosis (MS). B cell-targeted therapies with monoclonal antibodies or plasmapheresis have been shown to be successful in a subset of patients. Here, patients with either relapsing-remitting (n = 24) or secondary progressive (n = 6) MS presenting with an acute clinical relapse were screened for their B cell reactivity to brain antigens and were re-tested three to nine months later. Enzyme-linked immunospot technique (ELISPOT) was used to identify brain-reactive B cells in peripheral blood mononuclear cells (PBMC) directly ex vivo and after 96 h of polyclonal stimulation. Clinical severity of symptoms was determined using the Expanded Disability Status Scale (EDSS). Results Nine patients displayed B cells in the blood producing brain-specific antibodies directly ex vivo. Six patients were classified as B cell positive donors only after polyclonal B cell stimulation. In 15 patients a B cell response to brain antigens was absent. Based on the autoreactive B cell response we categorized MS relapses into three different patterns. Patients who displayed brain-reactive B cell responses both directly ex vivo and after polyclonal stimulation (pattern I) were significantly younger than patients in whom only memory B cell responses were detectable or entirely absent (patterns II and III; p = 0.003). In one patient a conversion to a positive B cell response as measured directly ex vivo and subsequently also after polyclonal stimulation was associated with the development of a clinical relapse. The evaluation of the predictive value of a brain antigen-specific B cell response showed that seven of eight patients (87.5\%) with a pattern I response encountered a clinical relapse during the observation period of 10 months, compared to two of five patients (40\%) with a pattern II and three of 14 patients (21.4\%) with a pattern III response (p = 0.0005; hazard ratio 6.08 (95\% confidence interval 1.87-19.77). Conclusions Our data indicate actively ongoing B cell-mediated immunity against brain antigens in a subset of MS patients that may be causative of clinical relapses and provide new diagnostic and therapeutic options for a subset of patients.}, language = {en} } @article{DopplerAppeltshauserKraemeretal.2015, author = {Doppler, Kathrin and Appeltshauser, Luise and Kr{\"a}mer, Heidrun H. and King Man Ng, Judy and Meinl, Edgar and Villmann, Carmen and Brophy, Peter and Dib-Hajj, Sulayman D. and Waxman, Stephen G. and Weishaupt, Andreas and Sommer, Claudia}, title = {Contactin-1 and Neurofascin-155/-186 Are Not Targets of Auto-Antibodies in Multifocal Motor Neuropathy}, series = {PLoS One}, volume = {10}, journal = {PLoS One}, number = {7}, doi = {10.1371/journal.pone.0134274}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-126156}, pages = {e0134274}, year = {2015}, abstract = {Multifocal motor neuropathy is an immune mediated disease presenting with multifocal muscle weakness and conduction block. IgM auto-antibodies against the ganglioside GM1 are detectable in about 50\% of the patients. Auto-antibodies against the paranodal proteins contactin-1 and neurofascin-155 and the nodal protein neurofascin-186 have been detected in subgroups of patients with chronic inflammatory demyelinating polyneuropathy. Recently, auto-antibodies against neurofascin-186 and gliomedin were described in more than 60\% of patients with multifocal motor neuropathy. In the current study, we aimed to validate this finding, using a combination of different assays for auto-antibody detection. In addition we intended to detect further auto-antibodies against paranodal proteins, specifically contactin-1 and neurofascin-155 in multifocal motor neuropathy patients' sera. We analyzed sera of 33 patients with well-characterized multifocal motor neuropathy for IgM or IgG anti-contactin-1, anti-neurofascin-155 or -186 antibodies using enzyme-linked immunosorbent assay, binding assays with transfected human embryonic kidney 293 cells and murine teased fibers. We did not detect any IgM or IgG auto-antibodies against contactin-1, neurofascin-155 or -186 in any of our multifocal motor neuropathy patients. We conclude that auto-antibodies against contactin-1, neurofascin-155 and -186 do not play a relevant role in the pathogenesis in this cohort with multifocal motor neuropathy.}, language = {en} } @article{WestermaierKoehlerLinsenmannetal.2015, author = {Westermaier, Thomas and Koehler, Stefan and Linsenmann, Thomas and Kinderlen, Michael and Pakos, Paul and Ernestus, Ralf-Ingo}, title = {Intraoperative Myelography in Cervical Multilevel Stenosis Using 3D Rotational Fluoroscopy: Assessment of Feasibility and Image Quality}, series = {Radiology Research and Practice}, volume = {2015}, journal = {Radiology Research and Practice}, doi = {10.1155/2015/498936}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-125779}, pages = {498936}, year = {2015}, abstract = {Background. Intraoperative myelography has been reported for decompression control in multilevel lumbar disease. Cervical myelography is technically more challenging. Modern 3D fluoroscopy may provide a new opportunity supplying multiplanar images. This study was performed to determine the feasibility and image quality of intraoperative cervical myelography using a 3D fluoroscope. Methods. The series included 9 patients with multilevel cervical stenosis. After decompression, 10 mL of water-soluble contrast agent was administered via a lumbar drainage and the operating table was tilted. Thereafter, a 3D fluoroscopy scan (O-Arm) was performed and visually evaluated. Findings. The quality of multiplanar images was sufficient to supply information about the presence of residual stenosis. After instrumentation, metal artifacts lowered image quality. In 3 cases, decompression was continued because myelography depicted residual stenosis. In one case, anterior corpectomy was not completed because myelography showed sufficient decompression after 2-level discectomy. Interpretation. Intraoperative myelography using 3D rotational fluoroscopy is useful for the control of surgical decompression in multilevel spinal stenosis providing images comparable to postmyelographic CT. The long duration of contrast delivery into the cervical spine may be solved by preoperative contrast administration. The method is susceptible to metal artifacts and, therefore, should be applied before metal implants are placed.}, language = {en} } @article{KleinschnitzLinkerMagnusetal.2015, author = {Kleinschnitz, Christoph and Linker, Ralf A. and Magnus, Tim and Korn, Thomas and Meuth, Sven G.}, title = {Report on the 6th scientific meeting of the "Verein zur F{\"o}rderung des Wissenschaftlichen Nachwuchses in der Neurologie" (NEUROWIND e.V.) held in Motzen, Germany, Oct. 31th - Nov. 2nd, 2014}, series = {Experimental \& Translational Stroke Medicine}, volume = {7}, journal = {Experimental \& Translational Stroke Medicine}, number = {1}, organization = {on behalf of the speakers at the 6'th NEUROWIND e.V. scientific meeting}, doi = {10.1186/s13231-014-0013-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-125049}, year = {2015}, abstract = {From October 31th - November 2nd, 2014, the 6th NEUROWIND e.V. meeting was held in Motzen, Brandenburg, Germany. 70 doctoral students and postdocs from over 25 different groups working in German and Swiss university hospitals or research institutes attended the meeting to discuss their latest experiments and findings in the fields of neuroimmunology, neurodegeneration and neurovascular research. The meeting was regarded as a very well organized platform to support research of young investigators in Germany and all participants enjoyed the stimulating environment for lively in depth discussions. According to the major aim of NEUROWIND e.V. to support younger researchers in Germany the 4th NEUROWIND YOUNG SCIENTIST AWARD for experimental neurology was awarded to Michael Breckwoldt on his work in the group of Thomas Misgeld (Institute of Neuronal Cell Biology, Technische Universit{\"a}t M{\"u}nchen, Germany). The successful project was published in Nature Medicine entitled "Multiparametric optical analysis of mitochondrial redox signals during neuronal physiology and pathology in vivo". This outstanding paper deals with a molecular imaging approach in living mice to optically analyze the role of mitochondrial redox signals in axons in health and disease. The award is endowed with 20.000 Euro sponsored by Merck Serono GmbH, Darmstadt, Germany (unrestricted educational grant). This year's keynote lecture was given by Bernhard Hemmer, Head of the Department of Neurology at the Klinikum rechts der Isar, Technische Universit{\"a}t M{\"u}nchen. Dr. Hemmer highlighted the particular role of B cells and (auto)antibodies in multiple sclerosis (MS). As a new highlight Dr. Urbahns, head of global discovery technologies at Merck research laboratories, gave insights from research practice in the pharmaceutical industry and introduced a shift in the view on present-day drug discovery paradigms.}, language = {en} } @article{KleinGrohWeishauptetal.2015, author = {Klein, Dennis and Groh, Janos and Weishaupt, Andreas and Martini, Rudolf}, title = {Endogenous antibodies contribute to macrophage-mediated demyelination in a mouse model for CMT1B}, series = {Journal of Neuroinflammation}, volume = {12}, journal = {Journal of Neuroinflammation}, number = {49}, doi = {10.1186/s12974-015-0267-y}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-125036}, year = {2015}, abstract = {Background We could previously identify components of both the innate and the adaptive immune system as disease modifiers in the pathogenesis of models for Charcot-Marie-Tooth (CMT) neuropathies type 1B and 1X. As part of the adaptive immune system, here we investigated the role of antibodies in a model for CMT1B. Methods Antibodies were localized and characterized in peripheral nerves of the CMT1B model by immunohistochemistry and Western blot analysis. Experimental ablation of antibodies was performed by cross breeding the CMT1B models with mutants deficient in B-lymphocytes (JHD-/- mutants). Ameliorated demyelination by antibody deficiency was reverted by intravenous injection of mouse IgG fractions. Histopathological analysis was performed by immunocytochemistry and light and quantitative electron microscopy. Results We demonstrate that in peripheral nerves of a mouse model for CMT1B, endogenous antibodies strongly decorate endoneurial tubes of peripheral nerves. These antibodies comprise IgG and IgM subtypes and are preferentially, but not exclusively, associated with nerve fiber aspects nearby the nodes of Ranvier. In the absence of antibodies, the early demyelinating phenotype is substantially ameliorated. Reverting the neuropathy by reconstitution with murine IgG fractions identified accumulating antibodies as potentially pathogenic at this early stage of disease. Conclusions Our study demonstrates that in a mouse model for CMT1B, endogenous antibodies contribute to early macrophage-mediated demyelination and disease progression. Thus, both the innate and adaptive immune system are mutually interconnected in a genetic model for demyelination. Since in Wallerian degeneration antibodies have also been shown to be involved in myelin phagocytosis, our study supports our view that inherited demyelination and Wallerian degeneration share common mechanisms, which are detrimental when activated under nonlesion conditions.}, language = {en} } @article{UeceylerKewenigKittelSchneideretal.2015, author = {{\"U}{\c{c}}eyler, Nurcan and Kewenig, Susanne and Kittel-Schneider, Sarah and Fallgatter, Andreas J. and Sommer, Claudia}, title = {Increased cortical activation upon painful stimulation in fibromyalgia syndrome}, series = {BMC Neurology}, volume = {15}, journal = {BMC Neurology}, number = {210}, doi = {10.1186/s12883-015-0472-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-125230}, year = {2015}, abstract = {Background Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread pain and associated symptoms. We investigated cerebral activation in FMS patients by functional near-infrared spectroscopy (fNIRS). Methods Two stimulation paradigms were applied: a) painful pressure stimulation at the dorsal forearm; b) verbal fluency test (VFT). We prospectively recruited 25 FMS patients, ten patients with unipolar major depression (MD) without pain, and 35 healthy controls. All patients underwent neurological examination and all subjects were investigated with questionnaires (pain, depression, FMS, empathy). Results FMS patients had lower pressure pain thresholds than patients with MD and controls (p < 0.001) and reported higher pain intensity (p < 0.001). Upon unilateral pressure pain stimulation fNIRS recordings revealed increased bilateral cortical activation in FMS patients compared to controls (p < 0.05). FMS patients also displayed a stronger contralateral activity over the dorsolateral prefrontal cortex in direct comparison to patients with MD (p < 0.05). While all three groups performed equally well in the VFT, a frontal deficit in cortical activation was only found in patients with depression (p < 0.05). Performance and cortical activation correlated negatively in FMS patients (p < 0.05) and positively in patients with MD (p < 0.05). Conclusion Our data give further evidence for altered central nervous processing in patients with FMS and the distinction between FMS and MD.}, language = {en} } @article{HansenKahnZelleretal.2015, author = {Hansen, Niels and Kahn, Ann-Kathrin and Zeller, Daniel and Katsarava, Zaza and Sommer, Claudia and {\"U}{\c{c}}eyler, Nurcan}, title = {Amplitudes of pain-related evoked potentials are useful to detect small fiber involvement in painful mixed fiber neuropathies in addition to quantitative sensory testing - an electrophysiological study}, series = {Frontiers in Neurology}, volume = {6}, journal = {Frontiers in Neurology}, doi = {10.3389/fneur.2015.00244}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-124824}, pages = {244}, year = {2015}, abstract = {To investigate the usefulness of pain-related evoked potentials (PREP) elicited by electrical stimulation for the identification of small fiber involvement in patients with mixed fiber neuropathy (MFN). Eleven MFN patients with clinical signs of large fiber impairment and neuropathic pain and ten healthy controls underwent clinical and electrophysiological evaluation. Small fiber function, electrical conductivity and morphology were examined by quantitative sensory testing (QST), PREP, and skin punch biopsy. MFN was diagnosed following clinical and electrophysiological examination (chronic inflammatory demyelinating neuropathy: n = 6; vasculitic neuropathy: n = 3; chronic axonal ­neuropathy: n = 2). The majority of patients with MFN characterized their pain by descriptors that mainly represent C-fiber-mediated pain. In QST, patients displayed elevated cold, warm, mechanical, and vibration detection thresholds and cold pain thresholds indicative of MFN. PREP amplitudes in patients correlated with cold (p < 0.05) and warm detection thresholds (p < 0.05). Burning pain and the presence of par-/dysesthesias correlated negatively with PREP amplitudes (p < 0.05). PREP amplitudes correlating with cold and warm detection thresholds, burning pain, and par-/dysesthesias support employing PREP amplitudes as an additional tool in conjunction with QST for detecting small fiber impairment in patients with MFN.}, language = {en} } @phdthesis{Ebert2015, author = {Ebert, S{\"o}nke}, title = {Small- und Large-fiber-Beteiligung bei Morbus Parkinson}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-124647}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2015}, abstract = {Die hier vorliegende Forschungsarbeit {\"u}berpr{\"u}fte eine m{\"o}gliche Beteiligung des peripheren Nervensystems bei M. Parkinson und den atypischen Parkinson-Syndromen. 31 Patienten mit einem idiopathischen Parkinson-Syndrom (IPD-Patienten) und neun Patienten mit einem atypischen Parkinson-Syndrom (APD-Patienten) sowie 35 altersentsprechende Kontrollprobanden wurden zwischen 2011 und 2012 f{\"u}r diese Studie rekrutiert. Neben der Eigenanamnese und der neurologischen Untersuchung erhielten die Patienten eine Suralisneurographie zur {\"U}berpr{\"u}fung der large fibers und eine Quantitative sensorische Testung (QST) zur Detektion einer m{\"o}glichen Small-fiber-Dysfunktion. Die Vitamin-Bestimmung diente der Untersuchung m{\"o}glicher Zusammenh{\"a}nge zwischen der Levodopa-Therapie, eventuell daraus resultierenden Vitamin-Mangelzust{\"a}nden und einer reduzierten intraepidermalen Nervenfaser-Dichte (IENF-Dichte) beim M. Parkinson. F{\"u}r die histologische Auswertung der IENF-Dichte und der dermalen, myelinisierten Nervenfaserb{\"u}ndel (PGP 9.5- / MBP- Doppelf{\"a}rbung) sowie f{\"u}r die immunohistochemische Untersuchung der Nervenfasersubtypen (anti-alpha-CGRP- und anti-Substanz P-Antik{\"o}rper) wurden bei jedem Probanden vier Hautbiopsien von den Extremit{\"a}ten und dem K{\"o}rperstamm entnommen. Sieben IPD-Patienten und ein Proband mit einem atypischen Parkinson-Syndrom wiesen ein vermindertes sensorisches Nervenaktionspotenzial (SNAP) in der Suralisneurographie auf. Dagegen war eine pathologisch reduzierte Nervenleitgeschwindigkeit nur bei einem IPD-Patienten nachweisbar. Auff{\"a}llig war zudem eine negative Korrelation zwischen der Erkrankungsdauer und dem SNAP (Korrelationskoeffizient -0,367, p<0,03). In der Auswertung der Hautbiopsien konnte eine statistisch signifikante Reduktion der myelinisierten B{\"u}ndel am Unterschenkel der IPD-Patienten festgestellt werden. Bei zehn von 30 IPD-Patienten, jedoch bei keinem der Probanden mit einem atypischen Parkinson-Syndrom, konnte eine verminderte IENF-Dichte nachgewiesen werden. In der statistischen {\"U}berpr{\"u}fung wurde außerdem am Unterschenkel ein signifikanter Unterschied zwischen den IPD-Patienten und der Kontrollkohorte sowie eine negative Korrelation zwischen der Krankheitsdauer und der IENF-Dichte (Korrelationskoeffizient -0,320, p<0,05) festgestellt. Die QST konnte dagegen keinen statistisch signifikanten Unterschied zwischen den einzelnen Kohorten aufzeigen. Im Kontrast dazu fand sich eine l{\"a}ngenunabh{\"a}ngige Reduktion der CGRP-positiven und der Substanz P-positiven IENF-Dichte bei den Patienten mit einem idiopathischen Parkinson-Syndrom. Bemerkenswert war zudem eine signifikante Verminderung der Substanz P-positiven intraepidermalen Nervenfasern am Oberschenkel und R{\"u}cken bei den APD-Patienten. Eine statistisch signifikante Abweichung der CGRP- und Substanz P-positiven B{\"u}ndel konnte dagegen nicht festgestellt werden. In der laborchemischen Untersuchung war ein Zusammenhang zwischen den bestimmten Vitamin-Spiegeln und der kumulativen Levodopa-Dosis sowie zwischen den Vitaminen und der IENF-Dichte lediglich bei dem Vitamin B6 nachweisbar. Zusammengefasst erscheint eine Beteiligung des peripheren Nervensystems beim idiopathischen Parkinson als wahrscheinlich, wohingegen bei den atypischen Parkinson-Syndromen vor allem von einer zentralen Genese ausgegangen werden kann. Basierend auf den Ergebnissen der Suralisneurographie und der Bestimmung der myelinisierten B{\"u}ndel erscheint eine krankheitsbedingte Large-fiber-Beeintr{\"a}chtigung beim M.Parkinson m{\"o}glich. Die nachgewiesene l{\"a}ngenabh{\"a}ngige Small-fiber-Reduktion bei IPD-Patienten wird vermutlich durch eine axonale Transportst{\"o}rung verursacht. Einen krankheitsbedingten Erkl{\"a}rungsansatz f{\"u}r die l{\"a}ngenunabh{\"a}ngige Reduktion der CGRP-positiven und der Substanz P-positiven IENF-Dichte bei IPD-Patienten liefert der Nachweis von neurotoxischem α-Synuclein in den sensiblen Spinatganglien mit einem daraus resultierenden Untergang von sensorischen Nervenfasern. Aufgrund der geringen Anzahl an Parkinson-Patienten mit sensiblen Symptomen und dem fehlenden Nachweis eines statistisch signifikanten Unterschiedes in der QST liegt der Verdacht nahe, dass die ermittelte intraepidermale Nervenfaserreduktion der IPD-Patienten nicht stark genug ausgepr{\"a}gt ist, um eine signifikante Abweichung der QST-Ergebnisse zu verursachen. Weiterhin konnte kein Zusammenhang zwischen der kumulativen Levodopa-Menge, den Vitaminen B12, Methylmalons{\"a}ure sowie Homocystein und dem Auftreten einer Nervenfaserverminderung nachgewiesen werden, was gegen eine iatrogene Beteiligung des peripheren Nervensystems als Nebenwirkung der Levodopa-Therapie spricht. Das idiopathische Parkinson-Syndrom geht mit einer Reduktion der kleinen Nervenfasern einher, welche vermutlich auf die Grunderkrankung selbst zur{\"u}ckzuf{\"u}hren ist. Die Untersuchung der Haut erscheint somit vielversprechend f{\"u}r die Erforschung der Pathogenese und f{\"u}r die Differentialdiagnostik des M. Parkinson.}, subject = {Parkinson-Krankheit}, language = {de} } @article{LanghauserHeilerGrudzenskietal.2012, author = {Langhauser, Friederike L. and Heiler, Patrick M. and Grudzenski, Saskia and Lemke, Andreas and Alonso, Angelika and Schad, Lothar R. and Hennerici, Michael G. and Meairs, Stephen and Fata, Marc}, title = {Thromboembolic stroke in C57BL/6 mice monitored by 9.4 T MRI using a 1H cryo probe}, series = {Experimental and Translational Stroke Medicine}, volume = {4}, journal = {Experimental and Translational Stroke Medicine}, number = {18}, doi = {10.1186/2040-7378-4-18}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-124218}, year = {2012}, abstract = {Background A new thromboembolic animal model showed beneficial effects of t-PA with an infarct volume reduction of 36.8\% in swiss mice. Because knock-out animal experiments for stroke frequently used C57BL76 mice we evaluated t-PA effects in this mouse strain and measured infarct volume and vascular recanalisation in-vivo by using high-field 9.4 T MRI and a 1H surface cryo coil. Methods Clot formation was triggered by microinjection of murine thrombin into the right middle cerebral artery (MCA). Animals (n = 28) were treated with 10 mg/kg, 5 mg/kg or no tissue plasminogen activator (t-PA) 40 min after MCA occlusion. For MR-imaging a Bruker 9.4 T animal system with a 1H surface cryo probe was used and a T2-weighted RARE sequence, a diffusion weighted multishot EPI sequence and a 3D flow-compensated gradient echo TOF angiography were performed. Results The infarct volume in animals treated with t-PA was significantly reduced (0.67 ± 1.38 mm3 for 10 mg/kg and 10.9 ± 8.79 mm3 for 5 mg/kg vs. 19.76 ± 2.72 mm3 ; p < 0.001) compared to untreated mice. An additional group was reperfused with t-PA inside the MRI. Already ten minutes after beginning of t-PA treatment, reperfusion flow was re-established in the right MCA. However, signal intensity was lower than in the contralateral MCA. This reduction in cerebral blood flow was attenuated during the first 60 minutes after reperfusion. 24 h after MCA occlusion and reperfusion, no difference in signal intensity of the contralateral and ipsilateral MCAs was observed. Conclusions We confirm a t-Pa effect using this stroke model in the C57BL76 mouse strain and demonstrate a chronological sequence MRI imaging after t-PA using a 1H surface cryo coil in a 9.4 T MRI. This setting will allow testing of new thrombolytic strategies for stroke treatment in-vivo in C57BL76 knock-out mice.