@article{WolfBraunHainingetal.2016, author = {Wolf, Karen and Braun, Attila and Haining, Elizabeth J. and Tseng, Yu-Lun and Kraft, Peter and Schuhmann, Michael K. and Gotru, Sanjeev K. and Chen, Wenchun and Hermanns, Heike M. and Stoll, Guido and Lesch, Klaus-Peter and Nieswandt, Bernhard}, title = {Partially Defective Store Operated Calcium Entry and Hem(ITAM) Signaling in Platelets of Serotonin Transporter Deficient Mice}, series = {PLoS One}, volume = {11}, journal = {PLoS One}, number = {1}, doi = {10.1371/journal.pone.0147664}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-146399}, pages = {e0147664}, year = {2016}, abstract = {Background Serotonin (5-hydroxytryptamin, 5-HT) is an indolamine platelet agonist, biochemically derived from tryptophan. 5-HT is secreted from the enterochromaffin cells into the gastrointestinal tract and blood. Blood 5-HT has been proposed to regulate hemostasis by acting as a vasoconstrictor and by triggering platelet signaling through 5-HT receptor 2A (5HTR2A). Although platelets do not synthetize 5-HT, they take 5-HT up from the blood and store it in their dense granules which are secreted upon platelet activation. Objective To identify the molecular composite of the 5-HT uptake system in platelets and elucidate the role of platelet released 5-HT in thrombosis and ischemic stroke. Methods: 5-HT transporter knockout mice (5Htt\(^{-/-}\)) were analyzed in different in vitro and in vivo assays and in a model of ischemic stroke. Results In 5Htt\(^{-/-}\) platelets, 5-HT uptake from the blood was completely abolished and agonist-induced Ca2+ influx through store operated Ca\(^{2+}\) entry (SOCE), integrin activation, degranulation and aggregation responses to glycoprotein VI (GPVI) and C-type lectin-like receptor 2 (CLEC-2) were reduced. These observed in vitro defects in 5Htt\(^{-/-}\) platelets could be normalized by the addition of exogenous 5-HT. Moreover, reduced 5-HT levels in the plasma, an increased bleeding time and the formation of unstable thrombi were observed ex vivo under flow and in vivo in the abdominal aorta and carotid artery of 5Htt\(^{-/-}\) mice. Surprisingly, in the transient middle cerebral artery occlusion (tMCAO) model of ischemic stroke 5Htt\(^{-/-}\) mice showed nearly normal infarct volume and the neurological outcome was comparable to control mice. Conclusion Although secreted platelet 5-HT does not appear to play a crucial role in the development of reperfusion injury after stroke, it is essential to amplify the second phase of platelet activation through SOCE and plays an important role in thrombus stabilization.}, language = {en} } @article{WhiteWiederholdLoeffleretal.2016, author = {White, P. Lewis and Wiederhold, Nathan P. and Loeffler, Juergen and Najvar, Laura K. and Melchers, Willem and Herrera, Monica and Bretagne, Stephane and Wickes, Brian and Kirkpatrick, William R. and Barnes, Rosemary A. and Donnelly, J. Peter and Patterson, Thomas F.}, title = {Comparison of nonculture blood-based tests for diagnosing invasive aspergillosis in an animal model}, series = {Journal of Clinical Microbiology}, volume = {54}, journal = {Journal of Clinical Microbiology}, number = {4}, doi = {10.1128/JCM.03233-15}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-189674}, pages = {960-966}, year = {2016}, abstract = {The European Aspergillus PCR Initiative (EAPCRI) has provided recommendations for the PCR testing of whole blood (WB) and serum/plasma. It is important to test these recommended protocols on nonsimulated "in vivo" specimens before full clinical evaluation. The testing of an animal model of invasive aspergillosis (IA) overcomes the low incidence of disease and provides experimental design and control that is not possible in the clinical setting. Inadequate performance of the recommended protocols at this stage would require reassessment of methods before clinical trials are performed and utility assessed. The manuscript describes the performance of EAPCRI protocols in an animal model of invasive aspergillosis. Blood samples taken from a guinea pig model of IA were used for WB and serum PCR. Galactomannan and beta-D-glucan detection were evaluated, with particular focus on the timing of positivity and on the interpretation of combination testing. The overall sensitivities for WB PCR, serum PCR, galactomannan, and beta-D-glucan were 73\%, 65\%, 68\%, and 46\%, respectively. The corresponding specificities were 92\%, 79\%, 80\%, and 100\%, respectively. PCR provided the earliest indicator of IA, and increasing galactomannan and beta-D-glucan values were indicators of disease progression. The combination of WB PCR with galactomannan and beta-D-glucan proved optimal (area under the curve AUC], 0.95), and IA was confidently diagnosed or excluded. The EAPRCI-recommended PCR protocols provide performance comparable to commercial antigen tests, and clinical trials are warranted. By combining multiple tests, IA can be excluded or confirmed, highlighting the need for a combined diagnostic strategy. However, this approach must be balanced against the practicality and cost of using multiple tests.}, language = {en} } @article{WernerBeykanHiguchietal.2016, author = {Werner, Rudolf A. and Beykan, Seval and Higuchi, Takahiro and L{\"u}ckerath, Katharina and Weich, Alexander and Scheurlen, Michael and Bluemel, Christina and Herrmann, Ken and Buck, Andreas K. and Lassmann, Michael and Lapa, Constantin and H{\"a}nscheid, Heribert}, title = {The impact of \(^{177}\)Lu-octreotide therapy on \(^{99m}\)Tc-MAG3 clearance is not predictive for late nephropathy}, series = {Oncotarget}, volume = {7}, journal = {Oncotarget}, number = {27}, doi = {10.18632/oncotarget.9775}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-177318}, pages = {41233-41241}, year = {2016}, abstract = {Peptide Receptor Radionuclide Therapy (PRRT) for the treatment of neuroendocrine tumors may lead to kidney deterioration. This study aimed to evaluate the suitability of \(^{99m}\)Tc-mercaptoacetyltriglycine (\(^{99m}\)Tc-MAG3) clearance for the early detection of PRRT-induced changes on tubular extraction (TE). TE rate (TER) was measured prior to 128 PRRT cycles (7.6±0.4 GBq \(^{177}\)Lu-octreotate/octreotide