@phdthesis{Ostertag2023, author = {Ostertag, Viktoria Charlotte Caroline}, title = {Pr{\"a}ventive und therapeutische Behandlung mit einem CSF-1-Rezeptorinhibitor bei verschiedenen Charcot-Marie-Tooth Mausmodellen}, doi = {10.25972/OPUS-30852}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-308528}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {Die Charcot-Marie-Tooth-Neuropathie umfasst eine heterogene Gruppe von erblichen unter anderem demyelinisierenden Erkrankungen des peripheren Nervensystems. Trotz ihrer hohen Pr{\"a}valenz von 1:2.500 gibt es bis dato keine kausalen Therapiem{\"o}glichkeiten. Durch den progressiven Krankheitsverlauf wird die Lebensqualit{\"a}t der Patienten stetig gemindert; der fortschreitende Verlust der Muskelkraft und St{\"o}rungen des Gangbildes sind besonders belastend. Urs{\"a}chlich f{\"u}r die CMT1-Neuropathie sind unter anderem Mutationen in Genen, die f{\"u}r Molek{\"u}le des Myelins von Schwannzellen codieren. Diese Mutationen f{\"u}hren zu einer verminderten Stabilit{\"a}t und Funktion des Myelins und so letzten Endes zu einer Demyelinisierung und axonalen Sch{\"a}digung der peripheren Nerven. Weitere Studien in CMT1-Mausmodellen zeigten jedoch, dass nicht nur die verringerte Myelinstabilit{\"a}t sondern auch eine durch das Immunsystem vermittelte geringgradige Entz{\"u}ndungsreaktion f{\"u}r die Symptome urs{\"a}chlich sein k{\"o}nnte. Hier spielen vor allem Makrophagen eine zentrale Rolle. Das Zytokin CSF-1 aktiviert die Makrophagen und verursacht so eine Demyelinisierung der peripheren Nerven. In P0het und Cx32def Mausmodellen konnte nachgewiesen werden, dass eine medikament{\"o}se Inhibition des CSF-1-Rezeptors an Makrophagen zu einem verbesserten Nervph{\"a}notypen und einer deutlichen Abmilderung des Krankheitsbildes f{\"u}hrte. In dieser Arbeit wurden in P0het und Cx32def Mausmodellen weiterf{\"u}hrende Behandlungsstudien mit einem CSF-1-RI durchgef{\"u}hrt, die untersuchen, zu welchem Zeitpunkt innerhalb des Krankheitsverlaufs (therapeutisch oder pr{\"a}ventiv) eine erfolgreiche Therapie noch m{\"o}glich ist und ob bei einem fr{\"u}heren Beginn eine noch bessere Wirkung erzielt werden kann. Abh{\"a}ngig von den verschiedenen Start- und Endpunkten waren unterschiedliche Ergebnisse zu beobachten: Hinsichtlich der klinischen Parameter wie der Greifkraft und der Anzahl an abnormal innervierten Synapsen zeigten die Tiere im pr{\"a}ventiven Behandlungszweig in beiden Mausmodellen das beste Ergebnis im Vergleich zu den Kontrolltieren. Diese substantielle Verbesserung ließ sich unabh{\"a}ngig von einem Makrophagen-Reflux sogar noch 6 Monate nach Behandlungsabbruch nachweisen. Bez{\"u}glich der endoneuralen Makrophagendepletion war sowohl in den P0het als auch den Cx32def Tieren im pr{\"a}ventiven sowie im therapeutischen Behandlungszweig eine signifikante Verbesserung zu beobachten. Diese Ergebnisse heben ein weiteres Mal die Bedeutung der Makrophagen als Teil einer Entz{\"u}ndungsreaktion in der Pathogenese der CMT1-Neuropathie hervor. Des Weiteren konnte die These gefestigt werden, dass eine Inhibition des CSF-1-Rezeptors zu verbesserten histopathologischen sowie funktionellen Parametern f{\"u}hrt. Um ein gutes Ansprechen auf die Therapie zu erzielen, m{\"u}ssen ein m{\"o}glichst fr{\"u}her Therapiebeginn sowie eine nachhaltige Behandlungsdauer gew{\"a}hrleistet sein.}, subject = {Charcot-Marie-Syndrom}, language = {de} } @phdthesis{Pausch2017, author = {Pausch, Jonas Franz}, title = {Pr{\"a}ferentielle Lokalisation von Makrophagen im r{\"a}umlichen Umfeld von Ranvier'schen Schn{\"u}rringen - Morphologische Analysen zur r{\"a}umlichen Verteilung von Makrophagen in Mausmodellen f{\"u}r erbliche Neuropathien}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-143801}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2017}, abstract = {Die Charcot-Marie-Tooth Typ 1 Erkrankungen sind eine genetisch heterogene Gruppe, aktuell nicht kurativ therapierbarer, erblicher Neuropathien des Peripheren Nervensystems. Klinische Manifestationen reichen von Sensibilit{\"a}ts-st{\"o}rungen, verminderten Muskeleigenreflexen, sowie fortschreitenden L{\"a}hmungen, bis hin zu Muskelatrophie und bedeuten f{\"u}r die betroffenen Patienten eine starke Einschr{\"a}nkung der Lebensqualit{\"a}t. Anhand fr{\"u}herer Studien wurde Makrophagen, als Teil des angeborenen Immunsystems, eine entscheidende Rolle in der Pathogenese dreier CMT1-Unterformen zugeschrieben. Abgesehen von den morphologischen Manifestationen der demyelinisierenden CMT1-Erkrankungen, wie simultanes Auftreten von Dedifferenzierung, sowie Hypo-, und Demyelinisierung erkrankter Schwann-Zellen, sind pathologische Ver{\"a}nderungen der Dom{\"a}nengliederung der Ranvier'schen Schn{\"u}rringe betroffener Nervenfasern ebenfalls von der Aktivierung pathogener Makrophagen abh{\"a}ngig. Auf der Basis verschiedener ver{\"o}ffentlichter Studien, welche sowohl demyelinisierende Erkrankungen des ZNS, aber auch prim{\"a}r durch axonale Sch{\"a}den gekennzeichnete Erkrankungen des PNS beinhalten, besteht ein m{\"o}glicher r{\"a}umlicher Zusammenhang zwischen Architekturst{\"o}rungen der RS und aktivierten pathogenen Mikrogliazellen bzw. Makrophagen. In dieser Studie konnte, anhand morphologischer Analysen von peripherem Nervengewebe, in Wt-M{\"a}usen erstmals eine unerwartete pr{\"a}ferentielle Lokalisation von Makrophagen im r{\"a}umlichen Umfeld von RS beobachtet werden. Hierbei scheint, trotz des Fehlens einer direkten Zell-Zell-Interaktion zwischen Makrophagen und RS, vor allem im Hinblick auf die ebenfalls im r{\"a}umlichen Umfeld von RS nachweisbare EZM und Fibroblasten, eine funktionelle Relevanz der assoziierten Makrophagen f{\"u}r die Aufrechterhaltung der Dom{\"a}nengliederung bzw. elektrophysiologischen Eigenschaften myelinisierter peripherer Nervenfasern denkbar. Im Gegensatz dazu wurde trotz der signifikanten Zunahme der Makrophagenanzahlen in den drei untersuchten CMT1-Mausmodellen keine erh{\"o}hte r{\"a}umliche Assoziation mit den RS der mutierten Schwann-Zellen beobachtet. Vielmehr konnten anhand des Vergleiches mit wildtypischen Kontrollm{\"a}usen signifikant erniedrigte Assoziationsraten beider Strukturen in den CMT1-Modelltieren festgestellt werden. Folglich scheint die von der Einwanderung und Aktivierung pathogener Makrophagen abh{\"a}ngige St{\"o}rung der Dom{\"a}nengliederung der RS der mutierten Schwann-Zellen, nicht durch eine direkte Interaktion bzw. r{\"a}umliche Assoziation von Makrophagen mit RS ausgel{\"o}st zu werden.}, subject = {Makrophagen}, language = {de} } @phdthesis{Beaucamp2021, author = {Beaucamp, Marcel}, title = {Pr{\"a}diktion des Verschlusses großer intrakranieller Arterien anhand pr{\"a}klinischer Schlaganfallscores}, doi = {10.25972/OPUS-21511}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-215117}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {2015 konnte in mehreren Studien ESCAPE, EXTENDED IA, MR CLEAN, REVASCAT, SWIFT-PRIME eine signifikante {\"U}berlegenheit der mechanischen Thrombektomie verglichen mit der alleinigen i. v. Lysetherapie mit rtPA bezogen auf Revaskularisierung bei Patienten mit einer LVO (large vessel occlusion) nachgewiesen werden. Diese neue Therapiem{\"o}glichkeit erforderte eine Aufteilung der Patienten die von einer Thrombektomie profitieren (LVO) und der Patienten, die keiner Thrombektomie zugef{\"u}hrt werden k{\"o}nnen (nLVO). Die zentrale Fragestellung der Studie ist: Kann ein symptomorientierter Schlaganfallscore die Wahrscheinlichkeit eines großen intrakraniellen Gef{\"a}ßverschlusses mit hinreichender Pr{\"a}zision vorhersagen und kann auf Basis dieser Vorhersage ein Patient direkt in ein {\"u}bergeordnetes Schlagfanfallzentrum gebracht werden, obwohl sich dadurch eine Bridging Lysetherapie verz{\"o}gern w{\"u}rde? Um diesen Fragen auf den Grund zu gehen f{\"u}hrten wir eine monozentrische Querschnittstudie durch, in deren Rahmen 215 Patienten rekrutiert wurden. Die Rekrutierung erfolgte mittels eines aus Subitems bereits etablierter Schlafanfallscores (FAST, CPSS, LAPSS, 3ISS, RACE), zusammengesetzten Fragebogens. Die ausgef{\"u}llten Frageb{\"o}gen wurde in Excel digitalisiert und mittels SPSS, Signifikanz und Odds Ratio berechnet. Anschließend wurde aus den signifikanten Subitems mit der h{\"o}chsten Odds Ratio ein neuer einfach anzuwendender Schlaganfallscore, bestehend aus den pr{\"a}klinisch erhobenen Daten gebildet (W{\"u}rzburg Score of Large Vessel Occlusions, WOLVE- Score). Weiter wurden Signifikanz, Odds Ratio, Sensitivit{\"a}t und Spezifit{\"a}t des WOLVE-Score mit denen der oben genannten etablieren Scores verglichen.}, subject = {Schlaganfall}, language = {de} } @phdthesis{Moenter2004, author = {M{\"o}nter, Boris}, title = {Protonenempfindlichkeit von Spinalganglienneuronen bei Wildtypm{\"a}usen und Mausmutanten mit einem Mangel an TRPV 1 oder ASIC 3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-10271}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2004}, abstract = {In den letzten Jahren wurden große Fortschritte in der Aufkl{\"a}rung von Mechanismen der Protonensensibilit{\"a}t auf molekularer Ebene gemacht, die ein wesentliches Element der Nozizeption darstellt. In dieser Arbeit wurde der Einfluss von den in diesem Zusammenhang entdeckten Kan{\"a}len TRPV1 und ASIC3 auf die Protonensensitivit{\"a}t von nativen Spinalganglienneuronen, sowie Unterschiede zwischen der IB4-positiven und der IB4-negativen Population untersucht. Hierzu wurden Patch-Clamp-Studien an isolierten Neuronen von TRPV1-defizienten und ASIC3-defizienten M{\"a}usen durchgef{\"u}hrt. Die Ergebnisse dieser Experimente best{\"a}tigen dabei die wesentliche Rolle von TRPV1 f{\"u}r die Protonensensibilit{\"a}t. Insbesondere f{\"u}r nicht desensibilisierende Komponenten von protoneninduzierten Str{\"o}men, die f{\"u}r die Transduktion extrazellu{\"a}rer azidotischer Schmerzzust{\"a}nde in eine anhaltende Erregung des nozizeptiven Systems verantwortlich sind, ist TRPV1 von großer Bedeutung. Diese sind in den TRPV1-defizienten Neuronen stark reduziert. Der Einfluss von ASIC3 auf diese Komponenten ist hingegen gering, auch wenn es Hinweise auf eine Beteiligung dieses Rezeptors an diesen Komponenten gibt. Gr{\"o}ßere Bedeutung hat ASIC3 f{\"u}r schnell desensibilisierende Komponenten der Reaktion dieser Neurone auf Protonen, die von ASIC3-defizienten seltener als von Wildtyp-Neuronen gezeigt werden. Die Bedeutung dieser transienten Komponenten ist nicht gekl{\"a}rt, wahrscheinlich erf{\"u}llen sie eine modulatorische Funktion, nicht nur im nozizeptiven System. Noch wenig ist {\"u}ber die funktionellen Unterschiede der zwei verschiedenen Subpopulationen nozizeptiver Neurone bekannt, die durch die Bindung des Isolektins B4 differenziert werden k{\"o}nnen. Diese Arbeit gibt Hinweise darauf, dass sich diese auch in ihrer Protonensensitivit{\"a}t unterscheiden. Das k{\"o}nnte Ausdruck daf{\"u}r sei, dass diese an der Wahrnehmung unterschiedlicher Schmerzzust{\"a}nde beteiligt sind. Die Charakterisierung der Mechanismen des komplexen nozizeptiven Systems auf zellul{\"a}rer und molekularer Ebene ist Vorraussetzung zur Entwicklung von gezielt wirkenden, analgetischen Pharmaka. Die schon lange bekannte Wirksamkeit von Capsaicin - dem wohl bekanntesten Agonisten von TRPV1 - bei verschiedenen schmerzhaften Zust{\"a}nden und fortschreitende Erkenntnisse {\"u}ber die Bedeutung dieses und der ASIC-Rezeptoren bei der Wahrnehmung von schmerzassoziierter Gewebsazidose, zeigt Wege auf, {\"u}ber die solche Medikamente ihre Wirkung entfalten k{\"o}nnten.}, language = {de} } @phdthesis{Peterka2021, author = {Peterka, Manuel}, title = {Propriozeptive St{\"o}rungen bei Morbus Parkinson - Explorative Untersuchungen zu Art, Ausmaß und potenzieller Rekalibrierung mithilfe der LSVT-BIG-Therapie}, doi = {10.25972/OPUS-22612}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-226129}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {Beim idiopathischen Parkinson Syndrom (IPS) gewinnen nicht-motorische Symptome in Forschung und Klinik zunehmend an Bedeutung. So findet sich in der Literatur vermehrt Evidenz, dass die Propriozeption bei Patienten mit IPS (PmIPS) gest{\"o}rt ist. Verschiedene klinische und neuroanatomische Studien weisen darauf hin, dass es beim IPS zu einer fehlerhaften sensomotorischen Integration von propriozeptiven Informationen in den Basalganglien kommt. Zudem gibt es Hinweise, dass die passiv-sensible Wahrnehmung von Propriozeption pathologisch ver{\"a}ndert ist. Außerdem wird vermutet, dass durch propriozeptives Training eine Verbesserung der Parkinsonsymptomatik erreicht werden kann. Ein spezielles Trainingsprogramm, die LSVT-BIG-Therapie, bei der gezielt trainiert wird, Bewegungen mit einer großen Amplitude durchzuf{\"u}hren, konnte motorische Symptome und Mobilit{\"a}t beim IPS effektiv verbessern. In der vorliegenden Arbeit stellten wir folgende Hypothesen auf: Das IPS geht mit einer fehlerhaften sensomotorischen Integration von Propriozeption einher. Die afferente propriozeptive Wahrnehmung ist ebenfalls pathologisch ver{\"a}ndert. Eine propriozeptive Rekalibrierung ist mithilfe der LSVT-BIG-Therapie m{\"o}glich. F{\"u}r die {\"U}berpr{\"u}fung dieser Hypothesen schlossen wir 30 PmIPS und 15 gesunde Probanden in unsere Fall-Kontroll-Studie ein und f{\"u}hrten eine Eingangsuntersuchung durch. 11 PmIPS absolvierten anschließend eine vierw{\"o}chige LSVT-BIG-Therapie. Die Folgeuntersuchungen fanden 4 und 8 Wochen nach der Eingangsuntersuchung statt. 