TY - JOUR A1 - Fortmann, Mats Ingmar A1 - Dirks, Johannes A1 - Goedicke-Fritz, Sybelle A1 - Liese, Johannes A1 - Zemlin, Michael A1 - Morbach, Henner A1 - Härtel, Christoph T1 - Immunization of preterm infants: current evidence and future strategies to individualized approaches JF - Seminars in Immunopathology N2 - Preterm infants are at particularly high risk for infectious diseases. As this vulnerability extends beyond the neonatal period into childhood and adolescence, preterm infants benefit greatly from infection-preventive measures such as immunizations. However, there is an ongoing discussion about vaccine safety and efficacy due to preterm infants’ distinct immunological features. A significant proportion of infants remains un- or under-immunized when discharged from primary hospital stay. Educating health care professionals and parents, promoting maternal immunization and evaluating the potential of new vaccination tools are important means to reduce the overall burden from infectious diseases in preterm infants. In this narrative review, we summarize the current knowledge about vaccinations in premature infants. We discuss the specificities of early life immunity and memory function, including the role of polyreactive B cells, restricted B cell receptor diversity and heterologous immunity mediated by a cross-reactive T cell repertoire. Recently, mechanistic studies indicated that tissue-resident memory (Trm) cell populations including T cells, B cells and macrophages are already established in the fetus. Their role in human early life immunity, however, is not yet understood. Tissue-resident memory T cells, for example, are diminished in airway tissues in neonates as compared to older children or adults. Hence, the ability to make specific recall responses after secondary infectious stimulus is hampered, a phenomenon that is transcriptionally regulated by enhanced expression of T-bet. Furthermore, the microbiome establishment is a dominant factor to shape resident immunity at mucosal surfaces, but it is often disturbed in the context of preterm birth. The proposed function of Trm T cells to remember benign interactions with the microbiome might therefore be reduced which would contribute to an increased risk for sustained inflammation. An improved understanding of Trm interactions may determine novel targets of vaccination, e.g., modulation of T-bet responses and facilitate more individualized approaches to protect preterm babies in the future. KW - preterm infants KW - immunization KW - vaccination KW - safety KW - mechanisms KW - resident memory T cells Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324261 VL - 44 IS - 6 ER - TY - JOUR A1 - Harter, Patrick N. A1 - Bernatz, Simon A1 - Scholz, Alexander A1 - Zeiner, Pia S. A1 - Zinke, Jenny A1 - Kiyose, Makoto A1 - Blasel, Stella A1 - Beschorner, Rudi A1 - Senft, Christian A1 - Bender, Benjamin A1 - Ronellenfitsch, Michael W. A1 - Wikman, Harriet A1 - Glatzel, Markus A1 - Meinhardt, Matthias A1 - Juratli, Tareq A. A1 - Steinbach, Joachim P. A1 - Plate, Karl H. A1 - Wischhusen, Jörg A1 - Weide, Benjamin A1 - Mittelbronn, Michel T1 - Distribution and prognostic relevance of tumor-infiltrating lymphocytes (TILs) and PD-1/PD-L1 immune checkpoints in human brain metastases JF - Oncotarget N2 - The activation of immune cells by targeting checkpoint inhibitors showed promising results with increased patient survival in distinct primary cancers. Since only limited data exist for human brain metastases, we aimed at characterizing tumor infiltrating lymphocytes (TILs) and expression of immune checkpoints in the respective tumors. Two brain metastases cohorts, a mixed entity cohort (n = 252) and a breast carcinoma validation cohort (n = 96) were analyzed for CD3+, CD8+, FOXP3+, PD-1+ lymphocytes and PD-L1+ tumor cells by immunohistochemistry. Analyses for association with clinico-epidemiological and neuroradiological parameters such as patient survival or tumor size were performed. TILs infiltrated brain metastases in three different patterns (stromal, peritumoral, diffuse). While carcinomas often show a strong stromal infiltration, TILs in melanomas often diffusely infiltrate the tumors. Highest levels of CD3+ and CD8+ lymphocytes were seen in renal cell carcinomas (RCC) and strongest PD-1 levels on RCCs and melanomas. High amounts of TILs, high ratios of PD-1+/CD8+ cells and high levels of PD-L1 were negatively correlated with brain metastases size, indicating that in smaller brain