each) in 32 patients. TER reduction during PRRT was corrected for age-related decrease and analyzed for the potential to predict loss of glomerular filtration (GF). The GF rate (GFR) as measure for renal function was derived from serum creatinine. The mean TER was 234 ± 53 ml/min/1.73 m² before PRRT (baseline) and 221 ± 45 ml/min/1.73 m² after a median follow-up of 370 days. The age-corrected decrease (mean: -3\%, range: -27\% to +19\%) did not reach significance (p=0.09) but significantly correlated with the baseline TER (Spearman p=-0.62, p<0.001). Patients with low baseline TER showed an improved TER after PRRT, high decreases were only observed in individuals with high baseline TER. Pre-therapeutic TER data were inferior to plasma creatinine-derived GFR estimates in predicting late nephropathy. TER assessed by \(^{99m}\)Tc-MAG3­clearance prior to and during PRRT is not suitable as early predictor of renal injury and an increased risk for late nephropathy.}, language = {en} } @article{UllmannSchmidtHieberBertzetal.2016, author = {Ullmann, Andrew J. and Schmidt-Hieber, Martin and Bertz, Hartmut and Heinz, Werner J. and Kiehl, Michael and Kr{\"u}ger, William and Mousset, Sabine and Neuburger, Stefan and Neumann, Silke and Penack, Olaf and Silling, Gerda and Vehreschild, J{\"o}rg Janne and Einsele, Hermann and Maschmeyer, Georg}, title = {Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016}, series = {Annals of Hematology}, volume = {95}, journal = {Annals of Hematology}, number = {9}, organization = {Infectious Diseases Working Party of the German Society for Hematology and Medical Oncology (AGIHO/DGHO) and the DAG-KBT (German Working Group for Blood and Marrow Transplantation)}, doi = {10.1007/s00277-016-2711-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-187587}, pages = {1435-1455}, year = {2016}, abstract = {Infectious complications after allogeneic haematopoietic stem cell transplantation (allo-HCT) remain a clinical challenge. This is a guideline provided by the AGIHO (Infectious Diseases Working Group) of the DGHO (German Society for Hematology and Medical Oncology). A core group of experts prepared a preliminary guideline, which was discussed, reviewed, and approved by the entire working group. The guideline provides clinical recommendations for the preventive management including prophylactic treatment of viral, bacterial, parasitic, and fungal diseases. The guideline focuses on antimicrobial agents but includes recommendations on the use of vaccinations. This is the updated version of the AGHIO guideline in the field of allogeneic haematopoietic stem cell transplantation utilizing methods according to evidence-based medicine criteria.}, language = {en} } @phdthesis{Sutor2016, author = {Sutor, Dominic Christian}, title = {Induktion von FGF19 \& FXR in humanen HT-29 Zellen unter Verwendung der nukle{\"a}ren Agonisten Vitamin D3, Vitamin A \& CDCA}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-141152}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2016}, abstract = {Ziel dieser Arbeit ist es, weitere Einblicke in die Aktivierung von FGF19 und FXR durch diverse nukle{\"a}re Agonisten und deren spezifischer Rezeptoren zu gewinnen. Hierbei soll im humanen Zellmodell versucht und mittels DNA-Analyse untersucht werden, welche messbaren molekularbiologischen Auswirkungen eine Behandlung mit unterschiedlichen Substanzen in variierenden Konzentrationen bewirkt. Genauer soll betrachtet werden, ob sich Vitamin A und Vitamin D als Induktoren von FGF19 in menschlichen Darmzelllinien eignen, da dies bereits im Mausmodel demonstriert werden konnte. Dieser initialen Vermutung folgend, sollen auch die m{\"o}glichen Wechselwirkungen und Synergismen untersucht werden - welche Mechanismen liegen diese zu Grunde und {\"u}ber welche molekularen Signalwege werden dies vermuteten Effekte vermittelt. Hierdurch soll ein besseres Verst{\"a}ndnis f{\"u}r die Rezeptor und Agonistenabh{\"a}ngigen Abl{\"a}ufe erm{\"o}glicht werden, um m{\"o}gliche R{\"u}ckschl{\"u}sse auf weitere Funktionen bereits bekannter Vertreter zu erlauben. Aufgrund der bereits oben beschriebenen Tiermodelle und der daraus gewonnenen Einsichten w{\"u}rde sich durch ein noch besseres Verst{\"a}ndnis des FGF15/19 und des Farnesoid X Rezeptors in menschlichen Zellen, auf eine zuk{\"u}nftige Anwendung in analytischen und/oder therapeutischen Bereichen hoffen lassen. Diese Arbeit soll sich deshalb den Fragen widmen, ob eine FGF19 Induktion in humanen Darmzellen durch die nukle{\"a}ren Agonisten VD3, 9-cis RA und CDCA, {\"a}hnlich dem Mausmodel, m{\"o}glich ist und welche Faktoren dabei Einfl{\"u}sse auf die beschriebenen Effekte haben.}, subject = {Fibroblastenwachstumsfaktor}, language = {de} } @article{StoelzelMohrKrameretal.2016, author = {St{\"o}lzel, F. and Mohr, B. and Kramer, M. and Oelschl{\"a}gel, U. and Bochtler, T. and Berdel, W. E. and Kaufmann, M. and Baldus, C. D. and Sch{\"a}fer-Eckart, K. and Stuhlmann, R. and Einsele, H. and Krause, S. W. and Serve, H. and H{\"a}nel, M. and Herbst, R. and Neubauer, A. and Sohlbach, K. and Mayer, J. and Middeke, J. M. and Platzbecker, U. and Schaich, M. and Kr{\"a}mer, A. and R{\"o}llig, C. and Schetelig, J. and Bornh{\"a}user, M. and Ehninger, G.}, title = {Karyotype complexity and prognosis in acute myeloid leukemia}, series = {Blood Cancer Journal}, volume = {6}, journal = {Blood Cancer Journal}, doi = {10.1038/bcj.2015.114}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-164530}, pages = {e386}, year = {2016}, abstract = {A complex aberrant karyotype consisting of multiple unrelated cytogenetic abnormalities is associated with poor prognosis in patients with acute myeloid leukemia (AML). The European Leukemia Net classification and the UK Medical Research Council recommendation provide prognostic categories that differ in the definition of unbalanced aberrations as well as the number of single aberrations. The aim of this study on 3526 AML patients was to redefine and validate a cutoff for karyotype complexity in AML with regard to adverse prognosis. Our study demonstrated that (1) patients with a pure hyperdiploid karyotype have an adverse risk irrespective of the number of chromosomal gains, (2) patients with translocation t(9;11)(p21∼22;q23) have an intermediate risk independent of the number of additional aberrations, (3) patients with 4 abnormalities have an adverse risk per se and (4) patients with three aberrations in the absence of abnormalities of strong influence (hyperdiploid karyotype, t(9;11)(p21∼22;q23), CBF-AML, unique adverse-risk aberrations) have borderline intermediate/adverse risk with a reduced overall survival compared with patients with a normal karyotype.