}, language = {en} } @article{HansenSeilerRumpfetal.2012, author = {Hansen, Niels and Seiler, Carola and Rumpf, Julian and Kraft, Peter and Dlaske, Henry and Abele-Horn, Marianne and Muellges, Wolfgang}, title = {Human Tuberculous Meningitis Caused by \(Mycobacterium\) \(caprae\)}, series = {Case Reports in Neurology}, volume = {4}, journal = {Case Reports in Neurology}, number = {1}, doi = {10.1159/000337299}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-123425}, pages = {54-60}, year = {2012}, abstract = {INTRODUCTION: Tuberculous meningitis (TM) causes substantial morbidity and mortality in humans. Human TM has been known to be induced by bacteria from the Mycobacterium tuberculosis complex (MTBC), such as M. tuberculosis and M. bovis. CASE PRESENTATION: We describe a case of meningitis treated with fosfomycin, which showed partial effectiveness in an 80-year-old patient. After a lethal myocardial infarction, M. caprae (MC) was identified in cerebrospinal fluid culture. This isolated acid-fast organism was first identified as MTBC by MTBC-specific PCR (16S rDNA-PCR). Furthermore, species-specific identification of the isolate was done by gyrB PCR-restriction fragment length polymorphism analysis of a part of gyrB DNA. Colony morphology of the isolated MC strain showed dysgonic growth on Lowenstein-Jensen medium. The strain was susceptible to pyrazinamide (PZA). CONCLUSION: This isolated strain was convincingly identified as MC according to the phenotypic and genotypic characteristics and PZA sensitivity. This is the first report of MC causing TM.}, language = {en} } @article{WeiseStoll2012, author = {Weise, Gesa and Stoll, Guido}, title = {Magnetic resonance imaging of blood brain/nerve barrier dysfunction and leukocyte infiltration: closely related or discordant?}, series = {Frontiers in Neurology}, volume = {3}, journal = {Frontiers in Neurology}, number = {178}, doi = {10.3389/fneur.2012.00178}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-123359}, year = {2012}, abstract = {Unlike other organs the nervous system is secluded from the rest of the organism by the blood brain barrier (BBB) or blood nerve barrier (BNB) preventing passive influx of fluids from the circulation. Similarly, leukocyte entry to the nervous system is tightly controlled. Breakdown of these barriers and cellular inflammation are hallmarks of inflammatory as well as ischemic neurological diseases and thus represent potential therapeutic targets. The spatiotemporal relationship between BBB/BNB disruption and leukocyte infiltration has been a matter of debate. We here review contrast-enhanced magnetic resonance imaging (MRI) as a non-invasive tool to depict barrier dysfunction and its relation to macrophage infiltration in the central and peripheral nervous system under pathological conditions. Novel experimental contrast agents like Gadofluorine M (Gf) allow more sensitive assessment of BBB dysfunction than conventional Gadolinium (Gd)-DTPA enhanced MRI. In addition, Gf facilitates visualization of functional and transient alterations of the BBB remote from lesions. Cellular contrast agents such as superparamagnetic iron oxide particles (SPIO) and perfluorocarbons enable assessment of leukocyte (mainly macrophage) infiltration by MR technology. Combined use of these MR contrast agents disclosed that leukocytes can enter the nervous system independent from a disturbance of the BBB, and vice versa, a dysfunctional BBB/BNB by itself is not sufficient to attract inflammatory cells from the circulation. We will illustrate these basic imaging findings in animal models of multiple sclerosis, cerebral ischemia, and traumatic nerve injury and review corresponding findings in patients.}, language = {en} } @article{WurmbSchlerethKredeletal.2014, author = {Wurmb, Thomas Erik and Schlereth, Stefan and Kredel, Markus and Muellenbach, Ralf M. and Wunder, Christian and Brederlau, J{\"o}rg and Roewer, Norbert and Kenn, Werner and Kunze, Ekkehard}, title = {Routine Follow-Up Cranial Computed Tomography for Deeply Sedated, Intubated, and Ventilated Multiple Trauma Patients with Suspected Severe Head Injury}, series = {BioMed Research International}, journal = {BioMed Research International}, number = {361949}, doi = {10.1155/2014/361949}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-120084}, year = {2014}, abstract = {Background. Missed or delayed detection of progressive neuronal damage after traumatic brain injury (TBI) may have negative impact on the outcome. We investigated whether routine follow-up CT is beneficial in sedated and mechanically ventilated trauma patients. Methods. The study design is a retrospective chart review. A routine follow-up cCT was performed 6 hours after the admission scan. We defined 2 groups of patients, group I: patients with equal or recurrent pathologies and group II: patients with new findings or progression of known pathologies. Results. A progression of intracranial injury was found in 63 patients (42\%) and 18 patients (12\%) had new findings in cCT 2 (group II). In group II a change in therapy was found in 44 out of 81 patients (54\%). 55 patients with progression or new findings on the second cCT had no clinical signs of neurological deterioration. Of those 24 patients (44\%) had therapeutic consequences due to the results of the follow-up cCT. Conclusion. We found new diagnosis or progression of intracranial pathology in 54\% of the patients. In 54\% of patients with new findings and progression of pathology, therapy was changed due to the results of follow-up cCT. In trauma patients who are sedated and ventilated for different reasons a routine follow-up CT is beneficial.}, language = {en} } @phdthesis{Klein2015, author = {Klein, Dennis}, title = {The pathogenic role of endogenous antibodies in a mouse model for Charcot-Marie-Tooth 1B neuropathy}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-121941}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2015}, abstract = {Charcot-Marie-Tooth (CMT) type 1 neuropathies are a genetically heterogeneous group of non-treatable inherited disorders affecting the peripheral nervous system that lead to sensory and motor dysfunction. Secondary low grade inflammation, implicating the innate and adaptive immune system, could previously be identified as a substantial disease modifier in two mouse models for CMT1, CMT1B and 1X, respectively. However, the exact mechanism how the adaptive immune system contributes to disease pathogenesis is not completely understood. Based on observations that the accumulation of endogenous antibodies to myelin components is important for rapid myelin clearance after nerve injury during Wallerian degeneration, a possibly similar mechanism was considered for endogenous antibodies as disease amplifier in mice heterozygously deficient for P0 (P0het), mimicking some typical features of CMT1B. In this study an increased antibody deposition was detected in the affected peripheral nerves of P0het myelin mutant mice. By crossbreeding P0het mutants with mice specifically lacking B-lymphocytes, and therefore antibodies (JHD-/-), a decline of endoneurial macrophages together with a substantially ameliorated demyelination could be demonstrated in 6-month-old mutant mice. Moreover, reconstitution with murine IgGs reverted the neuropathic phenotype, substantiating that endogenous antibodies are potentially pathogenic at this early stage of disease. Unexpectedly, in 12-months-old P0het mutants, JHD deficiency resulted in disease aggravation accompanied by an increased inflammatory reaction and M2-polarized macrophage response. These observations suggest that in a mouse model for CMT1B, the lack of endogenous antibodies has a dichotomous effect: ameliorating early macrophage-mediated demyelination, as opposed to increasing inflammatory reactions leading to disease aggravation at older ages.}, subject = {Maus}, language = {en} } @article{IsaiasDipaolaMichietal.2014, author = {Isaias, Ioannis Ugo and Dipaola, Mariangela and Michi, Marlies and Marzegan, Alberto and Volkmann, Jens and Rodocanachi Roidi, Mariana L. and Frigo, Carlo Albino and Cavallari, Paolo}, title = {Gait Initiation in Children with Rett Syndrome}, series = {PLoS ONE}, volume = {9}, journal = {PLoS ONE}, number = {4}, issn = {1932-6203}, doi = {10.1371/journal.pone.0092736}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-119789}, pages = {e92736}, year = {2014}, abstract = {Rett syndrome is an X-linked neurodevelopmental condition mainly characterized by loss of spoken language and a regression of purposeful hand use, with the development of distinctive hand stereotypies, and gait abnormalities. Gait initiation is the transition from quiet stance to steady-state condition of walking. The associated motor program seems to be centrally mediated and includes preparatory adjustments prior to any apparent voluntary movement of the lower limbs. Anticipatory postural adjustments contribute to postural stability and to create the propulsive forces necessary to reach steady-state gait at a predefined velocity and may be indicative of the effectiveness of the feedforward control of gait. In this study, we examined anticipatory postural adjustments associated with gait initiation in eleven girls with Rett syndrome and ten healthy subjects. Muscle activity (tibialis anterior and soleus muscles), ground reaction forces and body kinematic were recorded. Children with Rett syndrome showed a distinctive impairment in temporal organization of all phases of the anticipatory postural adjustments. The lack of appropriate temporal scaling resulted in a diminished impulse to move forward, documented by an impairment in several parameters describing the efficiency of gait start: length and velocity of the first step, magnitude and orientation of centre of pressure-centre of mass vector at the instant of (swing-)toe off. These findings were related to an abnormal muscular activation pattern mainly characterized by a disruption of the synergistic activity of antagonistic pairs of postural muscles. This study showed that girls with Rett syndrome lack accurate tuning of feedforward control of gait.}, language = {en} } @article{KraftDrechslerGunrebenetal.2014, author = {Kraft, Peter and Drechsler, Christiane and Gunreben, Ignaz and Nieswandt, Bernhard and Stoll, Guido and Heuschmann, Peter Ulrich and Kleinschnitz, Christoph}, title = {Von Willebrand Factor Regulation in Patients with Acute and Chronic Cerebrovascular Disease: A Pilot, Case-Control Study}, series = {PLoS ONE}, volume = {9}, journal = {PLoS ONE}, number = {6}, issn = {1932-6203}, doi = {10.1371/journal.pone.0099851}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-119588}, pages = {e99851}, year = {2014}, abstract = {Background and Purpose In animal models, von Willebrand factor (VWF) is involved in thrombus formation and propagation of ischemic stroke. However, the pathophysiological relevance of this molecule in humans, and its potential use as a biomarker for the risk and severity of ischemic stroke remains unclear. This study had two aims: to identify predictors of altered VWF levels and to examine whether VWF levels differ between acute cerebrovascular events and chronic cerebrovascular disease (CCD). Methods A case-control study was undertaken between 2010 and 2013 at our University clinic. In total, 116 patients with acute ischemic stroke (AIS) or transitory ischemic attack (TIA), 117 patients with CCD, and 104 healthy volunteers (HV) were included. Blood was taken at days 0, 1, and 3 in patients with AIS or TIA, and once in CCD patients and HV. VWF serum levels were measured and correlated with demographic and clinical parameters by multivariate linear regression and ANOVA. Results Patients with CCD (158±46\%) had significantly higher VWF levels than HV (113±36\%, P<0.001), but lower levels than AIS/TIA patients (200±95\%, P<0.001). Age, sex, and stroke severity influenced VWF levels (P<0.05). Conclusions VWF levels differed across disease subtypes and patient characteristics. Our study confirms increased VWF levels as a risk factor for cerebrovascular disease and, moreover, suggests that it may represent a potential biomarker for stroke severity, warranting further investigation.}, language = {en} } @article{IsaiasSpiegelBrumbergetal.2014, author = {Isaias, Ioannis Ugo and Spiegel, J{\"o}rg and Brumberg, Joachim and Cosgrove, Kelly P. and Marotta, Giorgio and Oishi, Naoya and Higuchi, Takahiro and K{\"u}sters, Sebastian and Schiller, Markus and Dillmann, Ulrich and van Dyck, Christopher H. and Buck, Andreas and Herrmann, Ken and Schloegl, Susanne and Volkmann, Jens and Lassmann, Michael and Fassbender, Klaus and Lorenz, Reinhard and Samnick, Samuel}, title = {Nicotinic acetylcholine receptor density in cognitively intact subjects at an early stage of Parkinson's disease}, series = {Frontiers in Aging Neuroscience}, volume = {6}, journal = {Frontiers in Aging Neuroscience}, doi = {10.3389/fnagi.2014.00213}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-119351}, pages = {213}, year = {2014}, abstract = {We investigated in vivo brain nicotinic acetylcholine receptor (nAChR) distribution in cognitively intact subjects with Parkinson's disease (PD) at an early stage of the disease. Fourteen patients and 13 healthy subjects were imaged with single photon emission computed tomography and the radiotracer 5-[(123)I]iodo-3-[2(S)-2-azetidinylmethoxy]pyridine ([(123)I]5IA). Patients were selected according to several criteria, including short duration of motor signs (<7 years) and normal scores at an extensive neuropsychological evaluation. In PD patients, nAChR density was significantly higher in the putamen, the insular cortex and the supplementary motor area and lower in the caudate nucleus, the orbitofrontal cortex, and the middle temporal gyrus. Disease duration positively correlated with nAChR density in the putamen ipsilateral (ρ = 0.56, p < 0.05) but not contralateral (ρ = 0.49, p = 0.07) to the clinically most affected hemibody. We observed, for the first time in vivo, higher nAChR density in brain regions of the motor and limbic basal ganglia circuits of subjects with PD. Our findings support the notion of an up-regulated cholinergic activity at the striatal and possibly cortical level in cognitively intact PD patients at an early stage of disease.}, language = {en} } @article{AlbertWeissenbergerMenclSchuhmannetal.2014, author = {Albert-Weissenberger, Christiane and Mencl, Stine and Schuhmann, Michael K. and Salur, Irmak and G{\"o}b, Eva and Langhauser, Friederike and Hopp, Sarah and Hennig, Nelli and Meuth, Sven G. and Nolte, Marc W. and Sir{\´e}n, Anna-Leena and Kleinschnitz, Christoph}, title = {C1-Inhibitor protects from focal brain trauma in a cortical cryolesion mice model by reducing thrombo-inflammation}, series = {Frontiers in Cellular Neuroscience}, volume = {8}, journal = {Frontiers in Cellular Neuroscience}, issn = {1662-5102}, doi = {10.3389/fncel.2014.00269}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-119263}, pages = {269}, year = {2014}, abstract = {Traumatic brain injury (TBI) induces a strong inflammatory response which includes blood-brain barrier damage, edema formation and infiltration of different immune cell subsets. More recently, microvascular thrombosis has been identified as another pathophysiological feature of TBI. The contact-kinin system represents an interface between inflammatory and thrombotic circuits and is activated in different neurological diseases. C1-Inhibitor counteracts activation of the contact-kinin system at multiple levels. We investigated the therapeutic potential of C1-Inhibitor in a model of TBI. Male and female C57BL/6 mice were subjected to cortical cryolesion and treated with C1-Inhibitor after 1 h. Lesion volumes were assessed between day 1 and day 5 and blood-brain barrier damage, thrombus formation as well as the local inflammatory response were determined post TBI. Treatment of male mice with 15.0 IU C1-Inhibitor, but not 7.5 IU, 1 h after cryolesion reduced lesion volumes by ~75\% on day 1. This protective effect was preserved in female mice and at later stages of trauma. Mechanistically, C1-Inhibitor stabilized the blood-brain barrier and decreased the invasion of immune cells into the brain parenchyma. Moreover, C1-Inhibitor had strong antithrombotic effects. C1-Inhibitor represents a multifaceted anti-inflammatory and antithrombotic compound that prevents traumatic neurodegeneration in clinically meaningful settings.}, language = {en} } @article{AlbertWeissenbergerMenclHoppetal.2014, author = {Albert-Weissenberger, Christiane and Mencl, Stine and Hopp, Sarah and Kleinschnitz, Christoph and Siren, Anna-Leena}, title = {Role of the kallikrein-kinin system in traumatic brain injury}, series = {Frontiers in Cellular Neuroscience}, volume = {8}, journal = {Frontiers in Cellular Neuroscience}, issn = {1662-5102}, doi = {10.3389/fncel.2014.00345}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-118226}, pages = {345}, year = {2014}, abstract = {Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. Despite improvements in acute intensive care, there are currently no specific therapies to ameliorate the effects of TBI. Successful therapeutic strategies for TBI should target multiple pathophysiologic mechanisms that occur at different stages of brain injury. The kallikrein-kinin system is a promising therapeutic target for TBI as it mediates key pathologic events of traumatic brain damage, such as edema formation, inflammation, and thrombosis. Selective and specific kinin receptor antagonists and inhibitors of plasma kallikrein and coagulation factor XII have been developed, and have already shown therapeutic efficacy in animal models of stroke and TBI. However, conflicting preclinical evaluation, as well as limited and inconclusive data from clinical trials in TBI, suggests that caution should be taken before transferring observations made in animals to humans. This review summarizes current evidence on the pathologic significance of the kallikrein-kinin system during TBI in animal models and, where available, the experimental findings are compared with human data.}, language = {en} } @article{GiordanoCanesiIsalbertietal.2014, author = {Giordano, Rosaria and Canesi, Margherita and Isalberti, Maurizio and Isaias, Ioannis Ugo and Montemurro, Tiziana and Vigan{\`o}, Mariele and Montelatici, Elisa and Boldrin, Valentina and Benti, Riccardo and Cortelezzi, Agostino and Fracchiolla, Nicola and Lazzari, Lorenza and Pezzoli, Gianni}, title = {Autologous mesenchymal stem cell therapy for progressive supranuclear palsy: translation into a phase I controlled, randomized clinical study}, series = {Journal of Translational Medicine}, volume = {12}, journal = {Journal of Translational Medicine}, number = {14}, doi = {10.1186/1479-5876-12-14}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-117594}, year = {2014}, abstract = {Background: Progressive Supranuclear Palsy (PSP) is a sporadic and progressive neurodegenerative disease which belongs to the family of tauopathies and involves both cortical and subcortical structures. No effective therapy is to date available. Methods/design: Autologous bone marrow (BM) mesenchymal stem cells (MSC) from patients affected by different type of parkinsonisms have shown their ability to improve the dopaminergic function in preclinical and clinical models. It is also possible to isolate and expand MSC from the BM of PSP patients with the same proliferation rate and immuphenotypic profile as MSC from healthy donors. BM MSC can be efficiently delivered to the affected brain regions of PSP patients where they can exert their beneficial effects through different mechanisms including the secretion of neurotrophic factors. Here we propose a randomized, placebo-controlled, double-blind phase I clinical trial in patients affected by PSP with MSC delivered via intra-arterial injection. Discussion: To our knowledge, this is the first clinical trial to be applied in a no-option parkinsonism that aims to test the safety and to exploit the properties of autologous mesenchymal stem cells in reducing disease progression. The study has been designed to test the safety of this " first-in-man" approach and to preliminarily explore its efficacy by excluding the placebo effect. Trial registration: NCT01824121}, language = {en} } @article{MeyerzuHoersteCordesMausbergetal.2014, author = {Meyer zu H{\"o}rste, Gerd and Cordes, Steffen and Mausberg, Anne K. and Zozulya, Alla L. and Wessig, Carsten and Sparwasser, Tim and Mathys, Christian and Wiendl, Heinz and Hartung, Hans-Peter and Kieseier, Bernd C.}, title = {FoxP3+Regulatory T Cells Determine Disease Severity in Rodent Models of Inflammatory Neuropathies}, series = {PLOS ONE}, volume = {9}, journal = {PLOS ONE}, number = {10}, doi = {10.1371/journal.pone.0108756}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-115239}, pages = {e108756}, year = {2014}, abstract = {Inflammatory neuropathies represent disabling human autoimmune disorders with considerable disease variability. Animal models provide insights into defined aspects of their disease pathogenesis. Forkhead box P3 (FoxP3)+ regulatory T lymphocytes (Treg) are anti-inflammatory cells that maintain immune tolerance and counteract tissue damage in a variety of immune-mediated disorders. Dysfunction or a reduced frequency of Tregs have been associated with different human autoimmune disorders. We here analyzed the functional relevance of Tregs in determining disease manifestation and severity in murine models of autoimmune neuropathies. We took advantage of the DEREG mouse system allowing depletion of Treg with high specificity as well as anti-CD25 directed antibodies to deplete Tregs in mice in actively induced experimental autoimmune neuritis (EAN). Furthermore antibody-depletion was performed in an adoptive transfer model of chronic neuritis. Early Treg depletion increased clinical EAN severity both in active and adoptive transfer chronic neuritis. This was accompanied by increased proliferation of myelin specific T cells and histological signs of peripheral nerve inflammation. Late stage Treg depletion after initial disease manifestation however did not exacerbate inflammatory neuropathy symptoms further. We conclude that Tregs determine disease severity in experimental autoimmune neuropathies during the initial priming phase, but have no major disease modifying function after disease manifestation. Potential future therapeutic approaches targeting Tregs should thus be performed early in inflammatory neuropathies.}, language = {en} } @article{BischoffRingstedPetersenetal.2014, author = {Bischoff, Joakim M. and Ringsted, Thomas K. and Petersen, Marian and Sommer, Claudia and {\"U}{\c{c}}eyler, Nurcan and Werner, Mads U.