78 Diese beinhalteten neuropsychologische Testungen, außerdem die Bestimmung der Lebensqualit{\"a}t, die Erhebung des motorischen Teils der Movement Disorder Society Unified Parkinson´s Disease Rating Scale (MDS-UPDRS III), Untersuchungen zur Feinmotorik, die Durchf{\"u}hrung einer diagnostischen Transkraniellen Magnetstimulation (TMS) sowie Testverfahren zur Propriozeption, darunter sowohl Zeigeversuche, als auch die Bestimmung der Position einer Extremit{\"a}t, ohne visuelle Kontrolle. Die Ergebnisse zeigten, dass die IPS-Gruppe gegen{\"u}ber der gesunden Kontrollgruppe signifikant gr{\"o}ßere Zeigefehler machte, wohingegen die Bestimmung der Position einer Extremit{\"a}t in beiden Gruppen vergleichbar pr{\"a}zise m{\"o}glich war. Zus{\"a}tzlich zeigte eine von sieben Messungen der Feinmotorik einen signifikanten Unterschied zwischen PmIPS und Kontrollen. Die Messungen der TMS erbrachten hingegen keine signifikant messbaren Unterschiede zwischen den Gruppen. In den Folgeuntersuchungen nach therapeutischer Intervention ergaben die Zeige{\"u}bungen eine signifikante Verbesserung der BIG-Gruppe im Zeitverlauf. Die Untersuchungen zu Feinmotorik und MDS-UPDRS III ergaben zwar eine tendenzielle Verbesserung durch die LSVT-BIG-Therapie, waren jedoch statistisch nicht signifikant. Die Lebensqualit{\"a}t der PmIPS in der BIG-Gruppe verbesserte sich signifikant nach Intervention. Die Ergebnisse sprechen f{\"u}r die Hypothese der fehlerhaften propriozeptiven Integration beim Morbus Parkinson. Dies zeigte sich f{\"u}r aktive sensomotorische Tasks, nicht hingegen in der passiv-sensiblen propriozeptiven Testung. Auch wenn weitere Studien mit gr{\"o}ßeren Kohorten ben{\"o}tigt werden, legt unsere Studie nahe, dass die LSVT-BIG-Therapie mit einer propriozeptiven Rekalibrierung einhergeht. Damit erkl{\"a}rt sich m{\"o}glicherweise der nachhaltige Erfolg der Therapie.}, subject = {Propriozeption}, language = {de} } @article{SteinhardtWiercinskaPhametal.2020, author = {Steinhardt, M. J. and Wiercinska, E. and Pham, M. and Grigoleit, G. U. and Mazzoni, A. and Da-Via, M. and Zhou, X. and Meckel, K. and Nickel, K. and Duell, J. and Krummenast, F. C. and Kraus, S. and Hopkinson, C. and Weissbrich, B. and M{\"u}llges, W. and Stoll, G. and Kort{\"u}m, K. M. and Einsele, H. and Bonig, H. and Rasche, L.}, title = {Progressive multifocal leukoencephalopathy in a patient post allo-HCT successfully treated with JC virus specific donor lymphocytes}, series = {Journal of Translational Medicine}, volume = {18}, journal = {Journal of Translational Medicine}, doi = {10.1186/s12967-020-02337-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-229307}, year = {2020}, abstract = {Background Progressive multifocal leukoencephalopathy is a demyelinating CNS disorder. Reactivation of John Cunningham virus leads to oligodendrocyte infection with lysis and consequent axonal loss due to demyelination. Patients usually present with confusion and seizures. Late diagnosis and lack of adequate therapy options persistently result in permanent impairment of brain functions. Due to profound T cell depletion, impairment of T-cell function and potent immunosuppressive factors, allogeneic hematopoietic cell transplantation recipients are at high risk for JCV reactivation. To date, PML is almost universally fatal when occurring after allo-HCT. Methods To optimize therapy specificity, we enriched JCV specific T-cells out of the donor T-cell repertoire from the HLA-identical, anti-JCV-antibody positive family stem cell donor by unstimulated peripheral apheresis [1]. For this, we selected T cells responsive to five JCV peptide libraries via the Cytokine Capture System technology. It enables the enrichment of JCV specific T cells via identification of stimulus-induced interferon gamma secretion. Results Despite low frequencies of responsive T cells, we succeeded in generating a product containing 20 000 JCV reactive T cells ready for patient infusion. The adoptive cell transfer was performed without complication. Consequently, the clinical course stabilized and the patient slowly went into remission of PML with JCV negative CSF and containment of PML lesion expansion. Conclusion We report for the first time feasibility of generating T cells with possible anti-JCV activity from a seropositive family donor, a variation of virus specific T-cell therapies suitable for the post allo transplant setting. We also present the unusual case for successful treatment of PML after allo-HCT via virus specific T-cell therapy.}, language = {en} } @phdthesis{Yin2023, author = {Yin, Jing}, title = {Progressive alterations of pro- and antidegeneration markers in the nigrostriatal tract of the AAV1/2-A53T-α synuclein rat model of Parkinson's disease}, doi = {10.25972/OPUS-26064}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-260645}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {Neurodegeneration plays an essential role in Parkinson's disease (PD). Several crucial neuronal pro-and antidegeneration markers were described to be altered in disease models accompanied by neurodegeneration. In the AAV1/2-A53T-aSyn PD rat model progressive time-dependent motor impairment and neurodegeneration in the nigrostriatal tract starting from 2 weeks after PD model induction could be found. Downregulation of Nrf2 in SN and nigrostriatal axon localization, a trend of Tau downregulation in SN and upregulation in axon localization in the AAV1/2-A53T-aSyn PD rat model were observed, indicating potential therapeutic value of these two molecular targets in PD. No alterations of SARM1 and NMNAT2 could be detected, indicating little relevance of these two molecules with our AAV1/2-A53T-aSyn rat model.}, 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{GoepfertTraubSelletal.2023, author = {G{\"o}pfert, Dennis and Traub, Jan and Sell, Roxane and Homola, Gy{\"o}rgy A. and Vogt, Marius and Pham, Mirko and Frantz, Stefan and St{\"o}rk, Stefan and Stoll, Guido and Frey, Anna}, title = {Profiles of cognitive impairment in chronic heart failure—A cluster analytic approach}, series = {Frontiers in Human Neuroscience}, volume = {17}, journal = {Frontiers in Human Neuroscience}, doi = {10.3389/fnhum.2023.1126553}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-313429}, year = {2023}, abstract = {Background Cognitive impairment is a major comorbidity in patients with chronic heart failure (HF) with a wide range of phenotypes. In this study, we aimed to identify and compare different clusters of cognitive deficits. Methods The prospective cohort study "Cognition.Matters-HF" recruited 147 chronic HF patients (aged 64.5 ± 10.8 years; 16.2\% female) of any etiology. All patients underwent extensive neuropsychological testing. We performed a hierarchical cluster analysis of the cognitive domains, such as intensity of attention, visual/verbal memory, and executive function. Generated clusters were compared exploratively with respect to the results of cardiological, neurological, and neuroradiological examinations without correction for multiple testing. Results Dendrogram and the scree plot suggested three distinct cognitive profiles: In the first cluster, 42 patients (28.6\%) performed without any deficits in all domains. Exclusively, the intensity of attention deficits was seen in the second cluster, including 55 patients (37.4\%). A third cluster with 50 patients (34.0\%) was characterized by deficits in all cognitive domains. Age (p = 0.163) and typical clinical markers of chronic HF, such as ejection fraction (p = 0.222), 6-min walking test distance (p = 0.138), NT-proBNP (p = 0.364), and New York Heart Association class (p = 0.868) did not differ between clusters. However, we observed that women (p = 0.012) and patients with previous cardiac valve surgery (p = 0.005) prevailed in the "global deficits" cluster and the "no deficits" group had a lower prevalence of underlying arterial hypertension (p = 0.029). Total brain volume (p = 0.017) was smaller in the global deficit cluster, and serum levels of glial fibrillary acidic protein were increased (p = 0.048). Conclusion Apart from cognitively healthy and globally impaired HF patients, we identified a group with deficits only in the intensity of attention. Women and patients with previous cardiac valve surgery are at risk for global cognitive impairment when suffering HF and could benefit from special multimodal treatment addressing the psychosocial condition.}, language = {en} } @article{DeebGiordanoRossietal.2016, author = {Deeb, Wissam and Giordano, James J. and Rossi, Peter J. and Mogilner, Alon Y. and Gunduz, Aysegul and Judy, Jack W. and Klassen, Bryan T. and Butson, Christopher R. and Van Horne, Craig and Deny, Damiaan and Dougherty, Darin D. and Rowell, David and Gerhardt, Greg A. and Smith, Gwenn S. and Ponce, Francisco A. and Walker, Harrison C. and Bronte-Stewart, Helen M. and Mayberg, Helen S. and Chizeck, Howard J. and Langevin, Jean-Philippe and Volkmann, Jens and Ostrem, Jill L. and Shute, Jonathan B. and Jimenez-Shahed, Joohi and Foote, Kelly D. and Wagle Shukla, Aparna and Rossi, Marvin A. and Oh, Michael and Pourfar, Michael and Rosenberg, Paul B. and Silburn, Peter A. and de Hemptine, Coralie and Starr, Philip A. and Denison, Timothy and Akbar, Umer and Grill, Warren M. and Okun, Michael S.}, title = {Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies}, series = {Frontiers in Integrative Neuroscience}, volume = {10}, journal = {Frontiers in Integrative Neuroscience}, number = {38}, doi = {10.3389/fnint.2016.00038}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-168493}, year = {2016}, abstract = {This paper provides an overview of current progress in the technological advances and the use of deep brain stimulation (DBS) to treat neurological and neuropsychiatric disorders, as presented by participants of the Fourth Annual DBS Think Tank, which was convened in March 2016 in conjunction with the Center for Movement Disorders and Neurorestoration at the University of Florida, Gainesveille FL, USA. The Think Tank discussions first focused on policy and advocacy in DBS research and clinical practice, formation of registries, and issues involving the use of DBS in the treatment of Tourette Syndrome. Next, advances in the use of neuroimaging and electrochemical markers to enhance DBS specificity were addressed. Updates on ongoing use and developments of DBS for the treatment of Parkinson's disease, essential tremor, Alzheimer's disease, depression, post-traumatic stress disorder, obesity, addiction were presented, and progress toward innovation(s) in closed-loop applications were discussed. Each section of these proceedings provides updates and highlights of new information as presented at this year's international Think Tank, with a view toward current and near future advancement of the field.}, language = {en} } @phdthesis{Cholewa2005, author = {Cholewa, Ute}, title = {Procalcitonin in der Fr{\"u}hdiagnose der bakteriellen Meningitis}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-16490}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2005}, abstract = {Die Prognose einer lebensbedrohlichen Meningitis wird bestimmt durch m{\"o}glichst erregergerechte und m{\"o}glichst fr{\"u}hzeitige Therapie. Dabei spielt die Unterscheidung zwischen eitriger Meningitis durch typische oder schwer anz{\"u}chtbare Bakterien und abakterieller Meningitis eine Rolle, um die potentiellen Komplikationen unn{\"o}tiger Polypragmasie zu vermeiden. Daher sind m{\"o}glichst einfach und rasch zu bestimmende Laborparameter zur Untersuchung w{\"u}nschenswert. Als relativ neuer Parameter zur Differenzierung bakterieller von nicht bakteriellen Infekten ist Procalcitonin (PCT) eingef{\"u}hrt, dessen Bestimmung jetzt auch am Krankenbett m{\"o}glich ist. PCT hat bisher seine N{\"u}tzlichkeit v. a. in der Sepsiserkennung und -therapie gezeigt. Erste Fragestellung dieser retrospektiven Analyse von Meningoencephalitispatienten war, ob bei Erwachsenen durch Messung des PCT-Spiegels eine Differenzierung zwischen bakterieller oder viraler Genese gelingt, und ob der Bedsidetest so zuverl{\"a}ssig ist wie der aufw{\"a}ndigere LUMItest®. Dazu wurden retrospektiv die Daten von 141 Patienten erhoben, die 1992-2001 an der Neurologischen Universit{\"a}tsklinik W{\"u}rzburg mit gesicherter Meningitis behandelt wurden, von denen sowohl Akten als auch Liquor- und Serumasservate vorlagen, in denen die PCT-Messungen durchgef{\"u}hrt wurden. In den Untersuchungen von Schwarz et al. [102], Gendrel et al. [100] und Jereb et al. [104] wurde bei einem PCT-Grenzwert von 0,5 ng/ml eine Spezifit{\"a}t von 100 \% f{\"u}r die Differenzierung bakterielle verusus abakterielle Meninigitis gefunden. Dagegen w{\"a}ren bei gleicher Messmethodik im hier vorliegendem gr{\"o}ßeren Patientengut 35 \% der gesicherten bakteriellen Meningitiden bei einem „cut-off" von 0,5 ng/ml nicht als solche erkannt worden. 5 \% der nicht-bakteriellen Meningitiden w{\"a}ren mittels PCT-Messung als bakteriell eingestuft worden. Im hier untersuchten Patientenkollektiv hatte PCT als diagnostischer Parameter f{\"u}r diese Fragestellung bei einem Grenzwert von 0,5 ng/ml eine Sensitivit{\"a}t von 65 \% und eine Spezifit{\"a}t von 96 \%. Eine 100 \% Spezifit{\"a}t w{\"a}re in unserer Untersuchung bei einem „cut-off" von 1 ng/ml erreicht worden. Diese Grenze wird jedoch auf dem Schnelltest nicht angegeben. Es stellte sich hier heraus, dass der PCT®-Q Schnelltest im Bereich > 0,5 ng/ml bzw. <0,5 ng/ml dem LUMItest® vergleichbare Ergebnisse lieferte. Das bedeutet zwar, dass alle bakteriellen Meningitiden durch typische Erreger (Meningokokken und Pneumokokken) rasch und sicher bettseitig mittels PCT-Schnelltest h{\"a}tten identifiziert werden k{\"o}nnen. Aber ein niedriger PCT-Wert schloss eine bakterielle Meningitis, insbesondere eine durch „atypische Erreger" wie Listerien und Mycobakterien, nicht sicher aus. Denkbare St{\"o}rgr{\"o}ßen f{\"u}r das vorliegende Ergebnis sind Antibiotikagabe und Immunschw{\"a}che. Ein statistisch auffallender Einfluss einer Antibiotikatherapie auf den PCT-Spiegel konnte in unserem Patientengut nicht festgestellt werden. F{\"u}r die wenigen F{\"a}lle mit anzunehmender verminderter Immunleistung ließ sich keine Regel bez{\"u}glich der PCT-Reaktion ableiten. Damit erscheint der Schnelltest im klinischen Alltag f{\"u}r eine 100\% spezifische, sichere Unterscheidung bakterielle vs. nicht-bakterielle Meniongoencephalitis nicht geeignet; das bisher gr{\"o}ßte untersuchte Kollektiv hat den in der Literatur angegebenen „cut-off" von 0,5 ng/ml f{\"u}r eine sichere Differenzierung nicht best{\"a}tigen k{\"o}nnen. Die zweite Frage ist, ob die Messung des PCT den traditionellen Parametern Liquorzellzahl, Liquoreiweiß, Liquor/Serum-Glucosequotient, BSG, Serumleukozytenzahl oder CRP bez{\"u}glich Spezifit{\"a}t und Sensitivit{\"a}t in der Differentialdiagnose {\"u}berlegen ist. Es zeigte sich, dass CRP bei einem Grenzwert von 5-6 mg/dl mit einer Sensitivit{\"a}t und Spezifit{\"a}t von 95 \% und 98 \% die sicherste Differenzierung zwischen bakterieller und abakterieller Meningitis bei diesem Patientenkollektiv leistete. Mithin kann die PCT-Bestimmung am Krankenbett in der Akutaufnahmesituation eines Patienten mit Meningoencephalitis bei Werten > 10 ng/ml zwar treffsicher die Diagnose einer Meningokokken- oder Pneumokokken-Infektion st{\"u}tzen. F{\"u}r jede dar{\"u}ber hinaus gehende Schlussfolgerung erscheint die PCT-Messung aber entbehrlich wegen mangelhafter Spezifit{\"a}t und Sensitivit{\"a}t und v.a. der Unterlegenheit gegen{\"u}ber traditionell herangezogenen Laborparametern, insbesondere CRP. Folglich erwies sich die Bestimmung des PCT bei akuter Meningoencephalitis als entbehrlich.