}, language = {en} } @article{SchofferSchueleinArandetal.2016, author = {Schoffer, Olaf and Sch{\"u}lein, Stefanie and Arand, Gerlinde and Arnholdt, Hans and Baaske, Dieter and Bargou, Ralf C. and Becker, Nikolaus and Beckmann, Matthias W. and Bodack, Yves and B{\"o}hme, Beatrix and Bozkurt, Tayfun and Breitsprecher, Regine and Buchali, Andre and Burger, Elke and Burger, Ulrike and Dommisch, Klaus and Elsner, Gudrun and Fernschild, Karin and Flintzer, Ulrike and Funke, Uwe and Gerken, Michael and G{\"o}bel, Hubert and Grobe, Norbert and Gumpp, Vera and Heinzerling, Lucie and Kempfer, Lana Raffaela and Kiani, Alexander and Klinkhammer-Schalke, Monika and Kl{\"o}cking, Sabine and Kreibich, Ute and Knabner, Katrin and Kuhn, Peter and Lutze, Stine and M{\"a}der, Uwe and Maisel, Tanja and Maschke, Jan and Middeke, Martin and Neubauer, Andreas and Niedostatek, Antje and Opazo-Saez, Anabelle and Peters, Christoph and Schell, Beatrice and Schenkirsch, Gerhard and Schmalenberg, Harald and Schmidt, Peter and Schneider, Constanze and Schubotz, Birgit and Seide, Anika and Strecker, Paul and Taubenheim, Sabine and Wackes, Matthias and Weiß, Steffen and Welke, Claudia and Werner, Carmen and Wittekind, Christian and Wulff, J{\"o}rg and Zettl, Heike and Klug, Stefanie J.}, title = {Tumour stage distribution and survival of malignant melanoma in Germany 2002-2011}, series = {BMC Cancer}, volume = {16}, journal = {BMC Cancer}, number = {936}, doi = {10.1186/s12885-016-2963-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-164544}, year = {2016}, abstract = {Background Over the past two decades, there has been a rising trend in malignant melanoma incidence worldwide. In 2008, Germany introduced a nationwide skin cancer screening program starting at age 35. The aims of this study were to analyse the distribution of malignant melanoma tumour stages over time, as well as demographic and regional differences in stage distribution and survival of melanoma patients. Methods Pooled data from 61 895 malignant melanoma patients diagnosed between 2002 and 2011 and documented in 28 German population-based and hospital-based clinical cancer registries were analysed using descriptive methods, joinpoint regression, logistic regression and relative survival. Results The number of annually documented cases increased by 53.2\% between 2002 (N = 4 779) and 2011 (N = 7 320). There was a statistically significant continuous positive trend in the proportion of stage UICC I cases diagnosed between 2002 and 2011, compared to a negative trend for stage UICC II. No trends were found for stages UICC III and IV respectively. Age (OR 0.97, 95\% CI 0.97-0.97), sex (OR 1.18, 95\% CI 1.11-1.25), date of diagnosis (OR 1.05, 95\% CI 1.04-1.06), 'diagnosis during screening' (OR 3.24, 95\% CI 2.50-4.19) and place of residence (OR 1.23, 95\% CI 1.16-1.30) had a statistically significant influence on the tumour stage at diagnosis. The overall 5-year relative survival for invasive cases was 83.4\% (95\% CI 82.8-83.9\%). Conclusions No distinct changes in the distribution of malignant melanoma tumour stages among those aged 35 and older were seen that could be directly attributed to the introduction of skin cancer screening in 2008. "}, language = {en} } @article{SchmidtHieberSillingSchalketal.2016, author = {Schmidt-Hieber, M. and Silling, G. and Schalk, E. and Heinz, W. and Panse, J. and Penack, O. and Christopeit, M. and Buchheidt, D. and Meyding-Lamad{\´e}, U. and H{\"a}hnel, S. and Wolf, H. H. and Ruhnke, M. and Schwartz, S. and Maschmeyer, G.}, title = {CNS infections in patients with hematological disorders (including allogeneic stem-cell transplantation)-Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)}, series = {Annals of Oncology}, volume = {27}, journal = {Annals of Oncology}, number = {7}, doi = {10.1093/annonc/mdw155}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-188210}, pages = {1207-1225}, year = {2016}, abstract = {Infections of the central nervous system (CNS) are infrequently diagnosed in immunocompetent patients, but they do occur in a significant proportion of patients with hematological disorders. In particular, patients undergoing allogeneic hematopoietic stem-cell transplantation carry a high risk for CNS infections of up to 15\%. Fungi and Toxoplasma gondii are the predominant causative agents. The diagnosis of CNS infections is based on neuroimaging, cerebrospinal fluid examination and biopsy of suspicious lesions in selected patients. However, identification of CNS infections in immunocompromised patients could represent a major challenge since metabolic disturbances, side-effects of antineoplastic or immunosuppressive drugs and CNS involvement of the underlying hematological disorder may mimic symptoms of a CNS infection. The prognosis of CNS infections is generally poor in these patients, albeit the introduction of novel substances (e.g. voriconazole) has improved the outcome in distinct patient subgroups. This guideline has been developed by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) with the contribution of a panel of 14 experts certified in internal medicine, hematology/oncology, infectious diseases, intensive care, neurology and neuroradiology. Grades of recommendation and levels of evidence were categorized by using novel criteria, as recently published by the European Society of Clinical Microbiology and Infectious Diseases.