}, title = {A Capsaicin (8\%) Patch in the Treatment of Severe Persistent Inguinal Postherniorrhaphy Pain: A Randomized, Double-Blind, Placebo-Controlled Trial}, series = {PLOS ONE}, volume = {9}, journal = {PLOS ONE}, number = {10}, issn = {1932-6203}, doi = {10.1371/journal.pone.0109144}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-115198}, pages = {e109144}, year = {2014}, abstract = {Background: Persistent pain after inguinal herniorrhaphy is a disabling condition with a lack of evidence-based pharmacological treatment options. This randomized placebo-controlled trial investigated the efficacy of a capsaicin 8\% cutaneous patch in the treatment of severe persistent inguinal postherniorrhaphy pain. Methods: Forty-six patients with persistent inguinal postherniorrhaphy pain were randomized to receive either a capsaicin 8\% patch or a placebo patch. Pain intensity (Numerical Rating Scale [NRS 0-10]) was evaluated under standardized conditions (at rest, during movement, and during pressure) at baseline and at 1, 2 and 3 months after patch application. Skin punch biopsies for intraepidermal nerve fiber density (IENFD) measurements were taken at baseline and 1 month after patch application. Quantitative sensory testing was performed at baseline and at 1, 2, and 3 months after patch application. The primary outcome was comparisons of summed pain intensity differences (SPIDs) between capsaicin and placebo treatments at 1, 2 and 3 months after patch application (significance level P<0.01). Results: The maximum difference in SPID, between capsaicin and placebo treatments, was observed at 1 month after patch application, but the pain reduction was not significant (NRS, mean difference [95\% CI]: 5.0 [0.09 to 9.9]; P=0.046). No differences in SPID between treatments were observed at 2 and 3 months after patch application. Changes in IENFD on the pain side, from baseline to 1 month after patch application, did not differ between capsaicin and placebo treatment: 1.9 [-0.1 to 3.9] and 0.6 [-1.2 to 2.5] fibers/mm, respectively (P=0.32). No significant changes in sensory function, sleep quality or psychological factors were associated with capsaicin patch treatment. Conclusions: The study did not demonstrate significant differences in pain relief between capsaicin and placebo treatment, although a trend toward pain improvement in capsaicin treated patients was observed 1 month after patch application.}, language = {en} } @article{NorrmenFigliaLebrunJulienetal.2014, author = {Norrmen, Camilla and Figlia, Gianluca and Lebrun-Julien, Frederic and Pereira, Jorge A. and Tr{\"o}tzm{\"u}ller, Martin and K{\"o}feler, Harald C. and Rantanen, Ville and Wessig, Carsten and van Deijk, Anne-Lieke F. and Smit, August B. and Verheijen, Mark H. G. and R{\"u}egg, Markus A. and Hall, Michael N. and Suter, Ueli}, title = {mTORC1 Controls PNS Myelination along the mTORC1-RXR gamma-SREBP-Lipid Biosynthesis Axis in Schwann Cells}, series = {Cell Reports}, volume = {9}, journal = {Cell Reports}, number = {2}, issn = {2211-1247}, doi = {10.1016/j.celrep.2014.09.001}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-114847}, pages = {646-660}, year = {2014}, abstract = {Myelin formation during peripheral nervous system (PNS) development, and reformation after injury and in disease, requires multiple intrinsic and extrinsic signals. Akt/mTOR signaling has emerged as a major player involved, but the molecular mechanisms and downstream effectors are virtually unknown. Here, we have used Schwann-cell-specific conditional gene ablation of raptor and rictor, which encode essential components of the mTOR complexes 1 (mTORC1) and 2 (mTORC2), respectively, to demonstrate that mTORC1 controls PNS myelination during development. In this process, mTORC1 regulates lipid biosynthesis via sterol regulatory element-binding proteins (SREBPs). This course of action is mediated by the nuclear receptor RXRg, which transcriptionally regulates SREBP1c downstream of mTORC1. Absence of mTORC1 causes delayed myelination initiation as well as hypomyelination, together with abnormal lipid composition and decreased nerve conduction velocity. Thus, we have identified the mTORC1-RXR gamma-SREBP axis controlling lipid biosynthesis as a major contributor to proper peripheral nerve function.}, language = {en} } @article{CruccuPennisiAntoninietal.2014, author = {Cruccu, Giorgio and Pennisi, Elena M. and Antonini, Giovanni and Biasiotta, Antonella and Di Stefano, Giulia and La Cesa, Silvia and Leone, Caterina and Raffa, Salvatore and Sommer, Claudia and Truini, Andrea}, title = {Trigeminal isolated sensory neuropathy (TISN) and FOSMN syndrome: despite a dissimilar disease course do they share common pathophysiological mechanisms?}, series = {BMC Neurology}, volume = {14}, journal = {BMC Neurology}, issn = {1471-2377}, doi = {10.1186/s12883-014-0248-2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-114249}, year = {2014}, abstract = {Background: Patients presenting with bilateral trigeminal hypoesthesia may go on to have trigeminal isolated sensory neuropathy, a benign, purely trigeminal neuropathy, or facial-onset sensory motor neuronopathy (FOSMN), a malignant life-threatening condition. No diagnostic criteria can yet differentiate the two conditions at their onset. Nor is it clear whether the two diseases are distinct entities or share common pathophysiological mechanisms. Methods: Seeking pathophysiological and diagnostic information to distinguish these two conditions at their onset, in this neurophysiological and morphometric study we neurophysiologically assessed function in myelinated and unmyelinated fibres and histologically examined supraorbital nerve biopsy specimens with optic and electron microscopy in 13 consecutive patients with recent onset trigeminal hypoesthesia and pain. Results: The disease course distinctly differed in the 13 patients. During a mean 10 year follow-up whereas in eight patients the disease remained relatively stable, in the other five it progressed to possibly life-threatening motor disturbances and extra-trigeminal spread. From two to six years elapsed between the first sensory symptoms and the onset of motor disorders. In patients with trigeminal isolated sensory neuropathy (TISN) and in those with FOSMN neurophysiological and histological examination documented a neuronopathy manifesting with trigeminal nerve damage selectively affecting myelinated fibres, but sparing the Ia-fibre-mediated proprioceptive reflex. Conclusions: Although no clinical diagnostic criteria can distinguish the two conditions at onset, neurophysiological and nerve-biopsy findings specify that in both disorders trigeminal nerve damage manifests as a dissociated neuronopathy affecting myelinated and sparing unmyelinated fibres, thus suggesting similar pathophysiological mechanisms.}, language = {en} } @phdthesis{Nowak2013, author = {Nowak, Eva}, title = {Expression und Funktion von Integrin α-4 in humanen zerebralen Endothelzellen - Analysen unter Zuhilfenahme des therapeutisch eingesetzten Antik{\"o}rpers Natalizumab}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-99300}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2013}, abstract = {Natalizumab ist ein humanisierter monoklonaler Antik{\"o}rper gegen das Oberfl{\"a}chenadh{\"a}sionsmolek{\"u}l Integrin α-4, der zur Therapie von schweren Verlaufsformen der Multiplen Sklerose (MS) zugelassen ist. Integrin α-4/β-1 wird durch Leukozyten exprimiert und steuert deren Extravasation {\"u}ber die Bindung an VCAM-1 (vascular cell adhesion molecule-1) auf Endothelzellen. Natalizumab wirkt {\"u}ber eine Blockade der Leukozytenadh{\"a}sion. In einigen Publikationen konnte dar{\"u}ber hinaus gezeigt werden, dass Integrin α-4 auch auf zerebralen Endothelzellen von M{\"a}usen und Ratten exprimiert wird. In der vorliegenden Arbeit wurde die Expression und Funktion von Integrin α-4 in kultivierten prim{\"a}ren humanen zerebralen Endothelzellen untersucht. Die im Rahmen dieser Arbeit an verschiedenen Einzelspenderpr{\"a}parationen durchgef{\"u}hrten FACS-Analysen zeigten, dass Integrin α-4 in unterschiedlicher Auspr{\"a}gung auf prim{\"a}ren zerebralen Endothelzellisolationen nachzuweisen war. Mit Hilfe immunzytochemischer F{\"a}rbungen konnte ein spezifisches Verteilungsmuster des Integrin α-4 in Form eines feinen, granul{\"a}ren Musters im Bereich des Zellleibes dokumentiert werden. In Adh{\"a}sionsversuchen zeigten Integrin α-4-exprimierende Endothelzellen nach Zugabe von Natalizumab in niedriger Konzentration eine verminderte F{\"a}higkeit zur Haftung an Fibronectin, einem Bindungspartner in der extrazellul{\"a}ren Matrix. In hohen Konzentrationen dominierte im eingesetzten experimentellen System ein unspezifischer Blockadeeffekt, der auch mit Kontrollantik{\"o}rpern zu beobachten war. In MS-L{\"a}sionen findet sich auch die l{\"o}sliche Form des VCAM-1 (sVCAM-1), die m{\"o}glicherweise mit endothelialem Integrin α-4 interagiert. Daher wurde mit Hilfe von Western-Blot-Untersuchungen die intrazellul{\"a}re Signaltransduktion unter Stimulation mit sVCAM-1 untersucht. Es zeigte sich wie in anderen Endothelarten vorbeschrieben eine Aktivierung des p38-MAP-Kinase-Signalweges. Zusammenfassend wurde demonstriert, dass prim{\"a}re humane zerebrale Endothelzellen Integrin α-4 exprimieren und dass dieses wahrscheinlich nicht nur f{\"u}r die mechanische Verankerung in der Extrazellul{\"a}rmatrix eine Bedeutung besitzt, sondern auch als Induktor intrazellul{\"a}rer Signaltransduktion fungiert, welche die Schrankeneigenschaften zerebraler Endothelzellen beeinflussen k{\"o}nnte.}, subject = {Integrin}, language = {de} } @article{UeceylerValetKafkeetal.2014, author = {{\"U}{\c{c}}eyler, Nurcan and Valet, Michael and Kafke, Waldemar and T{\"o}lle, Thomas R. and Sommer, Claudia}, title = {Local and Systemic Cytokine Expression in Patients with Postherpetic Neuralgia}, doi = {10.1371/journal.pone.0105269}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-113041}, year = {2014}, abstract = {Background Postherpetic neuralgia (PHN) is the painful complication of a varicella zoster virus reactivation. We investigated the systemic and local gene expression of pro- and anti-inflammatory cytokine expression in patients with PHN. Methods Thirteen patients with PHN at the torso (Th4-S1) were recruited. Skin punch biopsies were obtained from the painful and the contralateral painless body area for intraepidermal nerve fiber density (IENFD) and cytokine profiling. Additionally, blood was withdrawn for systemic cytokine expression and compared to blood values of healthy controls. We analyzed the gene expression of selected pro- and anti-inflammatory cytokines (tumor necrosis factor-alpha [TNF] and interleukins [IL]-1β, IL-2, and IL-8). Results IENFD was lower in affected skin compared to unaffected skin (p<0.05), while local gene expression of pro- and anti-inflammatory cytokines did not differ except for two patients who had 7fold higher IL-6 and 10fold higher IL-10 gene expression in the affected skin compared to the contralateral unaffected skin sample. Also, the systemic expression of cytokines in patients with PHN and in healthy controls was similar. Conclusion While the systemic and local expression of the investigated pro- and anti-inflammatory cytokines was not different from controls, this may have been influenced by study limitations like the low number of patients and different disease durations. Furthermore, other cytokines or pain mediators need to be considered.}, language = {en} } @article{UeceylerHomolaGonzalezetal.2014, author = {{\"U}{\c{c}}eyler, Nurcan and Homola, Gy{\"o}rgy A. and Gonz{\´a}lez, Hans Guerrero and Kramer, Daniela and Wanner, Christoph and Weidemann, Frank and Solymosi, L{\´a}szl{\´o} and Sommer, Claudia}, title = {Increased Arterial Diameters in the Posterior Cerebral Circulation in Men with Fabry Disease}, doi = {10.1371/journal.pone.0087054}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-112614}, year = {2014}, abstract = {A high load of white matter lesions and enlarged basilar arteries have been shown in selected patients with Fabry disease, a disorder associated with an increased stroke risk. We studied a large cohort of patients with Fabry disease to differentially investigate white matter lesion load and cerebral artery diameters. We retrospectively analyzed cranial magnetic resonance imaging scans of 87 consecutive Fabry patients, 20 patients with ischemic stroke, and 36 controls. We determined the white matter lesion load applying the Fazekas score on fluid-attenuated inversion recovery sequences and measured the diameters of cerebral arteries on 3D-reconstructions of the time-of-flight-MR-angiography scans. Data of different Fabry patient subgroups (males - females; normal - impaired renal function) were compared with data of patients with stroke and controls. A history of stroke or transient ischemic attacks was present in 4/30 males (13\%) and 5/57 (9\%) females with Fabry disease, all in the anterior circulation. Only one man with Fabry disease showed confluent cerebral white matter lesions in the Fazekas score assessment (1\%). Male Fabry patients had a larger basilar artery (p<0.01) and posterior cerebral artery diameter (p<0.05) compared to male controls. This was independent of disease severity as measured by renal function and did not lead to changes in arterial blood flow properties. A basilar artery diameter of >3.2 mm distinguished between men with Fabry disease and controls (sensitivity: 87\%, specificity: 86\%, p<0.001), but not from stroke patients. Enlarged arterial diameters of the posterior circulation are present only in men with Fabry disease independent of disease severity.}, language = {en} } @article{UeceylerKewenigKafkeetal.2014, author = {{\"U}{\c{c}}eyler, Nurcan and Kewenig, Susanne and Kafke, Waldemar and Kittel-Schneider, Sarah and Sommer, Claudia}, title = {Skin cytokine expression in patients with fibromyalgia syndrome is not different from controls}, doi = {10.1186/s12883-014-0185-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-110624}, year = {2014}, abstract = {Background Fibromyalgia syndrome (FMS) is a chronic pain syndrome of unknown etiology. There is increasing evidence for small nerve fiber impairment in a subgroup of patients with FMS. We investigated whether skin cytokine and delta opioid receptor (DOR) gene expression in FMS patients differs from controls as one potential contributor to small nerve fiber sensitization. Methods We investigated skin punch biopsies of 25 FMS patients, ten patients with monopolar depression but no pain, and 35 healthy controls. Biopsies were obtained from the lateral upper thigh and lower calf. Gene expression of the pro-inflammatory cytokines tumor necrosis factor-alpha (TNF), interleukin (IL)-6, and IL-8 and of the anti-inflammatory cytokine IL-10 was analyzed using quantitative real-time PCR and normalizing data to 18sRNA as housekeeping gene. Additionally, we assessed DOR gene expression. Results All cytokines and DOR were detectable in skin samples of FMS patients, patients with depression, and healthy controls without intergroup difference. Also, gene expression was not different in skin of the upper and lower leg within and between the groups and in FMS patient subgroups. Conclusions Skin cytokine and DOR gene expression does not differ between patients with FMS and controls. Our results do not support a role of the investigated cytokines in sensitization of peripheral nerve fibers as a potential mechanism of small fiber pathology in FMS.}, language = {en} } @article{GrohStadlerButtmannetal.2014, author = {Groh, Janos and Stadler, David and Buttmann, Mathias and Martini, Rudolf}, title = {Non-invasive assessment of retinal alterations in mouse models of infantile and juvenile neuronal ceroid lipofuscinosis by spectral domain optical coherence tomography}, doi = {10.1186/2051-5960-2-54}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-110566}, year = {2014}, abstract = {Introduction The neuronal ceroid lipofuscinoses constitute a group of fatal inherited lysosomal storage diseases that manifest in profound neurodegeneration in the CNS. Visual impairment usually is an early symptom and selective degeneration of retinal neurons has been described in patients suffering from distinct disease subtypes. We have previously demonstrated that palmitoyl protein thioesterase 1 deficient (Ppt1-/-) mice, a model of the infantile disease subtype, exhibit progressive axonal degeneration in the optic nerve and loss of retinal ganglion cells, faithfully reflecting disease severity in the CNS. Here we performed spectral domain optical coherence tomography (OCT) in Ppt1-/- and ceroid lipofuscinosis neuronal 3 deficient (Cln3-/-) mice, which are models of infantile and juvenile neuronal ceroid lipofuscinosis, respectively, in order to establish a non-invasive method to assess retinal alterations and monitor disease severity in vivo. Results Blue laser autofluorescence imaging revealed increased accumulation of autofluorescent storage material in the inner retinae of 7-month-old Ppt1-/- and of 16-month-old Cln3-/- mice in comparison with age-matched control littermates. Additionally, optical coherence tomography demonstrated reduced thickness of retinae in knockout mice in comparison with age-matched control littermates. High resolution scans and manual measurements allowed for separation of different retinal composite layers and revealed a thinning of layers in the inner retinae of both mouse models at distinct ages. OCT measurements correlated well with subsequent histological analysis of the same retinae. Conclusions These results demonstrate the feasibility of OCT to assess neurodegenerative disease severity in mouse models of neuronal ceroid lipofuscinosis and might have important implications for diagnostic evaluation of disease progression and therapeutic efficacy in patients. Moreover, the non-invasive method allows for longitudinal studies in experimental models, reducing the number of animals used for research.}, language = {en} } @article{KleinschnitzGoebelMeuthetal.2014, author = {Kleinschnitz, Christoph and G{\"o}bel, Kerstin and Meuth, Sven G. and Kraft, Peter}, title = {Glatiramer acetate does not protect from acute ischemic stroke in mice}, doi = {10.1186/2040-7378-6-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-110528}, year = {2014}, abstract = {Background The role of the immune system in the pathophysiology of acute ischemic stroke is increasingly recognized. However, targeted treatment strategies to modulate immunological pathways in stroke are still lacking. Glatiramer acetate is a multifaceted immunomodulator approved for the treatment of relapsing-remitting multiple sclerosis. Experimental studies suggest that glatiramer acetate might also work in other neuroinflammatory or neurodegenerative diseases apart from multiple sclerosis. Findings We evaluated the efficacy of glatiramer acetate in a mouse model of brain ischemia/reperfusion injury. 60 min of transient middle cerebral artery occlusion was induced in male C57Bl/6 mice. Pretreatment with glatiramer acetate (3.5 mg/kg bodyweight) 30 min before the induction of stroke did not reduce lesion volumes or improve functional outcome on day 1. Conclusions Glatiramer acetate failed to protect from acute ischemic stroke in our hands. Further studies are needed to assess the true therapeutic potential of glatiramer acetate and related immunomodulators in brain ischemia.}, language = {en} } @phdthesis{Herrmann2014, author = {Herrmann, Alexander Michael}, title = {CD8+ Lymphozyten mediierter Angriff auf Neuronen des ZNS: Relevanz von Granzym B und Perforin f{\"u}r akute elektrophysiologische Ver{\"a}nderungen}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-109124}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2014}, abstract = {Zytotoxische CD8+ T-Lymphozyten spielen in vielen inflammatorischen, aber auch prim{\"a}r neurodegenerativen Erkrankungen eine wichtige Rolle. Daher besitzt die Fragestellung inwiefern CD8+ ZTL Neurone direkt sch{\"a}digen und ggf. welche mechanistischen Aspekte dieser Sch{\"a}digung zugrunde liegen, eine hohe Relevanz. Um diese Fragestellung eingehender zu beleuchten, wurde mit dem OT-I-System gearbeitet. Dieses gut vorcharakterisierte CD8+ T-Zell-Modell besitzt den Vorteil, dass diese transgenen Zellen nur eine Peptidsequenz des Ovalbumin (OVA) Protein als spezifisches Antigen erkennen. Zun{\"a}chst wurden in der vorliegenden Arbeit Co-Kultivierungs-Experimente durchgef{\"u}hrt. Hierzu wurden akut isolierte murine Hippokampus-Neurone unter verschiedenen Bedingungen mit OT-I Lymphozyten co-kultiviert. Hierbei konnte gezeigt werden, dass unter Antigenpr{\"a}sentation der Neurone signifikant mehr Neurone in die Apoptose/Nekrose gef{\"u}hrt werden, als unter Kontroll-Bedingungen, in denen entweder kein Antigen oder ein Antigen, das nicht von OT-I Lymphozyten erkannt wird, pr{\"a}sentiert wird. Nachdem die Antigen-abh{\"a}ngigen zytotoxischen Effekte auf Neurone gezeigt werden konnten, wurde mithilfe elektrophysiologischer Techniken die mechanistischen und funktionellen Konsequenzen des direkten neuronalen/OT-I-vermittelten Zellkontakts untersucht. Bei diesem experimentellen Ansatz wurde durch elektrisches Auslenken eines Neurons nach Kontakt mit einem OT-I Lymphozyt die passiven elektrischen Parameter der Neuronenmembran gemessen. In diesen Messungen konnte gezeigt werden, dass nach unmittelbarem Kontakt eines Neurons mit einem OT-I Lymphozyt der neuronale Membranwiderstand reduziert wird bzw. die Leitf{\"a}higkeit der Zellmembran erh{\"o}ht wird. Diese {\"A}nderung der neuronalen Membran-Leitf{\"a}higkeit findet in einem Zeitraum von 10 min nach dem Zell-Zell-Kontakt statt. Auch hier konnte gezeigt werden, dass dieser Einfluss von OT-I Lymphozyten auf Neurone strikt Antigen-abh{\"a}ngig ist. Zur Untersuchung des Mechanismus der OT-I T-Lymphozyten auf Neurone wurde das Augenmerk auf verschiedene T-Zell-induzierte Apoptosewegegelegt. Es konnte gezeigt werden, dass durch Blockieren der Fas/FasL-Interaktion mittels eines Antik{\"o}rpers kein Unterschied, weder in der neuronalen Apoptoserate nach Co-Kultivierung, noch eine {\"A}nderung der passiven neuronalen Membran-Leitf{\"a}higkeit auftritt. Weiterhin wurde die Rolle der von T-Zellen sezernierten Granula Perforin und Granzym B untersucht. Um den Einfluss dieser Granula aufzukl{\"a}ren, wurden OT-I Lymphozyten verwendet, die entweder defizient f{\"u}r Perforin oder Granzym B waren. In diesem experimentellen Ansatz wurde gezeigt, dass ausschließlich Perforin f{\"u}r die Erniedrigung des passiven neuronalen Membran-Widerstandes verantwortlich ist. Diese Erh{\"o}hung der neuronalen Membranleitf{\"a}higkeit f{\"u}hrte aber nicht direkt zum neuronalen Zelltod. Vielmehr wurde durch die einhergehende Depolarisation des Neurons die elektrische Aktivit{\"a}t der Zelle vermindert, sodass es zu einem sogenannten „electrical silencing" kommt. Dieser Umstand konnte auch in der Betrachtung der spontanen Netzwerkaktivit{\"a}t von Neuronenkulturen gezeigt werden. Hierf{\"u}r wurden hoch dichte Neuronenkulturen auf MEA-Chips kultiviert. Mit Hilfe dieser MEA konnten die Summenfeldpotentiale der Neuronenkulturen detektiert werden. Hierbei wurde beobachtet, dass nach Beladung der Neuronen mit dem spezifischen OT-I-Antigen und OT-I Zellen eine Verringerung der spontanen Netzwerkaktivit{\"a}t einhergeht. Auch in diesem Effekt konnte eine Antigen-Spezifit{\"a}t nachgewiesen werden. Da der Prozess der zellul{\"a}ren Apoptose mit einem Anstieg der intrazellul{\"a}ren Ca2+-Konzentration einhergeht, und Perforin als Ca2+-durchl{\"a}ssiger unselektiver Porenbildner fungiert, wurden zur {\"U}berpr{\"u}fung der Hypothese calcium imaging-Experimente durchgef{\"u}hrt. Analog zu den elektrophysiologischen Messungen wurde gezeigt, dass nach direktem Zell-Zell-Kontakt zwischen Neuron und OT-I Lymphozyt eine Erh{\"o}hung der intrazellul{\"a}ren Ca2+-Konzentration zu messen ist. Dass diese {\"A}nderung des neuronalen Ca2+-Einstroms durch Perforin-abh{\"a}ngige Membranporen hervorgerufen wird, konnte durch die Verwendung von Perforin-defizienten OT-I Lymphozyten bewiesen werden. Unter Verwendung von Perforin-defizienten OT-I Lymphozyten wurde keine {\"A}nderung der neuronalen Ca2+-Konzentration ermittelt. Weiterhin wurde in diesem experimentellen Ansatz gezeigt, dass auch der OT-I-vermittelte neuronale Ca2+-Anstieg strikt Antigen-abh{\"a}ngig ist.Zusammengefasst konnte in dieser Arbeit gezeigt werden, dass MHC-I/Antigen-vermittelte CD8+ Lymphozyten-Interaktion mit einem Neuron zu „electrical silencing" des Neurons f{\"u}hrt. Dieser Prozess ist klar Perforin-abh{\"a}ngig, f{\"u}hrt jedoch nicht zum unmittelbaren Zelltod des Neurons.