}, language = {de} } @article{SaudekCahovaHavrdovaetal.2018, author = {Saudek, František and Cahov{\´a}, Monika and Havrdov{\´a}, Terezie and Zacharovov{\´a}, Kl{\´a}ra and Daňkov{\´a}, Helena and Voska, Luděk and L{\´a}nsk{\´a}, Věra and {\"U}{\c{c}}eyler, Nurcan and Sommer, Claudia}, title = {Preserved Expression of Skin Neurotrophic Factors in Advanced Diabetic Neuropathy Does Not Lead to Neural Regeneration despite Pancreas and Kidney Transplantation}, series = {Journal of Diabetes Research}, volume = {2018}, journal = {Journal of Diabetes Research}, number = {2309108}, doi = {10.1155/2018/2309108}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-227469}, pages = {1-11}, year = {2018}, abstract = {Diabetic peripheral neuropathy (DPN) is a common complication of diabetes with potential severe consequences. Its pathogenesis involves hyperglycemia-linked mechanisms, which may include changes in the expression of neurotrophic growth factors. We analyzed the expression of 29 factors potentially related to nerve degeneration and regeneration in skin biopsies from 13 type 1 diabetic pancreas and kidney recipients with severe DPN including severe depletion of intraepidermal nerve fibers (IENF) in lower limb skin biopsies (group Tx1 1st examination). The investigation was repeated after a median 28-month period of normoglycemia achieved by pancreas transplantation (group Tx1 2nd examination). The same tests were performed in 13 stable normoglycemic pancreas and kidney recipients 6-12 years posttransplantation (group Tx2), in 12 matched healthy controls (group HC), and in 12 type 1 diabetic subjects without severe DPN (group DM). Compared to DM and HC groups, we found a significantly higher (p < 0.05-0.001) expression of NGF (nerve growth factor), NGFR (NGF receptor), NTRK1 (neurotrophic receptor tyrosine kinase 1), GDNF (glial cell-derived neurotrophic factor), GFRA1 (GDNF family receptor alpha 1), and GFAP (glial fibrillary acidic protein) in both transplant groups (Tx1 and Tx2). Enhanced expression of these factors was not normalized following the median 28-month period of normoglycemia (Tx1 2nd examination) and negatively correlated with IENF density and with electrophysiological indices of DPN (vibration perception threshold, electromyography, and autonomic tests). In contrast to our expectation, the expression of most of 29 selected factors related to neural regeneration was comparable in subjects with severe peripheral nerve fiber depletion and healthy controls and the expression of six factors was significantly upregulated. These findings may be important for better understanding the pathophysiology of nerve regeneration and for the development of intervention strategies.}, language = {en} } @article{GulbertiMollHameletal.2015, author = {Gulberti, A. and Moll, C.K.E. and Hamel, W. and Buhmann, C. and Koeppen, J.A. and Boelmans, K. and Zittel, S. and Gerloff, C. and Westphal, M. and Schneider, T.R. and Engel, A.K.}, title = {Predictive timing functions of cortical beta oscillations are impaired in Parkinson's disease and influenced by L-DOPA and deep brain stimulation of the subthalamic nucleus Impaired beta-band timing functions in PD}, series = {NeuroImage: Clinical}, volume = {9}, journal = {NeuroImage: Clinical}, doi = {10.1016/j.nicl.2015.09.013}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-150049}, pages = {436-449}, year = {2015}, abstract = {Cortex-basal ganglia circuits participate in motor timing and temporal perception, and are important for the dynamic configuration of sensorimotor networks in response to exogenous demands. In Parkinson's disease (PD) patients, rhythmic auditory stimulation (RAS) induces motor performance benefits. Hitherto, little is known concerning contributions of the basal ganglia to sensory facilitation and cortical responses to RAS in PD. Therefore, we conducted an EEG study in 12 PD patients before and after surgery for subthalamic nucleus deep brain stimulation (STN-DBS) and in 12 age-matched controls. Here we investigated the effects of levodopa and STN-DBS on resting-state EEG and on the cortical-response profile to slow and fast RAS in a passive-listening paradigm focusing on beta-band oscillations, which are important for auditory-motor coupling. The beta-modulation profile to RAS in healthy participants was characterized by local peaks preceding and following auditory stimuli. In PD patients RAS failed to induce pre-stimulus beta increases. The absence of pre-stimulus beta-band modulation may contribute to impaired rhythm perception in PD. Moreover, post-stimulus beta-band responses were highly abnormal during fast RAS in PD patients. Treatment with levodopa and STN-DBS reinstated a post-stimulus beta-modulation profile similar to controls, while STN-DBS reduced beta-band power in the resting-state. The treatment-sensitivity of beta oscillations suggests that STN-DBS may specifically improve timekeeping functions of cortical beta oscillations during fast auditory pacing.}, language = {en} } @article{FarinelliPalmisanoMarcheseetal.2020, author = {Farinelli, Veronica and Palmisano, Chiara and Marchese, Silvia Maria and Strano, Camilla Mirella Maria and D'Arrigo, Stefano and Pantaleoni, Chiara and Ardissone, Anna and Nardocci, Nardo and Esposti, Roberto and Cavallari, Paolo}, title = {Postural control in children with cerebellar ataxia}, series = {Applied Sciences}, volume = {10}, journal = {Applied Sciences}, number = {5}, issn = {2076-3417}, doi = {10.3390/app10051606}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200692}, year = {2020}, abstract = {Controlling posture, i.e., governing the ensemble of involuntary muscular activities that manage body equilibrium, represents a demanding function in which the cerebellum plays a key role. Postural activities are particularly important during gait initiation when passing from quiet standing to locomotion. Indeed, several studies used such motor task for evaluating pathological conditions, including cerebellar disorders. The linkage between cerebellum maturation and the development of postural control has received less attention. Therefore, we evaluated postural control during quiet standing and gait initiation in children affected by a slow progressive generalized cerebellar atrophy (SlowP) or non-progressive vermian hypoplasia (Joubert syndrome, NonP), compared to that of healthy children (H). Despite the similar clinical evaluation of motor impairments in NonP and SlowP, only SlowP showed a less stable quiet standing and a shorter and slower first step than H. Moreover, a descriptive analysis of lower limb and back muscle activities suggested a more severe timing disruption in SlowP. Such differences might stem from the extent of cerebellar damage. However, literature reports that during childhood, neural plasticity of intact brain areas could compensate for cerebellar agenesis. We thus proposed that the difference might stem from disease progression, which contrasts the consolidation of compensatory strategies.}, 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{Kohl2009, author = {Kohl, Bianca Dorothea}, title = {PMP22-overexpressing mice as a model for Charcot-Marie-Tooth 1A neuropathy implicate a role of immune-related cells}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-43066}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2009}, abstract = {Charcot-Marie-Tooth disease (CMT) is a cohort of human hereditary disorders of the peripheral nervous system (PNS) which exhibit symptoms like sensory dysfunction, muscle weakness and gait disturbances. Different mutations are described as causation for this neuropathy, such as a duplication of chromosome 17 comprising the gene for the peripheral myelin protein-22 (PMP22). Based on different animal models former studies identified immune cells, i.e. macrophages and T-lymphocytes, as crucial mediators of pathology in these neuropathies. In this study, PMP22-overexpressing mice (PMP22tg, C61), serving as a model for a specific type of CMT - CMT1A - were crossbred with immune-deficient mutant mice to examine the impact of the immune system on nerve pathology. Crossbreeding of PMP22tg mice with recombination activating gene-1 (RAG-1) deficient mice, lacking mature T- and B-lymphocytes, caused no striking alterations of pathogenesis in peripheral nerves of mutant mice. In contrast, crossbreeding of PMP22tg myelin mutants with mice deficient in the chemokine monocyte chemoattractant protein-1 (MCP-1, CCL2) caused an amelioration of the demyelinating phenotype of peripheral nerves when MCP-1 was either reduced or completely absent. Furthermore, functional investigations, i.e. neurographic recordings and examinations of the grip strength of the extremities, revealed an amelioration in PMP22tg/MCP-1-/- mice in regard to a symptomatic improvement in the compound action muscle potential (CMAP) and stronger grip strength of the hindlimbs. Interestingly, peripheral nerves of PMP22tg mice showed an irregular distribution of potassium channels in presence of MCP-1, whereas the absence of MCP-1 in the myelin mutants rescued the ion channel distribution and resulted in a more wild type-like phenotype. Having shown the impact of MCP-1 as an important mediator of nerve pathology in PMP22/MCP-1 double mutants, the regulation of this chemokine became an important target for potential treatment strategies. We found that the signaling cascade MEK1/2/ERK1/2 was more strongly activated in peripheral nerves of PMP22tg mice compared to nerves of wild type mice. This activation corresponded to an increase in MCP-1 mRNA expression in peripheral nerves at the same age. Furthermore, a MEK1/2-inhibitor was used in vivo to confirm the regulation of MCP-1 by the MEK1/2/ERK1/2 pathway. After a treatment period of three weeks, a clear reduction of ERK1/2-phosphorylation as well as a reduction of MCP-1 mRNA expression was observed, accompanied by a decline in macrophage number in peripheral nerves of PMP22tg mice. These observations suggest that the expression of MCP-1 is crucial for the neuropathological progression in a mouse model for CMT1A. Therefore, this chemokine could provide a basis for a putative treatment strategy of inherited neuropathies.}, subject = {Myelin}, language = {en} } @article{LueningschroerBinottiDombertetal.2017, author = {L{\"u}ningschr{\"o}r, Patrick and Binotti, Beyenech and Dombert, Benjamin and Heimann, Peter and Perez-Lara, Angel and Slotta, Carsten and Thau-Habermann, Nadine and von Collenberg, Cora R. and Karl, Franziska and Damme, Markus and Horowitz, Arie and Maystadt, Isabelle and F{\"u}chtbauer, Annette and F{\"u}chtbauer, Ernst-Martin and Jablonka, Sibylle and Blum, Robert and {\"U}{\c{c}}eyler, Nurcan and Petri, Susanne and Kaltschmidt, Barbara and Jahn, Reinhard and Kaltschmidt, Christian and Sendtner, Michael}, title = {Plekhg5-regulated autophagy of synaptic vesicles reveals a pathogenic mechanism in motoneuron disease}, series = {Nature Communications}, volume = {8}, journal = {Nature Communications}, number = {678}, doi = {10.1038/s41467-017-00689-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-170048}, year = {2017}, abstract = {Autophagy-mediated degradation of synaptic components maintains synaptic homeostasis but also constitutes a mechanism of neurodegeneration. It is unclear how autophagy of synaptic vesicles and components of presynaptic active zones is regulated. Here, we show that Pleckstrin homology containing family member 5 (Plekhg5) modulates autophagy of synaptic vesicles in axon terminals of motoneurons via its function as a guanine exchange factor for Rab26, a small GTPase that specifically directs synaptic vesicles to preautophagosomal structures. Plekhg5 gene inactivation in mice results in a late-onset motoneuron disease, characterized by degeneration of axon terminals. Plekhg5-depleted cultured motoneurons show defective axon growth and impaired autophagy of synaptic vesicles, which can be rescued by constitutively active Rab26. These findings define a mechanism for regulating autophagy in neurons that specifically targets synaptic vesicles. Disruption of this mechanism may contribute to the pathophysiology of several forms of motoneuron disease.