TY - THES A1 - Winkler, Jana T1 - Einfluss von D-β-Hydroxybutyrat auf Stoffwechsel und Interaktion mit Chemo-/Strahlentherapie bei triple negativen Mamma-Karzinom Zellen T1 - The effect of D-ß-Hydroxybutyrat on metabolism and proliferation in combination with Chemotherapy / Radiation on triple negativ breast cancer N2 - Das triple negative Mamma-Karzinom stellt eine Tumorart dar, welche besonders junge Frauen betrifft und eine schlechte Prognose aufweist. Unterstützende und pro- gnoseverbessernde Therapien sind deshalb Gegenstand aktueller Forschung. Eine mögliche unterstützende Therapie stellt hierbei die ketogene Diät dar. Diese Arbeit untersuchte die Fragestellung, ob β-Hydroxybutyrat (3OHB), welches als Hauptme- tabolit unter ketogener Diät oder beim Fasten erhöht ist, Einfluss auf das Zellwachs- tum triple-negativer Brustkrebszellen ausübt. Außerdem wurde eruiert, ob 3OHB die üblichen Behandlungsformen - Chemotherapie und Strahlentherapie - positiv oder negativ beeinflusst. In vitro wurden Versuche mit drei triple-negativen Brust- krebszellreihen unter möglichst physiologischen Bedingungen durchgeführt. Hierbei konnte durch 3OHB weder ein wachstumsfördernder noch ein wachstumshemmender Effekt beobachtet werden. Genauso zeigte sich bei den Chemo- oder Strahlenthera- pieversuchen keine durch 3OHB induzierte Wechselwirkung. In vivo durchgeführte Studien über den Einfluss einer ketogenen Diät finden sich nur vereinzelt. Um be- lastbare Daten zu erhalten werden deshalb weitere Studien in Zukunft vonnöten sein. Eine ketogene Diät könnte hierbei im Rahmen eines multimodalen Therapie- konzeptes eine unterstützende Rolle spielen, wofür erste Einzelfallstudien Hinweise geben N2 - Triple-negative breast cancer is an aggressive cancer subtype affecting predominantly younger women. Owing to the worse prognosis obtained with standard therapy, alternative supportive approaches like ketogenic diet gain popular interest. Beta-hydroxybutyrate (3-OHB) is the main physiologic substrate generated during ketogenic diet. In this paper the effect of 3-OHB on metabolism, proliferation, and viability of triple negative breast cancer cells in vitro with exposure to cytotoxic chemotherapy and radiation was investigated. Different concentrations for 3-OHB, oxygen, chemotherapeutic agents and radiation doses were applied, resembling physiologic conditions within the tumor. 3-OHB did not influence cell proliferation and metabolism. Neither an inhibitory nor a growth-promoting effect for 3-OHB could be detected. The cytotoxic effects of chemotherapeutic agents as well as radiation were similar with or without the addition of 3-OHB. Given the limitations of in-vitro studies and the promising results of individual case studies, clinical trials investigating the effects of a ketogenic diet are necessary to provide further insights. KW - Ketogene Kost KW - Brustkrebs KW - Betahydroxybutyrat KW - triple negatives Mamma Karzinom Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-347044 ER - TY - THES A1 - Wallner, Theresa Veronika T1 - Auswirkungen von Endometriose und ihrer vollständigen Resektion auf die Embryonenqualität T1 - Effects of endometriosis and its complete resection on embryo quality N2 - Ziel dieser Arbeit war es, den Einfluss von Endometriose sowie den Einfluss einer vollständigen Endometriose-Resektion auf morphokinetische, mit dem Implantationserfolg korrelierende Aspekte der Embryonenqualität zu untersuchen. Für die zugrundeliegende retrospektive Studie wurden 258 im Rahmen von IVF- und/oder ICSI-Zyklen befruchtete und kultivierte Embryonen von 44 Patientinnen mit histologisch gesicherter Endometriose und 43 Patientinnen mit laparoskopisch ausgeschlossener Endometriose ausgewertet. Sowohl Endometriose als auch die vollständige Endometriose-Resektion wurden als Einflussfaktor der frühen Embryonalentwicklung untersucht. Hierfür wurde unter Anwendung des KIDScore\(^{TM}\) D3 und D5 Implantationsdaten-Algorithmus die Morphokinetik der jeweiligen Embryonen verglichen. Die Analyse ergab keine signifikanten Unterschiede bei den medianen KIDScores\(^{TM}\) D3 zwischen den drei Gruppen aus Patientinnen ohne Endometriose, Patientinnen mit vollständig resezierter Endometriose und Patientinnen ohne vollständige operative Entfernung ihrer Endometriose. Bei den KIDScores\(^{TM}\) D5 erreichten die Embryonen von Patientinnen mit Endometriose ohne vollständige Resektion einen Medianwert von 2,6 (auf einer Skala von 1 bis 9,9), während die Embryonen der Kontrollgruppe aus Patientinnen ohne Endometriose einen Wert von 6,8 erreichten (p = 0,003). Der Medianwert für Embryonen von Endometriose-Patientinnen mit vollständiger chirurgischer Entfernung ihrer Endometriose betrug 7,2, was einen signifikanten Anstieg im Vergleich zu Embryonen von Patientinnen ohne vollständige Resektion darstellt (p = 0,002). Die Umrechnung in die Effektstärke d (Cohens d) ergab einen mittleren Effekt (d = 0,639) für „keine Endometriose“ versus „Endometriose ohne Resektion“ sowie einen großen Effekt (d = 0,93) für „Endometriose-Komplettresektion“ versus „Endometriose ohne Resektion“. In einer Fallserie aus vier Patientinnen, die sich sowohl vor als auch nach vollständiger Resektion ihrer Endometriose IVF-/ICSI-Zyklen unterzogen hatten, zeigten drei von vier Patientinnen eine deutliche Verbesserung der KIDScores\(^{TM}\) nach vollständiger Resektion. Die Schwangerschafts- und Abortraten zwischen Frauen mit und ohne Endometriose(resektion) wichen nicht signifikant voneinander ab. Zusammenfassend scheint die vollständige Resektion der Endometriose die ansonsten tendenziell verminderte Embryonenqualität von Patientinnen, die sich einer künstlichen Befruchtung unterziehen, zu verbessern. Die Daten sprechen daher dafür, Patientinnen mit Endometriose vor IVF oder ICSI zu einem chirurgischen Eingriff zu raten. N2 - The objective of this work was to investigate the effect of endometriosis and its complete resection on embryo quality as assessed by morphokinetic parameters predictive of implantation success. For the underlying retrospective study, 258 embryos fertilized and cultured during IVF and/or ICSI cycles from 44 patients with histologically confirmed endometriosis and 43 patients with laparoscopically excluded endometriosis were evaluated. Endometriosis and complete resection of endometriosis were analyzed as factors influencing early embryonic development. For this purpose, morphokinetic parameters of the respective embryos were compared using the KIDScore\(^{TM}\) D3 and D5 implantation data algorithm. The analysis showed no significant differences in median KIDScores\(^{TM}\) D3 between the three groups of patients without endometriosis, patients with completely resected endometriosis and patients without full surgical removal of endometriosis. For KIDScoresTM D5, embryos from patients with endometriosis without complete resection achieved a median score of 2.6 (on a scale from 1 to 9.9), whereas control group embryos from patients without endometriosis achieved a score of 6.8 (p = 0.003). The median score for embryos from endometriosis patients with complete surgical removal of endometriosis was 7.2, representing a significant increase compared to embryos from patients without complete resection (p = 0.002). Conversion to effect size d (Cohen's d) showed a medium effect (d = 0.639) for "no endometriosis" versus "endometriosis without resection" and a large effect (d = 0.93) for "endometriosis complete resection" versus "endometriosis without resection". In a case series of four patients who underwent IVF/ICSI cycles before and after complete resection, three out of four patients showed a significant improvement in KIDScores\(^{TM}\) after surgery. Pregnancy and miscarriage rates between women with and without endometriosis (resection) did not differ significantly. In conclusion, complete resection of endometriosis appears to improve the otherwise presumably impaired embryo quality in patients undergoing assisted reproduction. The data therefore support recommending surgery prior to IVF or ICSI to patients with endometriosis-associated infertility. KW - Endometriose KW - Resektion KW - Sterilität KW - Reproduktionsmedizin KW - Embryo KW - Embryonenqualität KW - Morphokinetik Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-350246 ER - TY - THES A1 - Wegmann [geb. Wallo], Monika Eva T1 - Tumorkachexie diagnostizieren und behandeln - die Rolle der Bioimpedanzanalyse T1 - Diagnose and treat cancer-related cachexia - the role of bioimpedance analysis N2 - Die tumorbedingte Mangelernährung und Kachexie ist ein Syndrom mit sowohl medizinischer als auch gesundheitsökonomischer Relevanz. In den letzten Jahren wurde ein besseres Verständnis für die komplexe Pathophysiologie, bestehend aus Stoffwechselstörungen, verminderter Energiezufuhr und Entzündungsprozessen, die zum fortschreitenden Muskel- und Fettmassenverlust führen, erreicht. Dieses Verständnis dient bis heute der Entwicklung möglicher präventiver und therapeutischer Ansätze. Geeignete Screening-Tests tragen dazu bei, das Syndrom rechtzeitig zu erkennen und weitere Maßnahmen einzuleiten. Da der Muskel- und Fettmassenverlust nicht immer durch einen reinen Gewichtsverlust gekennzeichnet ist, ist die Erfassung der Körperzusammensetzung ein wesentlicher Bestandteil in der Betreuung onkologisch Erkrankter. Die BIA ist ein hierfür geeignetes Verfahren, welches leicht in den klinischen Alltag zu integrieren ist und besonders zur interindividuellen Verlaufskontrolle herangezogen werden könnte. Ernährungsmedizinische und bewegungstherapeutische Maßnahmen sind bereits fester Bestandteil internationaler Leitlinien. Für pharmakologische Therapiekonzepte besteht noch weiterer Forschungsbedarf, um eine Arzneimittelzulassung zu erreichen. Eine alleinige Intervention ist in der Behandlung der onkologischen Mangelernährung und Kachexie wenig effektiv. Deshalb müssen die Bedeutung und der potentielle Nutzen einer Kombination der einzelnen Behandlungsbausteine näher betrachtet werden, um eine bessere Evidenz zu erhalten. Der nachweisliche Mangel an Ernährungsstrukturen und ernährungsmedizinischer Fachkompetenz, Schwierigkeiten der Definitionsentwicklung und Gestaltung von Studien sowie finanzierungstechnische Fragen stellen ein zentrales Problem in der angemessenen Betreuung der Erkrankten dar. Jedoch bestehen klare Handlungsempfehlungen und Strategien, durch die entsprechende Herausforderungen reduziert oder beseitigt werden könnten. Dadurch profitieren sowohl Erkrankte als auch das Gesundheitssystem. Dies kann durch eine verbesserte Versorgung mittels Prävention, frühzeitiger Erfassung, Diagnose und Einleitung angebrachter Therapiemaßnahmen auf dem Gebiet der tumorbedingten Mangelernährung und Kachexie erreicht werden. N2 - Cancer-related malnutrition and cachexia is a syndrome with both medical and health economic relevance. In recent years, a better understanding of the complex pathophysiology, consisting of metabolic disorders, reduced energy intake and inflammatory processes that lead to progressive muscle and fat mass loss, has been achieved. This understanding is still used today to develop possible preventive and therapeutic approaches. Suitable screening tests help to detect the syndrome in good time and initiate further measures. Since the loss of muscle and fat mass is not always characterized by just weight loss, the assessment of body composition is an essential component in the care of oncologically ill patients. The BIA is a suitable method for this, it is easy to integrate into everyday clinical practice and could be used in particular for inter-individual progress monitoring. Nutritional and exercise therapy measures are already an integral part of international guidelines. There is still a need for further research into pharmacological therapy concepts in order to obtain drug approval. Intervention alone is not very effective in the treatment of oncological malnutrition and cachexia. Therefore, the importance and potential benefits of a combination of the individual treatment components must be examined