}, language = {en} } @article{ScharbatkeBehrensSchmalzingetal.2016, author = {Scharbatke, Eva C. and Behrens, Frank and Schmalzing, Marc and Koehm, Michaela and Greger, Gerd and Gnann, Holger and Burkhardt, Harald and Tony, Hans-Peter}, title = {Association of improvement in pain with therapeutic response as determined by individual improvement criteria in patients with rheumatoid arthritis}, series = {Arthritis Care \& Research}, volume = {68}, journal = {Arthritis Care \& Research}, number = {11}, doi = {10.1002/acr.22884}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-186817}, pages = {1607-1615}, year = {2016}, abstract = {Objective To use statistical methods to establish a threshold for individual response in patient-reported outcomes (PROs) in patients with rheumatoid arthritis. Methods We used an analysis of variance model in patients on stable therapy (discovery cohort) to establish critical differences (d(crit)) for the minimum change associated with a significant individual patient response (beyond normal variation) in the PRO measures of pain (0-10), fatigue (0-10), and function (Funktionsfragebogen Hannover questionnaire; 0-100). We then evaluated PRO responses in patients initiating adalimumab in a noninterventional study (treatment cohort). Results In the discovery cohort (n=700), PROs showed excellent long-term retest reliability. The minimum change that exceeded random fluctuation was conservatively determined to be 3 points for pain, 4 points for fatigue, and 16 points for function. In the treatment cohort (n=2,788), 1,483 patients (53.2\%) achieved a significant individual therapeutic response as assessed by Disease Activity Score in 28 joints (DAS28)-d(crit) (1.8 points) after 12 months of adalimumab treatment; 68.5\% of patients with a DAS28-d(crit) response achieved a significant improvement in pain, whereas approximately 40\% achieved significant improvements in fatigue or function. Significant improvements in all 3 PROs occurred in 22.7\% of patients; 22.8\% did not have any significant PRO responses. In contrast, significant improvements in all 3 PROs occurred in only 4.4\% of 1,305 patients who did not achieve a DAS28-d(crit) response at month 12, and 59.1\% did not achieve any significant PRO responses. Conclusion The establishment of critical differences in PROs distinguishes true responses from random variation and provides insights into appropriate patient management.}, language = {en} } @article{SanMiguelEinseleMoreau2016, author = {San-Miguel, Jesus F. and Einsele, Hermann and Moreau, Philippe}, title = {The Role of Panobinostat Plus Bortezomib and Dexamethasone in Treating Relapsed or Relapsed and Refractory Multiple Myeloma: A European Perspective}, series = {Advances in Therapy}, volume = {33}, journal = {Advances in Therapy}, number = {11}, doi = {10.1007/s12325-016-0413-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-186840}, pages = {1896-1920}, year = {2016}, abstract = {Panobinostat is an oral pan-histone deacetylase inhibitor developed by Novartis. Panobinostat acts via epigenetic modification and inhibition of the aggresome pathway. In August 2015, the European Commission authorized panobinostat for use in combination with bortezomib and dexamethasone for the treatment of relapsed or relapsed and refractory multiple myeloma (MM) in patients who have received aeyen2 prior regimens including bortezomib and an immunomodulatory drug. In January 2016, the National Institute for Health and Care Excellence recommended panobinostat for use in the same combination and patient population. The authorization and recommendation were based on results from the pivotal phase 3 PANORAMA 1 (NCT01023308) clinical trial, which demonstrated an improvement in median progression-free survival of 7.8 months for the three-drug combination compared with placebo plus bortezomib and dexamethasone in this patient population. This review will discuss the current treatment landscape for relapsed/refractory MM, the mechanism of action of panobinostat, clinical data supporting the European authorization, concerns about safety and strategies for mitigating toxicity, and how panobinostat fits into the current MM landscape in Europe.}, language = {en} } @article{RechHueberFinzeletal.2016, author = {Rech, Juergen and Hueber, Axel J. and Finzel, Stephanie and Englbrecht, Matthias and Haschka, Judith and Manger, Bernhard and Kleyer, Arnd and Reiser, Michaela and Cobra, Jayme Fogagnolo and Figueiredo, Camille and Tony, Hans-Peter and Kleinert, Stefan and Wendler, Joerg and Schuch, Florian and Ronneberger, Monika and Feuchtenberger, Martin and Fleck, Martin and Manger, Karin and Ochs, Wolfgang and Schmitt-Haendle, Matthias and Lorenz, Hanns-Martin and Nuesslein, Hubert and Alten, Rieke and Henes, Joerg and Krueger, Klaus and Schett, Georg}, title = {Prediction of disease relapses by multibiomarker disease activity and autoantibody status in patients with rheumatoid arthritis on tapering DMARD treatment}, series = {Annals of the Rheumatic Diseases}, volume = {75}, journal = {Annals of the Rheumatic Diseases}, number = {9}, doi = {10.1136/annrheumdis-2015-207900}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-187519}, pages = {1637-1644}, year = {2016}, abstract = {Objective To analyse the role of multibiomarker disease activity (MBDA) score in predicting disease relapses in patients with rheumatoid arthritis (RA) in sustained remission who tapered disease modifying antirheumatic drug (DMARD) therapy in RETRO, a prospective randomised controlled trial. Methods MBDA scores (scale 1-100) were determined based on 12 inflammation markers in baseline serum samples from 94 patients of the RETRO study. MBDA scores were compared between patients relapsing or remaining in remission when tapering DMARDs. Demographic and disease-specific parameters were included in multivariate logistic regression analysis for defining predictors of relapse. Results Moderate-to-high MBDA scores were found in 33\% of patients with RA overall. Twice as many patients who relapsed (58\%) had moderate/high MBDA compared with patients who remained in remission (21\%). Baseline MBDA scores were significantly higher in patients with RA who were relapsing than those remaining in stable remission (N=94; p=0.0001) and those tapering/stopping (N=59; p=0.0001). Multivariate regression analysis identified MBDA scores as independent predictor for relapses in addition to anticitrullinated protein antibody (ACPA) status. Relapse rates were low (13\%) in patients who were MBDA-/ACPA-, moderate in patients who were MBDA+/ACPA- (33.3\%) and MBDA-ACPA+ (31.8\%) and high in patients who were MBDA+/ACPA+ (76.4\%). Conclusions MBDA improved the prediction of relapses in patients with RA in stable remission undergoing DMARD tapering. If combined with ACPA testing, MBDA allowed prediction of relapse in more than 80\% of the patients. Trial registration number EudraCT 2009-015740-42.