}, language = {en} } @phdthesis{ZimmermannneePapp2024, author = {Zimmermann [n{\´e}e Papp], Lena}, title = {Platelets as modulators of blood-brain barrier disruption and inflammation in the pathophysiology of ischemic stroke}, doi = {10.25972/OPUS-30285}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-302850}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Ischemia-reperfusion injury (I/R injury) is a common complication in ischemic stroke (IS) treatment, which is characterized by a paradoxical perpetuation of tissue damage despite the successful re-establishment of vascular perfusion. This phenomenon is known to be facilitated by the detrimental interplay of platelets and inflammatory cells at the vascular interface. However, the spatio-temporal and molecular mechanisms underlying these cellular interactions and their contribution to infarct progression are still incompletely understood. Therefore, this study intended to clarify the temporal mechanisms of infarct growth after cerebral vessel recanalization. The data presented here could show that infarct progression is driven by early blood-brain-barrier perturbation and is independent of secondary thrombus formation. Since previous studies unravelled the secretion of platelet granules as a molecular mechanism of how platelets contribute to I/R injury, special emphasis was placed on the role of platelet granule secretion in the process of barrier dysfunction. By combining an in vitro approach with a murine IS model, it could be shown that platelet α-granules exerted endothelial-damaging properties, whereas their absence (NBEAL2-deficiency) translated into improved microvascular integrity. Hence, targeting platelet α-granules might serve as a novel treatment option to reduce vascular integrity loss and diminish infarct growth despite recanalization. Recent evidence revealed that pathomechanisms underlying I/R injury are already instrumental during large vessel occlusion. This indicates that penumbral tissue loss under occlusion and I/R injury during reperfusion share an intertwined relationship. In accordance with this notion, human observational data disclosed the presence of a neutrophil dominated immune response and local platelet activation and secretion, by the detection of the main components of platelet α-granules, within the secluded vasculature of IS patients. These initial observations of immune cells and platelets could be further expanded within this thesis by flow cytometric analysis of local ischemic blood samples. Phenotyping of immune cells disclosed a yet unknown shift in the lymphocyte population towards CD4+ T cells and additionally corroborated the concept of an immediate intravascular immune response that is dominated by granulocytes. Furthermore, this thesis provides first-time evidence for the increased appearance of platelet-leukocyte-aggregates within the secluded human vasculature. Thus, interfering with immune cells and/or platelets already under occlusion might serve as a potential strategy to diminish infarct expansion and ameliorate clinical outcome after IS.}, subject = {Schlaganfall}, language = {en} } @article{SchuhmannBieberFrankeetal.2021, author = {Schuhmann, Michael K. and Bieber, Michael and Franke, Maximilian and Kollikowski, Alexander M. and Stegner, David and Heinze, Katrin G. and Nieswandt, Bernhard and Pham, Mirko and Stoll, Guido}, title = {Platelets and lymphocytes drive progressive penumbral tissue loss during middle cerebral artery occlusion in mice}, series = {Journal of Neuroinflammation}, volume = {18}, journal = {Journal of Neuroinflammation}, number = {1}, doi = {10.1186/s12974-021-02095-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-259172}, pages = {46}, year = {2021}, abstract = {Background In acute ischemic stroke, cessation of blood flow causes immediate tissue necrosis within the center of the ischemic brain region accompanied by functional failure in the surrounding brain tissue designated the penumbra. The penumbra can be salvaged by timely thrombolysis/thrombectomy, the only available acute stroke treatment to date, but is progressively destroyed by the expansion of infarction. The underlying mechanisms of progressive infarction are not fully understood. Methods To address mechanisms, mice underwent filament occlusion of the middle cerebral artery (MCAO) for up to 4 h. Infarct development was compared between mice treated with antigen-binding fragments (Fab) against the platelet surface molecules GPIb (p0p/B Fab) or rat immunoglobulin G (IgG) Fab as control treatment. Moreover, Rag1\(^{-/-}\) mice lacking T-cells underwent the same procedures. Infarct volumes as well as the local inflammatory response were determined during vessel occlusion. Results We show that blocking of the platelet adhesion receptor, glycoprotein (GP) Ibα in mice, delays cerebral infarct progression already during occlusion and thus before recanalization/reperfusion. This therapeutic effect was accompanied by decreased T-cell infiltration, particularly at the infarct border zone, which during occlusion is supplied by collateral blood flow. Accordingly, mice lacking T-cells were likewise protected from infarct progression under occlusion. Conclusions Progressive brain infarction can be delayed by blocking detrimental lymphocyte/platelet responses already during occlusion paving the way for ultra-early treatment strategies in hyper-acute stroke before recanalization.}, language = {en} } @article{KollikowskiPhamMaerzetal.2022, author = {Kollikowski, Alexander M. and Pham, Mirko and M{\"a}rz, Alexander G. and Papp, Lena and Nieswandt, Bernhard and Stoll, Guido and Schuhmann, Michael K.}, title = {Platelet Activation and Chemokine Release Are Related to Local Neutrophil-Dominant Inflammation During Hyperacute Human Stroke}, series = {Translational Stroke Research}, volume = {13}, journal = {Translational Stroke Research}, number = {3}, issn = {1868-601X}, doi = {10.1007/s12975-021-00938-w}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-270194}, pages = {364-369}, year = {2022}, abstract = {Experimental evidence has emerged that local platelet activation contributes to inflammation and infarct formation in acute ischemic stroke (AIS) which awaits confirmation in human studies. We conducted a prospective observational study on 258 consecutive patients undergoing mechanical thrombectomy (MT) due to large-vessel-occlusion stroke of the anterior circulation (08/2018-05/2020). Intraprocedural microcatheter aspiration of 1 ml of local (occlusion condition) and systemic arterial blood samples (self-control) was performed according to a prespecified protocol. The samples were analyzed for differential leukocyte counts, platelet counts, and plasma levels of the platelet-derived neutrophil-activating chemokine C-X-C-motif ligand (CXCL) 4 (PF-4), the neutrophil attractant CXCL7 (NAP-2), and myeloperoxidase (MPO). The clinical-biological relevance of these variables was corroborated by specific associations with molecular-cellular, structural-radiological, hemodynamic, and clinical-functional parameters. Seventy consecutive patients fulfilling all predefined criteria entered analysis. Mean local CXCL4 (+ 39\%: 571 vs 410 ng/ml, P = .0095) and CXCL7 (+ 9\%: 693 vs 636 ng/ml, P = .013) concentrations were higher compared with self-controls. Local platelet counts were lower (- 10\%: 347,582 vs 383,284/µl, P = .0052), whereas neutrophil counts were elevated (+ 10\%: 6022 vs 5485/µl, P = 0.0027). Correlation analyses revealed associations between local platelet and neutrophil counts (r = 0.27, P = .034), and between CXCL7 and MPO (r = 0.24, P = .048). Local CXCL4 was associated with the angiographic degree of reperfusion following recanalization (r =  - 0.2523, P = .0479). Functional outcome at discharge correlated with local MPO concentrations (r = 0.3832, P = .0014) and platelet counts (r = 0.288, P = .0181). This study provides human evidence of cerebral platelet activation and platelet-neutrophil interactions during AIS and points to the relevance of per-ischemic thrombo-inflammatory mechanisms to impaired reperfusion and worse functional outcome following recanalization.}, language = {en} } @article{GschmackMonoranuMaroufetal.2022, author = {Gschmack, Eva and Monoranu, Camelia-Maria and Marouf, Hecham and Meyer, Sarah and Lessel, Lena and Idris, Raja and Berg, Daniela and Maetzler, Walter and Steigerwald, Frank and Volkmann, Jens and Gerlach, Manfred and Riederer, Peter and Koutsilieri, Eleni and Scheller, Carsten}, title = {Plasma autoantibodies to glial fibrillary acidic protein (GFAP) react with brain areas according to Braak staging of Parkinson's disease}, series = {Journal of Neural Transmission}, volume = {129}, journal = {Journal of Neural Transmission}, number = {5-6}, doi = {10.1007/s00702-022-02495-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-325161}, pages = {545-555}, year = {2022}, abstract = {Idiopathic Parkinson's disease (PD) is characterized by a progredient degeneration of the brain, starting at deep subcortical areas such as the dorsal motor nucleus of the glossopharyngeal and vagal nerves (DM) (stage 1), followed by the coeruleus-subcoeruleus complex; (stage 2), the substantia nigra (SN) (stage 3), the anteromedial temporal mesocortex (MC) (stage 4), high-order sensory association areas and prefrontal fields (HC) (stage 5) and finally first-order sensory association areas, premotor areas, as well as primary sensory and motor field (FC) (stage 6). Autoimmunity might play a role in PD pathogenesis. Here we analyzed whether anti-brain autoantibodies differentially recognize different human brain areas and identified autoantigens that correlate with the above-described dissemination of PD pathology in the brain. Brain tissue was obtained from deceased individuals with no history of neurological or psychiatric disease and no neuropathological abnormalities. Tissue homogenates from different brain regions (DM, SN, MC, HC, FC) were subjected to SDS-PAGE and Western blot. Blots were incubated with plasma samples from 30 PD patients and 30 control subjects and stained with anti-IgG antibodies to detect anti-brain autoantibodies. Signals were quantified. Prominent autoantigens were identified by 2D-gel-coupled mass spectrometry sequencing. Anti-brain autoantibodies are frequent and occur both in healthy controls and individuals with PD. Glial fibrillary acidic protein (GFAP) was identified as a prominent autoantigen recognized in all plasma samples. GFAP immunoreactivity was highest in DM areas and lowest in FC areas with no significant differences in anti-GFAP autoantibody titers between healthy controls and individuals with PD. The anti-GFAP autoimmunoreactivity of different brain areas correlates with the dissemination of histopathological neurodegeneration in PD. We hypothesize that GFAP autoantibodies are physiological but might be involved as a cofactor in PD pathogenesis secondary to a leakage of the blood-brain barrier.}, language = {en} } @article{BellingerAltenmuellerVolkmann2017, author = {Bellinger, Daniel and Altenm{\"u}ller, Eckart and Volkmann, Jens}, title = {Perception of time in music in patients with Parkinson's disease - The processing of musical syntax compensates for rhythmic deficits}, series = {Frontiers in Neuroscience}, volume = {11}, journal = {Frontiers in Neuroscience}, doi = {10.3389/fnins.2017.00068}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-171805}, year = {2017}, abstract = {Objective: Perception of time as well as rhythm in musical structures rely on complex brain mechanisms and require an extended network of multiple neural sources. They are therefore sensitive to impairment. Several psychophysical studies have shown that patients with Parkinson's disease (PD) have deficits in perceiving time and rhythms due to a malfunction of the basal ganglia (BG) network. Method: In this study we investigated the time perception of PD patients during music perception by assessing their just noticeable difference (JND) in the time perception of a complex musical Gestalt. We applied a temporal discrimination task using a short melody with a clear beat-based rhythm. Among the subjects, 26 patients under L-Dopa administration and 21 age-matched controls had to detect an artificially delayed time interval in the range between 80 and 300 ms in the middle of the musical period. We analyzed the data by (a) calculating the detection threshold directly, (b) by extrapolating the JNDs, (c) relating it to musical expertise. Results: Patients differed from controls in the detection of time-intervals between 220 and 300 ms (*p = 0.0200, n = 47). Furthermore, this deficit depended on the severity of the disease (*p = 0.0452; n = 47). Surprisingly, PD patients did not show any deficit of their JND compared to healthy controls, although the results showed a trend (*p = 0.0565, n = 40). Furthermore, no significant difference of the JND was found according to the severity of the disease. Additionally, musically trained persons seemed to have lower thresholds in detecting deviations in time and syntactic structures of music (*p = 0.0343, n = 39). Conclusion: As an explanation of these results, we would like to propose the hypothesis of a time-syntax-congruency in music perception suggesting that processing of time and rhythm is a Gestalt process and that cortical areas involved in processing of musical syntax may compensate for impaired BG circuits that are responsible for time processing and rhythm perception. This mechanism may emerge more strongly as the deficits in time processing and rhythm perception progress. Furthermore, we presume that top-down-bottom-up-processes interfere additionally and interact in this context of compensation.