in more detail in order to obtain better evidence. The demonstrable lack of nutritional structures and nutritional expertise, difficulties in developing definitions and designing studies as well as funding issues represent a central problem in the appropriate care of patients. However, there are clear recommendations for action and strategies that could reduce or eliminate these challenges. This benefits both patients and the healthcare system. This can be achieved by improving care through prevention, early detection, diagnosis and initiation of appropriate therapeutic measures in the area of cancer-related malnutrition and cachexia. KW - Kachexie KW - Mangelernährung KW - Tumorkachexie KW - Bioimpedanzanalyse KW - Tumorstoffwechsel KW - Bioimpedance Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-351509 ER - TY - THES A1 - Gruber, Lina T1 - Evaluation der psychischen Belastung bei Patientinnen mit Dysplasien der Zervix uteri abhängig von Informationsbeschaffung, Bildung und Alter T1 - Evaluation of the psychological distress in patients with dysplasia of the cervix uteri depending on information gathering, education and age N2 - Ziel dieser Arbeit war es, die psychische Belastung bei Patientinnen mit auffälligen PAP-Abstrichen oder dysplastischen Veränderungen der Zervix uteri im Rahmen der Dysplasie-Sprechstunde zu erheben. Durch Auswertung und Analyse der Daten im Rahmen des Qualitätsmanagements sollte eine Grundlage für eine verbesserte und angepasste Versorgung geschaffen werden. In dem erhobenen Fragebogen waren vier Fragen von besonderer Bedeutung - die Informationslage bei Vorstellung, die Art der Informationsbeschaffung, der mögliche Wunsch nach mehr Information und der Bildungsstand. In der Auswertung des ausgeteilten Fragebogens konnte erhoben werden, dass 56,9% der Patientinnen bei der Erstvorstellung psychisch belastet waren. Das ist ein großer Anteil in Anbetracht der Tatsache, dass das PAP-Screening eine jährliche Vorsorgeuntersuchung für über 15 Millionen Frauen darstellt [19]. Der Großteil der in der Dysplasie-Sprechstunde erhobenen PAP-Abstriche waren auffällig und somit weiter abklärungsbedürftig. Über 70% der HPV-Tests waren „high risk“ positiv. Der Mittelwert der Verteilung des Alters lag bei 44 Jahren, was bedeutet, dass viele junge Frauen mit potenziell bestehendem Kinderwunsch oder jungen Familien betroffen sind. Die jungen Frauen sind durchschnittlich besser gebildet und psychisch belasteter als die Kohorte der älteren Patientinnen. Ein Blick auf die Verteilung der Bildung zeigt, dass bei Betrachtung der gesamten Kohorte, schlechter gebildete Frauen verunsicherter sind. Viele der Patientinnen, 40,9%, fühlten sich vor der Erstvorstellung nicht ausreichend informiert und mehr als 53,8% der Patientinnen hätten sich mehr Informationen gewünscht. Sieht man sich die Antworten auf die Frage nach der Quelle der Informationsbeschaffung an, fällt auf, dass mit 68,5% weiterhin der/die betreuende Arzt/Ärztin die wichtigste Informationsquelle darstellt. Zusammenfassend lässt sich sagen, dass trotz des 2020 deutschlandweit begonnenen organisierten Screenings die betroffenen Frauen anhaltend belastet sind und sich mehr Informationen wünschen. Ein wichtiger Schritt zur Vorbeugung psychischer Belastung wäre eine verbesserte Vermittlung von Information seitens der behandelnden Ärzte/Ärztinnen, auch unter Hinweis auf die online zur Verfügung stehenden Informationen des Bundesministeriums für Gesundheit. N2 - The aim of this work was to assess the psychological stress of patients with conspicuous PAP smears or dysplastic changes of the cervical uteri during the consultation in the “Dysplasie-Sprechstunde”. By evaluating and analyzing the data within the framework of quality management, a basis for improved and adapted care should be created. In the questionnaire four questions were of particular importance - the information situation at the time of presentation, the way in which information was obtained, the possible desire for more information and the level of education. In the evaluation of the distributed questionnaire it could be found that 56.9% of the patients were psychologically stressed at the first presentation. This is a large proportion considering that PAP screening is an annual screening for over 15 million women [19]. The majority of the PAP smears taken during the dysplasia consultation were conspicuous and therefore in need of further clarification. Over 70% of HPV tests were "high risk" positive. The mean distribution of the age was 44 years, which means that many young women with a potential desire to have children or young families are affected. On average, the young women are better educated and more psychologically stressed than the cohort of older patients. A look at the distribution of education shows that if you look at the whole cohort, less educated women are more insecure. Many of the patients, 40.9%, did not feel sufficiently informed before the first presentation and more than 53.8% of the patients would have liked more information. If one looks at the answers to the question about the source of information, it is striking that with 68.5% the attending physician continues to be the most important source of information. In summary, it can be said that despite the organized screening that began throughout Germany in 2020, the affected women are still burdened and would like more information. An important step towards the prevention of psychological stress would be an improved communication of information on the part of the treating physicians, also with reference to the information available online from the Federal Ministry of Health. KW - psychische Belastung KW - PAP-Abstrich KW - Pap-Test Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-303796 ER - TY - JOUR A1 - Glaser, Kirsten A1 - Kern, David A1 - Speer, Christian P. A1 - Schlegel, Nicolas A1 - Schwab, Michael A1 - Thome, Ulrich H. A1 - Härtel, Christoph A1 - Wright, Clyde J. T1 - Imbalanced inflammatory responses in preterm and term cord blood monocytes and expansion of the CD14\(^+\)CD16\(^+\) subset upon toll-like receptor stimulation JF - International Journal of Molecular Sciences N2 - Developmentally regulated features of innate immunity are thought to place preterm and term infants at risk of infection and inflammation-related morbidity. Underlying mechanisms are incompletely understood. Differences in monocyte function including toll-like receptor (TLR) expression and signaling have been discussed. Some studies point to generally impaired TLR signaling, others to differences in individual pathways. In the present study, we assessed mRNA and protein expression of pro- and anti-inflammatory cytokines in preterm and term cord blood (CB) monocytes compared with adult controls stimulated ex vivo with Pam3CSK4, zymosan, polyinosinic:polycytidylic acid, lipopolysaccharide, flagellin, and CpG oligonucleotide, which activate the TLR1/2, TLR2/6, TLR3, TLR4, TLR5, and TLR9 pathways, respectively. In parallel, frequencies of monocyte subsets, stimulus-driven TLR expression, and phosphorylation of TLR-associated signaling molecules were analyzed. Independent of stimulus, pro-inflammatory responses of term CB monocytes equaled adult controls. The same held true for preterm CB monocytes—except for lower IL-1β levels. In contrast, CB monocytes released lower amounts of anti-inflammatory IL-10 and IL-1ra, resulting in higher ratios of pro-inflammatory to anti-inflammatory cytokines. Phosphorylation of p65, p38, and ERK1/2 correlated with adult controls. However, stimulated CB samples stood out with higher frequencies of intermediate monocytes (CD14\(^+\)CD16\(^+\)). Both pro-inflammatory net effect and expansion of the intermediate subset were most pronounced upon stimulation with Pam3CSK4 (TLR1/2), zymosan (TR2/6), and lipopolysaccharide (TLR4). Our data demonstrate robust pro-inflammatory and yet attenuated anti-inflammatory responses in preterm and term CB monocytes, along with imbalanced cytokine ratios. Intermediate monocytes, a subset ascribed pro-inflammatory features, might participate in this inflammatory state. KW - neonatal immunology KW - inflammation KW - preterm infants KW - monocytes KW - cord blood KW - monocyte subsets KW - cytokines KW - Toll-like receptor signaling Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-311056 SN - 1422-0067 VL - 24 IS - 5 ER - TY - JOUR A1 - Sitter, Magdalena A1 - Fröhlich, Corinna A1 - Kranke, Peter A1 - Markus, Christian A1 - Wöckel, Achim A1 - Rehn, Monika A1 - Bartmann, Catharina A1 - Frieauff, Eric A1 - Meybohm, Patrick A1 - Pecks, Ulrich A1 - Röder, Daniel T1 - ECMO-Therapie bei COVID-19-ARDS in der Schwangerschaft ermöglicht den Erhalt einer Schwangerschaft mit termingerechter Entbindung T1 - ECMO therapy for COVID-19 ARDS (Acute Respiratory Distress Syndrome) during pregnancy enables preservation of pregnancy and full-term delivery JF - Die Anaesthesiologie N2 - No abstract available. KW - ECMO-Therapie KW - COVID-19-ARDS KW - Schwangerschaft KW - ECMO therapy KW - COVID-19-ARDS KW - pregnancy Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-346762 VL - 72 IS - 3 ER - TY - THES A1 - Palm, Nicole T1 - Sensitivität von benignen und malignen Zellen gegenüber dem mitochondrialen Entkoppler 2,4-Dinitrophenol, gemessen mittels Mikrokalorimetrie und LDH-Aktivität T1 - Sensitivity of benign and malignant cells to the mitochondrial uncoupler 2,4-dinitrophenol measured by microcalorimetry and LDH activity N2 - Die mitochondriale Entkopplung ist ein effektiver Weg, um die Thermogenese und basale metabolische Rate einer Zelle anzuheben. Im Versuchsaufbau mit malignen Zellen führte dies zu einer Apoptose. 2,4-DNP als spezifischer Entkoppler der Atmungskette zeigte in diesem Zusammenhang mittels LDH-Analysen an HACAT-, PA1-, BT20 und MDA-MB 231- Zellen eine dosisabhängige Wirkung auf die Zellproliferation in allen verwendeten Zelllinien, unter den verwendeten Tumorzellen am eindrucksvollsten bei den Ovarialkarzinom Zellen. Allen Zellarten gemeinsam war dabei eine Wachstumshemmung abhängig von der Länge der Inkubationszeit. Die mikrokalorimetrischen Analysen wurden an HACAT-, BT20- und MDA-MB 231- Zellen durchgeführt. Eine höhere 2,4-DNP-Konzentration führte dabei ebenfalls zu einer gesteigerten Wärmefreisetzung, wobei eine positive Korrelation zwischen Einwirkdauer und Wärmefreisetzung bestand. Eine signifikante Zytotoxizität ließ sich bei hohen DNP-Konzentrationen und bei langer Inkubationszeit in den PA1- und MDA-MB 231- Zelllinien nachweisen. MDA-MB 231- Zellen reagierten dabei besonders sensibel. In der aktuellen Tumortherapie bietet die Kombination von Alterationen der mitochondrialen und glykolytischen Abläufen neben den gängigen Behandlungsoptionen einen vielversprechenden Therapieansatz (8, 28). Durch den Einsatz von mitochondrialen Entkopplern als Ergänzung zu den herkömmlichen Therapieschemata könnte effektiv in den metabolischen Stoffwechsel der Zellen eingegriffen und neben der Tumorzellproliferation auch die Regression positiv beeinflusst werden. Das Ziel wäre, eine kontrollierte Apoptose bei möglichst wenigen systemischen Nebenwirkungen auszulösen. Hierzu werden im Rahmen der optimalen Dosisfindung für den Einsatz von 2,4-DNP jedoch weitere Versuchsansätze mit Inkubationszeiten von mindestens 48h benötigt. N2 - Mitochondrial uncoupling is an effective way to raise the thermogenesis and basal metabolic rate of a cell. In the experimental setup with malignant cells, this led to apoptosis. In this context 2,4-DNP as a specific uncoupler of the respiratory chain showed a dose-dependent effect on cell proliferation in all cell lines used by means of LDH analyses on HACAT, PA1, BT20 and MDA-MB 231 cells. Among the used tumor cells this effect was most impressively documented in ovarian carcinoma cells. Common to all cell types was a growth inhibition dependent on the length of the incubation period. Microcalorimetric analyses were performed on HACAT, BT20, and MDA-MB 231 cells. A higher 2,4-DNP concentration also resulted in increased heat release, with