}, subject = {Antigen CD8}, language = {de} } @phdthesis{Schaefer2014, author = {Sch{\"a}fer, Kristina}, title = {L{\"a}sst sich eine Vaskulitische Polyneuropathie mittels B-Bild-Sonographie der Beinnerven identifizieren?}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-104712}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2014}, abstract = {{\"U}ber die Nervensonographie wurde bereits in den 1980er Jahren erstmals berichtet. Die rasche Weiterentwicklung der Technik hat dazu gef{\"u}hrt, dass es inzwischen zahlreiche Fallberichte und einige Studien gibt, die sich mit der Darstellung peripherer Nerven durch Ultraschall als Mittel zur Diagnose verschiedener Nervpathologien besch{\"a}ftigen. Besonders bei der Diagnostik des epidemiologisch h{\"a}ufigen Karpaltunnelsyndroms ist die sonographische Beurteilung des N. medianus in dieser Lokalisation vielerorts bereits etablierter Bestandteil der Diagnostik. In der hier vorgelegten Studie sollte der Stellenwert der B-Bild-Sonographie peripherer Nerven am Unterschenkel f{\"u}r die Diagnose einer Vaskulitischen Neuropathie gepr{\"u}ft werden. Dazu musste zun{\"a}chst die Ultraschalluntersuchung spezieller Nerven am Unterschenkel etabliert werden. Diese ist technisch deutlich anspruchsvoller als die Darstellung von Karpaltunnelsyndrom oder Armplexus. Durch die f{\"u}nfmalige Untersuchung zehn junger Personen wurden ultraschalltechnisch leicht reproduzierbar anatomisch auffindbare und Anisotropie-vermeidende Abschnitte von N. suralis, N. peroneus communis, profundus, superfcialis und N. tibialis definiert und als Messpunkte der Studie zu Grunde gelegt. In die von der Ethikkommission der Medizinischen Fakult{\"a}t positiv beschiedene Studie wurden 26 Patienten/-innen, die klinisch und elektrophysiologisch nachgewiesen eine Polyneuropathie hatten und bei denen zur Ursachendiagnostik eine Biopsie und histologische Aufarbeitung des N. suralis durchgef{\"u}hrt wurde (Abteilung f{\"u}r Neuropathologie des Pathologischen Instituts der Universit{\"a}t sowie Histologielabor der Neurologischen Universit{\"a}tsklinik), sowie 26 Kontrollpersonen ohne klinischen Hinweis auf eine Polyneuropathie nach informiertem Einverst{\"a}ndnis aufgenommen. F{\"u}r jede/-n Patienten/-in wurde ein/-e Proband/-in gleichen Geschlechts mit einem Altersunterschied von h{\"o}chstens f{\"u}nf Jahren in die Kontrollgruppe aufgenommen. Alle 52 Untersuchten mussten erwachsen und 160 - 180 cm groß sein. Bei allen Patienten/-innen und Kontrollpersonen wurden jeweils der GD, der KD, der LD und die QSF des N. suralis am unteren Drittel der Wade und distal im Bereich des Außenkn{\"o}chels, des N. tibialis nahe des Innenkn{\"o}chels, des N. peroneus communis im Bereich des Fibulak{\"o}pfchens, des N. peroneus profundus am Fußr{\"u}cken und nahe der Großzehen und des N. peroneus superficialis im Bereich des distalen Schienbeins bestimmt. Alle gesuchten Nerven waren bei allen Versuchspersonen eindeutig identifizierbar. Die Untersuchungen wurden durch eine Untersucherin mit demselben Ger{\"a}t, geblindet f{\"u}r das Ergebnis der Histologie, durchgef{\"u}hrt. Das gew{\"a}hrleistete eine Konstanz in der schwierigen und mit Unsicherheiten behafteten Messung der Nervenstrukturen, was ausf{\"u}hrlich diskutiert wird. Ein statistisch signifikanter Unterschied zwischen den sonographisch erhobenen Messdaten der PNP-Gruppe und der Kontrollgruppe konnte bei 20 der 28 Parameter gezeigt werden. Bei 11 der 28 Parameter konnte zwischen Vaskulitis-Patienten/-innen und allen anderen, also PNP-Patienten/-innen und der Kontrollgruppe, ein statistisch signifikanter Unterschied festgestellt werden. Außerdem ergab die statistische Analyse bei drei der 28 Messgr{\"o}ßen einen statistisch signifikanten Unterschied zwischen Patienten/-innen mit und ohne Demyelinisierung des N. suralis in der feingeweblichen Untersuchung. Die sonographischen Ergebnisse der Vakulitis-Patienten/-innen unterschieden sich nicht von denen der PNP-Patienten/-innen mit anderer {\"A}tiologie. Es wurde auch kein statistisch signifikanter Unterschied zwischen den Werten der PNP-Patienten/-innen mit und ohne histologisch gesicherte entz{\"u}ndliche Komponente beobachtet. Gem{\"a}ß der histologischen Untersuchung der Biopsate wurde bei sechs Patienten/-innen eine Vaskulitis diagnostiziert. Bei f{\"u}nf dieser Patienten/-innen fielen teilweise Kaliberspr{\"u}nge im Sinne einer Zunahme der QSF oder Abflachung im Verlauf des N. suralis, N. peroneus superficialis und N. peroneus communis auf. Aber auch bei Patienten/-innen mit einer anderen Form der Polyneuropathie und einigen Kontrollpersonen waren Besonderheiten im sonographischen Bild einzelner Nerven zu beobachten. Mit der vorgelegten Untersuchung konnte zwar nicht gezeigt werden, dass die Nervensonographie einen Beitrag zur differentialdiagnostischen Abgrenzung Vaskulitischer Polyneuropathien leisten kann, der den Goldstandard invasiver Nervenbiopse entbehrlich machen k{\"o}nnte. Das war bei der histologischen Unterschiedlichkeit der besch{\"a}digten Nervenanatomie bei Vaskulitis aber auch nicht ernsthaft zu erwarten. Die vorgelegte Arbeit zeigt aber auch, dass kranke periphere Nerven von gesunden Nerven im Ultraschall unterscheidbar sind, wenn man wie hier systematisch mit 28 Parametern an sieben Messpunkten untersucht. Dies allerdings dauert auch f{\"u}r einen Ge{\"u}bten 40 bis 60 Minuten, so dass die Polyneuropathiediagnostik oder gar Differentialdiagnostik mittels Ultraschall aktuell noch als Forschungsinstrument an großen Fallzahlen anzusehen ist. Dabei wird es k{\"u}nftig f{\"u}r die Gruppenbildung der sonographisch Untersuchten neben {\"a}tiologischer und histologischer Gruppenbildung darauf ankommen, das Krankheitsbild besser zu definieren, d.h. Ausmaß von Demyelinisierung, Remyelinisierung und axonalem Untergang in geeignete Skalen zu fassen. Auch die Magnetresonanztomographie stellt eine Option als diagnostischer Baustein bei Vaskulitischer Polyneuropathie dar. Dieses bildgebende Verfahren kann bereits zur Diagnostik von traumatischen Nervverletzungen, Kompressionensyndromen, Raumforderungen im Bereich der Nerven und Plexusneuritis eingesetzt werden.}, subject = {Ultraschalldiagnostik}, language = {de} } @phdthesis{Kewenig2014, author = {Kewenig, Susanne Katharina}, title = {Messung der zerebralen Aktivierung mittels funktioneller Nah-Infrarot-Spektroskopie bei Patienten mit Fibromyalgie-Syndrom}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-107515}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2014}, abstract = {Wir untersuchten die zerebrale Aktivierung von Patienten mit Fibromyalgie-Syndrom (FMS) mittels funktioneller Nah-Infrarot-Spektroskopie (fNIRS). Das FMS ist ein Symptomenkomplex aus Schmerzen in mehreren K{\"o}rperregionen sowie weiteren k{\"o}rperlichen und seelischen Beschwerden, wie Schlafst{\"o}rungen, kognitiven Defiziten und Depressionen. Die fNIRS ist eine neue, nicht-invasive Technik, die eine indirekte Messung der regionalen kortikalen Hirnaktivierung erlaubt. Es wurden 25 FMS-Patienten, 10 MD-Patienten ohne Schmerzen und 35 gesunde Kontrollen in die Studie eingeschlossen. Alle Patienten wurden klinisch-neurologisch untersucht. Dar{\"u}ber hinaus f{\"u}llten alle Teilnehmer Frageb{\"o}gen zu Schmerzen (GCPS, NPSI), FMS-Symptomen (FIQ), Depressionen (BDI II, ADS) und Empathief{\"a}higkeit (SPF) aus. Die kortikale Aktivierung wurde unter drei Stimulations-Bedingungen mittels fNIRS gemessen: 1.) Anwendung mechanischer (Druck-) Schmerzreize auf den dorsalen Unterarm; 2.) Anwendung visuell-emotionaler Reize in Form von neutralen, negativen und Schmerz-assoziierten Bildern; 3.) Wortfl{\"u}ssigkeitstest. Erg{\"a}nzend wurden die unter 2.) pr{\"a}sentierten Bilder bewertet sowie ein Zahlenverbindungstest durchgef{\"u}hrt. FMS-Patienten hatten in den Schmerzfrageb{\"o}gen und im FIQ-Fragebogen deutlich h{\"o}here Werte als MD-Patienten und Kontrollen (p < 0,001). In den Depressionsfrageb{\"o}gen erreichten FMS-Patienten {\"a}hnlich hohe Werte wie MD-Patienten. Die Empathief{\"a}higkeit war bei FMS-Patienten tendenziell st{\"a}rker ausgepr{\"a}gt als bei MD-Patienten und Kontrollen. FMS-Patienten zeigten niedrigere Druckschmerzschwellen bei gleicher Schmerzintensit{\"a}t als MD-Patienten und Kontrollen (p < 0,001). Auf einen unilateralen schmerzhaften Druckreiz reagierten FMS-Patienten mit einer verst{\"a}rkten bilateralen kortikalen Aktivierung, die sich im Vergleich zu Kontrollen insbesondere im rechten pr{\"a}frontalen Kortex (p < 0,05) sowie zu MD-Patienten bilateral im Frontalkortex unterschied (p < 0,05). Auf einen Druckreiz der gleichen St{\"a}rke, der f{\"u}r FMS-Patienten schmerzhaft, aber f{\"u}r Zusatzkontrollen schmerzfrei war, zeigten FMS-Patienten im Vergleich zu diesen eine verst{\"a}rkte Aktivierung im linken dorsolateralen pr{\"a}frontalen Kortex (p < 0,05). Der kortikale Aktivierungsunterschied bei Schmerz-assoziierten versus neutralen Bildern war bei FMS-Patienten im linken pr{\"a}frontalen Kortex wesentlich ausgepr{\"a}gter als bei Kontrollen (p < 0,05), w{\"a}hrend die Schmerz-assoziierten Bilder von FMS-Patienten weniger unangenehm bewertet wurden als von Kontrollen. Der Aktivierungsunterschied bei negativen versus neutralen Bildern war bei MD-Patienten im linken Frontalkortex wesentlich geringer ausgepr{\"a}gt als bei FMS-Patienten und Kontrollen (p < 0,05). Im Wortfl{\"u}ssigkeitstest und im Zahlenverbindungstest konnten keine kognitiven Defizite bzw. Aktivierungsunterschiede zwischen FMS-Patienten und Kontrollen gefunden werden. Allerdings zeigten MD-Patienten in beiden Bedingungen des Wortfl{\"u}ssigkeitstests eine geringere frontale Aktivierung als FMS-Patienten und Kontrollen (p < 0,05). Diese Studie belegt die ver{\"a}nderte zentrale Schmerzverarbeitung bei FMS-Patienten und zeigt, dass diese mittels fNIRS messbar ist. FMS-Patienten zeigten st{\"a}rkere Aktivierungen Schmerz-assoziierter Hirnareale w{\"a}hrend mechanischer und visueller Schmerzstimuli im Vergleich zu gesunden Kontrollen. Zudem best{\"a}tigt diese Studie die Unterscheidung zwischen FMS und Depression.}, subject = {Fibromyalgie}, language = {de} } @phdthesis{Ruschil2014, author = {Ruschil, Christoph}, title = {Der Einfluss von Autoantik{\"o}rpern gegen Aquaporin 4 bei der Pathogenese der Neuromyelitis optica}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-105787}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2014}, abstract = {Neuromyelitis optica (NMO) ist eine schwerwiegende Autoimmunerkrankung des zentralen Nervensystems, deren pathogene Ursache in Zusammenhang mit Autoantik{\"o}rpern gegen Aquaporin 4 (AQP4) steht. In einem intrathekalen Passiv-Transfermodell der Ratte wurden die Auswirkungen von NMO-Immunglobulin (IgG) aus Plasmapheresematerial und rekombinanten Antik{\"o}rpern gegen AQP4 sowie der Effekt von additiver Applikation von humanem Komplement untersucht. NMO-IgG, rekombinante Antik{\"o}rper und modifizierte Antik{\"o}rper ohne F{\"a}higkeit zur Aktivierung der Komplementkaskade waren bei repetitiver Applikation in der Lage, auch ohne additives humanes Komplement NMO-{\"a}hnliche progrediente motorische Symptome zu induzieren. Durch Ko-Injektion von humanem Komplement konnte keine signifikante Exazerbation der Pathologie bewirkt werden. MRT-Studien zeigten lokale Schrankenst{\"o}rungen am Ort der h{\"o}chsten Antik{\"o}rperkonzentration. In histologischen Aufarbeitungen von R{\"u}ckenmarksschnitten zeigten sich lokale Deposition an humanem IgG, ein dazu korrelierender Verlust an AQP4 sowie eine dar{\"u}ber hinausgehende Reduktion des Glutamattransporters EAAT2, w{\"a}hrend GFAP-reaktive Astrozyten tendenziell hypertroph und vermehrt waren. Auch bei additiver Applikation von humanem Komplement wiesen die L{\"a}sionsareale im Gegensatz zu histopathologischen Befunden bei NMO-Patienten und anderen Tiermodellen nur eine geringe Ablagerung von aktivem Komplement und wenig Infiltration durch ED1-positive Makrophagen auf. Da in einem Kontrollexperiment mit intrazerebraler intraparenchymaler Applikation von NMO-IgG die beschriebene additive Zytotoxizit{\"a}t von humanem Komplement reproduziert werden konnte, erscheint die Verwendbarkeit des intrathkalen Modells zur Evaluation der Wirkung von humanem Komplement bei Autoimmunerkrankungen mit intraspinalen Zielepitopen nicht geeignet. Die Ergebnisse lassen sich als Komplement-unabh{\"a}ngige intrinsische Wirkungen von Antik{\"o}rpern gegen AQP4 deuten, die in einer Reduktion der Oberfl{\"a}chenexpresseion von AQP4 und EAAT2 resultieren und zu einer progredienten Myelopathie f{\"u}hren. Neben der bekannten Antik{\"o}rper-induzierten Komplement-abh{\"a}ngigen Zytotoxizit{\"a}t k{\"o}nnten diese Effekte einen bislang nicht beschriebenen zus{\"a}tzlichen Pathomechanismus bei der NMO darstellen.}, subject = {Autoantik{\"o}rper}, language = {de} } @phdthesis{Schmid2012, author = {Schmid, Benedikt}, title = {Relation between cerebral arterio-venous transit time and neuropsychological performance in patients with vascular dementia}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-71234}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2012}, abstract = {Dementia, or any form of degenerative cognitive decline, is one of the major problems in present, and even more will be in future medicine. With Alzheimer's disease (AD) being the most prevalent, Vascular Dementia is the second most entity of dementing processes in the elderly. As diagnostic criteria are still imprecise and in many cases do not embrace early stages of the disease, recent studies have proposed more detailed classifications of the newly created condition Vascular Cognitive Impairment (VCI). Of all conditions subsumed under this term, subcortical small-vessel alterations are the most common cause for cognitive decline. The diagnosis of dementia / cognitive impairment is presently often made in late stages of the disease, when therapeutical options are poor. Thus, early detection of changes of the subcortical small vessels is desirable, when there is still time to identify and aggressively treat risk factors and underlying conditions like diabetes, hyper- or hypotension, and hyperlipidemia. This study aimed to evaluate whether cTT correlates to cognitive dysfunction, i.e. if cTT is fit as an early diagnostic tool for VCI. The study cohort included 38 patients from the Neurological Clinic of the W{\"u}rzburg University hospital admitted due to diagnoses other than dementia or stroke. As a result of this study it turned out that cTT is certainly capable of fulfilling the task to easily and effectively detect and evaluate possible microvascular lesions of the brain with respect to the actual clinical relevance for the patient. When compared to the other proposed diagnostic tools, neuropsychological testing and MRI, the advantages of cTT are obvious: its measurement is a low-cost and quick procedure which would spare both patients and examiners a long neuropsychological exam or complement it. cTT is safe to assess as the only possible risks derive from the use of the contrast agent, which are rare and easily manageable. It has also proven to be more accurate in showing the extent of cognitive impairment than MRI. Finally, it is widely available. The only prerequisite is an ultrasound machine capable of transcranial color-coded duplex sonography. No cost-intensive procedures like MRI are needed. So, with neuropsychological testing remaining the gold standard, cTT here proved to be a reliable alternative which is more time- and cost-effective than MRI.}, subject = {Demenz}, language = {en} } @article{KleinschnitzMenclGarzetal.2013, author = {Kleinschnitz, Christoph and Mencl, Stine and Garz, Cornelia and Niklass, Solveig and Braun, Holger and G{\"o}b, Eva and Homola, Gy{\"o}rgy and Heinze, Hans-Jochen and Reymann, Klaus G. and Schreiber, Stefanie}, title = {Early microvascular dysfunction in cerebral small vessel disease is not detectable on 3.0 Tesla magnetic resonance imaging: a longitudinal study in spontaneously hypertensive stroke-prone rats}, series = {Experimental \& Translational Stroke Medicine}, journal = {Experimental \& Translational Stroke Medicine}, doi = {10.1186/2040-7378-5-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-97056}, year = {2013}, abstract = {Background Human cerebral small vessel disease (CSVD) has distinct histopathologic and imaging findings in its advanced stages. In spontaneously hypertensive stroke-prone rats (SHRSP), a well-established animal model of CSVD, we recently demonstrated that cerebral microangiopathy is initiated by early microvascular dysfunction leading to the breakdown of the blood-brain barrier and an activated coagulatory state resulting in capillary and arteriolar erythrocyte accumulations (stases). In the present study, we investigated whether initial microvascular dysfunction and other stages of the pathologic CSVD cascade can be detected by serial magnetic resonance imaging (MRI). Findings Fourteen SHRSP and three control (Wistar) rats (aged 26-44 weeks) were investigated biweekly by 3.0 Tesla (3 T) MRI. After perfusion, brains were stained with hematoxylin-eosin and histology was correlated with MRI data. Three SHRSP developed terminal CSVD stages including cortical, hippocampal, and striatal infarcts and macrohemorrhages, which could be detected consistently by MRI. Corresponding histology showed small vessel thromboses and increased numbers of small perivascular bleeds in the infarcted areas. However, 3 T MRI failed to visualize intravascular erythrocyte accumulations, even in those brain regions with the highest densities of affected vessels and the largest vessels affected by stases, as well as failing to detect small perivascular bleeds. Conclusion Serial MRI at a field strength of 3 T failed to detect the initial microvascular dysfunction and subsequent small perivascular bleeds in SHRSP; only terminal stages of cerebral microangiopathy were reliably detected. Further investigations at higher magnetic field strengths (7 T) using blood- and flow-sensitive sequences are currently underway.}, language = {en} } @article{UeceylerKahnKrameretal.2013, author = {{\"U}{\c{c}}eyler, Nurcan and Kahn, Ann-Kathrin and Kramer, Daniela and Zeller, Daniel and Casanova-Molla, Jordi and Wanner, Christoph and Weidemann, Frank and Katsarava, Zaza and Sommer, Claudia}, title = {Impaired small fiber conduction in patients with Fabry disease: a neurophysiological case-control study}, series = {BMC Neurology}, journal = {BMC Neurology}, doi = {10.1186/1471-2377-13-47}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-96527}, year = {2013}, abstract = {Background Fabry disease is an inborn lysosomal storage disorder which is associated with small fiber neuropathy. We set out to investigate small fiber conduction in Fabry patients using pain-related evoked potentials (PREP). Methods In this case-control study we prospectively studied 76 consecutive Fabry patients for electrical small fiber conduction in correlation with small fiber function and morphology. Data were compared with healthy controls using non-parametric statistical tests. All patients underwent neurological examination and were investigated with pain and depression questionnaires. Small fiber function (quantitative sensory testing, QST), morphology (skin punch biopsy), and electrical conduction (PREP) were assessed and correlated. Patients were stratified for gender and disease severity as reflected by renal function. Results All Fabry patients (31 men, 45 women) had small fiber neuropathy. Men with Fabry disease showed impaired cold (p < 0.01) and warm perception (p < 0.05), while women did not differ from controls. Intraepidermal nerve fiber density (IENFD) was reduced at the lower leg (p < 0.001) and the back (p < 0.05) mainly of men with impaired renal function. When investigating A-delta fiber conduction with PREP, men but not women with Fabry disease had lower amplitudes upon stimulation at face (p < 0.01), hands (p < 0.05), and feet (p < 0.01) compared to controls. PREP amplitudes further decreased with advance in disease severity. PREP amplitudes and warm (p < 0.05) and cold detection thresholds (p < 0.01) at the feet correlated positively in male patients. Conclusion Small fiber conduction is impaired in men with Fabry disease and worsens with advanced disease severity. PREP are well-suited to measure A-delta fiber conduction.}, language = {en} } @article{GunrebenGeisKleinschnitz2013, author = {Gunreben, Ignaz and Geis, Christian and Kleinschnitz, Christoph}, title = {Acute tetraparesis secondary to bilateral precentral gyral cerebral ischemia: a case report}, series = {Journal of Medical Case Reports}, journal = {Journal of Medical Case Reports}, doi = {10.1186/1752-1947-7-61}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-96179}, year = {2013}, abstract = {Introduction Sudden tetraparesis represents a neurological emergency and is most often caused by traumatic spinal cord injury, spinal epidural bleeding or brainstem ischemia and less frequently by medial disc herniation or spinal ischemia. Case presentation Here we report the rare case of an 82-year-old Caucasian man who developed severe tetraparesis four days after radical cystoprostatectomy. An emergency diagnostic study for spinal cord affection was normal. Brain magnetic resonance imaging revealed acute bilateral ischemic strokes in the precentral gyri as the underlying cause. Conclusions This case report underlines the need to also consider unusual causes of tetraparesis in an emergency situation apart from spinal cord or brain stem injury in order not to leave severe symptomatology unclear and possibly miss therapeutic options.