}, language = {en} } @article{BieniussaKahramanSkornickaetal.2022, author = {Bieniussa, Linda and Kahraman, Baran and Skornicka, Johannes and Schulte, Annemarie and Voelker, Johannes and Jablonka, Sibylle and Hagen, Rudolf and Rak, Kristen}, title = {Pegylated insulin-like growth factor 1 attenuates hair cell loss and promotes presynaptic maintenance of medial olivocochlear cholinergic fibers in the cochlea of the progressive motor neuropathy mouse}, series = {Frontiers in Neurology}, volume = {13}, journal = {Frontiers in Neurology}, issn = {1664-2295}, doi = {10.3389/fneur.2022.885026}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-276669}, year = {2022}, abstract = {The progressive motor neuropathy (PMN) mouse is a model of an inherited motor neuropathy disease with progressive neurodegeneration. Axon degeneration associates with homozygous mutations of the TBCE gene encoding the tubulin chaperone E protein. TBCE is responsible for the correct dimerization of alpha and beta-tubulin. Strikingly, the PMN mouse also develops a progressive hearing loss after normal hearing onset, characterized by degeneration of the auditory nerve and outer hair cell (OHC) loss. However, the development of this neuronal and cochlear pathology is not fully understood yet. Previous studies with pegylated insulin-like growth factor 1 (peg-IGF-1) treatment in this mouse model have been shown to expand lifespan, weight, muscle strength, and motor coordination. Accordingly, peg-IGF-1 was evaluated for an otoprotective effect. We investigated the effect of peg-IGF-1 on the auditory system by treatment starting at postnatal day 15 (p15). Histological analysis revealed positive effects on OHC synapses of medial olivocochlear (MOC) neuronal fibers and a short-term attenuation of OHC loss. Peg-IGF-1 was able to conditionally restore the disorganization of OHC synapses and maintain the provision of cholinergic acetyltransferase in presynapses. To assess auditory function, frequency-specific auditory brainstem responses and distortion product otoacoustic emissions were recorded in animals on p21 and p28. However, despite the positive effect on MOC fibers and OHC, no restoration of hearing could be achieved. The present work demonstrates that the synaptic pathology of efferent MOC fibers in PMN mice represents a particular form of "efferent auditory neuropathy." Peg-IGF-1 showed an otoprotective effect by preventing the degeneration of OHCs and efferent synapses. However, enhanced efforts are needed to optimize the treatment to obtain detectable improvements in hearing performances.}, language = {en} } @article{BrandtZimmermannKaufholdetal.2012, author = {Brandt, Alexander U. and Zimmermann, Hanna and Kaufhold, Falko and Promesberger, Julia and Schippling, Sven and Finis, David and Aktas, Orhan and Geis, Christian and Ringelstein, Marius and Ringelstein, E. Bernd and Hartung, Hans-Peter and Paul, Friedemann and Kleffner, Ilka and D{\"o}rr, Jan}, title = {Patterns of Retinal Damage Facilitate Differential Diagnosis between Susac Syndrome and MS}, series = {PLoS One}, volume = {7}, journal = {PLoS One}, number = {6}, doi = {10.1371/journal.pone.0038741}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-134013}, pages = {e38741}, year = {2012}, abstract = {Susac syndrome, a rare but probably underdiagnosed combination of encephalopathy, hearing loss, and visual deficits due to branch retinal artery occlusion of unknown aetiology has to be considered as differential diagnosis in various conditions. Particularly, differentiation from multiple sclerosis is often challenging since both clinical presentation and diagnostic findings may overlap. Optical coherence tomography is a powerful and easy to perform diagnostic tool to analyse the morphological integrity of retinal structures and is increasingly established to depict characteristic patterns of retinal pathology in multiple sclerosis. Against this background we hypothesised that differential patterns of retinal pathology facilitate a reliable differentiation between Susac syndrome and multiple sclerosis. In this multicenter cross-sectional observational study optical coherence tomography was performed in nine patients with a definite diagnosis of Susac syndrome. Data were compared with age-, sex-, and disease duration-matched relapsing remitting multiple sclerosis patients with and without a history of optic neuritis, and with healthy controls. Using generalised estimating equation models, Susac patients showed a significant reduction in either or both retinal nerve fibre layer thickness and total macular volume in comparison to both healthy controls and relapsing remitting multiple sclerosis patients. However, in contrast to the multiple sclerosis patients this reduction was not distributed over the entire scanning area but showed a distinct sectorial loss especially in the macular measurements. We therefore conclude that patients with Susac syndrome show distinct abnormalities in optical coherence tomography in comparison to multiple sclerosis patients. These findings recommend optical coherence tomography as a promising tool for differentiating Susac syndrome from MS.}, language = {en} } @article{KarlWussmannKressetal.2019, author = {Karl, Franziska and Wußmann, Maximiliane and Kreß, Luisa and Malzacher, Tobias and Fey, Phillip and Groeber-Becker, Florian and {\"U}{\c{c}}eyler, Nurcan}, title = {Patient-derived in vitro skin models for investigation of small fiber pathology}, series = {Annals of Clinical and Translational Neurology}, volume = {6}, journal = {Annals of Clinical and Translational Neurology}, number = {9}, doi = {10.1002/acn3.50871}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-201649}, pages = {1797-1806}, year = {2019}, abstract = {Objective To establish individually expandable primary fibroblast and keratinocyte cultures from 3-mm skin punch biopsies for patient-derived in vitro skin models to investigate of small fiber pathology. Methods We obtained 6-mm skin punch biopsies from the calf of two patients with small fiber neuropathy (SFN) and two healthy controls. One half (3 mm) was used for diagnostic intraepidermal nerve fiber density (IENFD). From the second half, we isolated and cultured fibroblasts and keratinocytes. Cells were used to generate patient-derived full-thickness three-dimensional (3D) skin models containing a dermal and epidermal component. Cells and skin models were characterized morphologically, immunocyto- and -histochemically (vimentin, cytokeratin (CK)-10, CK 14, ki67, collagen1, and procollagen), and by electrical impedance. Results Distal IENFD was reduced in the SFN patients (2 fibers/mm each), while IENFD was normal in the controls (8 fibers/mm, 7 fibers/mm). Two-dimensional (2D) cultured skin cells showed normal morphology, adequate viability, and proliferation, and expressed cell-specific markers without relevant difference between SFN patient and healthy control. Using 2D cultured fibroblasts and keratinocytes, we obtained subject-derived 3D skin models. Morphology of the 3D model was analogous to the respective skin biopsy specimens. Both, the dermal and the epidermal layer carried cell-specific markers and showed a homogenous expression of extracellular matrix proteins. Interpretation Our protocol allows the generation of disease-specific 2D and 3D skin models, which can be used to investigate the cross-talk between skin cells and sensory neurons in small fiber pathology.}, language = {en} } @phdthesis{Knorr2024, author = {Knorr, Susanne}, title = {Pathophysiology of early-onset isolated dystonia in a DYT-TOR1A rat model with trauma-induced dystonia-like movements}, doi = {10.25972/OPUS-20609}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-206096}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Early-onset torsion dystonia (DYT-TOR1A, DYT1) is an inherited hyperkinetic movement disorder caused by a mutation of the TOR1A gene encoding the torsinA protein. DYT-TOR1A is characterized as a network disorder of the central nervous system (CNS), including predominantly the cortico-basal ganglia-thalamo-cortical loop resulting in a severe generalized dystonic phenotype. The pathophysiology of DYTTOR1A is not fully understood. Molecular levels up to large-scale network levels of the CNS are suggested to be affected in the pathophysiology of DYT-TOR1A. The reduced penetrance of 30\% - 40\% indicates a gene-environmental interaction, hypothesized as "second hit". The lack of appropriate and phenotypic DYT-TOR1A animal models encouraged us to verify the "second hit" hypothesis through a unilateral peripheral nerve trauma of the sciatic nerve in a transgenic asymptomatic DYT-TOR1A rat model (∆ETorA), overexpressing the human mutated torsinA protein. In a multiscale approach, this animal model was characterized phenotypically and pathophysiologically. Nerve-injured ∆ETorA rats revealed dystonia-like movements (DLM) with a partially generalized phenotype. A physiomarker of human dystonia, describing increased theta oscillation in the globus pallidus internus (GPi), was found in the entopeduncular nucleus (EP), the rodent equivalent to the human GPi, of nerve-injured ∆ETorA rats. Altered oscillation patterns were also observed in the primary motor cortex. Highfrequency stimulation (HFS) of the EP reduced DLM and modulated altered oscillatory activity in the EP and primary motor cortex in nerve-injured ∆ETorA rats. Moreover, the dopaminergic system in ∆ETorA rats demonstrated a significant increased striatal dopamine release and dopamine turnover. Whole transcriptome analysis revealed differentially expressed genes of the circadian clock and the energy metabolism, thereby pointing towards novel, putative pathways in the pathophysiology of DYTTOR1A dystonia. In summary, peripheral nerve trauma can trigger DLM in genetically predisposed asymptomatic ΔETorA rats leading to neurobiological alteration in the central motor network on multiple levels and thereby supporting the "second hit" hypothesis. This novel symptomatic DYT-TOR1A rat model, based on a DYT-TOR1A genetic background, may prove as a valuable chance for DYT-TOR1A dystonia, to further investigate the pathomechanism in more detail and to establish new treatment strategies.}, subject = {Dystonie}, language = {en} } @phdthesis{Reymann2016, author = {Reymann, Stephan Andreas}, title = {Pathophysiologische Rolle und therapeutische Relevanz von Plasmakallikrein beim experimentellen Schlaganfall}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-135834}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2016}, abstract = {Die Rolle thromboinflammatorischer Vorg{\"a}nge in der Pathogenese des isch{\"a}mischen Schlaganfalls ist in den letzten Jahren immer mehr in den wissenschaftlichen Fokus ger{\"u}ckt. Plasmakallikrein (PK) spaltet von hochmolekularem Kininogen (KNG) Bradykinin (BK) ab und ist dadurch Ausgangspunkt des proinflammatorischen Kallikrein-Kinin-Systems (KKS). Zum anderen kann es den Gerinnungsfaktor XII (FXII) aktivieren, den Ausgangspunkt der intrinsischen Gerinnungskaskade. Es initiiert also sowohl inflammatorische als auch thrombotische Vorg{\"a}nge. Daher wurde in dieser Arbeit der Effekt einer Blockade PKs in einem Mausmodell der fokalen zerebralen Isch{\"a}mie untersucht - und zwar sowohl durch genetische Depletion als auch durch pharmakologische Blockade. Beide Ans{\"a}tze brachten einen nachhaltigen protektiven Effekt in Bezug auf Infarktgr{\"o}ßen und funktionelles Outcome, ohne die Blutungsgefahr zu erh{\"o}hen.}, subject = {Plasmakallikrein}, 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{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} } @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} } @phdthesis{Pozzi2020, author = {Pozzi, Nicol{\´o} Gabriele}, title = {Parkinson's disease revisited: multiple circuitopathies}, doi = {10.25972/OPUS-21671}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-216715}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2020}, abstract = {Parkinson's disease (PD) is among the most common neurodegenerative conditions, and it is characterized by the progressive loss of dopaminergic neurons and a great variability in clinical expression. Despite several effective medications, it still causes disability as all patients show treatment-resistant symptoms and complications. A possible reason for this therapeutic-burden and great clinical variability lies in a probable misconception about its pathophysiology, one that focuses on neurodegeneration, while largely neglecting its functional consequences and the related compensatory changes. In this thesis, I expand on the hypothesis that some PD symptoms have a dysfunctional origin and reflect derangements of neural network dynamics, the means by which brain coordination supports any motor behaviour. In particular, I have investigated resting tremor and freezing of gait, two common symptoms with an enigmatic mechanism and suboptimal management. In the case of tremor, I predicted a pathological change in response to dopamine loss, which included the activation of noradrenergic (NA) neurons of the locus coeruleus (LC) projecting to the cerebellum. This compensatory LC activation that supports dopaminergic neurons might indeed come at the expense of tremor development. To assess the role of LC-NA in tremor development, I recorded tremor occurrence in the reserpinized rat model of PD, one of very few showing tremor, after selective lesioning (with the neurotoxin DSP-4) of the LC-NA terminal axons. DSP-4 induced a severe reduction of LC-NA terminal axons in the cerebellar cortex and this was associated with a significant reduction in tremor development. Unlike its development, tremor frequency and the akinetic rigid signs did not differ between the groups, thus suggesting a dopaminergic dependency. These findings suggest that the LC-NA innervation of the cerebellum has a critical role for PD tremor, possibly by exerting a network effect, which gates the cerebello-thalamic-cortical circuit into pathological oscillations upon a dopaminergic loss in the basal ganglia. In contrast, for the study of freezing of gait, I worked with human PD subjects and deep brain stimulation, a therapeutic neuromodulation device that in some prototypes also allows the recording of neural activity in freely-moving subjects. Gait freezing is a disabling PD symptom that suddenly impairs effective stepping, thus causing falls and disability. Also in this study, I hypothesized that the underlying pathophysiology may be represented by dysfunctional neural network dynamics that abruptly impair locomotor control by affecting the communication in the supraspinal locomotor network. To test this hypothesis, I investigated the coupling between the cortex and the subthalamic nucleus, two main nodes of the supraspinal locomotor network, in freely-moving subjects PD patients and also performed molecular brain imaging of striatal dopamine receptor density and kinematic measurements. I found that in PD patients, walking is associated with cortical-subthalamic stable coupling in a low-frequency band (i.e. θ-α rhythms). In contrast, these structures decoupled when gait freezing occurred in the brain hemisphere with less dopaminergic innervation. These findings suggest that freezing of gait is a "circuitopathy", with dysfunctional cortical-subcortical communication. Altogether the results of my experiments support the hypothesis that the pathophysiology of PD goes beyond neurodegenerative (loss-of-function) processes and that derangement of neural network dynamics coincides with some disabling PD symptoms, thus suggesting that PD can be interpreted as the combination of multiple circuitopathies.