a positive correlation between exposure time and heat release. Significant cytotoxicity was detected at high DNP concentrations and with long incubation times in the PA1 and MDA-MB 231 cell lines. MDA-MB 231 cells reacted particularly sensitively. In current tumor therapy, the combination of alterations of mitochondrial and glycolytic pathways offers a promising therapeutic approach in addition to current treatment options (8, 28). The use of mitochondrial uncouplers as an adjunct to conventional therapeutic regimens could effectively interfere with cell metabolism and positively influence regression in addition to tumor cell proliferation. The goal would be to induce controlled apoptosis with as few systemic side effects as possible. For this, however, further experimental approaches with incubation times of at least 48h are needed in the context of optimal dose finding for the use of 2,4-DNP. KW - Dinitrophenol <2,4-> KW - Hyperthermie KW - Oxidative Phosphorylierung KW - Entkoppler KW - 2,4 DNP KW - Mammacarzinom KW - Dinitrophenole KW - Atmungskette KW - Brustkrebs KW - DNP Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-330089 ER - TY - THES A1 - Kristen, Alexander Kurt T1 - Effekt von β-Hydroxybutyrat und Acetoacetat auf die Proliferationsaktivität und die Strahlensensibilität von Kolonkarzinomzellen mit unterschiedlichem p53-Status T1 - Effect of β-hydroxybutyrate and acetoacetate on proliferation activity and radio sensitivity on colon carcinoma cell lines with different p53-status N2 - Die ketogene Diät besitzt ein breites mögliches therapeutisches Spektrum und aufgrund der induzierten Ketonkörper in der Theorie auch antiproliferative sowie antiinflammatorische Wirkmechanismen. Ziel dieser Arbeit war es, die Wirkung der Ketonkörper β-Hydroxybutyrat und Acetoacetat auf Kolonkarzinomzellen in vitro zu untersuchen. Hierfür wurden Proliferation, Koloniebildung, Gen- und Proteinexpression von drei verschiedenen Zelllinien analysiert. Um einen möglichen Zusammenhang der Ketonkörperwirkung und dem p53-Status zu prüfen, wurden Zelllinien mit unterschiedlichem p53-Status eingesetzt. Etwaige Effekte der Ketonkörper auf die Strahlensensibilität der Zellen wurden ebenfalls untersucht. Um möglichst tumorphysiologische Bedingungen herzustellen, wurden die Versuche nicht nur unter normoxischen Bedingungen (21 % Sauerstoff), sondern parallel unter 1,5 % Sauerstoffkonzentration durchgeführt. In den Tests zur Proteinexpression konnte festgestellt werden, dass die Expression von p53 nicht durch die Zugabe von Ketonkörpern beeinflusst wird. Die Proteinexpression von p21 und p27 war unabhängig von der Expression von p53. Die Analyse der Genexpression beweist, dass die untersuchten Zelllinien sowohl die Monocarboxylattransporter (MCTs) exprimieren, über welche die Ketonkörper aufgenommen werden können, als auch die G-Protein- gekoppelten Rezeptoren, über welche die Ketonkörper auf die Signalketten wirken können. Ein hemmender Einfluss der Ketonkörper auf die Zellproliferation ließ sich im WST-8-Test für die Zelllinie HT-29 unter Zugabe von 3-OHB in Kombination mit LiAcAc nachweisen. Nach Strahlenbehandlung stellten sich die Zelllinien CaCo-2 und HT-29 bei Betrachtung der Kurzzeitproliferation weitgehend strahlenresistent dar. Bei Untersuchung der Langzeitproliferation mittels Koloniebildungstest zeigte sich jedoch auch hier eine zytotoxische Wirkung der ionisierenden Strahlung. Für die Zelllinie CaCo2 konnte zudem durch Zugabe von LiAcAc allein und in Kombination mit 3-OHB eine signifikante Reduktion der Koloniebildung nach Bestrahlung mit 2 Gy festgestellt werden. Zusammenfassend weisen die durchgeführten Versuche darauf hin, dass die Ketonkörper unabhängig vom p53-Status in alle untersuchten Kolonkarzinomzellen aufgenommen und verwertet werden können. Ein allgemein synergistischer Effekt zwischen ionisierender Strahlung und den Ketonkörpern konnte nicht eindeutig nachgewiesen werden. Die Zugabe der Ketonkörper führte weder zu einer Proliferationsanregung noch zur Reduktion der Strahlensensitivität, so dass hier von einer klinischen Unbedenklichkeit ausgegangen werden kann. Fortführende klinische Studien sind notwendig, um die in vivo Effekte zu untersuchen. N2 - The ketogenic diet has a wide possible therapeutic spectrum and due to the ketone bodies, it also has possible antiproliferative and anti-inflammatory effects. The aim of this work was to investigate the effect of the ketone bodies β-hydroxybutyrate and acetoacetate on colon carcinoma cells in vitro. For this purpose, proliferation, colony formation, gene expression and protein expression of three different cell lines were analyzed. In order to investigate a possible correlation between the ketone body effect and p53 status, cell lines with different p53 status were used. Effects of the ketone bodies on radio sensitivity were also investigated. In order to create tumor-physiological conditions, the experiments were not only performed at normoxic (21% oxygen), but also at hypoxic conditions (1.5 % oxygen). In the protein expression assays, it was found that the expression of p53 was not affected by the addition of ketone bodies. The protein expression of p21 and p27 was independent of the expression of p53. The analysis of gene expression proves that the cell lines express both the monocarboxylate transporters (MCTs) through which ketone bodies can be taken up into the cells, as well as the G protein-coupled receptors through which the ketone bodies can act on the signaling chains. An inhibitory effect of the ketone bodies on cell proliferation could be detected in the WST-8 assay for the HT-29 cell line with the addition of 3-OHB in combination with LiAcAc. The cell lines CaCo-2 and HT-29 were largely resistant to radiation in terms of short-time proliferation. In the Colony-Forming-Assay, however, we also observed a cytotoxic effect of ionizing radiation on those cell lines. For the cell line CaCo2 the addition of LiAcAc alone and in combination with 3-OHB resulted in a significant reduction of colonies after irradiation with 2 Gy. In summary, the experiments performed indicate that the ketone bodies can be taken up and utilized in all colon carcinoma cells examined, irrespective of the p53 status. A general synergistic effect between irradiation and ketone bodies could not be clearly demonstrated. The addition of the ketone bodies did not lead to either a stimulation of proliferation or reduction of radio sensitivity, so that clinical safety can be assumed. Further clinical studies are necessary to investigate the in vivo effects. KW - Ketonkörper KW - Acetessigester KW - Hydroxybutyrat <3-> KW - Colonkrebs KW - Protein p53 KW - Ketonkörper KW - Beta-Hydroxybutyrat KW - Acetoacetat KW - Kolonkarzinom KW - HCT-116 KW - HT-29 KW - CaCo-2 Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-327068 ER - TY - JOUR A1 - Diessner, Joachim A1 - Anders, Laura A1 - Herbert, Saskia A1 - Kiesel, Matthias A1 - Bley, Thorsten A1 - Schlaiss, Tanja A1 - Sauer, Stephanie A1 - Wöckel, Achim A1 - Bartmann, Catharina T1 - Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm JF - Journal of Cancer Research and Clinical Oncology N2 - Purpose The reliable detection of tumor-infiltrated axillary lymph nodes for breast cancer [BC] patients plays a decisive role in further therapy. We aimed to find out whether cross-sectional imaging techniques could improve sensitivity for pretherapeutic axillary staging in nodal-positive BC patients compared to conventional imaging such as mammography and sonography. Methods Data for breast cancer patients with tumor-infiltrated axillary lymph nodes having received surgery between 2014 and 2020 were included in this study. All examinations (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) were interpreted by board-certified specialists in radiology. The sensitivity of different imaging modalities was calculated, and binary logistic regression analyses were performed to detect variables influencing the detection of positive lymph nodes. Results All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity. Conclusion We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Only the safe detection of these lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy, thereby allowing access to prognosis and improving new post-neoadjuvant therapies. KW - breast cancer imaging KW - positive nodal status KW - cross-sectional imaging KW - conventional imaging KW - post-neoadjuvant therapies KW - neoadjuvant therapies Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324047 VL - 149 IS - 7 ER - TY - JOUR A1 - Löb, Sanja A1 - Linsmeier, Eva A1 - Herbert, Saskia-Laureen A1 - Schlaiß, Tanja A1 - Kiesel, Matthias A1 - Wischhusen, Jörg A1 - Salmen, Jessica A1 - Kranke, Peter A1 - Quenzer, Anne A1 - Kurz, Florian A1 - Weiss, Claire A1 - Gerhard-Hartmann, Elena A1 - Wöckel, Achim A1 - Diessner, Joachim T1 - Prognostic effect of HER2 evolution from primary breast cancer to breast cancer metastases JF - Journal of Cancer Research and Clinical Oncology N2 - Purpose Therapeutic options for breast cancer (BC) treatment are constantly evolving. The Human Epidermal Growth Factor 2 (HER2)-low BC entity is a new subgroup, representing about 55% of all BC patients. New antibody–drug conjugates demonstrated promising results for this BC subgroup. Currently, there is limited information about the conversion of HER2 subtypes between primary tumor and recurrent disease. Methods This retrospective study included women with BC at the University Medical Centre Wuerzburg from 1998 to 2021. Data were retrieved from patients' records. HER2 evolution from primary diagnosis to the first relapse and the development of secondary metastases was investigated. Results In the HR-positive subgroup without HER2 overexpression, HER2-low expression in primary BC was 56.7 vs. 14.6% in the triple-negative subgroup (p < 0.000). In the cohort of the first relapse, HER2-low represented 64.1% of HR-positive vs. 48.2% of the triple-negative cohort (p = 0.03). In patients with secondary metastases, HER2-low was 75.6% vs. 50% in the triple negative subgroup (p = 0.10). The subgroup of HER2-positive breast cancer patients numerically increased in the course of disease; the HER2-negative overall cohort decreased. A loss of HER2 expression from primary BC to the first relapse correlated with a better OS (p = 0.018). No clinicopathological or therapeutic features could be identified as potential risk factors for HER2 conversion. Conclusion HER2 expression is rising during the progression of BC disease. In view of upcoming therapeutical options, the re-analysis of newly developed metastasis will become increasingly important. KW - breast cancer KW - HER2 conversion KW - HER2-low KW - trastuzumab deruxtecan KW - HER2 targeted therapy KW - trastuzumab Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324068 VL - 149 IS - 8 ER - TY - JOUR A1 - Herbert, Saskia-Laureen A1 - Hirzle, Paula A1 - Bartmann, Catharina A1 - Schlaiß, Tanja A1 - Kiesel, Matthias A1 - Curtaz, Carolin A1 - Löb, Sanja A1 - Wöckel, Achim A1 - Diessner, Joachim T1 - Optimized process quality in certified breast centers through adherence to stringent diagnostic and therapeutic algorithms effects of structural as well as socio-demographic factors on start of therapy JF - Archives of Gynecology and Obstetrics N2 - Purpose An increasing incidence of breast cancer can be observed worldwide. Since a delay of therapy can have a negative impact on prognosis, timely cancer care is an important quality indicator. By receiving treatment at a certified breast cancer center, the patient has the best chance of treatment in accordance with guidelines and the best prognosis. The identification of risk factors for a delay of therapy is of central importance and should be the basis for a continuous optimization of treatment at breast cancer centers. Methods This retrospective study included women with breast cancer (primary diagnosis, relapse, or secondary malignancy) at the University Hospital Würzburg in 2019 and 2020. Data were retrieved from