metastases CD8+ immune response might get blocked. PD-L1 expression strongly correlated with TILs and FOXP3 expression. No significant association of patient survival with TILs was observed, while high levels of PD-L1 showed a strong trend towards better survival in melanoma brain metastases (Log-Rank p = 0.0537). In summary, melanomas and RCCs seem to be the most immunogenic entities. Differences in immunotherapeutic response between tumor entities regarding brain metastases might be attributable to this finding and need further investigation in larger patient cohorts. KW - B7-H1 KW - PD-L1 KW - immunoresistance KW - immunosurveillance KW - safety KW - survival KW - expression KW - melanoma KW - breast cancer KW - PC-1 blockade KW - cell lung cancer KW - tumor-infiltrating lymphocytes KW - brain metastases KW - PD-1 Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-137107 VL - 6 IS - 38 SP - 40836 EP - 40849 ER - TY - THES A1 - Hofmann, Bernd T1 - Bienen-/Wespengiftallergie: Wirksamkeit und Sicherheit einer Immuntherapie mit 100 µg Gift über 3 bis 5 Jahre T1 - Hymenoptera venom allergy: Safety and effectiveness of immunotherapy N2 - Die Bienen-/Wespengiftallergie ist auf der einen Seite eine potentiell lebensbedrohliche IgE-vermittelte Allergiekrankheit, in Deutschland neben den Nahrungsmittelallergien die häufigste Ursache für eine tödlich verlaufende Anaphylaxie. Auf der anderen Seite steht mit der Bienen-/Wespengift-spezifischen Immuntherapie (SIT) gerade für diese Allergie seit Jahrzehnten eine hochwirksame kausale Therapie zur Verfügung. Placebokontrollierte Studien mit unbehandelten Patienten sind daher aus ethischen Gründen nicht vertretbar. Neue Erkenntnisse zur Sicherheit dieser Therapieform können nur aus der Verlaufsbeobachtung standardisiert behandelter Patientenkollektive gewonnen werden. Der besondere Wert der hier analysierten großen Patientenserie liegt vor allem darin, dass alle Patienten in einer Allergieambulanz (der Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie) betreut wurden. Im gesamten Behandlungszeitraum aller 679 Patienten wurde die Diagnostik und Therapie der Bienen-/Wespengiftallergie hoch standardisiert durchgeführt und nicht verändert. Die dadurch gleichbleibende Betreuung garantierten Qualität, Umfang und Homogenität der Dokumentation und damit die Vergleichbarkeit der retrospektiv erfassten Daten über den gesamten Zeitraum 1988 bis 2008. Für die besonders wichtige Verlaufsbeobachtung nach Ende der spezifischen Immuntherapie (SIT) wurden zusätzlich 616 der 679 Patienten aus Unterfranken und Umgebung direkt telefonisch befragt. Die bekannten charakteristischen Merkmale von Patienten mit Bienen-/Wespengiftallergie zeigten sich auch in dem untersuchten Kollektiv. Imkertätigkeit ist die wahrscheinlichste Erklärung warum Bienengiftallergiker jünger und häufiger männlich sind. Die prognostisch bedeutsamen Schweregrade der allergischen Indikatorstichreaktion (das Stichereignis mit der schwersten anaphylaktischen Reaktion vor SIT) unterscheiden sich zwischen Bienen- und Wespengiftallergikern dagegen nicht. In den diagnostischen Untersuchungen vor und auch am Ende der SIT waren die Schwellenwertkonzentrationen des Intrakutan- und Pricktests bei Bienengiftallergikern im Vergleich zu den Wespengiftallergikern signifikant niedriger, die spezifischen IgE-Serumspiegel höher. Die Wirksamkeit der SIT mit Bienengift betrug 89,0 %. Nur 11,0 % der Patienten (8 von 73 Patienten mit erneutem Bienenstich) hatten nach Beginn der SIT erneut eine N2 - The study analyzed patients with a bee venom allergy or a wasp venom allergy who had a specific immunotherapy for at least 3 years. Differences between bee and wasp venom allergy, safety and effectiveness of the immunotherapy and differences between patients with or without a tolerated sting (after immunotherapy) were investigated. KW - Bienengiftallergie KW - Wespengiftallergie KW - Immuntherapie ; Hyposensibilisierung KW - Wirksamkeit KW - Sicherheit KW - Unterschiede KW - Hymenoptera KW - venom KW - allergy KW - bee KW - wasp KW - immunotherapy KW - safety Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-57500 ER - TY - JOUR A1 - Lousada, Cláudio M. A1 - Soroka, Inna L. A1 - Yagodzinskyy, Yuriy A1 - Tarakina, Nadezda V. A1 - Todoshchenko, Olga A1 - Hänninen, Hannu A1 - Korzhavyi, Pavel A. A1 - Jonsson, Mats T1 - Gamma radiation induces hydrogen absorption by copper in water JF - Scientific Reports N2 - One of the most intricate issues of nuclear power is the