}, subject = {Parkinson-Krankheit}, 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} } @phdthesis{Stengel2022, author = {Stengel, Helena Maria}, title = {Paranodale und nodale Autoantik{\"o}rper: Charakterisierung der Anti-Neurofascin-Autoantik{\"o}rper-assoziierten Neuropathie und Untersuchung des Effektes von Anti-Contactin-1-Autoantik{\"o}rpern im Zellkulturmodell}, doi = {10.25972/OPUS-25466}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-254662}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Die (Para-)nodopathie ist neben der prim{\"a}r axonalen und der prim{\"a}r demyelinisierenden Polyneuropathie eine neue Krankheitsentit{\"a}t, die sich durch eine Sch{\"a}digung der Funktion des Ranvierschen Schn{\"u}rringes auszeichnet. Die Forschung zu (para-)nodalen Autoantik{\"o}rpern fokussierte sich bislang haupts{\"a}chlich auf Neurofascin-155- und Contactin-1-Autoantik{\"o}rper der Subklasse IgG4. In dieser Studie wurden die Seren von insgesamt 264 PatientInnen mit CIDP, GBS oder anderen Formen von Polyneuropathien mittels Bindungsassays an murinen Ischiadicuszupfnerven und gegebenenfalls ELISA auf (para-)nodale Autoantik{\"o}rper gescrennt. Positive Autoantik{\"o}rperbefunde wurden bei IgG-Autoantik{\"o}rpern mittels Bindungsassays an transfizierten HEK-293-Zellen und bei IgM-Autoantik{\"o}rpern mittels Western Blot best{\"a}tigt. ELISA Untersuchungen dienten zur n{\"a}heren Spezifizierung. Weiterhin wurde die zeitabh{\"a}ngige Wirkung von Contactin-1-Autoantik{\"o}rpern im Zellkulturmodell untersucht. Die im folgenden dargestellten Ergebnisse zeigen, dass die (Para-)nodopathie nicht auf die bisher am h{\"a}ufigsten beschriebene Erkrankung mit IgG4-Autoantik{\"o}rpern beschr{\"a}nkt werden sollte. Bei dem extrem schwer betroffenen IgG-Patient 1 konnte ein Pan-Neurofascin-IgG3-Autoantik{\"o}rper nachgewiesen werden. Als charakteristische Symptome f{\"u}r diese Autoantik{\"o}rper konnten in {\"U}bereinstimmung mit weiteren Fallberichten Tetraplegie, Beatmungspflichtigkeit sowie eine schwere Hirnnervenbeteiligung bis zur Locked-In-Symptomatik identifiziert werden. Diese Patienten heben sich deutlich von den PatientInnen mit den bisher haupts{\"a}chlich beschriebenen Neurofascin-155-IgG4-Autoantik{\"o}rpern ab, die wie IgG-Patient 2 charakteristischerweise in jungem Alter an einer CIDP mit Tremor ohne Besserung unter IVIG-Therapie leiden. Es wurden f{\"u}nf PatientInnen mit Neurofascin-155-IgM-Autoantik{\"o}rpern identifiziert, die eine akut beginnende Erkrankung mit Tetraparese, Tremor und neuropathischen Schmerzen zeigten. Ob sich dieser Ph{\"a}notyp als charakteristisch f{\"u}r eine Neurofascin-155-IgM-(Para-)nodopathie best{\"a}tigt, sollte in weiteren Studien untersucht werden. Im murinen Zellkulturmodell an cerebell{\"a}ren Neuronen und Spinalganglienneuronen zeigte sich nach Inkubation mit Contactin-1-IgG-Patientenantik{\"o}rpern eine zeitabh{\"a}ngige, rasch reversible Verminderung der Contactin-1-Protein-Expression in immunhistochemischen F{\"a}rbungen sowie Western Blots, die durch eine Internalisierung des Contactin-1-Proteins erkl{\"a}rbar w{\"a}re. Der Angriff von Autoantik{\"o}rpern an Spinalganglienneuronen und cerebell{\"a}ren Neurone sollte in weitere pathophysiologische {\"U}berlegungen miteinbezogen werden, da hierdurch typische Symptome der (Para-)nodopathie wie eine sensible Ataxie oder ein cerebell{\"a}rer Tremor erkl{\"a}rt werden k{\"o}nnten.}, subject = {Ranvier-Schn{\"u}rring}, language = {de} } @article{DelVecchioHanafiPozzietal.2023, author = {Del Vecchio, Jasmin and Hanafi, Ibrahem and Pozzi, Nicol{\´o} Gabriele and Capetian, Philipp and Isaias, Ioannis U. and Haufe, Stefan and Palmisano, Chiara}, title = {Pallidal recordings in chronically implanted dystonic patients: mitigation of tremor-related artifacts}, series = {Bioengineering}, volume = {10}, journal = {Bioengineering}, number = {4}, issn = {2306-5354}, doi = {10.3390/bioengineering10040476}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-313498}, year = {2023}, abstract = {Low-frequency oscillatory patterns of pallidal local field potentials (LFPs) have been proposed as a physiomarker for dystonia and hold the promise for personalized adaptive deep brain stimulation. Head tremor, a low-frequency involuntary rhythmic movement typical of cervical dystonia, may cause movement artifacts in LFP signals, compromising the reliability of low-frequency oscillations as biomarkers for adaptive neurostimulation. We investigated chronic pallidal LFPs with the Percept\(^{TM}\) PC (Medtronic PLC) device in eight subjects with dystonia (five with head tremors). We applied a multiple regression approach to pallidal LFPs in patients with head tremors using kinematic information measured with an inertial measurement unit (IMU) and an electromyographic signal (EMG). With IMU regression, we found tremor contamination in all subjects, whereas EMG regression identified it in only three out of five. IMU regression was also superior to EMG regression in removing tremor-related artifacts and resulted in a significant power reduction, especially in the theta-alpha band. Pallido-muscular coherence was affected by a head tremor and disappeared after IMU regression. Our results show that the Percept PC can record low-frequency oscillations but also reveal spectral contamination due to movement artifacts. IMU regression can identify such artifact contamination and be a suitable tool for its removal.}, language = {en} } @article{PoliteiBouhassiraGermainetal.2016, author = {Politei, Juan M. and Bouhassira, Didier and Germain, Dominique P. and Goizet, Cyril and Guerrero-Sola, Antonio and Hilz, Max J. and Hutton, Elspeth J. and Karaa, Amel and Liuori, Rocco and {\"U}ceyler, Nurcan and Zeltzer, Lonnie K. and Burlina, Alessandro}, title = {Pain in fabry disease: practical recommendations for diagnosis and treatment}, series = {CNS Neuroscience \& Therapeutics}, volume = {22}, journal = {CNS Neuroscience \& Therapeutics}, number = {7}, doi = {10.1111/cns.12542}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-188127}, pages = {568-576}, year = {2016}, abstract = {Aims: Patients with Fabry disease (FD) characteristically develop peripheral neuropathy at an early age, with pain being a crucial symptom of underlying pathology. However, the diagnosis of pain is challenging due to the heterogeneous and nonspecific symptoms. Practical guidance on the diagnosis and management of pain in FD is needed. Methods: In 2014, experts met to discuss recent advances on this topic and update clinical guidance. Results: Emerging disease-specific tools, including FabryScan, Fabry-specific Pediatric Health and Pain Questionnaire, and Wurzburg Fabry Pain Questionnaire, and more general tools like the Total Symptom Score can aid diagnosis, characterization, and monitoring of pain in patients with FD. These tools can be complemented by more objective and quantifiable sensory testing. In male and female patients of any age, pain related to FD can be an early indication to start disease-specific enzyme replacement therapy before potentially irreversible organ damage to the kidneys, heart, or brain occurs. Conclusion: To improve treatment outcomes, pain should be diagnosed early in unrecognized or newly identified FD patients. Treatment should include: (a) enzyme replacement therapy controlling the progression of underlying pathology; (b) adjunctive, symptomatic pain management with analgesics for chronic neuropathic and acute nociceptive, and inflammatory or mixed pain; and (c) lifestyle modifications.}, language = {en} } @phdthesis{Visan2003, author = {Visan, Ion Lucian}, title = {P0 specific T-cell repertoire in wild-type and P0 deficient mice}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-5734}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2003}, abstract = {Zusammenfassung Das Myelinprotein P0 stellt eine zentrale Komponente f{\"u}r die Stabilit{\"a}t und Funktionalit{\"a}t der Myelinscheiden des peripheren Nervensystems dar. Mutationen des P0-Proteins f{\"u}hren zu verschiedenen, schwer behindernden peripheren Neuropathien wie der Charcot-Marie-Tooth- oder der Dejerine-Sotas-Erkrankung. Wir haben das Tiermodell der P0-Knock-Out-M{\"a}use verwendet, um im Vergleich zu den C57BL/6-Wildtyp-Tieren Selektionsmechanismen des P0-spezifischen T-Zell-Repertoires zu untersuchen. Dazu wurde eine Reihe von {\"u}berlappenden 20-mer-Peptiden benutzt, die die gesamte Aminos{\"a}uresequenz von P0 abdeckten. Mit Hilfe dieser Peptide wurde ein sog. „Epitop-Mapping" der H2-Ab-restringierten T-Zell-Antwort durchgef{\"u}hrt. Auf diese Weise konnte das P0-Peptid 5 (Aminos{\"a}ure 41-60) in der extrazellul{\"a}ren P0-Dom{\"a}ne als immunogene Determinante identifiziert werden. Dieses immunogene Peptid wurde dann f{\"u}r Untersuchungen der Toleranzmechanismen verwendet und zeigte, dass in P0-Knock-Out-M{\"a}usen ein hochreaktives P0-spezifisches T-Zell-Repertoire vorliegt, w{\"a}hrend es in Wildtyp-Tieren inaktiviert ist und so Selbsttoleranz erzeugt wird. Die Toleranzerzeugung in Wildtyp- und heterozygoten P0 +/- M{\"a}usen h{\"a}ngt nicht von der Gen-Dosis ab. P0 ist ein gewebespezifisches Antigen, dessen Expression normalerweise auf myelinisierende Schwann-Zellen beschr{\"a}nkt ist. Die klassischen Vorstellungen zu Toleranzmechanismen gegen{\"u}ber gewebsspezifischen Antigenen schrieben diese vor allem peripheren Immunmechanismen zu. Durch den erstmaligen Nachweis von intrathymischer Expression gewebsspezifischer Antigene wie P0 konnten wir best{\"a}tigen, dass f{\"u}r P0 offensichtlich die Expression deutlich weiter verbreitet ist, insbesondere auch auf Thymus-Stroma-Zellen. Unter Verwendung von Knochenmarkschim{\"a}ren haben wir weitere Untersuchungen durchgef{\"u}hrt, wie Knochenmarks-abstammende Zellen im Vergleich zu nicht-h{\"a}matopoetischen Zellen Toleranz gegen{\"u}ber P0 erzeugen k{\"o}nnen. Unsere Befunde zeigen, dass Knochenmarks-abh{\"a}ngige Zellen nicht ausreichen, um v{\"o}llige Toleranz zu erzeugen. Zus{\"a}tzlich wurde eine P0-Expression auf anderen Geweben wie dem Thymus ben{\"o}tigt, um komplette Toleranz zu erhalten. Wir identifizierten ein kryptisches P0-Peptid 8 und zwei subdominante P0-Peptide 1 und 3. W{\"a}hrend das Peptid 8 sowohl in Wildtyp- als auch Knock-Out-M{\"a}usen erkannt wurde, wurden die Peptide 1 und 3 in Wildtyp-M{\"a}usen nicht als Immunogen erkannt. Die genannten Peptide wurden verwendet, um eine experimentelle autoimmune Neuritis (EAN) zu erzeugen. Mit keinem der experimentellen Ans{\"a}tze konnten wir klinische Zeichen einer EAN generieren, allerdings mit dem Peptid 3 doch Entz{\"u}ndung im peripheren Nerven beobachten. Es werden zuk{\"u}nftig weitere Untersuchungen ben{\"o}tigt, um P0-spezifische T-Zell-Linien zu etablieren und so mit h{\"o}herer Effizienz eine EAN zu erzeugen. Unsere Untersuchungen sprechen daf{\"u}r, dass bei gentherapeutischen Ans{\"a}tzen bei erblichen Neuropathien vorsichtig und schrittweise vorgegangen werden muss, da mit sekund{\"a}rer Autoimmunit{\"a}t und damit Inflammation im peripheren Nerven zu rechnen ist.}, subject = {Myelin}, 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{OderUeceylerLiuetal.2016, author = {Oder, Daniel and {\"U}ceyler, Nurcan and Liu, Dan and Hu, Kai and Petritsch, Bernhard and Sommer, Claudia and Ertl, Georg and Wanner, Christoph and Nordbeck, Peter}, title = {Organ manifestations and long-term outcome of Fabry disease in patients with the GLA haplotype D313Y}, series = {BMJ Open}, volume = {6}, journal = {BMJ Open}, doi = {10.1136/bmjopen-2015-010422}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-161210}, pages = {e010422}, year = {2016}, abstract = {Objectives: The severity of Fabry disease is dependent on the type of mutation in the α-galactosidase A (AgalA) encoding gene (GLA). This study focused on the impact of the GLA haplotype D313Y on long-term organ involvement and function. Setting and participants: In this monocentric study, all participants presenting with the D313Y haplotype between 2001 and 2015 were comprehensively clinically investigated at baseline and during a 4-year follow-up if available. Five females and one male were included. Primary and secondary outcome measures: Cardiac, nephrological, neurological, laboratory and quality of life data. Results: AgalA enzyme activity in leucocytes (0.3±0.9 nmol/min/mg protein (mean±SD)) and serum lyso-Gb3 (0.6±0.3 ng/mL at baseline) were in normal range in all patients. Cardiac morphology and function were normal (left-ventricular (LV) ejection fraction 66±8\%; interventricular septum 7.7±1.4 mm; LV posterior wall 7.5±1.4 mm; normalised LV mass in MRI 52±9 g/m2; LV global longitudinal strain -21.6±1.9\%) and there were no signs of myocardial fibrosis in cardiac MRI. Cardiospecific biomarkers were also in normal range. Renal function was not impaired (estimated glomerular filtration rate MDRD 103±15 mL/min; serum-creatinine 0.75±0.07 mg/dL; cystatin-c 0.71±0.12 mg/L). One female patient (also carrying a Factor V Leiden mutation) had a transitory ischaemic attack. One patient showed white matter lesions in brain MRI, but none had Fabry-associated pain attacks, pain crises, evoked pain or permanent pain. Health-related quality of life analysis revealed a reduction in individual well-being. At long-term follow-up after 4 years, no significant change was seen in any parameter. Conclusions: The results of the current study suggest that the D313Y genotype does not lead to severe organ manifestations as seen in genotypes known to be causal for classical FD."