}, language = {en} } @phdthesis{MuellerLeisse2016, author = {M{\"u}ller-Leisse, Johanna}, title = {Influence of myeloid-derived suppressor cells and neutrophil granulocytes on natural killer cell homeostasis and function}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-140734}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2016}, abstract = {Polymorphonuclear neutrophils (PMNs) are phagocytic cells of the innate immune system that efficiently kill bacteria. However, they also have regulatory effects on other immune cells and contribute to immunosuppression in cancer, which worsens the outcome. In particular, this has been demonstrated for a subset of granulocytic cells called myeloid- derived suppressor cells (MDSCs), but its distinction from PMNs is controversial. Most authors have explored the suppressive effects of MDSCs on T cells, but recent data suggest that NK cells are also affected. NK cells are crucial for the combat of tumor cells, in particular leukemic cells. There is hardly data available on the interaction between NK cells and suppressive granulocytic cells. Therefore, the aim of this thesis was to explore the effects of MDSCs and PMNs on the NK cell function against the leukemia cell line K562. In co-culture experiments, I demonstrate that granulocytic MDSCs and PMNs had similar effects on NK cell function and homeostasis. On the one hand, they positively influenced the survival and maturation of NK cells. On the other, they inhibited the activation, cytotoxicity and cytokine production of NK cells, both IFNγ and TNFα, in response to K562 target cells. Furthermore, I show a down-regulation of the activating receptor NKp30 on NK cells in the presence of MDSCs or PMNs, which may form part of the underlying suppressive mechanisms. However, there is also evidence for the involvement of other molecules. Further investigations are needed to confirm a relevant suppression of NK cells by granulocytic cells in cancer patients, and to identify therapeutic targets. The recognition that regular PMNs have similar effects on NK cells as MDSCs could simplify future experiments, since MDSCs are heterogeneous and laborious to isolate and identify. NKcells and granulocytes are among the first immune cells to reconstitute after hematopoietic stem cell transplantation, and NK cells may be particularly exposed to suppressive effects of granulocytes this scenario. Modulating these suppressive effects of granulocytes on NK cells therapeutically may yield a better NK cell function and an improved cancer prognosis. }, subject = {Nat{\"u}rliche Killerzelle}, language = {en} } @phdthesis{Moeller2016, author = {M{\"o}ller, Anne-Katrin}, title = {Prospektive Untersuchung der Inzidenz und Relevanz invasiver Mykosen bei allogen Stammzell-transplantierten Patienten sowie Evaluation der Risikofaktoren f{\"u}r systemische Pilzinfektionen}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-135852}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2016}, abstract = {Opportunistische Infektionen stellen ein ernst zu nehmendes Problem bei immunsupprimierten Patienten in der H{\"a}matologie und Onkologie sowie speziell bei Stammzell-transplantierten Patienten dar. Vor allem die Inzidenz invasiver Pilzinfektionen stieg in den letzten Jahrzehnten in diesem Risikokollektiv immer weiter an. Dabei verbleibt die Morbidit{\"a}t und Mortalit{\"a}t bei Patienten mit einer systemischen Mykose trotz verbesserter Diagnostik und Therapie weiterhin hoch. Im Rahmen dieser Studie sollte die Inzidenz und Relevanz invasiver Mykosen am Standort W{\"u}rzburg untersucht werden und die wesentlichen Risikofaktoren f{\"u}r eine Pilzinfektion bei h{\"a}matoonkologischen Hochrisiko-Patienten heraus gearbeitet werden. Um dies zu verwirklichen, wurden die Daten von 41 Patienten, welche eine allogene Stammzelltransplantation am Universit{\"a}ts-klinikum W{\"u}rzburg erhielten, detailliert dokumentiert und analysiert. Die aktive Beobachtung fand dabei bis 100 Tage nach Beginn der Konditionierungs-Chemotherapie statt. Eine Nachbetrachtung der Patientendaten in Bezug auf invasive Pilzinfektionen wurde ein halbes Jahr nach Studienstart durchgef{\"u}hrt. Zur Diagnostik von invasiven Pilzinfektionen wurden im Beobachtungszeitraum bei allen Studienteilnehmern regelm{\"a}ßig thorakale CT-Untersuchungen und Bestimmungen des Aspergillus-typischen Antigens Galactomannan im Serum durchgef{\"u}hrt. Zus{\"a}tzlich erfolgte bei einem Teil der Patienten eine PCR-Untersuchung ihres Serums auf Aspergillus-DNA. Dabei zeigte die PCR- Untersuchung eine 100\%ige Sensitivit{\"a}t und 55\%ige Spezifit{\"a}t bei einem einmalig positiven Ergebnis. Wenn zwei positive PCR-Ergebnisse gefordert wurden, war die Sensitivit{\"a}t deutlich reduziert. Bei der Betrachtung der Galactomannan-Bestimmung ergab sich eine 74\%ige Spezifit{\"a}t bei einem zweimalig positiven Ergebnis. Von den 41 Studienteilnehmern erkrankten innerhalb des ersten halben Jahres nach der Konditionierung 22\% an einer wahrscheinlichen invasiven Mykose und 17\% an einer m{\"o}glichen invasiven Mykose. Dabei waren 94\% der Erkrankungen auf den Schimmelpilz Aspergillus spp. zur{\"u}ckzuf{\"u}hren. Lediglich bei einem Patienten wurde der Schlauchpilz Fusarium spp. nachgewiesen. Systemische Hefepilzinfektionen traten nicht auf. Alle detektierten F{\"a}lle einer invasiven Pilzinfektion wiesen die Lunge als prim{\"a}ren Infektionsort auf. Der Großteil der Infektionen ereignete sich in den ersten 40 Tagen nach der Konditionierung, so waren 78\% der F{\"a}lle als fr{\"u}he Infektionen einzustufen. Als Risikofaktoren f{\"u}r die Entwicklung einer invasiven Mykose wurden in der vorliegenden Arbeit das Alter der Patienten und eine mit HLA-Missmatch durchgef{\"u}hrte Transplantation aufgedeckt. Die akute myeloische