patients’ records. Correlations and regression analyses were performed to detect potential risk factors for treatment delay. Results Patients who received the histological confirmation of breast cancer at an external institution experienced a later therapy start than those patients who received the histological confirmation at the University Hospital Würzburg itself. (35.7 vs. 32.2 days). The interval between histological confirmation and the first consultation at the University Hospital Würzburg correlated statistically significant with age, distress and distance to the hospital. Conclusion Patients with an in-house diagnosis of breast cancer are treated more quickly than those whose diagnosis was confirmed in an external institution. We identified factors such as increased age, greater distance to the hospital as well as increased distress to prolong the time until start of oncological treatment. Intensified patient care should be offered to these subgroups. KW - breast cancer KW - delay of therapy KW - prognosis KW - quality of care Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324057 VL - 307 IS - 4 ER - TY - THES A1 - Linsmeier, Eva Marie T1 - Untersuchung der HER2-Konversion vom primären zum fernmetastasierten Mammakarzinom T1 - Analysis of HER2 Conversion from Primary to Distant Metastatic Breast Cancer N2 - In der vorliegenden Arbeit wurden retrospektiv Daten von 321 Fällen eines fortgeschrit- tenen Mammakarzinoms ausgewertet. Beobachtungsdaten lagen bis einschließlich Juli 1998 vor. Ein Fokus dieser Arbeit lag auf der Trichotomie der HER2-Ausprägung und deren prognostischen Wert im Verlauf einer metastasierten Brustkrebserkrankung. In einer neueren Entwicklung wurde HER2-low als Nomenklatur einer Subgruppe etabliert für jene Mammakarzinome, die als IHC 1+ oder IHC 2+ gelten und ein negatives ISH- Ergebnis aufweisen. Neue Studien-Ergebnisse zeigten einen signifikanten klinischen Vorteil der Therapie mit HER2-basierten Antikörper-Wirkstoff-Konjugaten für HER2-low Patientinnen (91). Der Anteil der HER2-low Mammakarzinome nahm im Laufe einer fortgeschrittenen Brustkrebserkrankung kontinuierlich zu und lag bei 39,3 % im Primärtumor, bei 47,7 % im ersten Rezidiv und bei 47,8 % in einer zweiten Fernmetastase. Parallel vergrößerte sich die HER2-positive Subgruppe, wobei sich die HER2-negative Kohorte folglich ver- kleinerte. Es konnte entsprechend der aktuellen Literatur (117,156) eine Assoziation (p < 0.001) des HER2-low Subtypen und HR-positiven Mammakarzinomen gezeigt werden. HER2-low nahm in HR-positiven/Her2-negativen Mammakarzinomen im Laufe der Me- tastasierung zu (56,7 % - 64,1 % - 75,6 %). Der Anteil der HER2-low-Expression im Triple-negativen Subtypen initial bei 14,6 % und vergrößerte sich konstant (48,2 % - 50 %). Ein Verlust der HER2-Ausprägung im Krankheitsverlauf korrelierte statistisch signi- fikant mit einem besseren OS (Hazards Ratio 0,533, 95%-KI[0,316, 0,898], p = .018). Die Gruppe mit einer HER2-Konversion zu einer schwächeren Ausprägung wies im di- rekten Vergleich zur Gruppe mit einer Her2-Konversion zu einer stärkeren Ausprägung ein 21,0 Monate längeres Überleben auf (p = 0.177). Die Entwicklung eines HER2-posi- tiven Primärtumor zu einer HER2-low Metastase (Hazards Ratio 0,385, 95%-KI[0,17, 0.874], p = .023), eine Veränderung von einem HER2-0 Primärtumor zu einer HER2-low Metastase (Hazards Ratio 0,124, 95%-KI[0,023, 0,655], p = .014) sowie die ausblei- bende Veränderung eines HER2-low Primärtumor zu einer Fernmetastase (Hazards Ra- tio 0,169, 95%-KI[0,035, 0,813], p = .027) wurden in dieser Analyse als weitere protektive Faktoren nachgewiesen. Kein klinisch-pathologischer oder therapeutischer Faktor konnte als signifikanter Einflussfaktor auf eine Konversion im HER2-Rezeptor identifi- ziert werden. Die Ergebnisse dieser Arbeit lassen keine klare Aussage darüber treffen, ob die Anpassung der tumorspezifischen Therapie nach einer Rezeptorkonversion das OS verbessert. N2 - In the present study, data from 321 cases of advanced breast carcinoma were retrospectively analyzed. Observational data were available up to July 1998. A focal point of this study was the trichotomy of HER2 expression and its prognostic value in the course of metastatic breast cancer. In a recent development, HER2-low was established as nomenclature for a subgroup of breast carcinomas defined as IHC 1+ or IHC 2+ with a negative ISH result. New study findings indicated a significant clinical advantage of therapy using HER2-based antibody-drug conjugates for HER2-low patients (91). The proportion of HER2-low breast carcinomas steadily increased during advanced breast cancer, reaching 39.3% in the primary tumor, 47.7% in the first recurrence, and 47.8% in a second distant metastasis. Concurrently, the HER2-positive subgroup expanded, leading to a reduction in the HER2-negative cohort. Consistent with current literature (117,156), an association (p < 0.001) between the HER2-low subtype and HR-positive breast carcinomas was demonstrated. HER2-low prevalence increased during metastasis in HR-positive/HER2-negative breast carcinomas (56.7% - 64.1% - 75.6%). The proportion of HER2-low expression in the triple-negative subtype initially stood at 14.6% and steadily increased (48.2% - 50%). A loss of HER2 expression during the course of the disease significantly correlated with improved overall survival (Hazard Ratio 0.533, 95% CI [0.316, 0.898], p = .018). The group with a conversion to a weaker HER2 expression had a 21.0 months longer survival compared to the group with a conversion to a stronger expression (p = 0.177). The transition from a HER2-positive primary tumor to a HER2-low metastasis (Hazard Ratio 0.385, 95% CI [0.17, 0.874], p = .023), a change from a HER2-0 primary tumor to a HER2-low metastasis (Hazard Ratio 0.124, 95% CI [0.023, 0.655], p = .014), and the absence of transition from a HER2-low primary tumor to a distant metastasis (Hazard Ratio 0.169, 95% CI [0.035, 0.813], p = .027) were identified as additional protective factors in this analysis. No clinical-pathological or therapeutic factor was identified as a significant influencing factor on a receptor conversion in HER2. The results of this study do not provide a clear statement on whether adapting tumor-specific therapy after a receptor conversion improves overall survival. KW - Mammakarzinom KW - Rezeptorkonversion KW - Brustkrebs KW - Gynäkologie KW - HER2-Rezeptor KW - Anitkörpertherapie Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-344734 ER - TY - JOUR A1 - Heidt, Christina A1 - Kämmerer, Ulrike A1 - Fobker, Manfred A1 - Rüffer, Andreas A1 - Marquardt, Thorsten A1 - Reuss-Borst, Monika T1 - Assessment of intestinal permeability and inflammation bio-markers in patients with rheumatoid arthritis JF - Nutrients N2 - Increased intestinal permeability and inflammation, both fueled by dysbiosis, appear to contribute to rheumatoid arthritis (RA) pathogenesis. This single-center pilot study aimed to investigate zonulin, a marker of intestinal permeability, and calprotectin, a marker of intestinal inflammation, measured in serum and fecal samples of RA patients using commercially available kits. We also analyzed plasma lipopolysaccharide (LPS) levels, a marker of intestinal permeability and inflammation. Furthermore, univariate, and multivariate regression analyses were carried out to determine whether or not there were associations of zonulin and calprotectin with LPS, BMI, gender, age, RA-specific parameters, fiber intake, and short-chain fatty acids in the gut. Serum zonulin levels were more likely to be abnormal with a longer disease duration and fecal zonulin levels were inversely associated with age. A strong association between fecal and serum calprotectin and between fecal calprotectin and LPS were found in males, but not in females, independent of other biomarkers, suggesting that fecal calprotectin may be a more specific biomarker than serum calprotectin is of intestinal inflammation in RA. Since this was a proof-of-principle study without a healthy control group, further research is needed to validate fecal and serum zonulin as valid biomarkers of RA in comparison with other promising biomarkers. KW - rheumatoid arthritis KW - zonulin KW - calprotectin KW - LPS KW - fecal short-chain fatty acids KW - fiber intake KW - intestinal permeability KW - intestinal inflammation Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-319377 SN - 2072-6643 VL - 15 IS - 10 ER - TY - JOUR A1 - Ip, Chi Wang A1 - Wischhusen, Jörg T1 - Versatile guardians: regenerative regulatory T cells in Parkinson’s disease rodent models JF - Signal Transduction and Targeted Therapy N2 - No abstract available. KW - diseases of the nervous system KW - neuroimmunology KW - neurological disorders Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357674 VL - 8 ER - TY - JOUR A1 - Haake, Markus A1 - Haack, Beatrice A1 - Schäfer, Tina A1 - Harter, Patrick N. A1 - Mattavelli, Greta A1 - Eiring, Patrick A1 - Vashist, Neha A1 - Wedekink, Florian A1 - Genssler, Sabrina A1 - Fischer, Birgitt A1 - Dahlhoff, Julia A1 - Mokhtari, Fatemeh A1 - Kuzkina, Anastasia A1 - Welters, Marij J. P. A1 - Benz, Tamara M. A1 - Sorger, Lena A1 - Thiemann, Vincent A1 - Almanzar, Giovanni A1 - Selle, Martina A1 - Thein, Klara A1 - Späth, Jacob A1 - Gonzalez, Maria Cecilia A1 - Reitinger, Carmen A1 - Ipsen-Escobedo, Andrea A1 - Wistuba-Hamprecht, Kilian A1 - Eichler, Kristin A1 - Filipski, Katharina A1 - Zeiner, Pia S. A1 - Beschorner, Rudi A1 - Goedemans, Renske A1 - Gogolla, Falk Hagen A1 - Hackl, Hubert A1 - Rooswinkel, Rogier W. A1 - Thiem, Alexander A1 - Romer Roche, Paula A1 - Joshi, Hemant A1 - Pühringer, Dirk A1 - Wöckel, Achim A1 - Diessner, Joachim E. A1 - Rüdiger, Manfred A1 - Leo, Eugen A1 - Cheng, Phil F. A1 - Levesque, Mitchell P. A1 - Goebeler, Matthias A1 - Sauer, Markus A1 - Nimmerjahn, Falk A1 - Schuberth-Wagner, Christine A1 - Felten, Stefanie von A1 - Mittelbronn, Michel A1 - Mehling, Matthias A1 - Beilhack, Andreas A1 - van der Burg, Sjoerd H. A1 - Riedel, Angela A1 - Weide, Benjamin A1 - Dummer, Reinhard A1 - Wischhusen, Jörg T1 - Tumor-derived GDF-15 blocks LFA-1 dependent T cell recruitment and suppresses responses to anti-PD-1 treatment JF - Nature Communications N2 - Immune checkpoint blockade therapy is beneficial and even curative for some cancer patients. However, the majority don’t respond to immune therapy. Across different tumor types, pre-existing T cell infiltrates predict response to checkpoint-based immunotherapy. Based on in vitro pharmacological studies, mouse models and analyses of human melanoma patients, we show that the cytokine GDF-15 impairs LFA-1/β2-integrin-mediated adhesion of T cells to activated endothelial cells, which is a pre-requisite of T cell extravasation. In melanoma patients, GDF-15 serum levels strongly correlate with failure of PD-1-based immune checkpoint blockade therapy. Neutralization of GDF-15 improves both T cell trafficking and therapy efficiency in murine tumor models. Thus GDF-15, beside its known role in cancer-related anorexia and cachexia, emerges as a regulator of T cell extravasation into the tumor microenvironment, which provides an even stronger rationale for therapeutic anti-GDF-15 antibody development. KW - cancer microenvironment KW - immunotherapy KW - T cells KW - tumour immunology Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357333 VL - 14 ER - TY - JOUR A1 - Leonhardt, Jonas A1 - Winkler, Marcela A1 - Kollikowski, Anne A1 - Schiffmann, Lisa A1 - Quenzer, Anne A1 - Einsele, Hermann A1 - Löffler, Claudia T1 - Mind–body-medicine in oncology—from patient needs to tailored programs and interventions BT - a cross-sectional study JF - Frontiers in Psychology N2 - Introduction: National and international guidelines recommend early integration of evidence-based multimodal interventions and programs, especially with a focus on relaxation techniques and other Mind–Body-based methods to maintain the quality of life of oncology patients, improve treatment tolerability, and promote healthy lifestyle