}, language = {en} } @article{SommerKloseWelschetal.2020, author = {Sommer, Claudia and Klose, Petra and Welsch, Patrick and Petzke, Frank and H{\"a}user, Winfried}, title = {Opioids for chronic non-cancer neuropathic pain. An updated systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks duration}, series = {European Journal of Pain}, volume = {24}, journal = {European Journal of Pain}, number = {1}, doi = {10.1002/ejp.1494}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-218487}, pages = {3 -- 18}, year = {2020}, abstract = {Background and Objective This updated systematic review evaluated the efficacy, tolerability and safety of opioids compared to placebo in chronic non-cancer neuropathic pain. Databases and Data Treatment Clinicaltrials.gov, CENTRAL, PubMed and PsycINFO were searched from October 2013 to June 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks double-blinded duration were analysed. Primary outcomes were pain relief of 50\% or greater, disability, tolerability and safety. Effects were summarized by a random effects model using risk differences (RD) or standardized mean differences (SMD). We added four new studies with 662 participants for a total of 16 included studies with 2,199 participants. Study duration ranged between 4 and 12 weeks. Studies with a parallel and cross-over design: Based on low to moderate quality evidence, opioids (buprenorphine, hydromorphone, morphine, oxycodone, tramadol) provided a clinically relevant pain relief of 50\% or greater and reduction of disability compared to placebo. There was no clinically relevant harm with regards to the drop out rate due to adverse and serious adverse events by opioids compared to placebo. Enriched enrolment randomized withdrawal design: Based on low to moderate quality evidence, tapentadol provided a clinically relevant pain relief of 50\% or greater and reduction of disability compared to placebo in diabetic polyneuropathy. There was no clinically relevant harm with regards to the drop out rate due to adverse and serious adverse events by tapentadol compared to placebo. Conclusions Some opioids provided a short-term substantial pain relief in highly selected patients in some neuropathic pain syndromes. Significance Some opioids (buprenorphine, morphine, oxycodone, tramadol, tapentadol) provide substantial pain relief compared to placebo in postherpetic neuralgia and peripheral neuropathies of different aetiologies for 4-12 weeks. There is insufficient evidence to support or refute the suggestion that these drugs are effective in other neuropathic pain conditions. The safety of opioids with regards to abuse and deaths in the studies analysed cannot be extrapolated to routine clinical care.}, language = {en} } @article{PetzkeKloseWelschetal.2020, author = {Petzke, Frank and Klose, Petra and Welsch, Patrick and Sommer, Claudia and H{\"a}user, Winfried}, title = {Opioids for chronic low back pain: An updated systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks of double-blind duration}, series = {European Journal of Pain}, volume = {24}, journal = {European Journal of Pain}, number = {3}, doi = {10.1002/ejp.1519}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-218498}, pages = {497 -- 517}, year = {2020}, abstract = {Background and Objective This updated systematic review evaluated the efficacy, tolerability and safety of opioids compared to placebo in non-malignant chronic low back pain. Databases and Data Treatment Clinicaltrials.gov, CENTRAL, MEDLINE and PsycINFO were searched from October 2013 to May 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks of double-blinded duration were analysed. Primary outcomes were pain relief of 50\% or greater, disability, tolerability and safety. Effects were summarized by a random effects model using risk differences or standardized mean differences. We added nine new studies with 2,980 participants for a total of 21 studies with 7,650 participants. Study duration ranged between 4 and 15 weeks. Studies with a parallel and cross-over design: Based on very low to low-quality evidence, opioids provided no clinically relevant pain relief of 50\% or greater, but a clinically relevant reduction of disability compared to placebo. Enriched enrolment randomized withdrawal (EERW) design: Based on very low to low-quality evidence, opioids provided a clinically relevant pain relief of 50\% or greater, but not a clinically relevant reduction of disability compared to placebo. There was no clinically relevant harm with regard to serious adverse events by opioids compared to placebo in studies with parallel/cross-over and EERW design. There was a relevant harm with regard to drop out rates due to adverse events in studies with parallel/cross-over, but not in studies with EERW design. Conclusions Opioids may provide a safe and clinically relevant pain relief for 4-15 weeks in highly selected patients. Significance Within the context of randomized controlled trials of 4-15 weeks, opioids provided a clinically relevant pain relief of 30\% or greater and a clinically relevant reduction of disability compared to placebo in non-malignant chronic low back pain. Number needed to treat for an additional drop out due to side effects was 11 (95\% confidence interval: 6-33). Assessment of abuse and addiction was incomplete. The frequency of serious adverse events including deaths did not differ from placebo.}, language = {en} } @article{GeranUeckerPruessetal.2019, author = {Geran, Rohat and Uecker, Florian C. and Pr{\"u}ss, Harald and Haeusler, Karl Georg and Paul, Friedemann and Ruprecht, Klemens and Harms, Lutz and Schmidt, Felix A.}, title = {Olfactory and Gustatory Dysfunction in Patients With Autoimmune Encephalitis}, series = {Frontiers in Neurology}, volume = {10}, journal = {Frontiers in Neurology}, doi = {10.3389/fneur.2019.00480}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-232921}, year = {2019}, abstract = {Objective: To test the hypothesis that olfactory (OF) and gustatory function (GF) is disturbed in patients with autoimmune encephalitides (AE). Methods: The orthonasal OF was tested in 32 patients with AE and 32 age- and sex-matched healthy controls (HC) with the standardized Threshold Discrimination Identification (TDI) score. This validated olfactory testing method yields individual scores for olfactory threshold (T), odor discrimination (D), and identification (I), along with a composite TDI score. The GF was determined by the Taste Strip Test (TST). Results: Overall, 24/32 (75\%) of patients with AE, but none of 32 HC (p < 0.001) had olfactory dysfunction in TDI testing. The results of the threshold, discrimination and identification subtests were significantly reduced in patients with AE compared to HC (all p < 0.001). Assessed by TST, 5/19 (26.3\%) of patients with AE, but none of 19 HC presented a significant limitation in GF (p < 0.001). The TDI score was correlated with the subjective estimation of the olfactory capacity on a visual analog scale (VAS; rs = 0.475, p = 0.008). Neither age, sex, modified Rankin Scale nor disease duration were associated with the composite TDI score. Conclusions: This is the first study investigating OF and GF in AE patients. According to unblinded assessment, patients with AE have a reduced olfactory and gustatory capacity compared to HC, suggesting that olfactory and gustatory dysfunction are hitherto unrecognized symptoms in AE. Further studies with larger number of AE patients would be of interest to verify our results.}, language = {en} } @article{TuetuencueOlmaKunzeetal.2022, author = {T{\"u}t{\"u}nc{\"u}, Serdar and Olma, Manuel and Kunze, Claudia and Dietzel, Joanna and Schurig, Johannes and Fiessler, Cornelia and Malsch, Carolin and Haas, Tobias Eberhard and Dimitrijeski, Boris and Doehner, Wolfram and Hagemann, Georg and Hamilton, Frank and Honermann, Martin and Jungehulsing, Gerhard Jan and Kauert, Andreas and Koennecke, Hans-Christian and Mackert, Bruno-Marcel and Nabavi, Darius and Nolte, Christian H. and Reis, Joschua Mirko and Schmehl, Ingo and Sparenberg, Paul and Stingele, Robert and V{\"o}lzke, Enrico and Waldschmidt, Carolin and Zeise-Wehry, Daniel and Heuschmann, Peter U. and Endress, Matthias and Haeusler, Karl Georg}, title = {Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry}, series = {Journal of Neurology}, volume = {269}, journal = {Journal of Neurology}, number = {1}, issn = {1432-1459}, doi = {10.1007/s00415-021-10866-2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-266969}, pages = {470-480}, year = {2022}, abstract = {Aims We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke. Methods The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke. Results At stroke onset, an off-label daily dose was prescribed in 61 (25.5\%) of 239 NOAC patients with known AF and CHA2DS2-VASc score ≥ 1, of which 52 (21.8\%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95\% CI 1.05-7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95\% CI 1.04-10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2\%) of 61 patients. Overall, 79 (13.7\%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6\%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95\% CI 1.24-9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95\% CI 0.01-0.47, P < 0.01; n = 56], CHA2DS2-VASc score [OR per point 1.47, 95\% CI 1.08-2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95\% CI 1.28-2.84, P < 0.01]. Conclusion At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge.}, language = {en} } @phdthesis{Hochheimer2022, author = {Hochheimer, Vanessa Christine}, title = {Of cells and enzymes: How dermal fibroblasts can impact pain in Fabry Disease and Why looking at the 3D-structure of α-Galactosidase A may be worthwhile for clinical management of Fabry patients}, doi = {10.25972/OPUS-29660}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-296607}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Fabry Disease (FD) is a genetic lysosomal storage disorder based on mutations in the gene encoding α-Galactosidase A (α-GalA) leading to accumulation of globotriaosylceramide (Gb3). Missense mutations induce an amino acid exchange (AAE) in the α-GalA. Pain is a predominant symptom in FD and the pathophysiology is unclear. Skin punch biopsies were obtained from 40 adult FD patients and ten healthy controls and dermal fibroblast cultures were generated for cell culture experiments to investigate Gb3 load, gene and protein expression patterns and ion channel activity. The 3D-structure of α-GalA was downloaded into Pymol Graphics System and the AAE was depicted and located in order to investigate the correlation between the AAE location type in the α-GalA and the clinical FD phenotype. FD dermal fibroblasts showed high Gb3 load depending on treatment interval and expressed Kca1.1 channels. Activity was reduced in FD cells at baseline, but increased over-proportionately upon Gb3-cleavage by enzyme replacement therapy. Gene and protein expression of Kca1.1 was increased in FD cells. FD dermal fibroblasts showed higher gene expression of Notch1 and several cytokines. Further, it was shown that three different AAE location types can be differentiated: mutations in the active site ('active site'), those buried in the core of α-GalA ('buried') and those at another location, mostly on the protein surface ('other'). FD patients carrying active site or buried mutations showed a severe clinical phenotype with multi-organ manifestation and early disease onset. Patients with other mutations were less severely affected with oligo-organ manifestation sparing the nervous system and later disease onset. These results show that dermal fibroblasts may be involved in FD-associated pain and that stratification of FD patients carrying missense mutations by AAE location type may be an advantageous parameter that can help in the management of FD patients.