}, language = {en} } @phdthesis{Scheytt2013, author = {Scheytt, Sarah}, title = {Quantifizierung von GAP 43 positiven intraepidermalen Nervenfasern bei Patienten mit Polyneuropathie und gesunden Kontrollen}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-94782}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2013}, abstract = {Polyneuropathien (PNP) sind mit einer Pr{\"a}valenz von bis zu 7\% in der Gesamtbev{\"o}lkerung eine h{\"a}ufige Diagnose. Bei der Ursachenabkl{\"a}rung der PNP hat sich in den letzten Jahren die immunhistochemische Bestimmung der intraepidermalen Nervenfaserdichte aus Hautstanzbiopsien mittels einer axonalen PGP 9.5 F{\"a}rbung etabliert. Ein zus{\"a}tzlicher Marker ist GAP 43 - ein axonales Protein, das von regenerierenden Nervenfasern exprimiert wird. In der vorliegenden Studie wurde die Dichte von PGP 9.5 und GAP 43 positiven Nervenfasern anhand immunhistochemischer F{\"a}rbungen an Hautstanzbiopsien vom lateralen Unter- und Oberschenkel von Patienten mit PNP unterschiedlicher Genese und von gesunden Kontrollen quantifiziert. Wir konnten zeigen, dass PNP Patienten im Vergleich zu Kontrollpersonen deutlich weniger GAP 43 positive Nervenfasern in ihren Hautbiopsien aufweisen. Obwohl sich bei PNP Patienten absolut gesehen weniger GAP 43 positive Nervenfasern fanden, war der Anteil an GAP 43 positiven Nervenfasern im Vergleich zur Kontrollgruppe h{\"o}her, was mit einer gesteigerten regenerativen Aktivit{\"a}t in gesch{\"a}digten Nervenfasern zusammenh{\"a}ngen kann. In der Patienten- und Kontrollgruppe fanden sich mehr PGP 9.5 und GAP 43 positive Nervenfasern am Ober- als am Unterschenkel, was durch die grunds{\"a}tzlich dichtere Innervation proximaler Hautareale bedingt ist und bei PNP Patienten durch den im Krankheitsverslauf typischerweise l{\"a}ngenabh{\"a}ngigen Verlust der peripheren kutanen Innervation noch verst{\"a}rkt wird. Die Analyse potentieller Einflussfaktoren ergab beim Unterschenkel f{\"u}r beide F{\"a}rbungen eine negative Korrelation zwischen Alter und Nervenfaserdichte. Das Geschlecht und das Vorhandensein von Schmerzen hatten keinen Einfluss auf die Hautinnervation. Die Arbeit zeigt anhand des bisher gr{\"o}ßten Patienten- und Kontrollkollektivs, dass regenerierende intraepidermale Nervenfasern mittels einer Immunhistochemie f{\"u}r GAP 43 zuverl{\"a}ssig quantifizierbar sind. Bei k{\"u}nftigen longitudinalen Studien kann nun ein m{\"o}glicher Zusammenhang zwischen der Dichte GAP 43 positiver Nervenfasern und der Prognose bzw. dem Ansprechen auf Therapien untersucht werden.}, subject = {Polyneuropathie}, language = {de} } @phdthesis{Ritter2013, author = {Ritter, Christian}, title = {Pathomechanismen von Antik{\"o}rpern gegen Aquaporin 4 in einem Tiermodell f{\"u}r die Neuromyelitis Optica}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-85526}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2013}, abstract = {Die Neuromyelitis Optica (NMO) ist eine schwerwiegende autoimmune Erkrankung des zentralen Nervensystems (ZNS), die mit rezidivierenden Optikusneuritiden und Querschnittsmyelitiden einhergeht. Als serologischer Biomarker wurden Autoantik{\"o}rper gegen Aquaporin 4 (anti-AQP4-AK) identifiziert. Mit Hilfe eines passiv-Transfer Rattenmodelles mit implantierten intrathekalen Kathetern wurden aufgereinigte IgG Fraktionen (NMO-IgG) von Plasmapheresematerial anti-AQP4-AK positiver NMO Patienten verabreicht. Zum Nachweis der Antigen-Spezifit{\"a}t wurden in weiteren Versuchsgruppen rekombinante IgG-AK gegen AQP4 appliziert. Die repetitive Injektion von NMO-IgG oder anti-AQP4-AK f{\"u}hrte zu einer signifikanten klinischen Verschlechterung und einer reduzierten motorischen Leistungsf{\"a}higkeit der Versuchstiere im Vergleich zu Kontrollen. Mittels Magnetresonanztomographie konnten exemplarisch Kontrastmittel-aufnehmende L{\"a}sionsareale im R{\"u}ckenmark der Versuchstiere im Bereich der Katheterspitze detektiert werden. Histopathologisch zeigte sich in diesen L{\"a}sionsbereichen eine Anreicherung von intrathekal applizierten humanen IgG, ein Verlust der Expression von AQP4 und des Glutamattransporters EAAT2. Im Gegensatz zu der bisher bekannten, Komplement-induzierten Gewebedestruktion bei NMO-Patienten mit entz{\"u}ndlichen L{\"a}sionen wurde hier keine Depletion von Astrozyten oder Komplementaktivierung beobachtet. Stattdessen kam es in den hier beschriebenen Arealen mit IgG-Ablagerung zu einer Hypertrophie und Vermehrung der GFAP-positiven Astrozyten. Die Ergebnisse lassen auf eine pathophysiologisch relevante, intrinsische und komplement-unabh{\"a}ngige Wirkung von anti-AQP4-AK schließen.}, subject = {Autoantik{\"o}rper}, language = {de} } @phdthesis{Patzko2012, author = {Patzk{\´o}, {\´A}gnes}, title = {CSF-1 receptor as a target for the treatment of Charcot-Marie-Tooth disease 1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-85325}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2012}, abstract = {Previous studies by our group revealed that chronic low grade inflammation implicating phagocytosing macrophages is a highly relevant mechanism in the pathogenesis of Charcot-Marie-Tooth disease. The lack of CSF-1, the primary regulator of macrophage function and survival, led to a robust and persistent amelioration of the phenotype in two authentic mouse models of CMT. Moreover, a close contact between CSF-1 producing fibroblasts and endoneurial macrophages carrying CSF-1R has been confirmed in nerve biopsies of CMT patients, further supporting the clinical significance of this pathway. In the current study we treated 3 distinct mouse models of CMT1: the PMP22tg mice as a model for CMT1A, the P0+/- mice as a model for CMT1B and the Cx32def mice as a model for CMT1X, with a CSF-1R specific kinase (c-FMS) inhibitor (800-1200 mg PLX5622/ kg chow) according to different treatment regimes mimicking an ideal early onset treatment, a late onset treatment and the withdrawal of the drug. Using the above mentioned doses of PLX5622, we documented a dramatic decrease in macrophage numbers in the PNS of all 3 myelin mutants, except for the quadriceps nerve of Cx32def mice. Fibroblast numbers remained unchanged in treated animals. Surprisingly, in spite of the decrease in the number of detrimental macrophages we could not detect an unequivocal phenotypic improvement. CMAP amplitudes were reduced in both wild type and myelin mutant mice treated with CSF-1R inhibitor in comparison to untreated littermates. Corresponding to the electrophysiological findings, the axon number and the percentage of large diameter axons were reduced in the quadriceps nerve of treated P0+/- and Cx32def mice. By contrast we observed a higher number of fully myelinated axons, in parallel with a decrease in the percentage of demyelinated (and hypermyelinated in PMP22tg mice) fibers in the ventral roots of P0+/- mice treated with CSF-1R inhibitor from 3 months up to 6 months of age and PMP22tg animals treated from 9 months up to 15 months of age. Our results indicate that CSF-1R inhibitor has the potential to improve the demyelinating phenotype of at least two models of CMT1. Nevertheless, further studies are necessary (for example with lower doses of the inhibitor) to minimize or even eliminate the putative neurotoxic effect we observed with high dose treatment conditions.}, subject = {Makrophage}, language = {en} } @phdthesis{Dreykluft2013, author = {Dreykluft, Angela}, title = {The PD-1/B7-H1 Pathway in a Transgenic Mouse Model for Spontaneous Autoimmune Neuroinflammation: Immunological Studies on Devic B7-H1-/- Mice}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-83288}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2013}, abstract = {Multiple sclerosis is an autoimmune disease of the central nervous system characterized by inflammatory, demyelinating lesions and neuronal death. Formerly regarded as a variant of MS, neuromyelitis optica (NMO)/Devic's disease is now recognized as a distinct neurological disorder exhibiting characteristic inflammatory and demyelinated foci in the optic nerves and the spinal cord sparing the brain. With the introduction of the double-transgenic "Devic mouse" model featuring spontaneous, adjuvant-free incidence of autoimmune neuroinflammation due to the interaction of transgenic MOG-specific T and B cells, a promising tool was found for the analysis of factors triggering or preventing autoimmunity. The co-inhibitory molecule B7-H1 has been proposed to contribute to the maintenance of peripheral tolerance and to confine autoimmune inflammatory damage via the PD-1/B7-H1 pathway. Compared to Devic B7-H1+/+ mice, Devic B7-H1-/- mice developed clinical symptoms with a remarkably higher incidence rate and faster kinetics emphasized by deteriorated disease courses and a nearly quadrupled mortality rate. Remarkably enlarged immune-cell accumulation in the CNS of Devic B7-H1-/- mice, in particular of activated MOG-specific CD4+ T cells, correlated with the more severe clinical features. Our studies showed that the CNS not only was the major site of myelin-specific CD4+ T-cell activation but also that B7-H1 expression within the target organ significantly influenced T-cell activation and differentiation levels. Analysis at disease maximum revealed augmented accumulation of MOG-specific CD4+ T cells in the peripheral lymphoid organs of Devic B7-H1-/- mice partly due to increased T-cell proliferation rates. Transgenic MOG-specific B cells of Devic B7-H1-/- mice activated MOG-specific CD4+ T cells more efficiently than B cells of Devic B7-H1+/+ mice. This observation indicated a relevant immune-modulating role of B7-H1 on APCs (antigen-presenting cells) in this mouse model. We also assumed altered thymic selection processes to be involved in increased peripheral CD4+ T-cell numbers of Devic B7-H1-/- mice as we found more thymocytes expressing the transgenic MOG-specific T-cell receptor (TCR). Moreover, preliminary in vitro experiments hinted on an enhanced survival of TCRMOG-transgenic CD4+ T cells of Devic B7-H1-/- mice; a mechanism that might as well have led to higher peripheral T-cell accumulation. Elevated levels of MOG-specific CD4+ T cells in the periphery of Devic B7-H1-/- mice could have entailed the higher quantities in the CNS. However, mechanisms such as CNS-specific proliferation and/or apoptosis/survival could also have contributed. This should be addressed in future investigations. Judging from in vitro migration assays and adoptive transfer experiments on RAG-1-/- recipient mice, migratory behavior of MOG-specific CD4+ T cells of Devic B7-H1+/+ and Devic B7-H1-/- mice seemed not to differ. However, enhanced expression of the transmigration-relevant integrin LFA-1 on CD4+ T cells in young symptom-free Devic B7-H1-/- mice might hint on temporally differently pronounced transmigration capacities during the disease course. Moreover, we attributed the earlier conversion of CD4+ T cells into Th1 effector cells in Devic B7-H1-/- mice during the initiation phase to the lack of co-inhibitory signaling via PD-1/B7-H1 possibly leading to an accelerated disease onset. Full blown autoimmune inflammatory processes could have masked these slight effects of B7-H1 in the clinical phase. Accordingly, at peak of the disease, Th1 and Th17 effector functions of peripheral CD4+ T cells were comparable in both mouse groups. Moreover, judging from titers of MOG-specific IgG1 and IgM antibodies, alterations in humoral immunity were not detected. Therefore, clinical differences could not be explained by altered T-cell or B-cell effector functions at disease maximum. B7-H1 rather seemed to take inhibitory effect in the periphery during the initiation phase only and consistently within the target organ by parenchymal expression. Our observations indicate that B7-H1 plays a relevant role in the regulation of T-cell responses in this mouse model for spontaneous CNS autoimmunity. By exerting immune-modulating effects in the preclinical as well as the clinical phase of the disease, B7-H1 contributed to the confinement of the immunopathological tissue damage in Devic B7-H1+/+ mice mirrored by later disease onsets and lower disease scores. As a model for spontaneous autoimmunity featuring a close to 100 \% incidence rate, the Devic B7-H1-/- mouse may prove instrumental in clarifying disease-triggering and -limiting factors and in validating novel therapeutic approaches in the field of autoimmune neuroinflammation, in particular the human Devic's disease.}, subject = {Autoimmunit{\"a}t}, language = {en} } @phdthesis{Groh2013, author = {Groh, Janos Michael}, title = {Pathogenic impact of immune cells in mouse models of neuronal ceroid lipofuscinosis}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-77684}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2013}, abstract = {The neuronal ceroid lipofuscinoses (NCLs) are fatal neurodegenerative disorders in which the visual system is affected in early stages of disease. A typical accompanying feature is neuroinflammation, the pathogenic impact of which is presently unknown. In this study, the role of inflammatory cells in the pathogenesis was investigated in Palmitoyl-protein thioesterase 1-deficient (Ppt1-/-) and Ceroidlipofuscinosis, neuronal 3-deficient (Cln3-/-) mice, models of the infantile and juvenile forms of NCL, respectively. Focusing predominantly on the visual system, an infiltration of CD8+ cytotoxic Tlymphocytes and an activation of microglia/macrophage-like cells was observed early in disease. To analyze the pathogenic impact of lymphocytes, Ppt1-/- mice were crossbred with mice lacking lymphocytes (Rag1-/-) and axonal transport, perturbation and neuronal survival were scored. Lack of lymphocytes led to a significant amelioration of neuronal disease and reconstitution experiments revealed a crucial role of CD8+ cytotoxic T-lymphocytes. Lack of lymphocytes also caused an improved clinical phenotype and extended longevity. To investigate the impact of microglia/macrophage-like cells, Ppt1-/- and Cln3-/- mice were crossbred with mice lacking sialoadhesin (Sn-/-), a monocyte lineage-restricted cell adhesion molecule important for interactions between macrophage-like cells and lymphocytes. Similar to the lack of lymphocytes, absence of sialoadhesin significantly ameliorated the disease in Ppt1-/- and Cln3-/- mice. Taken together, both T-lymphocytes and microglia/macrophage-like cells were identified as pathogenic mediators in two distinct forms of fatal inherited neurodegenerative storage disorders. These studies expand the concept of secondary inflammation as a common pathomechanistic feature in some neurological diseases and provide novel insights that may be crucial for developing treatment strategies for different forms of NCL.}, subject = {Nervendegeneration}, language = {en} } @techreport{LinkerMeuthMagnusetal.2012, author = {Linker, Ralf, A. and Meuth, Sven G. and Magnus, Tim and Korn, Thomas and Kleinschnitz, Christoph}, title = {Report on the 4'th scientific meeting of the "Verein zur F{\"o}rderung des Wissenschaftlichen Nachwuchses in der Neurologie" (NEUROWIND e.V.) held in Motzen, Germany, Nov. 2'nd - Nov. 4'th, 2012 [meeting report]}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-76407}, year = {2012}, abstract = {From November 2nd - 4th 2012, the 4th NEUROWIND e.V. meeting was held in Motzen, Brandenburg, Germany. Again more than 60 participants, predominantly at the doctoral student or postdoc level, gathered to share their latest findings in the fields of neurovascular research, neurodegeneration and neuroinflammation. Like in the previous years, the symposium provided an excellent platform for scientific exchange and the presentation of innovative projects in the stimulating surroundings of the Brandenburg outback. This year's keynote lecture on the pathophysiological relevance of neuronal networks was given by Christian Gerloff, Head of the Department of Neurology at the University Clinic of Hamburg-Eppendorf. Another highlight of the meeting was the awarding of the NEUROWIND e.V. prize for young scientists working in the field of experimental neurology. The award is donated by the Merck Serono GmbH, Darmstadt, Germany and is endowed with 20.000 Euro. This year the jury decided unanimously to adjudge the award to Michael Gliem from the Department of Neurology at the University Clinic of D{\"u}sseldorf (group of Sebastian Jander), Germany, for his outstanding work on different macrophage subsets in the pathogenesis of ischemic stroke published in the Annals of Neurology in 2012.}, subject = {Medizin}, language = {en} } @article{ZellerDangWeiseetal.2012, author = {Zeller, Daniel and Dang, Su-Yin and Weise, David and Rieckmann, Peter and Toyka, Klaus V. and Classen, Joseph}, title = {Excitability decreasing central motor plasticity is retained in multiple sclerosis patients}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-76333}, year = {2012}, abstract = {Background: Compensation of brain injury in multiple sclerosis (MS) may in part work through mechanisms involving neuronal plasticity on local and interregional scales. Mechanisms limiting excessive neuronal activity may have special significance for retention and (re-)acquisition of lost motor skills in brain injury. However, previous neurophysiological studies of plasticity in MS have investigated only excitability enhancing plasticity and results from neuroimaging are ambiguous. Thus, the aim of this study was to probe long-term depression-like central motor plasticity utilizing continuous theta-burst stimulation (cTBS), a non-invasive brain stimulation protocol. Because cTBS also may trigger behavioral effects through local interference with neuronal circuits, this approach also permitted investigating the functional role of the primary motor cortex (M1) in force control in patients with MS. Methods: We used cTBS and force recordings to examine long-term depression-like central motor plasticity and behavioral consequences of a M1 lesion in 14 patients with stable mild-to-moderate MS (median EDSS 1.5, range 0 to 3.5) and 14 age-matched healthy controls. cTBS consisted of bursts (50 Hz) of three subthreshold biphasic magnetic stimuli repeated at 5 Hz for 40 s over the hand area of the left M1. Corticospinal excitability was probed via motor-evoked potentials (MEP) in the abductor pollicis brevis muscle over M1 before and after cTBS. Force production performance was assessed in an isometric right thumb abduction task by recording the number of hits into a predefined force window. Results: cTBS reduced MEP amplitudes in the contralateral abductor pollicis brevis muscle to a comparable extent in control subjects (69 ± 22\% of baseline amplitude, p < 0.001) and in MS patients (69 ± 18\%, p < 0.001). In contrast, postcTBS force production performance was only impaired in controls (2.2 ± 2.8, p = 0.011), but not in MS patients (2.0 ± 4.4, p = 0.108). The decline in force production performance following cTBS correlated with corticomuscular latencies (CML) in MS patients, but did not correlate with MEP amplitude reduction in patients or controls. Conclusions: Long-term depression-like plasticity remains largely intact in mild-to-moderate MS. Increasing brain injury may render the neuronal networks less responsive toward lesion-induction by cTBS.}, subject = {Medizin}, language = {en} } @article{KunzePhamRaslanetal.2012, author = {Kunze, Ekkehard and Pham, Mirko and Raslan, Furat and Stetter, Christian and Lee, Jin-Yul and Solymosi, Laszlo and Ernestus, Ralf-Ingo and Hamilton Vince, Giles and Westermaier, Thomas}, title = {Value of Perfusion CT, Transcranial Doppler Sonography and Neurological Examination to detect delayed Vasospasm after aneurysmal Subarachnoid Hemorrhage [Research Article]}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-76241}, year = {2012}, abstract = {Background If detected in time, delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) may be treated by balloon angioplasty or chemical vasospasmolysis in order to enhance cerebral blood flow (CBF) and protect the brain from ischemic damage. This study was conceived to compare the diagnostic accuracy of detailed neurological examination, Transcranial Doppler Sonography (TCD), and Perfusion-CT (PCT) to detect angiographic vasospasm. Methods The sensitivity, specificity, positive and negative predictive values of delayed ischemic neurological deterioration (DIND), pathological findings on PCT- maps, and accelerations of the mean flow velocity (MVF) were calculated. Results The accuracy of DIND to predict angiographic vasospasm was 0.88. An acceleration of MFV in TCD (>140 cm/s) had an accuracy of 0.64, positive PCT-findings of 0.69 with a higher sensitivity, and negative predictive value than TCD. Interpretation Neurological assessment at close intervals is the most sensitive and specific parameter for cerebral vasospasm. PCT has a higher accuracy, sensitivity and negative predictive value than TCD. If detailed neurological evaluation is possible, it should be the leading parameter in the management and treatment decisions. If patients are not amenable to detailed neurological examination, PCT at regular intervals is a helpful tool to diagnose secondary vasospasm after aneurysmal SAH.}, subject = {Medizin}, language = {en} } @article{RaslanAlbertWeissenbergerWestermaieretal.2012, author = {Raslan, Furat and Albert-Weißenberger, Christiane and Westermaier, Thomas and Saker, Saker and Kleinschmitz, Christoph and Lee, Jin-Yul}, title = {A modified double injection model of cisterna magna for the study of delayed cerebral vasospasm following subarachnoid hemorrhage in rats}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-76038}, year = {2012}, abstract = {Delayed cerebral vasospasm following subarachnoid hemorrhage (SAH) is a serious medical complication, characterized by constriction of cerebral arteries leading to varying degrees of cerebral ischemia. Numerous clinical and experimental studies have been performed in the last decades; however, the pathophysiologic mechanism of cerebral vasospasm after SAH still remains unclear. Among a variety of experimental SAH models, the double hemorrhage rat model involving direct injection of autologous arterial blood into the cisterna magna has been used most frequently for the study of delayed cerebral vasospasm following SAH in last years. Despite the simplicity of the technique, the second blood injection into the cisterna magna may result in brainstem injury leading to high mortality. Therefore, a modified double hemorrhage model of cisterna magna has been developed in rat recently. We describe here step by step the surgical technique to induce double SAH and compare the degree of vasospasm with other cisterna magna rat models using histological assessment of the diameter and cross-sectional area of the basilar artery}, subject = {Medizin}, language = {en} } @article{WestermaierStetterRaslanetal.2012, author = {Westermaier, Thomas and Stetter, Christian and Raslan, Furat and Vinc, Giles Hamilton and Ernestus, Ralf-Ingo}, title = {Brain edema formation correlates with perfusion deficit during the first six hours after experimental subarachnoid hemorrhage in rats}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-75765}, year = {2012}, abstract = {Background: Severe brain edema is observed in a number of patients suffering from subarachnoid hemorrhage (SAH). Little is known about its pathogenesis and time-course in the first hours after SAH. This study was performed to investigate the development of brain edema and its correlation with brain perfusion after experimental SAH. Methods: Male Sprague-Dawley rats, randomly assigned to one of six groups (n = 8), were subjected to SAH using the endovascular filament model or underwent a sham operation. Animals were sacrificed 15, 30, 60, 180 or 360 minutes after SAH. Intracranial pressure (ICP), mean arterial blood pressure (MABP), cerebral perfusion pressure (CPP) and bilateral local cerebral blood flow (LCBF) were continuously measured. Brain water content (BWC) was determined by the wet/dry-weight method. Results: After SAH, CPP and LCBF rapidly decreased. The decline of LCBF markedly exceeded the decline of CPP and persisted until the end of the observation period. BWC continuously increased. A significant correlation was observed between the BWC and the extent of the perfusion deficit in animals sacrificed after 180 and 360 minutes. Conclusions: The significant correlation with the perfusion deficit after SAH suggests that the development of brain edema is related to the extent of ischemia and acute vasoconstriction in the first hours after SAH.