behaviors. Consequently, we aim to understand what drives patients and how they navigate integrative medicine to best advise them. This study aimed to detect possible topics of particular interest to patients and identify the patient groups that could benefit most from further programs. Furthermore, we aimed to investigate if patients are open-minded toward integrative oncology concepts and learn about their motivational level to maintain or change behavior. Methods: Between August 2019 and October 2020 we surveyed patients undergoing oncological therapy in a university oncological outpatient center using a custom-developed questionnaire based on established Mind–Body Medicine concepts. Results: We included 294 patients with various cancers. More than half reported problems sleeping through (61%) and 42% felt stressed frequently, invariably rating this as detrimental to their health. Moreover, a slight majority (52%) felt physically limited due to their disease and only 30% performed defined exercise programs. Women were significantly more likely to feel stressed and reported with alarming frequency that they often feel “everything was up to them.” The 40–65-year-olds reported significantly less restful sleep, more stress and were more dissatisfied with their situation. However, this group already used natural remedies most frequently and was most often motivated to use relaxation techniques in the next 6 months. The lower the perceived individual energy level (EL), the less frequently patients did sport, the more frequently they felt their disease impaired their activity, mostly feeling stressed and tense. We also found significant associations between negative emotions/thoughts and the variables “sleep,” “use of relaxation techniques,” “personal stress perception,” and “successful lifestyle modification.” Conclusion: Mind–Body programs that focus on patient’s individual resources, with tools to explore impairing patterns of self-perception and cognitive biases, can be a valuable resource for oncology patients and should therefore be part of an integrative medical treatment concept. KW - lifestyle habits KW - symptom burden KW - individual mind state KW - motivational level KW - stress Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-321970 SN - 1664-1078 VL - 14 ER - TY - THES A1 - Lanz, Meike Berit T1 - Lebensqualität und Bedürfnisse von Patientinnen mit metastasiertem Brustkrebs - Eine Erhebung im Rahmen der Pilotphase des BRE-4-MED-Projektes T1 - Quality of life and needs of patients with metastatic breast cancer - A survey within the pilot phase of the BRE-4-MED project N2 - Die Ziele dieser Arbeit waren, das aktuelle Informationsbedürfnis von metastasierten Brustkrebspatientinnen und -patienten, deren Einschätzung der Arzt-Patient-Kommunikation sowie erwiesene Prädiktoren der QoL zu erheben und auf einen Zusammenhang mit der aktuellen patientenseitigen QoL zu untersuchen. Zu dieser oder ähnlichen Fragestellungen existieren lediglich Publikationen mit Brustkrebspatientinnen ohne Metastasierung. Studien mit ausschließlich metastasierten Brustkrebs-patientinnen sind generell sehr selten. Die Daten von 30 Patientinnen und einem Patienten mit metastasiertem Brustkrebs, rekrutiert in vier Kliniken in Bayern und Baden-Württemberg im Rahmen der Pilotphase des BRE-4-MED-Projektes, konnten ausgewertet werden. Die Studienteilnehmer waren zum Zeitpunkt der Rekrutierung zwischen 30 und 85 Jahre alt, das Durchschnittsalter betrug 57 Jahre (SD = 13,4). Für die Datenerhebung wurden nebst einzelner ordinalskalierter Fragen standardisierte, teils modifizierte Fragebögen wie die CARE-Skala, PROMIS PF4a, PHQ-4 oder ein Item des EORTC QLQ-C30 verwendet. In der QoL-Messung durch ein Item des EORTC QLQ-C30 Fragebogens erzielten die Probandinnen und Probanden geringfügig schlechtere Werte als eine gesunde deutsche Vergleichspopulation. Angesichts bisheriger Forschungsergebnisse wurde mit unbefriedigten Informations- und Kommunikationsbedürfnissen gerechnet. Außerdem wurden Zusammenhänge zwischen der QoL und unbefriedigten Informationsbedürfnissen, einer schlechten Arzt-Patient-Kommunikation sowie Prädiktoren der QoL erwartet. Diese Hypothesen wurden durch die vorliegende Arbeit zum Teil bestätigt, nämlich das Vorliegen von unerfüllten Informationsbedürfnissen sowie einer Korrelation der QoL mit Depression, körperlicher Funktionalität und mit Schmerz. Ein Zusammenhang mit dem Alter der Befragten bestand, jedoch genau entgegengesetzt der Erwartung. Letzteres Ergebnis sowie die nicht signifikanten Ergebnisse der Studie sind am ehesten durch eine zu geringe Probandenzahl bedingt. In puncto Informationsbedürfnisse der Patienten sowie Prädiktoren der QoL konnte die vorliegende Arbeit die bisherige Forschung größtenteils bestätigen, woraus die ärztlichen Handlungsempfehlungen abgeleitet werden können, auf diese Themen im Umgang mit metastasierten Mammakarzinompatienten besonders einzugehen. Die Aussagekraft der vorliegenden Ergebnisse ist allerdings angesichts der bisherigen Stichprobengröße als gering einzustufen, die Wiederholung der durchgeführten Analysen in der Hauptphase des BRE-4-MED-Projektes wären wünschenswert. Das BRE-4-MED-Register ist zusammenfassend als vielversprechendes Projekt zur Ergänzung der Versorgungsforschung und langfristig zur Verbesserung der Versorgung metastasierter Brustkrebspatienten einzustufen. N2 - The objectives of this work were to survey the current information needs of metastatic breast cancer patients, their assessment of physician-patient communication and proven predictors of QoL, and to examine for a correlation with current patient QoL. Only publications with breast cancer patients without metastasis exist on this or similar questions. Studies with exclusively metastasized breast cancer patients are generally rare. The data of 30 female patients and one male patient with metastatic breast cancer, recruited in four hospitals in Bavaria and Baden-Württemberg within the pilot phase of the BRE-4-MED project, could be analyzed. The study participants were between 30 and 85 years old at the time of recruitment, with a mean age of 57 years (SD = 13.4). For data collection, standardized, partly modified questionnaires such as the CARE scale, PROMIS PF4a, PHQ-4 or an item of the EORTC QLQ-C30 were used in addition to single ordinal scaled questions. In the QoL measurement, the patients scored slightly worse than a healthy German comparison population. Given previous research findings, unmet information and communication needs were expected. In addition, correlations between QoL and unmet information needs, poor physician-patient communication and predictors of QoL were expected. These hypotheses were partially confirmed by the present work, namely the presence of unmet information needs and a correlation of QoL with depression, physical functionality and with pain. A correlation with the age of the respondents existed, but opposite to the expectation. The latter result as well as the non-significant results of the study are most likely due to an insufficient number of subjects. With regard to the information needs of the patients as well as predictors of QoL, the present study was able to confirm previous research to a large extent, from which the physicians' recommendations for action can be derived to pay special attention to these topics in dealing with metastasized breast cancer patients. However, given the sample size to date, the significance of the present results must be considered low, and repetition of the analyses performed in the main phase of the BRE-4-MED project would be desirable. In summary, the BRE-4-MED registry can be classified as a promising project to complement health services research and, in the long term, to improve the care of metastatic breast cancer patients. KW - Lebensqualität KW - Bedürfnis KW - Metastase KW - Brustkrebs KW - Bedürfnisse KW - Metastasierung KW - Mammakarzinom KW - Quality of Life KW - Needs KW - Metastatic KW - Breast Cancer Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-296847 ER - TY - JOUR A1 - Hübner, Theresa A1 - Wolfgang, Tanja A1 - Theis, Ann-Catrin A1 - Steber, Magdalena A1 - Wiedenmann, Lea A1 - Wöckel, Achim A1 - Diessner, Joachim A1 - Hein, Grit A1 - Gründahl, Marthe A1 - Kämmerer, Ulrike A1 - Kittel-Schneider, Sarah A1 - Bartmann, Catharina T1 - The impact of the COVID-19 pandemic on stress and other psychological factors in pregnant women giving birth during the first wave of the pandemic JF - Reproductive Health N2 - Background The onset of mental illness such as depression and anxiety disorders in pregnancy and postpartum period is common. The coronavirus induced disease 2019 (COVID-19) pandemic and the resulting public policy responses represent an exceptional situation worldwide and there are hints for adverse psychosocial impact, hence, the study of psychological effects of the pandemic in women during hospitalization for delivery and in the postpartum period is highly relevant. Methods Patients who gave birth during the first wave of the COVID-19 pandemic in Germany (March to June 2020) at the Department of Obstetrics and Gynecology, University of Würzburg, Germany, were recruited at hospital admission for delivery. Biosamples were collected for analysis of SARS-CoV-2 infection and various stress hormones and interleukin-6 (IL-6). In addition to sociodemographic and medical obstetric data, survey questionnaires in relation to concerns about and fear of COVID-19, depression, stress, anxiety, loneliness, maternal self-efficacy and the mother–child bonding were administered at T1 (delivery stay) and T2 (3–6 months postpartum). Results In total, all 94 recruited patients had a moderate concern of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at T1 with a significant rise at T2. This concern correlated with low to low-medium general psychosocial stress levels and stress symptoms, and the women showed a significant increase of active coping from T1 to T2. Anxiety levels were low and the Edinburgh Postnatal Depression Scale showed a medium score of 5 with a significant (T1), but only week correlation with the concerns about SARS-CoV-2. In contrast to the overall good maternal bonding without correlation to SARS-CoV-2 concern, the maternal self-efficiency correlated negatively with the obstetric impairment caused by the COVID-19 pandemic. Conclusion Obstetric patients` concerns regarding SARS-CoV-2 and the accompanying pandemic increased during the course of the pandemic correlating positively with stress and depression. Of note is the increase in active coping over time and the overall good mother–child-bonding. Maternal self-efficacy was affected in part by the restrictions of the pandemic. KW - Covid-19 KW - stress KW - pregnancy Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300189 VL - 19 IS - 1 ER - TY - JOUR A1 - Hung, Sophia A1 - Dreher, Liane A1 - Diessner, Joachim A1 - Schwarz, Stefan A1 - Ohlsen, Knut A1 - Hertlein, Tobias T1 - MRSA infection in the thigh muscle leads to systemic disease, strong inflammation, and loss of human monocytes in humanized mice JF - Frontiers in Immunology N2 - MRSA (Methicillin-resistant Staphylococcus aureus) is the second-leading cause of deaths by antibiotic-resistant bacteria globally, with more than 100,000 attributable deaths annually. Despite the high urgency to develop a vaccine to control this pathogen, all clinical trials with pre-clinically effective candidates failed so far. The recent development of “humanized” mice might help to edge the pre-clinical evaluation closer to the clinical situation and thus close this gap. We infected humanized NSG mice (huNSG: (NOD)-scid IL2R\(_γ\)\(^{null}\) mice engrafted with human CD34+ hematopoietic stem cells) locally with S. aureus USA300 LAC* lux into the thigh muscle in order to investigate the human immune response to acute and chronic infection. These mice proved not only to be more susceptible to MRSA infection than wild-type or “murinized” mice, but displayed furthermore inferior survival and signs of systemic infection in an