}, subject = {Fabry-Krankheit}, language = {en} } @article{UllrichWeberPostetal.2018, author = {Ullrich, M and Weber, M and Post, A M and Popp, S and Grein, J and Zechner, M and Gonz{\´a}lez, H Guerrero and Kreis, A and Schmitt, A G and {\"U}ҫeyler, N and Lesch, K-P and Schuh, K}, title = {OCD-like behavior is caused by dysfunction of thalamo-amygdala circuits and upregulated TrkB/ERK-MAPK signaling as a result of SPRED2 deficiency}, series = {Molecular Psychiatry}, volume = {23}, journal = {Molecular Psychiatry}, doi = {10.1038/mp.2016.232}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-232096}, pages = {444-458}, year = {2018}, abstract = {Obsessive-compulsive disorder (OCD) is a common neuropsychiatric disease affecting about 2\% of the general population. It is characterized by persistent intrusive thoughts and repetitive ritualized behaviors. While gene variations, malfunction of cortico-striato-thalamo-cortical (CSTC) circuits, and dysregulated synaptic transmission have been implicated in the pathogenesis of OCD, the underlying mechanisms remain largely unknown. Here we show that OCD-like behavior in mice is caused by deficiency of SPRED2, a protein expressed in various brain regions and a potent inhibitor of Ras/ERK-MAPK signaling. Excessive self-grooming, reflecting OCD-like behavior in rodents, resulted in facial skin lesions in SPRED2 knockout (KO) mice. This was alleviated by treatment with the selective serotonin reuptake inhibitor fluoxetine. In addition to the previously suggested involvement of cortico-striatal circuits, electrophysiological measurements revealed altered transmission at thalamo-amygdala synapses and morphological differences in lateral amygdala neurons of SPRED2 KO mice. Changes in synaptic function were accompanied by dysregulated expression of various pre- and postsynaptic proteins in the amygdala. This was a result of altered gene transcription and triggered upstream by upregulated tropomyosin receptor kinase B (TrkB)/ERK-MAPK signaling in the amygdala of SPRED2 KO mice. Pathway overactivation was mediated by increased activity of TrkB, Ras, and ERK as a specific result of SPRED2 deficiency and not elicited by elevated brain-derived neurotrophic factor levels. Using the MEK inhibitor selumetinib, we suppressed TrkB/ERK-MAPK pathway activity in vivo and reduced OCD-like grooming in SPRED2 KO mice. Altogether, this study identifies SPRED2 as a promising new regulator, TrkB/ERK-MAPK signaling as a novel mediating mechanism, and thalamo-amygdala synapses as critical circuitry involved in the pathogenesis of OCD.}, language = {en} } @phdthesis{Weisensee2007, author = {Weisensee, Tim Andr{\´e}}, title = {Nutzen von Stroke-Unit-Behandlung f{\"u}r die geriatrische Rehabilitationsprognose}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-24937}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2007}, abstract = {Die vorliegende Arbeit {\"u}berpr{\"u}ft an einem nach Alter, Geschlecht, Barthel-Index und Mini-Mental-State-Test gematchten geriatrischen Patientenkollektiv mit erstmaligem Schlaganfall die Wirksamkeit einer vorausgegangenen Akutbehandlung an einer Stroke Unit (n=59) gegen{\"u}ber einer allgemeinen (internistischen oder neurologischen) station{\"a}ren Akutbehandlung (n=59) f{\"u}r die Prognose im Laufe einer nachfolgenden geriatrischen Rehabilitationsbehandlung. Hintergrund dieser Frage ist der erh{\"o}hte {\"o}konomische Druck im Gesundheitswesen, der eine Effizienzpr{\"u}fung einer personell, technisch und logistisch aufw{\"a}ndigeren und damit teureren Behandlung auf einer Spezialstation verlangt. Bei Anwendung zahlreicher funktioneller Skalen und Erhebung einiger sozio{\"o}konomischer Faktoren zeigte sich auf Signifikanzniveau, dass die auf Stroke Unit Vorbehandelten bei Aufnahme in die Rehabilitation motorisch schwerer beeintr{\"a}chtigt waren (timed up and go-Test p=0,044, Lachs-Test p=0,34) und sich dann ausgepr{\"a}gter (Transferleistung p=0,024) auf ein bei Rehabilitationsende schließlich vergleichbares Leistungsniveau verbesserten. Die urspr{\"u}nglich geplante Langzeiteffizienzbetrachtung im Gruppenvergleich scheiterte an Datenschutzbedenken. Gesundheits{\"o}konomisch relevant ist, dass die Vorverweildauer im Akutkrankenhaus bei Stroke Unit-Patienten sechs Tage k{\"u}rzer war, die Rehabilitationsdauer allerdings vier Tage l{\"a}nger. Weitergehende Kostenbetrachtungen scheiterten am Unwillen zur Leistungsoffenlegung verschiedener Beteiligter im Gesundheitssystem. Eine plausible Erkl{\"a}rung f{\"u}r diese positive motorische Leistungsweiterentwicklung nach Stroke Unit-Vorbehandlung kann in einer fr{\"u}hzeitigeren und effektiveren Anstrengung durch Krankengymnastik, Ergotherapie, Logop{\"a}die, aktivierende Pflege, „enriched environment" gesucht werden, die sich positiv auf die Plastizit{\"a}t im Gehirn als wesentliche Bedingung zur Funktionswiedergewinnung auswirken k{\"o}nnte, was aber noch umstritten ist und Ziel weiterer Untersuchungen sein muss.}, subject = {Geriatrie}, language = {de} } @article{HopfnerSchormairKnaufetal.2011, author = {Hopfner, Franziska and Schormair, Barbara and Knauf, Franziska and Berthele, Achim and T{\"o}lle, Thomas R. and Baron, Ralf and Maier, Christoph and Treede, Rolf-Detlef and Binder, Andreas and Sommer, Claudia and Maih{\"o}fner, Christian and Kunz, Wolfram and Zimprich, Friedrich and Heemann, Uwe and Pfeufer, Arne and N{\"a}bauer, Michael and K{\"a}{\"a}b, Stefan and Nowak, Barbara and Gieger, Christian and Lichtner, Peter and Trenkwalder, Claudia and Oexle, Konrad and Winkelmann, Juliane}, title = {Novel SCARB2 mutation in Action Myoclonus-Renal Failure syndrome and evaluation of SCARB2 mutations in isolated AMRF features}, series = {BMC Neurology}, volume = {11}, journal = {BMC Neurology}, number = {134}, doi = {10.1186/1471-2377-11-134}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-141209}, pages = {1-8}, year = {2011}, abstract = {Background: Action myoclonus-renal failure syndrome is a hereditary form of progressive myoclonus epilepsy associated with renal failure. It is considered to be an autosomal-recessive disease related to loss-of-function mutations in SCARB2. We studied a German AMRF family, additionally showing signs of demyelinating polyneuropathy and dilated cardiomyopathy. To test the hypothesis whether isolated appearance of individual AMRF syndrome features could be related to heterozygote SCARB2 mutations, we screened for SCARB2 mutations in unrelated patients showing isolated AMRF features. Methods: In the AMRF family all exons of SCARB2 were analyzed by Sanger sequencing. The mutation screening of unrelated patients with isolated AMRF features affected by either epilepsy (n = 103, progressive myoclonus epilepsy or generalized epilepsy), demyelinating polyneuropathy (n = 103), renal failure (n = 192) or dilated cardiomyopathy (n = 85) was performed as high resolution melting curve analysis of the SCARB2 exons. Results: A novel homozygous 1 bp deletion (c.111delC) in SCARB2 was found by sequencing three affected homozygous siblings of the affected family. A heterozygous sister showed generalized seizures and reduction of nerve conduction velocity in her legs. No mutations were found in the epilepsy, renal failure or dilated cardiomyopathy samples. In the polyneuropathy sample two individuals with demyelinating disease were found to be carriers of a SCARB2 frameshift mutation (c.666delCCTTA). Conclusions: Our findings indicate that demyelinating polyneuropathy and dilated cardiomyopathy are part of the action myoclonus-renal failure syndrome. Moreover, they raise the possibility that in rare cases heterozygous SCARB2 mutations may be associated with PNP features.}, language = {en} } @article{SilwedelSpeerHaarmannetal.2018, author = {Silwedel, Christine and Speer, Christian P. and Haarmann, Axel and Fehrholz, Markus and Claus, Heike and Buttmann, Mathias and Glaser, Kirsten}, title = {Novel insights into neuroinflammation: bacterial lipopolysaccharide, tumor necrosis factor α, and Ureaplasma species differentially modulate atypical chemokine receptor 3 responses in human brain microvascular endothelial cells}, series = {Journal of Neuroinflammation}, volume = {15}, journal = {Journal of Neuroinflammation}, number = {156}, doi = {10.1186/s12974-018-1170-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-175952}, year = {2018}, abstract = {Background: Atypical chemokine receptor 3 (ACKR3, synonym CXCR7) is increasingly considered relevant in neuroinflammatory conditions, in which its upregulation contributes to compromised endothelial barrier function and may ultimately allow inflammatory brain injury. While an impact of ACKR3 has been recognized in several neurological autoimmune diseases, neuroinflammation may also result from infectious agents, including Ureaplasma species (spp.). Although commonly regarded as commensals of the adult urogenital tract, Ureaplasma spp. may cause invasive infections in immunocompromised adults as well as in neonates and appear to be relevant pathogens in neonatal meningitis. Nonetheless, clinical and in vitro data on Ureaplasma-induced inflammation are scarce. Methods: We established a cell culture model of Ureaplasma meningitis, aiming to analyze ACKR3 variances as a possible pathomechanism in Ureaplasma-associated neuroinflammation. Non-immortalized human brain microvascular endothelial cells (HBMEC) were exposed to bacterial lipopolysaccharide (LPS) or tumor necrosis factor-α (TNF-α), and native as well as LPS-primed HBMEC were cultured with Ureaplasma urealyticum serovar 8 (Uu8) and U. parvum serovar 3 (Up3). ACKR3 responses were assessed via qRT-PCR, RNA sequencing, flow cytometry, and immunocytochemistry. Results: LPS, TNF-α, and Ureaplasma spp. influenced ACKR3 expression in HBMEC. LPS and TNF-α significantly induced ACKR3 mRNA expression (p < 0.001, vs. control), whereas Ureaplasma spp. enhanced ACKR3 protein expression in HBMEC (p < 0.01, vs. broth control). Co-stimulation with LPS and either Ureaplasma isolate intensified ACKR3 responses (p < 0.05, vs. LPS). Furthermore, stimulation wielded a differential influence on the receptor's ligands. Conclusions: We introduce an in vitro model of Ureaplasma meningitis. We are able to demonstrate a pro-inflammatory capacity of Ureaplasma spp. in native and, even more so, in LPS-primed HBMEC, underlining their clinical relevance particularly in a setting of co-infection. Furthermore, our data may indicate a novel role for ACKR3, with an impact not limited to auto-inflammatory diseases, but extending to infection-related neuroinflammation as well. AKCR3-induced blood-brain barrier breakdown might constitute a potential common pathomechanism.}, language = {en} } @article{PiroEckesKasaragodetal.2021, author = {Piro, Inken and Eckes, Anna-Lena and Kasaragod, Vikram Babu and Sommer, Claudia and Harvey, Robert J. and Schaefer, Natascha and Villmann, Carmen}, title = {Novel Functional Properties of Missense Mutations in the Glycine Receptor β Subunit in Startle Disease}, series = {Frontiers in Molecular Neuroscience}, volume = {14}, journal = {Frontiers in Molecular Neuroscience}, issn = {1662-5099}, doi = {10.3389/fnmol.2021.745275}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-246676}, year = {2021}, abstract = {Startle disease is a rare disorder associated with mutations in GLRA1 and GLRB, encoding glycine receptor (GlyR) α1 and β subunits, which enable fast synaptic inhibitory transmission in the spinal cord and brainstem. The GlyR β subunit is important for synaptic localization via interactions with gephyrin and contributes to agonist binding and ion channel conductance. Here, we have studied three GLRB missense mutations, Y252S, S321F, and A455P, identified in startle disease patients. For Y252S in M1 a disrupted stacking interaction with surrounding aromatic residues in M3 and M4 is suggested which is accompanied by an increased EC\(_{50}\) value. By contrast, S321F in M3 might stabilize stacking interactions with aromatic residues in M1 and M4. No significant differences in glycine potency or efficacy were observed for S321F. The A455P variant was not predicted to impact on subunit folding but surprisingly displayed increased maximal currents which were not accompanied by enhanced surface expression, suggesting that A455P is a gain-of-function mutation. All three GlyR β variants are trafficked effectively with the α1 subunit through intracellular compartments and inserted into the cellular membrane. In vivo, the GlyR β subunit is transported together with α1 and the scaffolding protein gephyrin to synaptic sites. The interaction of these proteins was studied using eGFP-gephyrin, forming cytosolic aggregates in non-neuronal cells. eGFP-gephyrin and β subunit co-expression resulted in the recruitment of both wild-type and mutant GlyR β subunits to gephyrin aggregates. However, a significantly lower number of GlyR β aggregates was observed for Y252S, while for mutants S321F and A455P, the area and the perimeter of GlyR β subunit aggregates was increased in comparison to wild-type β. Transfection of hippocampal neurons confirmed differences in GlyR-gephyrin clustering with Y252S and A455P, leading to a significant reduction in GlyR β-positive synapses. Although none of the mutations studied is directly located within the gephyrin-binding motif in the GlyR β M3-M4 loop, we suggest that structural changes within the GlyR β subunit result in differences in GlyR β-gephyrin interactions. Hence, we conclude that loss- or gain-of-function, or alterations in synaptic GlyR clustering may underlie disease pathology in startle disease patients carrying GLRB mutations.}, 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} } @phdthesis{Brunder2022, author = {Brunder, Anna-Michelle}, title = {Nodale und paranodale Autoantik{\"o}rper bei inflammatorischen Polyneuropathien: Nachweis, Charakterisierung und Assoziation zu klinischen Verlaufsformen}, doi = {10.25972/OPUS-28218}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-282185}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {In den letzten Jahren gewann das Konzept der Paranodopathien als eigene Krankheitsentit{\"a}t der inflammatorischen Polyneuropathien zunehmend an Bedeutung. Die Forschung konzentrierte sich dabei {\"u}berwiegend auf die chronisch inflammatorische Polyradikuloneuropathie (CIDP). In dieser Arbeit werden (para-)nodale Antik{\"o}rper gegen Neurofascin-155, panNeurofascin, Contactin-1 und Caspr-1 in einer großen Kohorte von Patienten mit Guillain-Barr{\´e}-Syndrom (GBS) und CIDP nachgewiesen. Patienten mit Anti-panNeurofascin-Antik{\"o}rpern zeigten besonders schwere Verlaufsformen. Patienten mit anderen (para-)nodalen Antik{\"o}rpern zeigten je nach IgG-Subklasse der Antik{\"o}rper spezifische klinische Merkmale und ein unterschiedliches Ansprechen auf die Therapie. Die Arbeit zeigt, dass die Bestimmung (para-)nodaler Antik{\"o}rper bei Patienten mit GBS und CIDP im klinischen Alltag zur Einordung der Prognose und Therapieplanung sinnvoll sein kann.}, subject = {Polyneuropathie}, language = {de} }