Leuk{\"a}mie als Grunderkrankung war ein weiterer, unabh{\"a}ngiger, pr{\"a}disponierender Faktor f{\"u}r eine m{\"o}gliche oder wahrscheinliche Mykose. Eine prolongierte aplastische Phase mit neutrophilen Granulozyten unter 100/µl sowie ein persistierendes neutropenes Fieber zeigten sich als Risikofaktoren f{\"u}r die Entwicklung einer m{\"o}glichen Aspergillose. In Bezug auf wahrscheinliche Pilzinfektionen zeigte sich hier jedoch kein Zusammenhang. Eine lange Fieberphase pr{\"a}sentierte sich als Hinweisfaktor f{\"u}r eine folgende m{\"o}gliche oder wahrscheinliche Infektion. Eine prolongierte Steroidzufuhr von mindestens 21 Tagen Dauer erwies sich als weiterer Risikofaktor f{\"u}r invasive m{\"o}gliche Mykosen. Das Geschlecht der Patienten, akute sowie chronische Abstoßungsreaktionen, der CMV-Status von Empf{\"a}nger und Spender und eine CMV-Reaktivierung, der HCT-CI Score, ein Nikotinabusus sowie respiratorische virale Infekte waren in der vorliegenden Studie keine signifikanten Risikofaktoren f{\"u}r eine invasive Pilzinfektion. Desweiteren waren im Studienkollektiv auch die Anzahl der verabreichten Antibiotika und ß-Lactam Antibiotika sowie die Dauer der neutropenen Phase mit weniger als 500 neutrophilen Granulozyten/µl keine relevanten Risikofaktoren f{\"u}r eine Pilzinfektion. Es zeigte sich, dass Patienten, die an einer invasiven Mykose erkrankt waren, eine signifikant l{\"a}ngere Krankenhausverweildauer hatten, als Patienten ohne Hinweis auf eine systemische Pilzinfektion. Nach einem halben Jahr Studienverlauf lag das Gesamt{\"u}berleben der Patienten bei 71,8\% (ohne 2 unklare F{\"a}lle gerechnet). Jedoch war das Auftreten einer invasiven Pilzinfektion mit einer deutlich h{\"o}heren Mortalit{\"a}t assoziiert. Nach 6 Monaten lebten von den Patienten mit einer wahrscheinlichen Mykose noch 33,3\%, wohingegen von den Patienten, welche ohne Zeichen einer Mykose als unklassifiziert eingestuft wurden, noch 84\% am Leben waren. Der Tod ereignete sich bei den Patienten mit einer m{\"o}glichen oder wahrscheinlichen Infektion im Durchschnitt 40 Tage nach der Erstdiagnose der Pilzinfektion. Zusammenfassend zeigte sich, dass der Anteil von F{\"a}llen mit invasiver Mykose im Studienkollektiv hoch lag und diese Infektion mit einer hohen Letalit{\"a}t assoziiert war. Anhand dieser Daten erscheint es indiziert, dass der Fokus bei allogen transplantierten Risiko-Patienten in Zukunft noch st{\"a}rker auf dem Erkennen dieser opportunistischen Infektionen liegen sollte, um fr{\"u}hzeitig und ad{\"a}quat intervenieren und therapieren zu k{\"o}nnen. Auch eine Aspergillus-aktive, antimykotische Prophylaxe ist f{\"u}r diesen Zeitraum zu pr{\"u}fen. Da sich die ersten 40 Tage nach der Transplantation als Hauptrisiko-Zeitraum f{\"u}r eine invasive Mykose herausgestellt haben, sollten gerade in dieser, zum Großteil station{\"a}ren, Phase besondere Anstrengungen unternommen werden, die erkrankten Patienten fr{\"u}h zu erkennen und zu behandeln. Auf diesem Wege w{\"a}re es eventuell m{\"o}glich, das Gesamt{\"u}berleben der Patienten nach einer allogenen Stammzelltransplantation noch weiter zu verbessern.}, subject = {Mykosen}, language = {de} } @article{LupianezVillaescusaCarvalhoetal.2016, author = {Lupia{\~n}ez, Carmen B. and Villaescusa, Maria T. and Carvalho, Agostinho and Springer, Jan and Lackner, Michaela and S{\´a}nchez-Maldonado, Jos{\´e} M. and Canet, Luz M. and Cunha, Cristina and Segura-Catena, Joana and Alcazar-Fuoli, Laura and Solano, Carlos and Fianchi, Luana and Pagano, Livio and Potenza, Leonardo and Aguado, Jos{\´e} M. and Luppi, Mario and Cuenca-Estrella, Manuel and Lass-Fl{\"o}rl, Cornelia and Einsele, Hermann and V{\´a}zquez, Lourdes and R{\´i}os-Tamayo, Rafael and Loeffler, J{\"u}rgen and Jurado, Manuel and Sainz, Juan}, title = {Common Genetic Polymorphisms within NF kappa B-Related Genes and the Risk of Developing Invasive Aspergillosis}, series = {Frontiers in Microbiology}, volume = {7}, journal = {Frontiers in Microbiology}, number = {1243}, doi = {10.3389/fmicb.2016.01243}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-165209}, year = {2016}, abstract = {Invasive Aspergillosis (IA) is an opportunistic infection caused by Aspergillus, a ubiquitously present airborne pathogenic mold. A growing number of studies suggest a major host genetic component in disease susceptibility. Here, we evaluated whether 14 single-nucleotide polymorphisms within NFκB1, NFκB2, RelA, RelB, Rel, and IRF4 genes influence the risk of IA in a population of 834 high-risk patients (157 IA and 677 non-IA) recruited through a collaborative effort involving the aspBIOmics consortium and four European clinical institutions. No significant overall associations between selected SNPs and the risk of IA were found in this large cohort. Although a hematopoietic stem cell transplantation (HSCT)-stratified analysis revealed that carriers of the IRF4rs12203592T/T genotype had a six-fold increased risk of developing the infection when compared with those carrying the C allele (ORREC = 6.24, 95\%CI 1.25-31.2, P = 0.026), the association of this variant with IA risk did not reach significance at experiment-wide significant threshold. In addition, we found an association of the IRF4AATC and IRF4GGTC haplotypes (not including the IRF4rs12203592T risk allele) with a decreased risk of IA but the magnitude of the association was similar to the one observed in the single-SNP analysis, which indicated that the haplotypic effect on IA risk was likely due to the IRF4rs12203592 SNP. Finally, no evidence of significant interactions among the genetic markers tested and the risk of IA was found. These results suggest that the SNPs on the studied genes do not have a clinically relevant impact on the risk of developing IA.}, language = {en} } @article{LoCascioGoetzeLatshangetal.2016, author = {Lo Cascio, Christian M. and Goetze, Oliver and Latshang, Tsogyal D. and Bluemel, Sena and Frauenfelder, Thomas and Bloch, Konrad E.