otherwise localized infection model. The rate of humanization correlated directly with the severity of disease and survival of the mice. Human and murine cytokine levels in blood and at the primary site of infection were strongly elevated in huNSG mice compared to all control groups. And importantly, differences in human and murine immune cell lineages surfaced during the infection, with human monocyte and B cell numbers in blood and bone marrow being significantly reduced at the later time point of infection. Murine monocytes in contrast behaved conversely by increasing cell numbers. This study demonstrates significant differences in the in vivo behavior of human and murine cells towards S. aureus infection, which might help to sharpen the translational potential of pre-clinical models for future therapeutic approaches. KW - humanized mice KW - MRSA - methicillin-resistant Staphylococcus aureus KW - monocyte KW - bacterial infection model KW - inflammation KW - NSG KW - staphylocccal infection/epidemiology Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-278050 SN - 1664-3224 VL - 13 ER - TY - JOUR A1 - Herbert, Saskia-Laureen A1 - Fick, Andrea A1 - Heydarian, Motaharehsadat A1 - Metzger, Marco A1 - Wöckel, Achim A1 - Rudel, Thomas A1 - Kozjak-Pavlovic, Vera A1 - Wulff, Christine T1 - Establishment of the SIS scaffold-based 3D model of human peritoneum for studying the dissemination of ovarian cancer JF - Journal of Tissue Engineering N2 - Ovarian cancer is the second most common gynecological malignancy in women. More than 70% of the cases are diagnosed at the advanced stage, presenting as primary peritoneal metastasis, which results in a poor 5-year survival rate of around 40%. Mechanisms of peritoneal metastasis, including adhesion, migration, and invasion, are still not completely understood and therapeutic options are extremely limited. Therefore, there is a strong requirement for a 3D model mimicking the in vivo situation. In this study, we describe the establishment of a 3D tissue model of the human peritoneum based on decellularized porcine small intestinal submucosa (SIS) scaffold. The SIS scaffold was populated with human dermal fibroblasts, with LP-9 cells on the apical side representing the peritoneal mesothelium, while HUVEC cells on the basal side of the scaffold served to mimic the endothelial cell layer. Functional analyses of the transepithelial electrical resistance (TEER) and the FITC-dextran assay indicated the high barrier integrity of our model. The histological, immunohistochemical, and ultrastructural analyses showed the main characteristics of the site of adhesion. Initial experiments using the SKOV-3 cell line as representative for ovarian carcinoma demonstrated the usefulness of our models for studying tumor cell adhesion, as well as the effect of tumor cells on endothelial cell-to-cell contacts. Taken together, our data show that the novel peritoneal 3D tissue model is a promising tool for studying the peritoneal dissemination of ovarian cancer. KW - ovarian cancer KW - 3D tissue model KW - co-culture KW - peritoneal metastasis KW - cancer dissemination Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-301311 SN - 2041-7314 VL - 13 ER - TY - JOUR A1 - Kiesel, Matthias A1 - Beyers, Inga A1 - Kalisz, Adam A1 - Joukhadar, Ralf A1 - Wöckel, Achim A1 - Herbert, Saskia-Laureen A1 - Curtaz, Carolin A1 - Wulff, Christine T1 - A 3D printed model of the female pelvis for practical education of gynecological pelvic examination JF - 3D Printing in Medicine N2 - Background Pelvic palpation is a core component of every Gynecologic examination. It requires vigorous training, which is difficult due to its intimate nature, leading to a need of simulation. Up until now, there are mainly models available for mere palpation which do not offer adequate visualization of the concerning anatomical structures. In this study we present a 3D printed model of the female pelvis. It can improve both the practical teaching of gynecological pelvic examination for health care professionals and the spatial understanding of the relevant anatomy. Methods We developed a virtual, simplified model showing selected parts of the female pelvis. 3D printing was used to create a physical model. Results The life-size 3D printed model has the ability of being physically assembled step by step by its users. Consequently, it improves teaching especially when combining it with commercial phantoms, which are built solely for palpation training. This is achieved by correlating haptic and visual sensations with the resulting feedback received. Conclusion The presented 3D printed model of the female pelvis can be of aid for visualizing and teaching pelvic anatomy and examination to medical staff. 3D printing provides the possibility of creating, multiplying, adapting and sharing such data worldwide with little investment of resources. Thus, an important contribution to the international medical community can be made for training this challenging examination. KW - gynecology KW - pelvic examination KW - pelvic palpation KW - 3D printing KW - FDM KW - SLA KW - teaching KW - visualization KW - education Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313347 VL - 8 ER - TY - JOUR A1 - Kiesel, Matthias A1 - Beyers, Inga A1 - Kalisz, Adam A1 - Wöckel, Achim A1 - Löb, Sanja A1 - Schlaiss, Tanja A1 - Wulff, Christine A1 - Diessner, Joachim T1 - Evaluating a novel 3D printed model for simulating Large Loop Excision of the Transformation Zone (LLETZ) JF - 3D Printing in Medicine N2 - Background Electrosurgical excisions are common procedures for treating cervical dysplasia and are often seen as minor surgeries. Yet, thorough training of this intervention is required, as there are considerable consequences of inadequate resections, e.g. preterm birth, the risk of recurrence, injuries and many more. Unfortunately, there is a lack of sufficiently validated possibilities of simulating electrosurgeries, which focus on high fidelity and patient safety. Methods A novel 3D printed simulator for examination and electrosurgical treatment of dysplastic areas of the cervix was compared with a conventional simulator. Sixty medical students experienced a seminar about cervical dysplasia. Group A underwent the seminar with the conventional and Group B with the novel simulator. After a theoretical introduction, the students were randomly assigned by picking a ticket from a box and went on to perform the hands-on training with their respective simulator. Each student first obtained colposcopic examination training. Then he or she performed five electrosurgical excisions (each). This was assessed with a validated score, to visualize their learning curve. Furthermore, adequate and inadequate resections and contacts between electrosurgical loop and vagina or speculum were counted. Both groups also assessed the seminar and their simulator with 18 questions (Likert-scales, 1–10, 1 = strongly agree / very good, 10 = strongly disagree / very bad). Group B additionally assessed the novel simulator with four questions (similar Likert-scales, 1–10). Results Nine of 18 questions showed statistically significant differences favoring Group B (p < 0.05). Group B also achieved more adequate R0-resections and less contacts between electrosurgical loop and vagina or speculum. The learning curves of the performed resections favored the novel simulator of Group B without statistically significant differences. The four questions focusing on certain aspects of the novel simulator indicate high appreciation of the students with a mean score of 1.6 points. Conclusion The presented novel simulator shows several advantages compared to the existing model. Thus, novice gynecologists can be supported with a higher quality of simulation to improve their training and thereby patient safety. KW - 3D printing KW - simulation KW - gynecology KW - Loop electrosurgical excision procedure (LEEP) KW - Large loop excision of the transformation zone (LLETZ) KW - teaching KW - education KW - patient safety KW - cervical dysplasia Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313356 VL - 8 ER - TY - JOUR A1 - Kiesel, Matthias A1 - Beyers, Inga A1 - Kalisz, Adam A1 - Wöckel, Achim A1 - Quenzer, Anne A1 - Schlaiß, Tanja A1 - Wulff, Christine A1 - Diessner, Joachim T1 - Evaluating the value of a 3D printed model for hands-on training of gynecological pelvic examination JF - 3D Printing in Medicine N2 - Background Simulation in the field of gynecological pelvic examination with educational purposes holds great potential. In the current manuscript we evaluate a 3D printed model of the female pelvis, which improves practical teaching of the gynecological pelvic examination for medical staff. Methods We evaluated the benefit of a 3D printed model of the female pelvis (Pelvisio®) as part of a seminar (“skills training”) for teaching gynecological examination to medical students. Each student was randomly assigned to Group A or B by picking a ticket from a box. Group A underwent the skills training without the 3D printed model. Group B experienced the same seminar with integration of the model. Both groups evaluated the seminar by answering five questions on Likert scales (1–10, 1 = “very little” or “very poor”, 10 equals “very much” or “very good”). Additionally, both groups answered three multiple-choice questions concerning pelvic anatomy (Question 6 to 8). Finally, Group B evaluated the 3D printed model with ten questions (Question 9 to 18, Likert scales, 1–10). Results Two of five questions concerning the students’ satisfaction with the seminar and their gained knowledge showed statistically significant better ratings in Group B (6.7 vs. 8.2 points and 8.1 vs. 8.9 points (p < 0.001 and p < 0.009). The other three questions showed no statistically significant differences between the traditional teaching setting vs. the 3D printed model (p < 0.411, p < 0.344 and p < 0.215, respectively). The overall mean score of Question 1 to 5 showed 8.4 points for Group B and 7.8 points for Group A (p < 0.001). All three multiple-choice questions, asking about female pelvic anatomy, were answered more often correctly by Group B (p < 0.001, p < 0.008 and p < 0.001, respectively). The mean score from the answers to Questions 9 to 18, only answered by Group B, showed a mean of 8.6 points, indicating, that the students approved of the model. Conclusion The presented 3D printed model Pelvisio® improves the education of female pelvic anatomy and examination for medical students. Hence, training this pivotal examination can be supported by a custom designed anatomical model tailored for interactive and explorative learning. KW - gynecology KW - pelvic examination KW - pelvic palpation KW - 3D printing KW - teaching KW - visualization KW - education KW - Pelvisio® Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313365 VL - 8 ER - TY - JOUR A1 - Oliveira-Ferrer, Leticia A1 - Schmalfeldt, Barbara A1 - Dietl, Johannes A1 - Bartmann, Catharina A1 - Schumacher, Udo A1 - Stürken, Christine T1 - Ovarian cancer-cell pericellular hyaluronan deposition negatively impacts prognosis of ovarian cancer patients JF - Biomedicines N2 - Background: Hyaluronan (HA), a component of the extracellular matrix, is frequently increased under pathological conditions including cancer. Not only stroma cells but also cancer cells themselves synthesize HA, and the interaction of HA with its cognate receptors promotes malignant progression and metastasis. Methods: In the present study, HA deposition in tissue sections was analyzed by hyaluronan-binding protein (HABP) ligand histochemistry in 17 borderline tumors and 102 primary and 20 recurrent ovarian cancer samples. The intensity and, particularly, localization of the HA deposition were recorded: for the localization, the pericellular deposition around the ovarian cancer cells was distinguished from the deposition within the stromal compartment. These histochemical data were correlated with clinical and pathological parameters. Additionally, within a reduced subgroup of ovarian