}, subject = {Medizin}, language = {en} } @article{KleinschnitzMeuthMagnusetal.2012, author = {Kleinschnitz, Christph and Meuth, Sven G. and Magnus, Tim and Korn, Thomas and Linker, Ralf A.}, title = {Report on the 3'rd scientific meeting of the "Verein zur F{\"o}rderung des Wissenschaftlichen Nachwuchses in der Neurologie" (NEUROWIND e.V.) held in Motzen, Germany, Nov. 4'th - Nov. 6'th, 2011}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-75388}, year = {2012}, abstract = {From November 4th- 6th 2011, the 3rd NEUROWIND e.V. meeting was held in Motzen, Brandenburg, Germany. Like in the previous years, the meeting provided an excellent platform for scientific exchange and the presentation of innovative projects for young colleagues in the fields of neurovascular research, neuroinflammation and neurodegeneration. As kick-off to the scientific sessions, Reinhard Hohlfeld, Head of the Institute for Clinical Neuroimmunology in Munich, gave an illustrious overview on the many fascinations of neuroimmunologic research. A particular highlight on the second day of the meeting was the award of the 1'st NEUROWIND e.V. prize for young academics in the field of experimental neurology. This award is posted for young colleagues under the age of 35 with a significant achievement in the field of neurovascular research, neuroinflammation or neurodegeneration and comprises an amount of 20.000 Euro, founded by Merck Serono GmbH, Darmstadt. Germany. The first prize was awarded to Ivana Nikic from Martin Kerschensteiner's group in Munich for her brilliant work on a reversible form of axon damage in experimental autoimmune encephalomyelitis and multiple sclerosis, published in Nature Medicine in 2011. This first prize award ceremony was a great incentive for the next call for proposals now upcoming in 2012.}, subject = {Medizin}, language = {en} } @article{AlbertWeissenbergerVarrallyayRaslanetal.2012, author = {Albert-Weißenberger, Christiane and V{\´a}rrallyay, Csan{\´a}d and Raslan, Furat and Kleinschnitz, Christoph and Sir{\´e}n, Anna-Leena}, title = {An experimental protocol for mimicking pathomechanisms of traumatic brain injury in mice}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-75368}, year = {2012}, abstract = {Traumatic brain injury (TBI) is a result of an outside force causing immediate mechanical disruption of brain tissue and delayed pathogenic events. In order to examine injury processes associated with TBI, a number of rodent models to induce brain trauma have been described. However, none of these models covers the entire spectrum of events that might occur in TBI. Here we provide a thorough methodological description of a straightforward closed head weight drop mouse model to assess brain injuries close to the clinical conditions of human TBI.}, subject = {Medizin}, language = {en} } @article{GeisWeishauptGruenewaldetal.2011, author = {Geis, Christian and Weishaupt, Andreas and Gr{\"u}newald, Benedikt and Wultsch, Thomas and Reif, Andreas and Gerlach, Manfred and Dirkx, Ron and Solimena, Michele and Perani, Daniela and Heckmann, Manfred and Toyka, Klaus V. and Folli, Franco and Sommer, Claudia}, title = {Human Stiff-Person Syndrome IgG Induces Anxious Behavior in Rats}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-74757}, year = {2011}, abstract = {Background: Anxiety is a heterogeneous behavioral domain playing a role in a variety of neuropsychiatric diseases. While anxiety is the cardinal symptom in disorders such as panic disorder, co-morbid anxious behavior can occur in a variety of diseases. Stiff person syndrome (SPS) is a CNS disorder characterized by increased muscle tone and prominent agoraphobia and anxiety. Most patients have high-titer antibodies against glutamate decarboxylase (GAD) 65. The pathogenic role of these autoantibodies is unclear. Methodology/Principal Findings: We re-investigated a 53 year old woman with SPS and profound anxiety for GABA-A receptor binding in the amygdala with (11)C-flumazenil PET scan and studied the potential pathogenic role of purified IgG from her plasma filtrates containing high-titer antibodies against GAD 65. We passively transferred the IgG fraction intrathecally into rats and analyzed the effects using behavioral and in vivo electrophysiological methods. In cell culture, we measured the effect of patient IgG on GABA release from hippocampal neurons. Repetitive intrathecal application of purified patient IgG in rats resulted in an anxious phenotype resembling the core symptoms of the patient. Patient IgG selectively bound to rat amygdala, hippocampus, and frontal cortical areas. In cultured rat hippocampal neurons, patient IgG inhibited GABA release. In line with these experimental results, the GABA-A receptor binding potential was reduced in the patient's amygdala/hippocampus complex. No motor abnormalities were found in recipient rats. Conclusion/Significance: The observations in rats after passive transfer lead us to propose that anxiety-like behavior can be induced in rats by passive transfer of IgG from a SPS patient positive for anti-GAD 65 antibodies. Anxiety, in this case, thus may be an antibody-mediated phenomenon with consecutive disturbance of GABAergic signaling in the amygdala region.}, subject = {Medizin}, language = {en} } @article{ChenPalmLeschetal.2011, author = {Chen, Y. and Palm, F. and Lesch, K. P. and Gerlach, M. and Moessner, R. and Sommer, C.}, title = {5-hydroxyindolacetic acid (5-HIAA), a main metabolite of serotonin, is responsible for complete Freund's adjuvant-induced thermal hyperalgesia in mice}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68858}, year = {2011}, abstract = {Background: The role of serotonin (5-hydroxytrptamine, 5-HT) in the modulation of pain has been widely studied. Previous work led to the hypothesis that 5-hydroxyindolacetic acid (5-HIAA), a main metabolite of serotonin, might by itself influence pain thresholds. Results: In the present study, we investigated the role of 5-HIAA in inflammatory pain induced by intraplantar injection of complete Freund's adjuvant (CFA) into the hind paw of mice. Wild-type mice were compared to mice deficient of the 5-HT transporter (5-HTT-/- mice) using behavioral tests for hyperalgesia and high-performance liquid chromatography (HPLC) to determine tissue levels of 5-HIAA. Wild-type mice reproducibly developed thermal hyperalgesia and paw edema for 5 days after CFA injection. 5-HTT-/- mice treated with CFA had reduced thermal hyperalgesia on day 1 after CFA injection and normal responses to heat hereafter. The 5-HIAA levels in spinal cord and sciatic nerve as measured with HPLC were lower in 5-HTT-/- mice than in wild-type mice after CFA injection. Pretreatment of wild-type mice with intraperitoneal injection of para-chlorophenylalanine (p-CPA), a serotonin synthesis inhibitor, resulted in depletion of the 5-HIAA content in spinal cord and sciatic nerve and decrease in thermal hyperalgesia in CFA injected mice. The application of exogenous 5-HIAA resulted in potentiation of thermal hyperalgesia induced by CFA in 5-HTT-/- mice and in wild-type mice pretreated with p- CPA, but not in wild-type mice without p-CPA pretreatment. Further, methysergide, a broad-spectrum serotonin receptor antagonist, had no effect on 5-HIAA-induced potentiation of thermal hyperalgesia in CFA-treated wildtype mice. Conclusion: Taken together, the present results suggest that 5-HIAA plays an important role in modulating peripheral thermal hyperalgesia in CFA induced inflammation, probably via a non-serotonin receptor mechanism.}, subject = {Medizin}, language = {en} } @phdthesis{Dang2011, author = {Dang, Su-Yin Judith}, title = {Funktionelle Bedeutung der Neuroplastizit{\"a}t bei Multipler Sklerose}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-73817}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2011}, abstract = {Die Multiple Sklerose ist eine chronische neurologische Erkrankung, welche in der industrialisierten Welt einen der h{\"a}ufigsten Gr{\"u}nde f{\"u}r eine bleibende Behinderung bei jungen Erwachsenen darstellt. Obwohl die ZNS-Sch{\"a}digung, charakterisiert durch Demyelinisierung und axonale Sch{\"a}digung im Rahmen entz{\"u}ndlicher Vorg{\"a}nge, durch verschiedene Reparaturmechanismen reduziert wird, akkumuliert die L{\"a}sionslast im zentralen Nervensystem mit der Zeit. T2-gewichtete MRT-Studien zeigen, dass die dargestellten Pathologien nur m{\"a}ßig mit den motorischen Defiziten korrelieren. Diese Diskrepanz wird unter anderem auf Vorg{\"a}nge der Neuroplastizit{\"a}t zur{\"u}ckgef{\"u}hrt, als deren Basismechanismen Langzeitpotenzierung (LTP) und -depression (LTD) gelten. In verschiedenen fMRT-Studien haben sich Hinweise ergeben, dass diese adaptiven Ver{\"a}nderungen zur Reorganisation kortikaler Repr{\"a}sentationmuster f{\"u}hren k{\"o}nnen, so dass bei MS-Patienten eine ausgedehntere Aktivierung ipsilateraler sensomotorischer Areale bei motorischen Aufgaben zu beobachten ist. Die transkranielle Magnetstimulation (TMS) bietet die M{\"o}glichkeit, mittels virtueller L{\"a}sionstechniken eine direkte Aussage {\"u}ber die kausale Beziehung zwischen Struktur und Funktion zu liefern. Die funktionelle Rolle ipsilateraler Motorareale wurde an 26 MS-Patienten, in Relation zu ihrer motorischen Beeintr{\"a}chtigung und ZNS-Sch{\"a}digung, und an nach Alter, Geschlecht und H{\"a}ndigkeit zugeordneten Kontrollprobanden, untersucht. Die motorische Leistungsf{\"a}higkeit wurde durch verschiedene Tests zur Handfunktion erhoben. Die ZNS-Sch{\"a}digung wurde mittels MR-Spektroskopie als NAA/Cr Quotient sowie durch die CML erhoben. Die Aufgabe zur einfachen Reaktionszeit (SRT) bestand aus einer isometrischen Abduktionsbewegung des rechten Daumens gegen einen Kraftaufnehmer auf ein akustisches Go-Signal. Mit TMS-Einzelreizen wurde mit Hilfe einer Neuronavigation eine reversible virtuelle L{\"a}sion {\"u}ber bestimmten Gehirnarealen, kontralateraler M1, ipsilateraler M1 und ipsilateraler PMd, erzeugt. Es wurde eine Kontrollstimulation {\"u}ber MO durchgef{\"u}hrt. Die TMS-Einzelreize wurden 100ms nach dem Go-Signal appliziert. Als SRT wurde der Zeitraum zwischen dem Go-Signal und EMG-Beginn im APB definiert. Die signifikanten SRT-Verl{\"a}ngerungen bei TMS {\"u}ber dem ipsilateralen M1 und dem ipsilateralen PMd zeigen, dass diese Regionen eine Rolle bei der motorischen Funktion bei MS spielen. Die fehlenden Korrelationen zwischen motorischen Funktionstest und NAA/Cr-Verh{\"a}ltnis sowie die inverse Korrelation zur kortikomuskul{\"a}ren Latenz sind durch strukturell von der krankheitsbedingten Pathologie betroffenen kompensierenden Gehirnregionen erkl{\"a}rbar. Bei dem Theta Burst Experiments (TBS) wurde ein virtueller L{\"a}sionseffekt durch eine repetitive TMS-Intervention {\"u}ber dem ipsilateralen M1 induziert. Die Ergebnisse zeigen {\"a}hnliche Ver{\"a}nderungen der Exzitabilit{\"a}t bei MS-Patienten und gesunden Kontrollprobanden, was schließen l{\"a}sst, dass die LTD bei mild bis moderat betroffenen MS-Patienten weitestgehend unbeeintr{\"a}chtigt ist. MS-Patienten zeigen im Vergleich zu den Kontrollen eine {\"a}hnliche Minderung der Verhaltensleistung, Trefferquote in ein Kraftfenster, der MS-Patienten im Kontrollvergleich. Die Ergebnisse zeigen, dass ipsilaterale motorische Areale in der Lage sind den prim{\"a}r motorischen Kortex soweit zu kompensieren, jedoch die F{\"a}higkeit zur Kompensation in fortgeschrittenen Krankheitsstadien eingeschr{\"a}nkt ist. Abschließend kann man zusammenfassen, dass die funktionelle Rekrutierung von ipsilateralen Motorarealen eine adaptive Antwort auf chronische Gehirnsch{\"a}digung bei MS-Patienten sein kann, allerdings mit Einschr{\"a}nkung der Kapazit{\"a}t in fortgeschrittenen Krankheitsstadien. Nachdem die synaptische Plastizit{\"a}t weitestgehend intakt scheint, sollte man besonders Mechanismen der sp{\"a}ten Phase der Plastizit{\"a}t f{\"o}rdern, welche auf eine langfristige kortikale Plastizit{\"a}t abzielen. Weitere Studien in diesem Forschungszweig k{\"o}nnten einen Beitrag zur Entwicklung therapeutischer Konzepte der Neurorehabilitation bei Multipler Sklerose leisten.}, subject = {Neuronale Plastizit{\"a}t}, language = {de} } @article{UeceylerBikoSommer2010, author = {Ueceyler, Nurcan and Biko, Lydia and Sommer, Claudia}, title = {MDL-28170 Has No Analgesic Effect on CCI Induced Neuropathic Pain in Mice}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68359}, year = {2010}, abstract = {The calpain inhibitor MDL-28710 blocks the early local pro-inflammatory cytokine gene expression in mice after chronic constriction nerve injury (CCI). Onehundred- thirteen wild type mice of C57Bl/6J background received CCI of the right sciatic nerve. Mechanical paw withdrawal thresholds and thermal withdrawal latencies were investigated at baseline and at 1, 3, and 7 days after CCI. Three application regimens were used for MDL-28170: a) single injection 40 min before CCI; b) serial injections of MDL- 28170 40 min before and up to day three after CCI; c) sustained application via intraperitoneal osmotic pumps. The control animals received the vehicle DMSO/PEG 400. The tolerable dose of MDL-28170 for mice was 30 mg/kg body weight, higher doses were lethal within the first hours after application. Mechanical withdrawal thresholds and thermal withdrawal latencies were reduced after CCI and did not normalize after single or serial injections, nor with application of MDL-28170 via osmotic pumps. Although the calpain inhibitor MDL-28170 inhibits the early local cytokine upregulation in the sciatic nerve after CCI, pain behavior is not altered. This finding implies that local cytokine upregulation after nerve injury alone is only one factor in the induction and maintenance of neuropathic pain.}, subject = {Medizin}, language = {en} } @article{ChenBoettgerReifetal.2010, author = {Chen, Yong and Boettger, Michael K. and Reif, Andreas and Schmitt, Angelika and Ueceyler, Nurcan and Sommer, Claudia}, title = {Nitric oxide synthase modulates CFA-induced thermal hyperalgesia through cytokine regulation in mice}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68349}, year = {2010}, abstract = {Background: Although it has been largely demonstrated that nitric oxide synthase (NOS), a key enzyme for nitric oxide (NO) production, modulates inflammatory pain, the molecular mechanisms underlying these effects remain to be clarified. Here we asked whether cytokines, which have well-described roles in inflammatory pain, are downstream targets of NO in inflammatory pain and which of the isoforms of NOS are involved in this process. Results: Intraperitoneal (i.p.) pretreatment with 7-nitroindazole sodium salt (7-NINA, a selective neuronal NOS inhibitor), aminoguanidine hydrochloride (AG, a selective inducible NOS inhibitor), L-N(G)-nitroarginine methyl ester (L-NAME, a non-selective NOS inhibitor), but not L-N(5)-(1-iminoethyl)-ornithine (L-NIO, a selective endothelial NOS inhibitor), significantly attenuated thermal hyperalgesia induced by intraplantar (i.pl.) injection of complete Freund's adjuvant (CFA). Real-time reverse transcription-polymerase chain reaction (RT-PCR) revealed a significant increase of nNOS, iNOS, and eNOS gene expression, as well as tumor necrosis factor-alpha (TNF), interleukin-1 beta (IL-1b), and interleukin-10 (IL-10) gene expression in plantar skin, following CFA. Pretreatment with the NOS inhibitors prevented the CFA-induced increase of the pro-inflammatory cytokines TNF and IL-1b. The increase of the antiinflammatory cytokine IL-10 was augmented in mice pretreated with 7-NINA or L-NAME, but reduced in mice receiving AG or L-NIO. NNOS-, iNOS- or eNOS-knockout (KO) mice had lower gene expression of TNF, IL-1b, and IL-10 following CFA, overall corroborating the inhibitor data. Conclusion: These findings lead us to propose that inhibition of NOS modulates inflammatory thermal hyperalgesia by regulating cytokine expression.}, subject = {Medizin}, language = {en} } @article{BraeuningerKleinschnitzStoll2010, author = {Braeuninger, Stefan and Kleinschnitz, C. and Stoll, G.}, title = {Interleukin-18 does not influence infarct volume or functional outcome in the early stage after transient focal brain ischemia in mice}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68141}, year = {2010}, abstract = {Interleukin-18 (IL-18) is a proinflammatory cytokine of the interleukin-1 family which is upregulated after cerebral ischemia. The functional role of IL-18 in cerebral ischemia is unknown. In the present study, we compared infarct size in IL-18 knock-out and wild-type mice 24 hours and 48 hours after 1-hour transient middle cerebral artery occlusion (tMCAO). Moreover, the functional outcome was evaluated in a modified Bederson score, foot fault test and grip test. There were no significant differences in infarct size or functional outcome tests between wild-type and IL-18 knock-out mice. These data indicate that the early inflammatory response to cerebral ischemia does not involve IL-18, in contrast to other interleukin-1 family members such as interleukin-1.}, subject = {Interleukin-18}, language = {en} } @article{EhlingBittnerBobaketal.2010, author = {Ehling, P. and Bittner, S. and Bobak, N. and Schwarz, T. and Wiendl, H. and Budde, T. and Kleinschnitz, Christoph and Meuth, S. G.}, title = {Two pore domain potassium channels in cerebral ischemia: a focus on K2p9.1 (TASK3, KCNK9)}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68129}, year = {2010}, abstract = {BACKGROUND: Recently, members of the two-pore domain potassium channel family (K2P channels) could be shown to be involved in mechanisms contributing to neuronal damage after cerebral ischemia. K2P3.1-/- animals showed larger infarct volumes and a worse functional outcome following experimentally induced ischemic stroke. Here, we question the role of the closely related K2P channel K2P9.1. METHODS: We combine electrophysiological recordings in brain-slice preparations of wildtype and K2P9.1-/- mice with an in vivo model of cerebral ischemia (transient middle cerebral artery occlusion (tMCAO)) to depict a functional impact of K2P9.1 in stroke formation. RESULTS: Patch-clamp recordings reveal that currents mediated through K2P9.1 can be obtained in slice preparations of the dorsal lateral geniculate nucleus (dLGN) as a model of central nervous relay neurons. Current characteristics are indicative of K2P9.1 as they display an increase upon removal of extracellular divalent cations, an outward rectification and a reversal potential close to the potassium equilibrium potential. Lowering extracellular pH values from 7.35 to 6.0 showed comparable current reductions in neurons from wildtype and K2P9.1-/- mice (68.31 +/- 9.80\% and 69.92 +/- 11.65\%, respectively). These results could be translated in an in vivo model of cerebral ischemia where infarct volumes and functional outcomes showed a none significant tendency towards smaller infarct volumes in K2P9.1-/- animals compared to wildtype mice 24 hours after 60 min of tMCAO induction (60.50 +/- 17.31 mm3 and 47.10 +/- 19.26 mm3, respectively). CONCLUSIONS: Together with findings from earlier studies on K2P2.1-/- and K2P3.1-/- mice, the results of the present study on K2P9.1-/- mice indicate a differential contribution of K2P channel subtypes to the diverse and complex in vivo effects in rodent models of cerebral ischemia.}, subject = {Kaliumkanal}, language = {en} } @article{PhamHelluyBraeuningeretal.2010, author = {Pham, Mirko and Helluy, X. and Braeuninger, S. and Jakob, P. and Stoll, G. and Kleinschnitz, Christoph and Bendszus, M.}, title = {Outcome of experimental stroke in C57Bl/6 and Sv/129 mice assessed by multimodal ultra-high field MRI}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68115}, year = {2010}, abstract = {Transgenic mice bred on C57Bl/6 or Sv/129 genetic background are frequently used in stroke research. It is well established that variations in cerebrovascular anatomy and hemodynamics can influence stroke outcome in different inbred mouse lines. We compared stroke development in C57Bl/6 and Sv/129 mice in the widely used model of transient middle cerebral artery occlusion (tMCAO) by multimodal ultra-high field magnetic resonance imaging (MRI). C57Bl/6 and Sv/129 mice underwent 60 min of tMCAO and were analyzed by MRI 2 h and 24 h afterwards. Structural and functional images were registered to a standard anatomical template. Probability maps of infarction were rendered by automated segmentation from quantitative T2-relaxometric images. Whole-brain segmentation of infarction was accomplished manually on high-resolution T2-weighted (T2-w) RARE images. Cerebral perfusion (cerebral blood flow, CBF) was measured quantitatively by modified continuous arterial-spin-labeling (CASL) and apparent diffusion coefficients (ADC) by spin-echo diffusion-weighted imaging (DWI). Probabilities of cortical (95.1\% ± 3.1 vs. 92.1\% ± 2.5; p > 0.05) and subcortical (100\% vs. 100\%; p > 0.05) infarctions at 24 h were similar in both groups as was the whole-brain volumetric extent of cerebral infarction. In addition, CBF and ADC values did not differ between C57Bl/6 and Sv/129 mice at any time point or region of interest. The C57Bl/6 and Sv/129 genetic background is no major confounding factor of infarct size and cerebral perfusion in the tMCAO model.