}, title = {Gastrointestinal Dysfunction in Patients with Duchenne Muscular Dystrophy}, series = {PLoS ONE}, volume = {11}, journal = {PLoS ONE}, number = {10}, doi = {10.1371/journal.pone.0163779}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-166793}, pages = {e0163779}, year = {2016}, abstract = {Background In adult patients with Duchenne muscular dystrophy (DMD) life-threatening constipation has been reported. Since gastrointestinal function in DMD has not been rigorously studied we investigated objective and subjective manifestations of gastrointestinal disturbances in DMD patients. Methods In 33 patients with DMD, age 12-41 years, eating behavior and gastrointestinal symptoms were evaluated by questionnaires. Gastric emptying half time (T\(_{1/2}\)) and oro-cecal transit time (OCTT) were evaluated by analyzing \(^{13}\)CO\(_{2}\) exhalation curves after ingestion of \(^{13}\)C labeled test meals. Colonic transit time (CTT) was measured by abdominal radiography following ingestion of radiopaque markers. Results The median (quartiles) T\(_{1/2}\) was 187 (168, 220) minutes, the OCTT was 6.3 (5.0, 7.9) hours, both substantially longer than normal data (Goetze 2005, T\(_{1/2}\): 107±10; Geypens 1999, OCTT 4.3±0.1 hours). The median CTT was 60 (48, 82) hours despite extensive use of laxative measures (Meier 1995, upper limit of normal: 60 hours). T\(_{1/2}\) and OCTT did not correlate with symptoms evaluated by the Gastroparesis Cardinal Symptom Index (GCSI) (Spearman r = -0.3, p = 0.1; and r = -0.15, p = 0.4, respectively). CTT was not correlated with symptoms of constipation assessed by ROME III criteria (r = 0.12, p = 0.5). Conclusions DMD patients have a markedly disturbed gastrointestinal motor function. Since objective measures of impaired gastrointestinal transport are not correlated with symptoms of gastroparesis or constipation our findings suggest that measures assuring adequate intestinal transport should be taken independent of the patient's perception in order to prevent potentially life threatening constipation, particularly in older DMD patients.}, language = {en} } @article{LichthardtKerscherDietzetal.2016, author = {Lichthardt, Sven and Kerscher, Alexander and Dietz, Ulrich A. and Jurowich, Christian and Kunzmann, Volker and von Rahden, Burkhard H. A. and Germer, Christoph-Thomas and Wiegering, Armin}, title = {Original article: role of adjuvant chemotherapy in a perioperative chemotherapy regimen for gastric cancer}, series = {BMC Cancer}, volume = {16}, journal = {BMC Cancer}, number = {650}, doi = {10.1186/s12885-016-2708-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-147743}, year = {2016}, abstract = {Background Multimodal treatment strategies - perioperative chemotherapy (CTx) and radical surgery - are currently accepted as treatment standard for locally advanced gastric cancer. However, the role of adjuvant postoperative CTx (postCTx) in addition to neoadjuvant preoperative CTx (preCTx) in this setting remains controversial. Methods Between 4/2006 and 12/2013, 116 patients with locally advanced gastric cancer were treated with preCTx. 72 patients (62 \%), in whom complete tumor resection (R0, subtotal/total gastrectomy with D2-lymphadenectomy) was achieved, were divided into two groups, one of which receiving adjuvant therapy (n = 52) and one without (n = 20). These groups were analyzed with regard to survival and exclusion criteria for adjuvant therapy. Results Postoperative complications, as well as their severity grade, did not correlate with fewer postCTx cycles administered (p = n.s.). Long-term survival was shorter in patients receiving postCTx in comparison to patients without postCTx, but did not show statistical significance. In per protocol analysis by excluding two patients with perioperative death, a shorter 3-year survival rate was observed in patients receiving postCTx compared to patients without postCTx (3-year survival: 71.2 \% postCTx group vs. 90.0 \% non-postCTx group; p = 0.038). Conclusion These results appear contradicting to the anticipated outcome. While speculative, they question the value of post-CTx. Prospectively randomized studies are needed to elucidate the role of postCTx.}, language = {en} } @article{KuntzenKuhnKuntzenetal.2016, author = {Kuntzen, Thomas and Kuhn, Sereina and Kuntzen, Daniela and Seifert, Burkhardt and M{\"u}llhaupt, Beat and Geier, Andreas}, title = {Influence of Ribavirin Serum Levels on Outcome of Antiviral Treatment and Anemia in Hepatitis C Virus Infection}, series = {PLoS ONE}, volume = {11}, journal = {PLoS ONE}, number = {7}, doi = {10.1371/journal.pone.0158512}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-166888}, pages = {e0158512}, year = {2016}, abstract = {Background Ribavirin blood levels vary considerably between patients with standard weight-based dosing. Their impact on sustained virological response (SVR) with pegylated interferon and ribavirin is controversial, but has mostly been studied before the IL28b gene polymorphism as a possible confounder was discovered. Methods The impact of serum ribavirin trough levels at week 4, at the end of treatment and of mean levels across the entire antiviral treatment with pegylated interferon and ribavirin on relapse, SVR rates and anemia was retrospectively studied by univariate and multivariable logistic regression analyses in 214 patients with HCV genotype 1-4 infection, including 88 patients with available IL28b genotyping. Results Mean ribavirin levels varied between 0.68-5.65 mg/l and significantly differed between patients with or without SVR. By multivariable regression including age, sex, HCV viral load, HCV genotype, liver fibrosis stage, prior treatments, immunosuppression and IL28b genotype, ribavirin levels consistently displayed significant influence on SVR and relapse without indication for a specific importance of higher concentrations early or late in the treatment course. Although hemoglobin decline was on average more pronounced in patients with higher ribavirin levels, hemoglobin remained relatively stable in a significant proportion of these, indicating that ribavirin levels alone are insufficient to predict anemia. Conclusion While data are scarce to draw conclusions applicable for modern DAA therapies, these results support ribavirin treatment based on serum levels instead of purely weight-based dosing in combination with pegylated interferon.