long-term safety of repositories for radioactive waste. These repositories can have an impact on future generations for a period of time orders of magnitude longer than any known civilization. Several countries have considered copper as an outer corrosion barrier for canisters containing spent nuclear fuel. Among the many processes that must be considered in the safety assessments, radiation induced processes constitute a key-component. Here we show that copper metal immersed in water uptakes considerable amounts of hydrogen when exposed to γ-radiation. Additionally we show that the amount of hydrogen absorbed by copper depends on the total dose of radiation. At a dose of 69 kGy the uptake of hydrogen by metallic copper is 7 orders of magnitude higher than when the absorption is driven by H\(_{2}\)(g) at a pressure of 1 atm in a non-irradiated dry system. Moreover, irradiation of copper in water causes corrosion of the metal and the formation of a variety of surface cavities, nanoparticle deposits, and islands of needle-shaped crystals. Hence, radiation enhanced uptake of hydrogen by spent nuclear fuel encapsulating materials should be taken into account in the safety assessments of nuclear waste repositories. KW - gamma radiation KW - radioactive waste KW - nuclear power KW - repositories KW - safety KW - copper KW - water Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-167730 VL - 6 IS - 24234 ER - TY - JOUR A1 - Merz, Maximilian A1 - Dechow, Tobias A1 - Scheyt, Mithun A1 - Schmidt, Christian A1 - Knop, Stefan T1 - The clinical management of lenalidomide-based therapy in patients with newly diagnosed multiple myeloma JF - Annals of Hematology N2 - Lenalidomide is an integral, yet evolving, part of current treatment pathways for both transplant-eligible and transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM). It is approved in combination with dexamethasone as first-line therapy for transplant-ineligible patients with NDMM, and as maintenance treatment following autologous stem cell transplantation (ASCT). Although strong clinical trial evidence has supported the integration of lenalidomide into current treatment paradigms for NDMM, applying those paradigms to individual patients and determining which patients are most likely to benefit from lenalidomide treatment are more complex. In this paper, we utilize the available clinical trial evidence to provide recommendations for patient selection and lenalidomide dosing in both the first-line setting in patients ineligible for ASCT and the maintenance setting in patients who have undergone ASCT. In addition, we provide guidance on management of those adverse events that are most commonly associated with lenalidomide treatment, and consider the optimal selection and sequencing of next-line agents following long-term frontline or maintenance treatment with lenalidomide. KW - adverse events KW - lenalidomide KW - multiple myeloma KW - newly diagnosed KW - safety Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231862 SN - 0939-5555 VL - 99 ER - TY - JOUR A1 - Mostovaya, Ira M. A1 - Grooteman, Muriel P.C. A1 - Basile, Carlo A1 - Davenport, Andrew A1 - de Roij van Zuijdewijn, Camiel L.M. A1 - Wanner, Christoph A1 - Nubé, Menso J. A1 - Blankestijn, Peter J. T1 - High convection volume in online post-dilution haemodiafiltration: relevance, safety and costs JF - Clinical Kidney Journal N2 - Increasing evidence suggests that treatment with online post-dilution haemodiafiltration (HDF) improves clinical outcome in patients with end-stage kidney disease, if compared with haemodialysis (HD). Although the primary analyses of three large randomized controlled trials (RCTs) showed inconclusive results, post hoc analyses of these and previous observational studies comparing online post-dilution HDF with HD showed that the risk of overall and cardiovascular mortality is lowest in patients who are treated with high-volume HDF. As such, the magnitude of the convection volume seems crucial and can be considered as the ‘dose’ of HDF. In this narrative review, the relevance of high convection volume in online post-dilution HDF is discussed. In addition, we briefly touch upon some safety and cost issues. KW - convection volume KW - costs KW - hemodiafiltration KW - mortality KW - safety Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-149814 VL - 8 IS - 4 ER - TY - JOUR A1 - Reiter, Theresa A1 - Gensler, Daniel A1 - Ritter, Oliver A1 - Weiss, Ingo A1 - Geistert, Wolfgang A1 - Kaufmann, Ralf A1 - Hoffmeister, Sabine A1 - Friedrich, Michael T. A1 - Wintzheimer, Stefan A1 - Düring, Markus A1 - Nordbeck, Peter A1 - Jakob, Peter M. A1 - Ladd, Mark E. A1 - Quick, Harald H. A1 - Bauer, Wolfgang R. T1 - Direct cooling of the catheter tip increases safety for CMR-guided electrophysiological procedures JF - Journal of Cardiovascular Magnetic Resonance N2 - Background: One of the safety concerns when performing electrophysiological (EP) procedures under magnetic resonance (MR) guidance is the risk of passive tissue heating due to the EP catheter being exposed to the radiofrequency (RF) field of the RF transmitting body coil. Ablation procedures that use catheters with irrigated tips are well established therapeutic options for the treatment of cardiac arrhythmias and when used in a modified mode might offer an additional system for suppressing passive catheter heating. Methods: A two-step approach was chosen. Firstly, tests on passive catheter heating were performed in a 1.5 T Avanto system (Siemens Healthcare Sector, Erlangen, Germany) using a ASTM Phantom in order to determine a possible maximum temperature rise. Secondly, a phantom was designed for simulation of the interface between blood and the vascular wall. The MR-RF induced temperature rise was simulated by catheter tip heating via a standard ablation generator. Power levels from 1 to 6 W were selected. Ablation duration was 120 s with no tip irrigation during the first 60 s and irrigation at rates from 2 ml/min to 35 ml/min for the remaining 60 s (Biotronik Qiona Pump, Berlin, Germany). The temperature was measured with fluoroscopic sensors (Luxtron, Santa Barbara, CA, USA) at a distance of 0 mm, 2 mm, 4 mm, and 6 mm from the catheter tip. Results: A maximum temperature rise of 22.4 degrees C at the catheter tip was documented in the MR scanner. This temperature rise is equivalent to the heating effect of an ablator's power output of 6 W at a contact force of the weight of 90 g (0.883 N). The catheter tip irrigation was able to limit the temperature rise to less than 2 degrees C for the majority of examined power levels, and for all examined power levels the residual temperature rise was less than 8 degrees C. Conclusion: Up to a maximum of 22.4 degrees C, the temperature rise at the tissue surface can be entirely suppressed by using the catheter's own irrigation system. The irrigated tip system can be used to increase MR safety of EP catheters by suppressing the effects of unwanted passive catheter heating due to RF exposure from the MR scanner. KW - EP Procedures KW - radiofrequency ablation KW - contact force KW - lesion size KW - MRI KW - temperature KW - tissue KW - wires KW - model KW - ablation KW - safety KW - catheter tip KW - MR guidance Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-134927 VL - 14 IS - 12 ER - TY - JOUR A1 - Shityakov, Sergey A1 - Puskás, István A1 - Pápai, Katalin A1 - Salvador, Ellaine A1 - Roewer, Norbert A1 - Förster, Carola A1 - Broscheit, Jens-Albert T1 - Sevoflurane-sulfobutylether-\(\beta\)-cyclodextrin complex: preparation, characterization, cellular toxicity, molecular modeling and blood-brain barrier transport studies JF - Molecules N2 - The objective of the present investigation was to study the ability of sulfobutylether-\(\beta\)-cyclodextrin (SBECD) to form an inclusion complex with sevoflurane (SEV), a volatile anesthetic with poor water solubility. The inclusion complex was prepared, characterized and its cellular toxicity and blood-brain barrier (BBB) permeation potential of the formulated SEV have also been examined for the purpose of controlled drug delivery. The SEV-SBE\(\beta\)CD complex was nontoxic to the primary brain microvascular endothelial (pEND) cells at a clinically relevant concentration of sevoflurane. The inclusion complex exhibited significantly higher BBB permeation profiles as compared with the reference substance (propranolol) concerning calculated apparent permeability values (P\(_{app}\)). In addition, SEV binding affinity to SBE\(\beta\)CD was confirmed by a minimal Gibbs free energy of binding (ΔG\(_{bind}\)) value of -1.727 ± 0.042 kcal・mol\(^{-1}\) and an average binding constant (K\(_{b}\)) of 53.66 ± 9.24 mM indicating rapid drug liberation from the cyclodextrin amphiphilic cavity. KW - pharmaceutical applications KW - in vitro KW - propranolol KW - water KW - primary microvascular endothelial cells KW - molecular liphophilicity potential KW - molecular docking KW - blood-brain barrier KW - ulfobutylether-\(\beta\)-cyclodextrin KW - sevoflurane KW - cyclodextrin formulations KW - safety KW - etomidate KW - formulations KW - hydrochloride KW - ether KW - intestinal absorption Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-148543 VL - 20 ER - TY - JOUR A1 - Stein, Anthony S. A1 - Kantarjian, Hagop A1 - Gökbuget, Nicola A1 - Bargou, Ralf A1 - Litzow, Mark R. A1 - Rambaldi, Alessandro A1 - Ribera, Josep-Maria A1 - Zhang, Alicia A1 - Zimmerman, Zachary A1 - Zugmaier, Gerhard A1 - Topp, Max S. T1 - Blinatumomab for Acute Lymphoblastic Leukemia Relapse after Allogeneic Hematopoietic Stem Cell Transplantation JF - Biology of Blood and Marrow Transplantation N2 - Patients with relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL) following allogeneic hematopoietic stem cell transplantation (alloHSCT) have a poor prognosis, and alternative therapies are needed for this patient population. Blinatumomab, a bispecific T cell engager immunotherapy, was evaluated in an open-label, single-arm, phase II study of adults with R/R Philadelphia chromosome-negative B cell precursor ALL and resulted in a rate of complete remission (CR) or CR with partial hematologic recovery of peripheral blood counts (CRh) of 43% within 2 treatment cycles. We conducted an exploratory analysis to determine the efficacy and safety of blinatumomab in 64 patients who had relapsed following alloHSCT before enrollment in the phase II study. Forty-five percent of the patients (29 of 64) achieved a CR/CRh within the first 2 cycles of treatment, 22 of whom had a minimal residual disease (MRD) response (including 19 with a complete MRD response). After 1 year and 3 years of follow-up, the median relapse-free survival was 7.4 months for patients who achieved CR/CRh in the first 2 cycles, and the median overall survival was 8.5 months; overall survival rate (Kaplan-Meier estimate) was 36% at 1 year and 18% at 3 years. Grade 3 and 4 adverse events were reported in 20 patients (31%) and 28 patients (44%), respectively, with grade 3 and 4 neurologic events in 8 and 2 patients, respectively, and grade 3 cytokine release syndrome in 2 patients. Eight patients had fatal adverse events, including 5 due to infections. Seven patients had grade ≤ 3 graft-versus-host disease during the study, none of which resulted in the discontinuation of blinatumomab or hospitalization. Our data suggest that blinatumomab is an effective salvage therapy in this patient population. KW - blinatumomab KW - Philadelphia chromosome-negative B precursor ALL KW - efficacy KW - safety KW - allogeneic hematopoietic stem cell transplantation Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239510 VL - 25 ER - TY - JOUR A1 - Strilciuc, Stefan A1 - Vécsei, László A1 - Boering, Dana A1 - Pražnikar, Aleš A1 - Kaut, Oliver A1 - Riederer, Peter A1 - Battistin, Leontino T1 - Safety of Cerebrolysin for neurorecovery after acute ischemic stroke: a systematic review and meta-analysis of twelve randomized-controlled trials JF - Pharmaceuticals N2 - We performed a systematic search and meta-analysis of available literature to determine the safety profile of Cerebrolysin in acute ischemic stroke, filling existing safety information gaps and inconsistent results. We searched EMBASE, PubMed, and Cochrane Databases of Systematic Reviews and Clinical Trials up to the end of February 2021. Data collection and analysis were conducted using methods described in the Cochrane Handbook for Systematic Reviews of Interventions. All safety outcomes were analyzed based on risk ratios (RR) and their 95% confidence intervals. The meta-analysis pooled 2202 patients from twelve randomized clinical trials, registering non-statistically significant (p > 0.05) differences between Cerebrolysin and placebo throughout main and subgroup analyses. The lowest rate of Serious Adverse Events (SAE), as compared to placebo, was observed for the highest dose of Cerebrolysin (50 mL), highlighting a moderate reduction (RR = 0.6). We observed a tendency of superiority of Cerebrolysin regarding SAE in high dose treatment courses for moderate-severe ischemic stroke, suggesting some effect of the agent against adverse events. This comprehensive safety meta-analysis confirms the safety profile for patients treated with Cerebrolysin after acute ischemic stroke, as compared to placebo. KW - ischemic stroke KW - safety KW - Cerebrolysin KW - neurorehabilitation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-252403 SN - 1424-8247 VL - 14 IS - 12 ER -