}, subject = {NMR-Tomographie}, language = {en} } @article{KraftSchwarzPochetetal.2010, author = {Kraft, P. and Schwarz, T. and Pochet, L. and Stoll, G. and Kleinschnitz, Christoph}, title = {COU254, a specific 3-carboxamide-coumarin inhibitor of coagulation factor XII, does not protect mice from acute ischemic stroke}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68103}, year = {2010}, abstract = {Background: Anticoagulation is an important means to prevent from acute ischemic stroke but is associated with a significant risk of severe hemorrhages. Previous studies have shown that blood coagulation factor XII (FXII)- deficient mice are protected from pathological thrombus formation during cerebral ischemia without bearing an increased bleeding tendency. Hence, pharmacological blockade of FXII might be a promising and safe approach to prevent acute ischemic stroke and possibly other thromboembolic disorders but pharmacological inhibitors selective over FXII are still lacking. In the present study we investigated the efficacy of COU254, a novel nonpeptidic 3-carboxamide-coumarin that selectively blocks FXII activity, on stroke development and post stroke functional outcome in mice. Methods: C57Bl/6 mice were treated with COU254 (40 mg/kg i.p.) or vehicle and subjected to 60 min transient middle cerebral artery occlusion (tMCAO) using the intraluminal filament method. After 24 h infarct volumes were determined from 2,3,5-Triphenyltetrazoliumchloride(TTC)-stained brain sections and functional scores were assessed. Hematoxylin and eosin (H\&E) staining was used to estimate the extent of neuronal cell damage. Thrombus formation within the infarcted brain areas was analyzed by immunoblot. Results: Infarct volumes and functional outcomes on day 1 after tMCAO did not significantly differ between COU254 pre-treated mice or untreated controls (p > 0.05). Histology revealed extensive ischemic neuronal damage regularly including the cortex and the basal ganglia in both groups. COU254 treatment did not prevent intracerebral fibrin(ogen) formation. Conclusions: COU254 at the given concentration of 40 mg/kg failed to demonstrate efficacy in acute ischemic stroke in this preliminary study. Further preclinical evaluation of 3-carboxamide-coumarins is needed before the antithrombotic potential of this novel class of FXII inhibitors can be finally judged.}, subject = {Schlaganfall}, language = {en} } @techreport{MagnusLinkerMeuthetal.2011, author = {Magnus, Tim and Linker, Ralf A. and Meuth, Sven G. and Kleinschnitz, Christoph and Korn, Thomas}, title = {Report on the 2nd scientific meeting of the "Verein zur Foerderung des Wissenschaftlichen Nachwuchses in der Neurologie" (NEUROWIND e.V.) held in Motzen, Germany, Oct. 29'th - Oct. 31'st, 2010}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68789}, year = {2011}, abstract = {Summary of the scientific contributions to the NEUROWIND meeting 2010: Contributions in the fields of neuroimmunology and neurodegeneration}, subject = {Wissenschaftlicher Nachwuchs}, language = {en} } @phdthesis{Topuzoglu2012, author = {Topuzoglu, Teng{\"u} G{\"u}ls{\"u}m}, title = {Charakterisierung von IL-4 Knockout-M{\"a}usen und ihrer Zytokin- und Opioidrezeptor-Expression im peripheren und zentralen Nervensystem}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-72372}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2012}, abstract = {In der vorliegenden Arbeit wurde der Einfluss eines Mangels des antiinflammatorischen Zytokins Interleukin(IL)-4 am Tiermodell einer experimentellen Mononeuropathie (engl. chronic constriction injury, CCI) untersucht. Zentrale Fragestellung der Studie war, ob IL-4 knockout(ko)-M{\"a}use im Vergleich zu Wildtyp(wt)-M{\"a}usen mit einem gesteigerten Schmerzverhalten sowie einer ver{\"a}nderten Zytokinantwort und Opioidrezeptor-Expression nach Anwendung eines neuropathischen Schmerzmodells (CCI) reagieren. In mehreren Tierstudien war zuvor eine antiinflammatorische und analgetische Wirkung von IL-4 belegt worden (Vale et al. 2003; Hao et al. 2006) und in klinischen Studien war ein verminderter IL-4-Spiegel bei Patienten mit verschiedenen neuropathischen Schmerzsyndromen mit einer gesteigerten Schmerzempfindung verbunden ({\"U}{\c{c}}eyler et al. 2006; {\"U}{\c{c}}eyler et al. 2007b). Da IL-4 die Transkription von Opioidrezeptoren induziert (Kraus et al. 2001; B{\"o}rner et al. 2004), wurde zudem das Ansprechen von IL-4 ko-M{\"a}usen auf Morphin und die Genexpression zentraler Opioidrezeptoren untersucht. Vor sowie bis vier Wochen nach Durchf{\"u}hrung einer CCI wurden IL-4 ko- sowie wt- M{\"a}use hinsichtlich ihrer Empfindlichkeit auf mechanische und thermische Stimuli analysiert. Zum Zeitpunkt des Schmerzmaximums nach CCI (Tag 7 bis 9) wurde zudem das Ansprechen beider Genotypen auf Morphin untersucht. Die Genexpression pro- (IL-1 beta, TNF) und antiinflammatorischer Zytokine (IL-10, IL- 13) im peripheren (N. ischiadicus) und zentralen Nervensystem (lumbales und zervikales R{\"u}ckenmark, Pons, Thalamus, Hypothalamus, Striatum, Kortex) sowie die Genexpression zentraler Opioidrezeptoren (m{\"u}-OR, delta-OR, kappa-OR) wurde bei beiden Genotypen vor sowie vier Wochen nach CCI mittels Real-Time-PCR bestimmt. Unbehandelte IL-4 ko-M{\"a}use zeigten im Vergleich zu wt-M{\"a}usen bereits vor Durchf{\"u}hrung einer CCI eine mechanische {\"U}berempfindlichkeit (Hyperalgesie), was m{\"o}glicherweise durch die bei IL-4-Mangel fehlenden zentralen inhibitorischen Mechanismen bedingt ist. Nach CCI entwickelten sowohl IL-4 ko- als auch wt-M{\"a}use eine gleich ausgepr{\"a}gte mechanische und thermische Hyperalgesie. Die Tatsache, dass die mechanische {\"U}berempfindlichkeit bei IL-4 ko-M{\"a}usen nach Nervenl{\"a}sion nicht {\"u}berproportional steigt, kann Ausdruck der nachgewiesenen kompensatorisch st{\"a}rker ausgepr{\"a}gten Genexpression proinflammatorischer, aber insbesondere auch antiinflammatorischer Zytokine in diesem Genotyp sein. Nur bei IL-4 ko-M{\"a}usen war vier Wochen nach CCI die Genexpression der anti- inflammatorischen Zytokine im N. ischiadicus (IL-10) und ipsilateralen R{\"u}ckenmark (IL-10, IL-13), jedoch auch die der proinflammatorischen Zytokine im ipsilateralen R{\"u}ckenmark (TNF, IL-1 beta) erh{\"o}ht. Nach CCI sprachen IL-4 ko-M{\"a}use schneller auf Morphingabe an als wt-M{\"a}use, was durch den bei diesem Genotyp st{\"a}rker ausgepr{\"a}gten Anstieg der Genexpression der Opioidrezeptortypen delta-OR und kappa-OR im kontralateralen Thalamus bedingt sein kann.}, subject = {Neuralgie}, language = {de} } @article{UeceylerHaeuserSommer2011, author = {{\"U}ceyler, Nurcan and H{\"a}user, Winfried and Sommer, Claudia}, title = {Systematic review with meta-analysis: Cytokines in fibromyalgia syndrome}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-69189}, year = {2011}, abstract = {Background: To perform a systematic review and meta-analysis on cytokine levels in patients with fibromyalgia syndrome (FMS). Methods: Through December 2010 we systematically reviewed the databases PubMed, MEDLINE, and PsycINFO and screened the reference lists of 22 review articles for suitable original articles. Original articles investigating cytokines in patients with FMS were included. Data were extracted by two independent authors. Differences of the cytokine levels of FMS patients and controls were summarized by standardized mean differences (SMD) using a random effects model. Study quality was assessed applying methodological scores: modified Center of Evidence Based Medicine, Newcastle-Ottawa-Scale, and W{\"u}rzburg Methodological Quality Score. Results: Twenty-five articles were included investigating 1255 FMS patients and 800 healthy controls. Data of 13/25 studies entered meta-analysis. The overall methodological quality of studies was low. The results of the majority of studies were not comparable because methods, investigated material, and investigated target cytokines differed. Systematic review of the selected 25 articles revealed that FMS patients had higher serum levels of interleukin (IL)-1 receptor antagonist, IL-6, and IL-8, and higher plasma levels of IL-8. Meta-analysis of eligible studies showed that FMS patients had higher plasma IL-6 levels compared to controls (SMD = -0.34 [-0.64, -0.03] 95\% CI; p = 0.03). The majority of investigated cytokines were not different between patients and controls. Conclusions: The pathophysiological role of cytokines in FMS is still unclear. Studies of higher quality and with higher numbers of subjects are needed.}, subject = {Fibromyalgie}, language = {en} } @article{PuschmannSommer2011, author = {Puschmann, Anne-Katrin and Sommer, Claudia}, title = {Hypervigilance or avoidance of trigger related cues in migraineurs? - A case-control study using the emotional stroop task}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-69103}, year = {2011}, abstract = {Background: "Negative affect" is one of the major migraine triggers. The aim of the study was to assess attentional biases for negative affective stimuli that might be related to migraine triggers in migraine patients with either few or frequent migraine and healthy controls. Methods: Thirty-three subjects with frequent migraine (FM) or with less frequent episodic migraine, and 20 healthy controls conducted two emotional Stroop tasks in the interictal period. In task 1, general affective words and in task 2, pictures of affective faces (angry, neutral, happy) were used. For each task we calculated two emotional Stroop indices. Groups were compared using one-way ANOVAs. Results: The expected attentional bias in migraine patients was not found. However, in task 2 the controls showed a significant attentional bias to negative faces, whereas the FM group showed indices near zero. Thus, the FM group responded faster to negative than to positive stimuli. The difference between the groups was statistically significant. Conclusions: The findings in the FM group may reflect a learned avoidance mechanism away from affective migraine triggers.}, subject = {Migr{\"a}ne}, language = {en} } @phdthesis{Kafke2011, author = {Kafke, Waldemar}, title = {Bestimmung von Zytokinexpressionsprofilen aus humanen Blut- und Hautproben bei Patienten mit small fiber Neuropathie}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-71132}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2011}, abstract = {Zusammenfassend konnte durch unsere Daten die eingangs gestellte Hypothese, dass Patienten mit SFN eine lokal und systemisch erh{\"o}hte Expression pro-inflammatorischer und algetischer Zytokine haben, auf lokaler Ebene bei der Untergruppe mit LD-SFN best{\"a}tigt werden. Bei der Untergruppe mit NLD-SFN waren keine Unterschiede bei den Zytokinexpressionen zwischen proximalen und distalen Hautbiopsien im Vergleich zu Kontrollprobanden nachweisbar. Zudem zeigten sich deutliche Unterschiede bei den Quotienten der IENFD zwischen beiden Untergruppen. Dies legt die Vermutung nahe, dass die Unterteilung in LD-SFN und NLD-SFN klinisch bedeutsam und ein m{\"o}glicher Grundstein f{\"u}r das Verst{\"a}ndnis der pathophysiologischen Mechanismen der SFN sein k{\"o}nnte. Hieraus k{\"o}nnten sich Fortschritte in der Diagnostik ergeben und gezielte symptomatische und vielleicht sogar kausale Therapien auf lokaler Ebene bei der SFN entwickeln.}, subject = {Small fiber Neuropathie}, language = {de} } @phdthesis{Stenner2011, author = {Stenner, Max-Philipp}, title = {Diapedese und immuntolerogene Funktion regulatorischer T Zellen in der schubf{\"o}rmigen Multiplen Sklerose unter Therapie mit Natalizumab}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-70573}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2011}, abstract = {Die schubf{\"o}rmige Multiple Sklerose (MS) ist eine chronisch-entz{\"u}ndliche, demyelinisierende, multifokale Erkrankung des Zentralnervensystems (ZNS). Autoreaktive immunologische Prozesse, insbesondere der T-Zell vermittelten Immunit{\"a}t, leisten einen entscheidenden Beitrag zur Pathogenese der schubf{\"o}rmigen MS. Ein wesentlicher Schritt in immunpathogenetischen Modellen ist die transendotheliale Migration von Immunzellen {\"u}ber die Blut-Hirn-Schranke. Die Interaktion des very late antigen 4 (VLA-4) mit dem vascular cell adhesion molecule 1 (VCAM-1) und mit Fibronectin leistet einen wesentlichen Beitrag zur Extravasation von T Zellen in das ZNS. Auf dieser Schl{\"u}sselfunktion des VLA-4 gr{\"u}ndet die Therapie mit Natalizumab, einem monoklonalen Antik{\"o}rper gegen die α4 Integrinkette. Ziel der vorliegenden Studie war es, die Auswirkungen der Therapie der schubf{\"o}rmigen MS mit Natalizumab auf die transendotheliale Migration von CD4+CD25+FOXP3+ und CD4+HLA-G+ regulatorischen T Zellen (Treg) und auf die antiproliferative Funktion von FOXP3+ Treg zu untersuchen. Zentrale Hypothese war, dass Natalizumab {\"u}ber eine universelle Blockade der Immunzellinvasion in das ZNS hinaus immunmodulatorisch wirkt. Unter Verwendung eines prospektiven, longitudinalen Studiendesigns wurden die T Zellen von RR-MS Patienten unter Therapie mit Natalizumab (n=31) sowie von stabilen RR-MS Patienten ohne Therapie und gesunden Spendern in jeweils zwei in vitro Modellen der Blut-Hirn-Schranke sowie Treg vermittelter Immuntoleranz untersucht. FOXP3+ regulatorische T-Zellen banden weniger Natalizumab und exprimierten weniger VLA-4 als nicht-regulatorische T Helferzellen, bewahrten unter Therapie jedoch einen h{\"o}heren Anteil ihrer urspr{\"u}nglichen VLA-4 Expression. FOXP3+ Treg gesunder Spender wiesen in vitro h{\"o}here Migrationsraten {\"u}ber mikrovaskul{\"a}re humane Hirnendothelzellen als nicht-regulatorische T Helferzellen auf und akkumulierten innerhalb der T-Zell Population nach Migration. Dagegen reicherten sich FOXP3+ Treg von MS Patienten in Folge der Migration nur nach Vorbehandlung des Endothel mit inflammatorischen Zytokinen an, nicht jedoch ohne diese Vorbehandlung. Natalizumab beeintr{\"a}chtigte die transendotheliale Migration von FOXP3+ Treg und nicht-regulatorischen T Helferzellen von MS Patienten in vergleichbaren Ausmaßen. HLA-G+ Treg zeigten in den Migrationsanalysen ein den FOXP3+ Treg entgegengesetztes Muster und wiesen ausschließlich in der MS, nicht jedoch im Gesunden, eine h{\"o}here Migrationsrate auf als HLA-G- T Helferzellen. Diese Akkumulation von HLA-G+ Treg in der migrierten Zellfraktion ließ sich nach Therapiebeginn nicht mehr nachweisen. Eine erg{\"a}nzende Einzelfallstudie zu Auswirkungen des LFA-1 Antagonisten Efalizumab auf Treg ergab Hinweise auf eine Schl{\"u}sselfunktion dieses Integrins f{\"u}r die Migration von FOXP3+ Treg. Die Analyse der FOXP3+ Treg Suppressorfunktion zeigte eine schrittweise Zunahme des suppressiven Einflusses von FOXP3+ Treg auf die Reifung dendritischer Zellen unter Natalizumabtherapie. Zeitlich parallel kam es zu einem Ungleichgewicht in der Expression von LFA-1 auf der Oberfl{\"a}che von FOXP3+ Treg und nicht-regulatorischen T Helferzellen. Zusammenfassend st{\"u}tzt die Studie die Hypothese immunmodulatorischer Effekte von Natalizumab in der schubf{\"o}rmigen Multiplen Sklerose, insbesondere auf den Antagonismus von regulatorischen und Effektor-T Zellen. Die Arbeit belegt, dass Natalizumab in vivo {\"u}ber die Blockade von VLA-4 hinaus modulatorisch in das Netzwerk von Adh{\"a}sionsmolek{\"u}len auf T Zellen eingreift. Die Studienergebnisse ergeben ein {\"U}berwiegen regulatorischer Einfl{\"u}sse auf die Reifung dendritischer Zellen unter Therapie. Berichte zum Beitrag von LFA-1 zur Suppressorfunktion von FOXP3+ Treg werden durch Daten der vorliegenden Studie unterst{\"u}tzt und um Hinweise auf eine zus{\"a}tzliche, spezifische Bedeutung des Integrins zur pr{\"a}ferentiellen Diapedese dieser Treg {\"u}ber die Blut-Hirn-Schranke im Gesunden erweitert. Zudem liefert die Arbeit erstmals Hinweise auf einen Defekt der transendothelialen Migration von FOXP3+ Treg {\"u}ber die Blut-Hirn-Schranke in der schubf{\"o}rmigen Multiplen Sklerose, der zur Entstehung neuer L{\"a}sionen beitragen k{\"o}nnte.}, subject = {Neuroimmunologie}, language = {de} } @article{KreisslStoutWongetal.2011, author = {Kreissl, Michael C. and Stout, David B. and Wong, Koon-Pong and Wu, Hsiao-Ming and Caglayan, Evren and Ladno, Waldemar and Zhang, Xiaoli and Prior, John and Reiners, Christoph and Huang, Sung-Cheng and Schelbert, Heinrich R.}, title = {Influence of Dietary Interventions and Insulin on Myocardial, Skeletal Muscle and Brain [18F]-Fluorodeoxyglucose Kinetics in Mice}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68775}, year = {2011}, abstract = {Background: We evaluated the effect of insulin stimulation and dietary changes on myocardial, skeletal muscle and brain [18F]-fluorodeoxyglucose (FDG) kinetics and uptake in vivo in intact mice. Methods: Mice were anesthetized with isoflurane and imaged under different conditions: non-fasted (n = 7; "controls"), non-fasted with insulin (2 IU/kg body weight) injected subcutaneously immediately prior to FDG (n = 6), fasted (n = 5), and fasted with insulin injection (n = 5). A 60-min small-animal PET with serial blood sampling and kinetic modeling was performed. Results: We found comparable FDG standardized uptake values (SUVs) in myocardium in the non-fasted controls and non-fasted-insulin injected group (SUV 45-60 min, 9.58 ± 1.62 vs. 9.98 ± 2.44; p = 0.74), a lower myocardial SUV was noted in the fasted group (3.48 ± 1.73; p < 0.001). In contrast, the FDG uptake rate constant (Ki) for myocardium increased significantly by 47\% in non-fasted mice by insulin (13.4 ± 3.9 ml/min/100 g vs. 19.8 ± 3.3 ml/min/100 g; p = 0.030); in fasted mice, a lower myocardial Ki as compared to controls was observed (3.3 ± 1.9 ml/min/100 g; p < 0.001). Skeletal muscle SUVs and Ki values were increased by insulin independent of dietary state, whereas in the brain, those parameters were not influenced by fasting or administration of insulin. Fasting led to a reduction in glucose metabolic rate in the myocardium (19.41 ± 5.39 vs. 3.26 ± 1.97 mg/min/100 g; p < 0.001), the skeletal muscle (1.06 ± 0.34 vs. 0.34 ± 0.08 mg/min/100 g; p = 0.001) but not the brain (3.21 ± 0.53 vs. 2.85 ± 0.25 mg/min/100 g; p = 0.19). Conclusions: Changes in organ SUVs, uptake rate constants and metabolic rates induced by fasting and insulin administration as observed in intact mice by small-animal PET imaging are consistent with those observed in isolated heart/muscle preparations and, more importantly, in vivo studies in larger animals and in humans. When assessing the effect of insulin on the myocardial glucose metabolism of non-fasted mice, it is not sufficient to just calculate the SUV - dynamic imaging with kinetic modeling is necessary.}, subject = {Insulin}, language = {en} } @article{SommerRichterRogauschetal.2011, author = {Sommer, Claudia and Richter, Helmut and Rogausch, Jan P. and Frettloh, Jule and Lungenhausen, Margitta and Maier, Christoph}, title = {A modified score to identify and discriminate neuropathic pain: a study on the German version of the neuropathic pain symptom inventory (NPSI)}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68716}, year = {2011}, abstract = {Background: Neuropathic pain must be correctly diagnosed for optimal treatment. The questionnaire named Neuropathic Pain Symptom Inventory (NPSI) was developed in its original French version to evaluate the different symptoms of neuropathic pain. We hypothesized that the NPSI might also be used to differentiate neuropathic from non-neuropathic pain. Methods: We translated the NPSI into German using a standard forward-backward translation and administered it in a case-control design to patients with neuropathic (n = 68) and non-neuropathic pain (headache and osteoarthritis, n = 169) to validate it and to analyze its discriminant properties, its sensitivity to change, and to detect neuropathic pain subgroups with distinct profiles. Results: Using a sum score (the NPSI-G score), we found sensitivity to change (r between 0.37 and 0.5 for pain items of the graded chronic pain scale) and could distinguish between neuropathic and other pain on a group basis, but not for individual patients. Post hoc development of a discriminant score with optimized diagnostic properties to distinguish neuropathic pain from non-neuropathic pain resulted in an instrument with high sensitivity (91\%) and acceptable specificity (70\%). We detected six different pain profiles in the patient group with neuropathic pain; three profiles were found to be distinct. Conclusions: The NPSI-G potentially combines the properties of a diagnostic tool and an instrument to identify subtypes of neuropathic pain.}, subject = {Neuralgie}, language = {en} } @phdthesis{Pizon2010, author = {Pizon, Dorothea}, title = {Prognose des raumfordernden Mediainfarktes bei konservativer vs. operativer Therapie am Universit{\"a}tsklinikum W{\"u}rzburg 1993-2005}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-70232}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2010}, abstract = {In dieser Studie wurden Schlaganfallpatienten untersucht, die einen ausgedehnten Infarkt im Versorgungsgebiet der A.cerebri media erlitten und wegen Bewusstseinstr{\"u}bung (sog. Maligner Mediainfarkt) auf der Neurologischen Intensivstation des Universit{\"a}tsklinikums W{\"u}rzburg im Zeitraum von 1991 bis 2005 behandelt wurde, um herauszufinden, welchen Einfluss eine operative Behandlung auf den kritisch erh{\"o}hten Hirnsdrucks zus{\"a}tzlich zur konservativen Intensivtherapie auf Mortalit{\"a}t sowie langfristige Lebensqualit{\"a}t hatte. Insgesamt konnten die Daten von 292 Patienten ausgewertet werden, wovon 259 konservativ und 33 operativ behandelt worden waren. Es zeigte sich insgesamt, dass eine stillschweigende g{\"u}nstige Selektion f{\"u}r eine Trepanation sprach (j{\"u}nger, eher keine Aphasie, weniger Komorbidit{\"a}ten). Die Hemikraniektomie senkte die Mortalit{\"a}t in der Akutphase hochsignifikant (K: 22, 4\%, T: 3,0\%; p=0,009). Sie hatte erwartungsgem{\"a}ß auch einen positiven Einfluss auf das Vigilanzniveau: die Quote von wachen Patienten war bei Entlassung der Trepanierten um 66\% h{\"o}her als bei Aufnahme, bei den konservativ Behandelten war sie nur um 33,3 \% gestiegen. Das vorherrschende Symptom bei Aufnahme und Entlassung war eine motorische bzw. sensomotorische Hemiparese. Der Anteil der Aphasiker bei den 201 konservativ therapierten Patienten, die den station{\"a}ren Aufenthalt {\"u}berlebt haben, ist von bei Aufnahme 56,2\% auf bei Entlassung 48,6\% gesunken. Bei den 32 trepanierten Patienten ist er dagegen mit 50\% gleich geblieben, obwohl 2/3 aller Patienten an der nicht-dominanten Hemisph{\"a}re operiert worden waren. Es war und ist auch nicht zu erwarten, dass eine Entlastung von Hirndruck qualitativ die hirninfarktbedingten Symptome beseitigt. Die Nachbefragung der Patienten fand im Schnitt 64,7 Monate nach erlittenem Mediainfarkt statt. Inzwischen waren von den 259 konservativ Behandelten 47,1\% verstorben, von den 33 Hemikraniektomierten nur 24,2\%. Die poststation{\"a}re Mortalit{\"a}t im weiteren Verlauf war anteilsm{\"a}ßig gering (K: 24\%, T: 21,2\%). Die {\"U}berlebensdauer der Trepanierten war dreimal so lang wie die der nicht operierten (K: 11,6 Monate, T: 34,4 Monate). Diese Unterschiede im Langzeit{\"u}berleben sind wahrscheinlicher auf die geringeren Komorbidit{\"a}ten der Trepanierten zur{\"u}ckzuf{\"u}hren, als auf die stattgehabte Operation an sich. Allerdings ist nicht auszuschließen, dass die durch Trepanation fr{\"u}hzeitiger verbesserte Wachheit sich auch g{\"u}nstig auf lebensverk{\"u}rzende Folgekomplikationen ausgewirkt haben k{\"o}nnte. In der Nachbefragung zeigte sich, dass bez{\"u}glich der erworbenen k{\"o}rperlichen Funktionsdefizite, gemessen am Barthel Index, zwischen den beiden Kollektiven kein signifikanter Unterschied bestand. Die ehemals konservativ behandelten Patienten kamen auf durchschnittlich 75, die trepanierten Patienten auf 60 von 100 Punkten. Im Lebensalltag schl{\"a}gt sich dieser Unterschied von 15 Punkten relevant nieder, aber insgesamt liegen beide Patientenkollektive im Bereich einer leichten bis nicht vorhandenen Abh{\"a}ngigkeit. Die vergleichbaren Langzeitdaten von Patienten mit Mediainfarkt liegen in einem {\"a}hnlichen Bereich. Erstmalig werden hier Langzeitdaten solcher Patienten {\"u}ber die Lebensqualit{\"a}t vorgelegt, gemessen mit dem SF-36. Nachvollziehbar zeigte sich ein deutlicher Unterschied zur Lebensqualit{\"a}t der Durchschnittsbev{\"o}lkerung, insbesondere im Bereich der k{\"o}rperlichen Belastbarkeit. F{\"u}r uns unerwartet g{\"u}nstig fielen die Antworten auf der eher psychologischen Ebene aus. Es zeigten sich bei allen Punkten des SF-36 keine signifikanten Unterschiede zwischen dem konservativ behandelten und den hemikraniektomierten Patienten, so dass die Operation als solche keinen eigenst{\"a}ndigen Einfluss auf die langfristige Lebensqualit{\"a}t nahm. Zusammengefasst verbesserte die osteoklastische Trepanation des raumfordernden malignen Mediainfarkts die {\"U}berlebenschance in der Akutphase signifikant, was mit inzwischen publizierten kontrollierten Studienergebnissen {\"u}bereinstimmt. Der Langzeitverlauf nach {\"u}berlebter Akutkrankheit gestaltet sich unabh{\"a}ngig von der Trepanation. Es gibt aufgrund der erworbenen Behinderung eine weiterhin relativ hohe l{\"a}ngerfristige Sterblichkeit. Bemerkenswert ist, dass die Selbsteinsch{\"a}tzung der Lebensqualit{\"a}t von Patienten mit einer erheblichen infarktbedingen k{\"o}rperlichen Behinderung psychologisch-emotional nur geringf{\"u}gig von der Selbstwahrnehmung in der nicht- behinderten Durchschnittsbev{\"o}lkerung. Dass bedeutet, dass Spekulationen {\"u}ber die zuk{\"u}nftige Lebensqualit{\"a}t keinen Einfluss auf die Operationsindikation nehmen sollten.