}, language = {en} } @article{KrajinovicReimerKudlichetal.2016, author = {Krajinovic, K. and Reimer, S. and Kudlich, T. and Germer, C. T. and Wiegering, A.}, title = {"Rendezvous technique" for intraluminal vacuum therapy of anastomotic leakage of the jejunum}, series = {Surgical Case Reports}, volume = {2}, journal = {Surgical Case Reports}, number = {114}, doi = {10.1186/s40792-016-0243-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-147883}, year = {2016}, abstract = {Background Anastomotic leakage (AL) is one of the most common and serious complications following visceral surgery. In recent years, endoluminal vacuum therapy has dramatically changed therapeutic options for AL, but its use has been limited to areas easily accessible by endoscope. Case presentation We describe the first use of endoluminal vacuum therapy in the small intestine employing a combined surgical and endoscopic "rendezvous technique" in which the surgeon assists the endoscopic placement of an endoluminal vacuum therapy sponge in the jejunum by means of a pullback string. This technique led to a completely closed AL after 27 days and 7 changes of the endosponge. Conclusion The combined surgical and endoscopic rendezvous technique can be useful in cases of otherwise difficult endosponge placement.}, language = {en} } @article{KepplerWeissbachLangeretal.2016, author = {Keppler, Sarah and Weißbach, Susann and Langer, Christian and Knop, Stefan and Pischimarov, Jordan and Kull, Miriam and St{\"u}hmer, Thorsten and Steinbrunn, Torsten and Bargou, Ralf and Einsele, Hermann and Rosenwald, Andreas and Leich, Ellen}, title = {Rare SNPs in receptor tyrosine kinases are negative outcome predictors in multiple myeloma}, series = {Oncotarget}, volume = {7}, journal = {Oncotarget}, number = {25}, doi = {10.18632/oncotarget.9607}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-177840}, pages = {38762-38774}, year = {2016}, abstract = {Multiple myeloma (MM) is a plasma cell disorder that is characterized by a great genetic heterogeneity. Recent next generation sequencing studies revealed an accumulation of tumor-associated mutations in receptor tyrosine kinases (RTKs) which may also contribute to the activation of survival pathways in MM. To investigate the clinical role of RTK-mutations in MM, we deep-sequenced the coding DNA-sequence of EGFR, EPHA2, ERBB3, IGF1R, NTRK1 and NTRK2 which were previously found to be mutated in MM, in 75 uniformly treated MM patients of the "Deutsche Studiengruppe Multiples Myelom". Subsequently, we correlated the detected mutations with common cytogenetic alterations and clinical parameters. We identified 11 novel non-synonymous SNVs or rare patient-specific SNPs, not listed in the SNP databases 1000 genomes and dbSNP, in 10 primary MM cases. The mutations predominantly affected the tyrosine-kinase and ligand-binding domains and no correlation with cytogenetic parameters was found. Interestingly, however, patients with RTK-mutations, specifically those with rare patient-specific SNPs, showed a significantly lower overall, event-free and progression-free survival. This indicates that RTK SNVs and rare patient-specific RTK SNPs are of prognostic relevance and suggests that MM patients with RTK-mutations could potentially profit from treatment with RTK-inhibitors.}, language = {en} } @article{KasangKalluvyaMajingeetal.2016, author = {Kasang, Christa and Kalluvya, Samuel and Majinge, Charles and Kongola, Gilbert and Mlewa, Mathias and Massawe, Irene and Kabyemera, Rogatus and Magambo, Kinanga and Ulmer, Albrecht and Klinker, Hartwig and Gschmack, Eva and Horn, Anne and Koutsilieri, Eleni and Preiser, Wolfgang and Hofmann, Daniela and Hain, Johannes and M{\"u}ller, Andreas and D{\"o}lken, Lars and Weissbrich, Benedikt and Rethwilm, Axel and Stich, August and Scheller, Carsten}, title = {Effects of Prednisolone on Disease Progression in Antiretroviral-Untreated HIV Infection: A 2-Year Randomized, Double-Blind Placebo-Controlled Clinical Trial}, series = {PLoS One}, volume = {11}, journal = {PLoS One}, number = {1}, doi = {10.1371/journal.pone.0146678}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-146479}, pages = {e0146678}, year = {2016}, abstract = {Background HIV-disease progression correlates with immune activation. Here we investigated whether corticosteroid treatment can attenuate HIV disease progression in antiretroviral-untreated patients. Methods Double-blind, placebo-controlled randomized clinical trial including 326 HIV-patients in a resource-limited setting in Tanzania (clinicaltrials.gov NCT01299948). Inclusion criteria were a CD4 count above 300 cells/μl, the absence of AIDS-defining symptoms and an ART-na{\"i}ve therapy status. Study participants received 5 mg prednisolone per day or placebo for 2 years. Primary endpoint was time to progression to an AIDS-defining condition or to a CD4-count below 200 cells/μl. Results No significant change in progression towards the primary endpoint was observed in the intent-to-treat (ITT) analysis (19 cases with prednisolone versus 28 cases with placebo, p = 0.1407). In a per-protocol (PP)-analysis, 13 versus 24 study participants progressed to the primary study endpoint (p = 0.0741). Secondary endpoints: Prednisolone-treatment decreased immune activation (sCD14, suPAR, CD38/HLA-DR/CD8+) and increased CD4-counts (+77.42 ± 5.70 cells/μl compared to -37.42 ± 10.77 cells/μl under placebo, p < 0.0001). Treatment with prednisolone was associated with a 3.2-fold increase in HIV viral load (p < 0.0001). In a post-hoc analysis stratifying for sex, females treated with prednisolone progressed significantly slower to the primary study endpoint than females treated with placebo (ITT-analysis: 11 versus 21 cases, p = 0.0567; PP-analysis: 5 versus 18 cases, p = 0.0051): No changes in disease progression were observed in men. Conclusions This study could not detect any significant effects of prednisolone on disease progression in antiretroviral-untreated HIV infection within the intent-to-treat population. However, significant effects were observed on CD4 counts, immune activation and HIV viral load. This study contributes to a better understanding of the role of immune activation in the pathogenesis of HIV infection.}, language = {en} }