}, subject = {Arteria cerebri media}, language = {de} } @article{DoerckGoebelWeiseetal.2010, author = {Doerck, Sebastian and Goebel, Kerstin and Weise, Gesa and Schneider-Hohendorf, Tilman and Reinhardt, Michael and Hauff, Peter and Schwab, Nicholas and Linker, Ralf and Maeurer, Mathias and Meuth, Sven G. and Wiendl, Heinz}, title = {Temporal Pattern of ICAM-I Mediated Regulatory T Cell Recruitment to Sites of Inflammation in Adoptive Transfer Model of Multiple Sclerosis}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68565}, year = {2010}, abstract = {Migration of immune cells to the target organ plays a key role in autoimmune disorders like multiple sclerosis (MS). However, the exact underlying mechanisms of this active process during autoimmune lesion pathogenesis remain elusive. To test if pro-inflammatory and regulatory T cells migrate via a similar molecular mechanism, we analyzed the expression of different adhesion molecules, as well as the composition of infiltrating T cells in an in vivo model of MS, adoptive transfer experimental autoimmune encephalomyelitis in rats. We found that the upregulation of ICAM-I and VCAM-I parallels the development of clinical disease onset, but persists on elevated levels also in the phase of clinical remission. However, the composition of infiltrating T cells found in the developing versus resolving lesion phase changed over time, containing increased numbers of regulatory T cells (FoxP3) only in the phase of clinical remission. In order to test the relevance of the expression of cell adhesion molecules, animals were treated with purified antibodies to ICAM-I and VCAM-I either in the phase of active disease or in early remission. Treatment with a blocking ICAM-I antibody in the phase of disease progression led to a milder disease course. However, administration during early clinical remission aggravates clinical symptoms. Treatment with anti-VCAM-I at different timepoints had no significant effect on the disease course. In summary, our results indicate that adhesion molecules are not only important for capture and migration of pro-inflammatory T cells into the central nervous system, but also permit access of anti-inflammatory cells, such as regulatory T cells. Therefore it is likely to assume that intervention at the blood brain barrier is time dependent and could result in different therapeutic outcomes depending on the phase of CNS lesion development.}, subject = {Multiple Sklerose}, language = {en} } @article{KraftBenzAustinatetal.2010, author = {Kraft, Peter and Benz, Peter Michael and Austinat, Madeleine and Brede, Marc Elmar and Schuh, Kai and Walter, Ulrich and Stoll, Guido and Kleinschnitz, Christoph}, title = {Deficiency of Vasodilator-Stimulated Phosphoprotein (VASP) Increases Blood-Brain-Barrier Damage and Edema Formation after Ischemic Stroke in Mice}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68522}, year = {2010}, abstract = {Background: Stroke-induced brain edema formation is a frequent cause of secondary infarct growth and deterioration of neurological function. The molecular mechanisms underlying edema formation after stroke are largely unknown. Vasodilator-stimulated phosphoprotein (VASP) is an important regulator of actin dynamics and stabilizes endothelial barriers through interaction with cell-cell contacts and focal adhesion sites. Hypoxia has been shown to foster vascular leakage by downregulation of VASP in vitro but the significance of VASP for regulating vascular permeability in the hypoxic brain in vivo awaits clarification. Methodology/Principal Findings: Focal cerebral ischemia was induced in Vasp2/2 mice and wild-type (WT) littermates by transient middle cerebral artery occlusion (tMCAO). Evan's Blue tracer was applied to visualize the extent of blood-brainbarrier (BBB) damage. Brain edema formation and infarct volumes were calculated from 2,3,5-triphenyltetrazolium chloride (TTC)-stained brain slices. Both mouse groups were carefully controlled for anatomical and physiological parameters relevant for edema formation and stroke outcome. BBB damage (p,0.05) and edema volumes (1.7 mm360.5 mm3 versus 0.8 mm360.4 mm3; p,0.0001) were significantly enhanced in Vasp2/2 mice compared to controls on day 1 after tMCAO. This was accompanied by a significant increase in infarct size (56.1 mm3617.3 mm3 versus 39.3 mm3610.7 mm3, respectively; p,0.01) and a non significant trend (p.0.05) towards worse neurological outcomes. Conclusion: Our study identifies VASP as critical regulator of BBB maintenance during acute ischemic stroke. Therapeutic modulation of VASP or VASP-dependent signalling pathways could become a novel strategy to combat excessive edema formation in ischemic brain damage.}, subject = {Vasodilatator-stimuliertes Phosphoprotein}, language = {en} } @article{KraftSchwarzMeijersetal.2010, author = {Kraft, Peter and Schwarz, Tobias and Meijers, Joost C. M. and Stoll, Guido and Kleinschnitz, Christoph}, title = {Thrombin-Activatable Fibrinolysis Inhibitor (TAFI) Deficient Mice Are Susceptible to Intracerebral Thrombosis and Ischemic Stroke}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68519}, year = {2010}, abstract = {Background: Thrombus formation is a key step in the pathophysiology of acute ischemic stroke and results from the activation of the coagulation cascade. Thrombin plays a central role in this coagulation system and contributes to thrombus stability via activation of thrombin-activatable fibrinolysis inhibitor (TAFIa). TAFIa counteracts endogenous fibrinolysis at different stages and elevated TAFI levels are a risk factor for thrombotic events including ischemic stroke. Although substantial in vitro data on the influence of TAFI on the coagulation-fibrinolysis-system exist, investigations on the consequences of TAFI inhibition in animal models of cerebral ischemia are still lacking. In the present study we analyzed stroke development and post stroke functional outcome in TAFI-/- mice. Methodology/Principal Findings: TAFI-/- mice and wild-type controls were subjected to 60 min transient middle cerebral artery occlusion (tMCAO) using the intraluminal filament method. After 24 hours, functional outcome scores were assessed and infarct volumes weremeasured from 2,3,5-Triphenyltetrazoliumchloride (TTC)-stained brain slices. Hematoxylin and eosin (H\&E) staining was used to estimate the extent of neuronal cell damage. Thrombus formation within the infarcted brain areas was analyzed by immunoblot. Infarct volumes and functional outcomes did not significantly differ between TAFI-/- mice and controls (p.0.05). Histology revealed extensive ischemic neuronal damage regularly including the cortex and the basal ganglia in both groups. TAFI deficiency also had no influence on intracerebral fibrin(ogen) formation after tMCAO. Conclusion: Our study shows that TAFI does not play a major role for thrombus formation and neuronal degeneration after ischemic brain challenge.}, subject = {Thrombus}, language = {en} } @article{HaarmannDeissProchaskaetal.2010, author = {Haarmann, Axel and Deiss, Annika and Prochaska, Juergen and Foerch, Christian and Weksler, Babette and Romero, Ignacio and Couraud, Pierre-Olivier and Stoll, Guido and Rieckmann, Peter and Buttmann, Mathias}, title = {Evaluation of Soluble Junctional Adhesion Molecule-A as a Biomarker of Human Brain Endothelial Barrier Breakdown}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68468}, year = {2010}, abstract = {Background: An inducible release of soluble junctional adhesion molecule-A (sJAM-A) under pro-inflammatory conditions was described in cultured non-CNS endothelial cells (EC) and increased sJAM-A serum levels were found to indicate inflammation in non-CNS vascular beds. Here we studied the regulation of JAM-A expression in cultured brain EC and evaluated sJAM-A as a serum biomarker of blood-brain barrier (BBB) function. Methodology/Principal Findings: As previously reported in non-CNS EC types, pro-inflammatory stimulation of primary or immortalized (hCMEC/D3) human brain microvascular EC (HBMEC) induced a redistribution of cell-bound JAM-A on the cell surface away from tight junctions, along with a dissociation from the cytoskeleton. This was paralleled by reduced immunocytochemical staining of occludin and zonula occludens-1 as well as by increased paracellular permeability for dextran 3000. Both a self-developed ELISA test and Western blot analysis detected a constitutive sJAM-A release by HBMEC into culture supernatants, which importantly was unaffected by pro-inflammatory or hypoxia/reoxygenation challenge. Accordingly, serum levels of sJAM-A were unaltered in 14 patients with clinically active multiple sclerosis compared to 45 stable patients and remained unchanged in 13 patients with acute ischemic non-small vessel stroke over time. Conclusion: Soluble JAM-A was not suited as a biomarker of BBB breakdown in our hands. The unexpected non-inducibility of sJAM-A release at the human BBB might contribute to a particular resistance of brain EC to inflammatory stimuli, protecting the CNS compartment.}, subject = {Biomarker}, language = {en} } @article{KleinschnitzGrundWingleretal.2010, author = {Kleinschnitz, Christoph and Grund, Henrike and Wingler, Kirstin and Armitage, Melanie E. and Jones, Emma and Mittal, Manish and Barit, David and Schwarz, Tobias and Geis, Christian and Kraft, Peter and Barthel, Konstanze and Schuhmann, Michael K. and Herrmann, Alexander M. and Meuth, Sven G. and Stoll, Guido and Meurer, Sabine and Schrewe, Anja and Becker, Lore and Gailus-Durner, Valerie and Fuchs, Helmut and Klopstock, Thomas and de Angelis, Martin Hrabe and Jandeleit-Dahm, Karin and Shah, Ajay M. and Weissmann, Norbert and Schmidt, Harald H. H. W.}, title = {Post-Stroke Inhibition of Induced NADPH Oxidase Type 4 Prevents Oxidative Stress and Neurodegeneration}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68416}, year = {2010}, abstract = {Ischemic stroke is the second leading cause of death worldwide. Only one moderately effective therapy exists, albeit with contraindications that exclude 90\% of the patients. This medical need contrasts with a high failure rate of more than 1,000 pre-clinical drug candidates for stroke therapies. Thus, there is a need for translatable mechanisms of neuroprotection and more rigid thresholds of relevance in pre-clinical stroke models. One such candidate mechanism is oxidative stress. However, antioxidant approaches have failed in clinical trials, and the significant sources of oxidative stress in stroke are unknown. We here identify NADPH oxidase type 4 (NOX4) as a major source of oxidative stress and an effective therapeutic target in acute stroke. Upon ischemia, NOX4 was induced in human and mouse brain. Mice deficient in NOX4 (Nox42/2) of either sex, but not those deficient for NOX1 or NOX2, were largely protected from oxidative stress, blood-brain-barrier leakage, and neuronal apoptosis, after both transient and permanent cerebral ischemia. This effect was independent of age, as elderly mice were equally protected. Restoration of oxidative stress reversed the stroke-protective phenotype in Nox42/2 mice. Application of the only validated low-molecular-weight pharmacological NADPH oxidase inhibitor, VAS2870, several hours after ischemia was as protective as deleting NOX4. The extent of neuroprotection was exceptional, resulting in significantly improved long-term neurological functions and reduced mortality. NOX4 therefore represents a major source of oxidative stress and novel class of drug target for stroke therapy.}, subject = {Schlaganfall}, language = {en} } @phdthesis{Schubert2011, author = {Schubert, Andrea Julia}, title = {Vergleich der Ergebnisse von Karotis-Stenting und -TEA an der Universit{\"a}tsklinik W{\"u}rzburg}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-67130}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2011}, abstract = {Der Vergleich der Verfahren Karotisstenting und Karotis-TEA an der Universit{\"a}tsklinik W{\"u}rzburg zeigt, dass bei richtiger Indikationsstellung sowie ausreichender Erfahrung der Neuroradiologen, CAS eine ernstzunehmende Alternative zu CEA darstellt. Besonderes Augenmerk lag dabei auf periprozeduale Komplikationen sowie Langzeitergebnisse bez{\"u}glich Tod,Insult und Restenose.}, subject = {Carotis}, language = {de} } @phdthesis{Fackelmann2011, author = {Fackelmann, Stefanie}, title = {Langzeitkorrelation evozierter Potentialparameter mit dem klinischen Verlauf bei Patienten mit Multipler Sklerose}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-64840}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2011}, abstract = {Evozierte Potenziale werden bereits als Hilfsmittel zur Diagnosestellung der Multiplen Sklerose herangezogen. Das Spektrum der Verl{\"a}ufe der Erkrankung ist sehr unterschiedlich. Ziel der Studie war es, zu pr{\"u}fen, ob visuell (VEP), somatosensibel (SEP) und Magnet- (MEP) evozierte Potentiale durch das Aufdecken klinisch noch stummer L{\"a}sionen eine prognostische Bedeutung haben. Es wurden 94 Patienten bei Erstvorstellung sowie zum 5-Jahres- und 10-Jahresverlaufszeitpunkt untersucht. Es wurde ein Zusammenhang von MEP- und SEP-Scores mit dem sp{\"a}teren Behinderungsgrad, gemessen in Form der EDSS nach f{\"u}nf und zehn jahren gefunden, sofern die elektrophysiologischen Untersuchungen in den ersten beiden Jahren nach Erstmanifestation klinischer Symptome durchgef{\"u}hrt worden waren (Gruppe 1, 44 Patienten). F{\"u}r Gruppe 2 (50 Patienten), deren Erstuntersuchung sp{\"a}ter im Verlauf stattgefunden hatte (im Mittel 9,6a) konnte keine prognostische Bedeutung gesehen werden. Die Durchf{\"u}hrung multimodaler evozierter Potenziale ist kann somit eine Hilfestellung zur fr{\"u}hzeitigen Therapieentscheidung geben.}, subject = {Multiple Sklerose}, language = {de} } @phdthesis{Subramanian2011, author = {Subramanian, Narayan}, title = {Role of NaV1.9 in activity dependent axon growth in embryonic cultured motoneurons}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-57536}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2011}, abstract = {Spontaneous neural activity has been shown to regulate crucial events in neurite growth including axonal branching and path finding. In animal models of spinal muscular atrophy (SMA) cultured embryonic mouse motoneurons show distinct defect in axon elongation and neural activity. This defect is governed by abnormal clustering of Ca2+ channels in the axonal regions and the protruding growth cone area. The mechanisms that regulate the opening of calcium channels in developing motoneurons are not yet clear. The question was addressed by blocking neural activity in embryonic cultured motoneurons by pharmacological inhibition of voltage-gated sodium channels (VGSC) by saxitoxin (STX) and tetrodotoxin (TTX). Low dosages of STX resulted in significant reduction of axon growth and neural activity in cultured motoneurons. This pharmacological treatment did not affect survival of motoneurons in comparison to control motoneurons that was grown in the presence of survival neurotrophic factors BDNF and CNTF. It was also found that STX was 10 times more potent than TTX a common inhibitor of VGSC with a reduced activity on the TTX-insensitive sodium channels NaV1.5, NaV1.8 and NaV1.9. Reverse Transcriptase-PCR experiments revealed the presence of NaV1.9 as the likely candidate that begins to express from embryonic stage sixteen in the mouse spinal cord. Immunolabelling experiments showed that the channel is expressed in the axonal compartments and axonal growth cones in cultured motoneurons. Suppression of NaV1.9 in cultured motoneurons by lentivirus mediated short hairpin-RNA (shRNA) resulted in shorter axon length in comparison with uninfected and scrambled constructs. Further, embryonic motoneurons cultured from NaV1.9 knockout mice also showed a significant reduction in neural activity and axon growth. The findings of this work highlight the role of NaV1.9 as an important contender in regulating activity dependent axon growth in embryonic cultured motoneurons. NaV1.9 could therefore be considered as a prospective molecule that could play an important role in regulating axon growth in motoneuron disease models like spinal muscular atrophy (SMA).}, subject = {Axon}, language = {en} } @phdthesis{Graulich2011, author = {Graulich, Michael}, title = {Spinale Effekte von TNF-α am Modell des tumorinduzierten Knochenschmerzes der Maus}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-54439}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2011}, abstract = {Am Modell des tumorinduzierten Schmerzes der Maus wurden sowohl das Schmerzverhalten der Tiere als auch spezifische morphologische Ver{\"a}nderungen im Hinterhorn des R{\"u}ckenmarks (Aktivierung von Astrozyten) und im tumorbefallenen Knochen analysiert. Durch Analyse von M{\"a}usen mit Defizienz f{\"u}r TNF-Rezeptor 1, TNF-Rezeptor 2 oder f{\"u}r beide Rezeptoren konnte die Rolle von TNF-α seiner Rezeptoren bei der Entstehung von tumorinduziertem Schmerz untersucht werden. Im Unterschied zu neuropathischen Schmerzmodellen konnte gezeigt werden, dass beide TNF-Rezeptoren ausgeschaltet werden m{\"u}ssen, um eine signifikante Schmerzreduktion zu erzielen. Die systemische Behandlung mit dem TNF-neutralisierenden Fusionsprotein Etanercept konnte die im genetischen Modell gezeigte Reduktion der mechanischen Allodynie teilweise, aber nicht vollst{\"a}ndig reproduzieren. Eine Hemmung der Mikrogliaaktivierung mittels Minocyclin erbrachte im Tumor-schmerzmodell keinen Effekt auf das Schmerzverhalten der Tiere. Die histologische Analyse der tumoraffizierten Knochen zeigte eine signifikante Zunahme der Osteoklastenaktivit{\"a}t in tumortragenden Tieren. Die Behandlung mit Minocyclin war ohne erkennbaren Effekt auf die Differenzierung und die Aktivit{\"a}t der Osteoklasten. Es ergaben sich jedoch Hinweise, dass TNF-α einen hemmenden Einfluss auf die Osteoklastenaktivit{\"a}t im Knochentumormodell hat, da sowohl in den TNFR-KO-Tieren als auch unter Gabe von Etanercept eine Steigerung der Osteoklastenaktivit{\"a}t nachgewiesen werden konnte. Die Ergebnisse dieser Arbeit zeigen, dass TNF-α eine wichtige Rolle, sowohl in der Entstehung, als auch in der Aufrechterhaltung von tumorinduziertem Schmerz spielt. Hier liegt der Ansatzpunkt f{\"u}r weitere Studien mit dem Ziel, eine spezifische Pharmakotherapie zu entwickeln mit wirksamer TNF-α Blockade auch bei Patienten mit Tumorschmerzen. Nach den Erkenntnissen dieser Arbeit mit Etanercept sollte ein spezielles Augenmerk auf die ZNS-G{\"a}ngigkeit dieser Substanzen gelegt werden und die Gefahr der M{\"o}glichkeit eines vermehrten Tumorwachstum bedacht werden.}, subject = {Neuralgie}, language = {de} } @article{FrerichsSirenFeuersteinetal.1992, author = {Frerichs, K. and Sir{\`e}n, Anna-Leena and Feuerstein, G. and Hallenbeck, JM}, title = {The onset of postischemic hypoperfusion in rats is precipitous and may be controlled by local neurons}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-47980}, year = {1992}, abstract = {Background and Purpose: Reperfusion following transient global cerebral ischemia is characterized by an initial hyperemic phase, which precedes hypo perfusion. The pathogenesis of these flow derangements remains obscure. Our study investigates the dynamics of postischemic cerebral blood flow changes, with particular attention to the role of local neurons. Metho(Js: We assessed local cortical blood flow continuously by laser Doppler flowmetry to permit observation of any rapid flow changes after forebrain ischemia induced by four-vessel occlusion for 20 minutes in rats. To investigate the role of local cortical neurons in the regulation of any blood flow fluctuations, five rats received intracortical microinjections of a neurotoxin (10 p,g ibotenic acid in 1 p,1; 1.5-mm-depth parietal cortex) 24 hours before ischemia to induce selective and localized neuronal depletion in an area corresponding to the sampie volume of the laser Doppler probe (1 mm3 ). Local cerebral blood flow was measured within the injection site and at an adjacent control site. Results: Ischemia was followed by marked hyperemia (235 ±23\% of control, n =7), followed by secondary hypoperfusion (45±3\% of control, n=7). The transition from hyperemia to hypoperfusioo occurred not gradually but precipitously (maximal slope of flow decay: 66±6\%/min; n=7). In ibotenic acid-injected rats, hyperemia was preserved at the injection site, but the sudden decline of blood flow was abolished (maximal slope of flow decay: 5±3\%/min compared with 53±8\%/min at the control site; n=5, p