cancer samples (n = 70), the RNA levels of several HA-associated genes were correlated with the HA localization and intensity. Results: Both stroma-localized and pericellular tumor-cell-associated HA deposition were observed. Cancer-cell pericellular HA deposition, irrespective of its staining intensity, was significantly associated with malignancy, and in the primary ovarian cancer cohort, it represents an independent unfavorable prognostic marker for overall survival. Furthermore, a significant association between high CD44, HAS2 and HAS3 mRNA levels and a cancer-cell pericellular HA-deposition pattern was noted. In contrast, stromal hyaluronan deposition had no impact on ovarian cancer prognosis. Conclusions: In conclusion, the site of HA deposition is of prognostic value, but the amount deposited is not. The significant association of only peritumoral cancer-cell HA deposition with high CD44 mRNA expression levels suggests a pivotal role of the CD44–HA signaling axis for malignant progression in ovarian cancer. KW - ovarian cancer KW - stromal hyaluronan KW - tumor-associated hyaluronan staining pattern KW - hyaluronan-related enzymes Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-297539 SN - 2227-9059 VL - 10 IS - 11 ER - TY - JOUR A1 - Grotemeyer, Alexander A1 - McFleder, Rhonda Leah A1 - Wu, Jingjing A1 - Wischhusen, Jörg A1 - Ip, Chi Wang T1 - Neuroinflammation in Parkinson’s disease – putative pathomechanisms and targets for disease-modification JF - Frontiers in Immunology N2 - Parkinson’s disease (PD) is a progressive and debilitating chronic disease that affects more than six million people worldwide, with rising prevalence. The hallmarks of PD are motor deficits, the spreading of pathological α-synuclein clusters in the central nervous system, and neuroinflammatory processes. PD is treated symptomatically, as no causally-acting drug or procedure has been successfully established for clinical use. Various pathways contributing to dopaminergic neuron loss in PD have been investigated and described to interact with the innate and adaptive immune system. We discuss the possible contribution of interconnected pathways related to the immune response, focusing on the pathophysiology and neurodegeneration of PD. In addition, we provide an overview of clinical trials targeting neuroinflammation in PD. KW - Parkinson’s disease KW - neuroinflammation KW - T cells KW - microglia KW - neurodegeneration KW - animal models KW - inflammatory cascades Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-274665 SN - 1664-3224 VL - 13 ER - TY - JOUR A1 - Kiesel, Matthias A1 - Beyers, Inga A1 - Kalisz, Adam A1 - Wöckel, Achim A1 - Herbert, Saskia-Laureen A1 - Curtaz, Carolin A1 - Diessner, Joachim A1 - Joukhadar, Ralf A1 - Wulff, Christine T1 - Introducing a novel model for simulating large loop excision of the transformation zone (LLETZ) using 3D printing technique JF - Archives of Gynecology and Obstetrics N2 - Purpose Electrosurgery is the gold-standard procedure for the treatment of cervical dysplasia. The quality of the outcome depends on the accuracy of performance, which underlines the role of adequate training of surgeons, especially, as this procedure is often performed by novice surgeons. According to our knowledge, medical simulation has up until now lacked a model, which focuses on realistically simulating the treatment of cervical dysplasia with the concerning anatomy. Methods and Result In our work, we present a model created using 3D printing for holistically simulating diagnostic, as well as surgical interventions of the cervix, as realistically as possible. Conclusion This novel simulator is compared to an existing model and both are evaluated. By doing so, we aim to provide novice gynecologists with standardized and high-quality simulation models for practicing to improve their proficiency. KW - fused deposition modeling (FDM) KW - 3D printing KW - virtual KW - gynecology KW - dysplasia KW - large loop excision of the transformation zone (LLETZ) Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266739 SN - 1432-0711 VL - 305 IS - 3 ER - TY - JOUR A1 - Sitter, Magdalena A1 - Schlesinger, Tobias A1 - Reinhold, Ann-Kristin A1 - Scholler, Axel A1 - Heymann, Christian von A1 - Welfle, Sabine A1 - Bartmann, Catharina A1 - Wöckel, Achim A1 - Kleinschmidt, Stefan A1 - Schneider, Sven A1 - Gottschalk, André A1 - Greve, Susanne A1 - Wermelt, Julius Z. A1 - Wiener, Roland A1 - Schulz, Frank A1 - Chappell, Daniel A1 - Brunner, Maya A1 - Neumann, Claudia A1 - Meybohm, Patrick A1 - Kranke, Peter T1 - COVID-19 in der geburtshilflichen Anästhesie: Prospektive Erfassung von SARS-CoV-2-Infektionen zum Zeitpunkt der Geburt sowie des peripartalen Verlaufs SARS-CoV-2-positiver Schwangerer JF - Der Anaesthesist N2 - Hintergrund Im Rahmen der Pandemie des SARS-CoV-2-Virus erlangte das Patientenkollektiv der Schwangeren früh Aufmerksamkeit. Initial wurde angesichts sich früh abzeichnender Krankheitsfälle bei jüngeren Patienten mit einem erheblichen Aufkommen peripartal zu betreuender, COVID-19-positiver Schwangerer gerechnet. Ziel der Arbeit Diese Arbeit vermittelt einen Einblick in die SARS-CoV-2-Infektionszahlen im Rahmen der geburtshilflichen Anästhesie zu Beginn der Pandemie sowie während der zweiten Infektionswelle in Deutschland. Methoden Über das COALA-Register (COVID-19 related Obstetric Anaesthesia Longitudinal Assessment-Registry) wurden sowohl von März bis Mai 2020 als auch von Oktober 2020 bis Februar 2021 in Deutschland und der Schweiz wöchentlich prospektiv Daten zu Verdachts- und bestätigten SARS-CoV-2-Fällen bei Schwangeren zum Zeitpunkt der Geburt erhoben. Betrachtet wurden die Verteilung dieser auf die Anzahl der Geburten, Zentren und Erhebungswochen sowie mütterliche Charakteristika und Krankheitsverläufe. Ergebnisse Neun Zentren haben im Verlauf 44 SARS-CoV-2-positive Schwangere zum Zeitpunkt der Geburt bei 7167 Geburten (0,6 %) gemeldet (3 Fälle auf 2270 Geburten (0,4 %) und 41 Fälle auf 4897 Geburten (0,8 %)). Berichtet wurden 2 schwere COVID-19-Verläufe (n = 1 mit Todesfolge nach ECMO, n = 1 mit ECMO überlebt). Bei 28 (68 %) Patientinnen verlief die Infektion asymptomatisch. Ein Neugeborenes wurde im Verlauf positiv auf SARS-CoV‑2 getestet. Schlussfolgerung Mithilfe des Registers konnte das Auftreten von Fällen zu Beginn der Pandemie zeitnah eingeschätzt werden. Es traten sporadisch Verdachtsfälle bzw. bestätigte Fälle auf. Aufgrund fehlender flächendeckender Testung muss aber von einer Dunkelziffer asymptomatischer Fälle ausgegangen werden. Während der zweiten Infektionswelle wurden 68 % asymptomatische Fälle gemeldet. Jedoch kann es bei jungen, gesunden Patientinnen ohne das Vorliegen typischer Risikofaktoren zu schwerwiegenden Verläufen kommen. KW - ECMO-Therapie KW - Geburtshilfe KW - Geburtshilfliche Intensivmedizin KW - COVID-19-Pademie KW - Infektionswellen Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-264878 SN - 1432-055X VL - 71 IS - 6 ER - TY - JOUR A1 - Curtaz, Carolin J. A1 - Reifschläger, Leonie A1 - Strähle, Linus A1 - Feldheim, Jonas A1 - Feldheim, Julia J. A1 - Schmitt, Constanze A1 - Kiesel, Matthias A1 - Herbert, Saskia-Laureen A1 - Wöckel, Achim A1 - Meybohm, Patrick A1 - Burek, Malgorzata T1 - Analysis of microRNAs in exosomes of breast cancer patients in search of molecular prognostic factors in brain metastases JF - International Journal of Molecular Sciences N2 - Brain metastases are the most severe tumorous spread during breast cancer disease. They are associated with a limited quality of life and a very poor overall survival. A subtype of extracellular vesicles, exosomes, are sequestered by all kinds of cells, including tumor cells, and play a role in cell-cell communication. Exosomes contain, among others, microRNAs (miRs). Exosomes can be taken up by other cells in the body, and their active molecules can affect the cellular process in target cells. Tumor-secreted exosomes can affect the integrity of the blood-brain barrier (BBB) and have an impact on brain metastases forming. Serum samples from healthy donors, breast cancer patients with primary tumors, or with brain, bone, or visceral metastases were used to isolate exosomes and exosomal miRs. Exosomes expressed exosomal markers CD63 and CD9, and their amount did not vary significantly between groups, as shown by Western blot and ELISA. The selected 48 miRs were detected using real-time PCR. Area under the receiver-operating characteristic curve (AUC) was used to evaluate the diagnostic accuracy. We identified two miRs with the potential to serve as prognostic markers for brain metastases. Hsa-miR-576-3p was significantly upregulated, and hsa-miR-130a-3p was significantly downregulated in exosomes from breast cancer patients with cerebral metastases with AUC: 0.705 and 0.699, respectively. Furthermore, correlation of miR levels with tumor markers revealed that hsa-miR-340-5p levels were significantly correlated with the percentage of Ki67-positive tumor cells, while hsa-miR-342-3p levels were inversely correlated with tumor staging. Analysis of the expression levels of miRs in serum exosomes from breast cancer patients has the potential to identify new, non-invasive, blood-borne prognostic molecular markers to predict the potential for brain metastasis in breast cancer. Additional functional analyzes and careful validation of the identified markers are required before their potential future diagnostic use. KW - breast cancer KW - breast cancer metastases KW - blood-brain barrier KW - patient serum KW - exosomes KW - microRNA KW - gene expression KW - prognostic marker Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-284476 SN - 1422-0067 VL - 23 IS - 7 ER - TY - JOUR A1 - Curtaz, Carolin J. A1 - Kiesel, Ludwig A1 - Meybohm, Patrick A1 - Wöckel, Achim A1 - Burek, Malgorzata T1 - Anti-hormonal therapy in breast cancer and its effect on the blood-brain barrier JF - Cancers N2 - Simple Summary Anti-hormonal therapie regimes are well established in oncological treatments in breast cancer. In contrast there is limited knowledge of their effects on metastatic brain metastases in advanced breast cancer and their ability to cross the blood brain-barrier. In this review, we point out the usual antihormonal therapy options in the primary disease, but also in metastatic breast cancer. In addition, we explain the epidemiological facts of brain metastases, as well as the basics of the blood-brain barrier and how this is overcome by metastase. Last but not least, we deal with the known anti-hormonal therapy options and present clinical studies on their intracerebral effect, as well as the known basics of their blood-brain barrier penetration. Not all common anti-hormonal therapeutics are able to penetrate the CNS. It is therefore important for the treating oncologists to use substances that have been proven to cross the BBB, despite the limited data available. Aromataseinhibitors, especially letrozole, probably also tamoxifen, everolimus and CDK4/6 inhibitors, especially abemaciclib, appear to act intracerebrally by overcoming the blood-brain barrier. Nevertheless, further data must be obtained in basic research, but also health care research in relation to patients with brain metastases. Abstract The molecular receptor status of breast cancer has implications for prognosis and long-term metastasis. Although metastatic luminal B-like, hormone-receptor-positive, HER2−negative, breast cancer causes brain metastases less frequently than other subtypes, though tumor metastases in the brain are increasingly being detected of this patient group. Despite the many years of tried and tested use of a wide variety of anti-hormonal therapeutic agents, there is insufficient data on their intracerebral effectiveness and their ability to cross the blood-brain barrier. In this review, we therefore summarize the current state of knowledge on anti-hormonal therapy and its intracerebral impact and effects on the blood-brain barrier in breast cancer. KW - anti-hormonal therapy KW - brain-metastasis KW - blood-brain barrier KW - breast cancer Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-290320 SN - 2072-6694 VL - 14 IS - 20 ER - TY - THES A1 - Grän, Franziska T1 - Rezeptor-vermittelte Chemotherapie von ovarialen Karzinomzellen mit Disorazol-GnRH-Konjugaten T1 - Targeted therapy of ovarian cancer cells with GnRH-Disorazol conjugates N2 - Das Ovarialkarzinom stellt einen häufigen maligen Tumor der Frau dar, der meist spät diagnostiziert wird. Therapeutische Optionen sind nur eingeschränkt verfügbar und nebenwirkungsbehaftet. In der modernen Tumortherapie sind zielgerichtete medikamentöse Ansätze von immer größer Bedeutung und sind bei verschiedenen Entitäten bereits zugelassen. Da Ovarialkarzinome häufig GnRH-Rezeptoren exprimieren, stellt dies einen guten Angriffspunkt für mögliche Therapeutika dar. In dieser Arbeit wurde die Wirkung von Disorazol, einem potenten Zytotoxin, in Kopplung an GnRH auf Ovarialkarzinom-Zellen untersucht. Unter anderem wurden hierbei RT-PCR, Kristallviolettversuche, WST-Versuche und FACS-Analysen durchgeführt. Molekularbiologisch war eine deutliche Expression von GnRH-Rezeptoren auf ovarialen Karzinomzellen zu sehen. Es zeigte sich eine spezifische Toxizität von GnRH-Disorazol-Konjugaten auf Ovarialkarzinom-Zelllinien und andere GnRH-tragende Zellen. Lymphozyten aus dem peripheren Blut waren nicht im besonderen Maße anfällig für Disorazol. Verapamil konnte in einzelnen Zelllinien die Toxizität des Konjugats verstärken, eine Cisplatin-Resistenz hatte jedoch keinen Einfluss darauf. Apoptose-inhibierende Substanzen wie zVAD verminderten den Anteil an toten Zellen, Necrostatin war dazu nicht in der Lage. Die spezifische Wirksamkeit von GnrH gekoppeltem Disorazol auf Ovarialkarzinomzellen bestätigt das ursprüngliche Therapiekonzept. Eine ausgeprägtere Hämatotoxizität konnte nicht nachgewiesen werden, was im Hinblick auf den klinischen Einsatz eine bedeutende Rolle spielt. Da einige weitere Entitäten wie das triple-negative Mamma-Karzinom GnRH-Rezeptor-exprimierende Zellen aufweisen, ist ein Einsatz auch in diesen Krankheitsbildern denkbar. N2 - Ovarian cancer is a frequent gynecological malignant disease with poor prognosis due to late diagnosis. Therapeutic options are limited. In modern oncologic treatment approaches, targeted therapy is a well-known therapeutic principle. Since ovarian cancer cells can express GnRH receptors, this can be used as a medical target. We investigated the toxic effect of conjugates consisting of Disorazol and GnRH on ovarian cancer cell lines. Among others RT-PCR, cristal violett assays, WST-assays and FACS-analysis were performed. RT-PCR revealed expression of the GnRH receptor in ovarian cancer cells. There was specific toxicity of GnRH-Disorazol-conjugates on cell lines representing ovarian cancer. In contrast, peripheral blood lymphocytes were not especially sensitive for Disorazol. Verapamil was able to enhance toxicity in distinct cell lines; Cisplatin resistant cell lines were sensitive for the conjugate too. Substances inhibiting apoptosis like z-VAD could decrease the amount of dead cells, whereas necrostatin had no effect. The specific toxicity of disorazol-GnRH-conjugates on ovarian cancer cells proofed the principle of this targeted therapy approach. Human lymphocytes were not especially sensitive to the toxin, which could play an important role with regard to the clinical use. Since other cancerous tissues like the triple negative breast cancer express GnRH receptors, this therapeutic approach could be reasonable in those entities. KW - Eierstockkrebs KW - Disorazole KW - Ovarialkarzinom KW - Disorazol KW - GnRH Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219957 ER - TY - THES A1 - Weiß, Claire Rachel T1 - Einfluss adjuvanter Therapien des initial hormonrezeptorpositiven Mammakarzinoms auf die Entwicklung einer Rezeptorkonversion im Rezidiv T1 - Influences of adjuvant treatments in hormone receptor positive breast cancer on receptor conversion in recurrent breast cancer N2 - In der vorliegenden Arbeit erfolgte eine retrospektive Auswertung der Daten von 2078 Patienten mit Erstdiagnose eines primär hormonrezeptorpositivem Mammakarzinoms, bezüglich der Entwicklung einer Rezeptorkonversion im Rezidiv. 196 Frauen entwickelten ein Rezidiv, wovon 29,1% eine Rezeptorveränderung im Östrogen-, Progesteron-, oder HER2-neu-Rezeptor zeigten. Ein niedriger Tumordifferenzierungsgrad und eine axilläre Lymphknotenbeteiligung zeigten ein erhöhtes Risiko für das Auftreten einer Rezeptorkonversion. Eine prämenopausale Tamoxifentherapie oder die Applikation einer Chemotherapie war mit einem geringerem Risiko für die Entwicklung eines östrogenrezeptornegativen Rezidivs assoziiert. Der Verlust der Rezeptorpositivität zeigte einen Trend zu einem geringeren Gesamtüberleben. N2 - In the following thesis the data of 2078 patients with primary hormone receptor positive breast cancer and their risks of developing discordance in receptor status in recurrent disease were analysed. 196 patients developed recurrent disease of which 29,1% showed a discordance in receptor status either in estrogen, progesterone or HER2-neu receptor. Low grading or axillary lymphnode involvement were associated with a higher risk of receptor discordance. Premenopausal patients with adjuvant tamoxifen therapy or application of chemotherapy had a lower risk for estrogen receptor discordance. The loss of receptor positivity showed a trend to worse overall survival. KW - Adjuvante Therapie KW - Hormonrezeptor KW - Mammakarzinom KW - Therapie KW - Rezeptorkonversion KW - Rezidiv KW - Breast cancer KW - therapy KW - recurrent KW - receptor conversion Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-221814 N1 - Ergebnisse wurden als Paper in "Achives of Gynecology and Obstetrics" veröffentlicht ER - TY - JOUR A1 - Gernert, Michael A1 - Kiesel, Matthias A1 - Fröhlich, Matthias A1 - Renner, Regina A1 - Strunz, Patrick-Pascal A1 - Portegys, Jan A1 - Tony, Hans-Peter A1 - Schmalzing, Marc A1 - Schwaneck, Eva Christina T1 - High Prevalence of Genital Human Papillomavirus Infection in Patients With Primary Immunodeficiencies JF - Frontiers in Immunology N2 - Background Genital human papillomavirus (HPV)-infections are common in the general population and are responsible for relevant numbers of epithelial malignancies. Much data on the HPV-prevalence is available for secondary immunodeficiencies, especially for patients with human immunodeficiency virus (HIV)-infection. Little is known about the genital HPV-prevalence in patients with primary immunodeficiencies (PIDs). Methods We performed a cross-sectional study of patients with PIDs and took genital swabs from male and female patients, which were analyzed with polymerase chain reaction for the presence of HPV-DNA. Clinical and laboratory data was collected to identify risk factors. Results 28 PID patients were included in this study. 10 of 28 (35.7%) had HPV-DNA in their genital swabs. 6 patients had high-risk HPV-types (21.4%). Most patients had asymptomatic HPV-infections, as genital warts were rare (2 of 28 patients) and HPV-associated malignancy was absent. Differences in the HPV-positivity regarding clinical PID-diagnosis, duration of PID, age, sex, immunosuppression, immunoglobulin replacement, or circumcision in males were not present. HPV-positive PID patients had higher numbers of T cells (CD3\(^+\)), of cytotoxic T cells (CD3\(^+\)/CD8\(^+\)), of transitional B cells (CD19\(^+\)/CD38\(^{++}\)/CD10\(^+\)/IgD\(^+\)), and of plasmablasts (CD19\(^+\)/CD38\(^+\)/CD27\(^{++}\)/IgD\(^-\)) compared to HPV-negative. Conclusion PID patients exhibit a high rate of genital HPV-infections with a high rate of high-risk HPV-types. Regular screening for symptomatic genital HPV-infection and HPV-associated malignancy in PID patients seems recommendable. KW - human papillomavirus KW - primary immunodeficiency KW - inborn errors of immunity (IEIs) KW - common variable immunodeficiency (CVID) KW - genital warts Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-250273 SN - 1664-3224 VL - 12 ER - TY - JOUR A1 - Bartmann, Catharina A1 - Fischer, Leah-Maria A1 - Hübner, Theresa A1 - Müller-Reiter, Max A1 - Wöckel, Achim A1 - McNeill, Rhiannon V. A1 - Schlaiss, Tanja A1 - Kittel-Schneider, Sarah A1 - Kämmerer, Ulrike A1 - Diessner, Joachim T1 - The effects of the COVID-19 pandemic on psychological stress in breast cancer patients JF - BMC Cancer N2 - Background: The majority of breast cancer patients are severely psychologically affected by breast cancer diagnosis and subsequent therapeutic procedures. The COVID-19 pandemic and associated restrictions on public life have additionally caused significant psychological distress for much of the population. It is therefore plausible that breast cancer patients might be particularly susceptible to the additional psychological stress caused by the pandemic, increasing suffering. In this study we therefore aimed to assess the level of psychological distress currently experienced by a defined group of breast cancer patients in our breast cancer centre, compared to distress levels preCOVID-19 pandemic. Methods: Female breast cancer patients of all ages receiving either adjuvant, neoadjuvant, or palliative therapies were recruited for the study. All patients were screened for current or previous COVID-19 infection. The participants completed a self-designed COVID-19 pandemic questionnaire, the Stress and Coping Inventory (SCI), the National Comprehensive Cancer Network (R) (NCCN (R)) Distress Thermometer (DT), the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30, and the BR23. Results: Eighty-two breast cancer patients were included. Therapy status and social demographic factors did not have a significant effect on the distress caused by the COVID-19 pandemic. The results of the DT pre and during COVID-19 pandemic did not differ significantly. Using the self-designed COVID-19 pandemic questionnaire, we detected three distinct subgroups demonstrating different levels of concerns in relation to SARS-CoV-2. The subgroup with the highest levels of concern reported significantly decreased life quality, related parameters and symptoms. Conclusions: This monocentric study demonstrated that the COVID-19 pandemic significantly affected psychological health in a subpopulation of breast cancer patients. The application of a self-created "COVID-19 pandemic questionnaire"could potentially be used to help identify breast cancer patients who are susceptible to increased psychological distress due to the COVID-19 pandemic, and therefore may need additional intensive psychological support. KW - COVID-19 KW - breast cancer KW - psychological distress Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265802 VL - 21 ER - TY - JOUR A1 - Kämmerer, Ulrike A1 - Klement, Rainer J. A1 - Joos, Fabian T. A1 - Sütterlin, Marc A1 - Reuss-Borst, Monika T1 - Low carb and ketogenic diets increase quality of life, physical performance, body composition, and metabolic health of women with breast cancer JF - Nutrients N2 - Breast cancer (BC) patients often ask for a healthy diet. Here, we investigated a healthy standard diet (SD), a low carb diet (LCD), and a ketogenic diet (KD) for BC patients during the rehabilitation phase. KOLIBRI was an open-label non-randomized one-site nutritional intervention trial, combining inpatient and outpatient phases for 20 weeks. Female BC patients (n = 152; mean age 51.7 years) could select their diet. Data collected were: Quality of life (QoL), spiroergometry, body composition, and blood parameters. In total 30, 92, and 30 patients started the KD, LCD, and SD, respectively. Of those, 20, 76, and 25 completed the final examination. Patients rated all diets as feasible in daily life. All groups enhanced QoL, body composition, and physical performance. LCD participants showed the most impressive improvement in QoL aspects. KD participants finished with a very good physical performance and muscle/fat ratio. Despite increased cholesterol levels, KD patients had the best triglyceride/high-density lipoprotein (HDL) ratio and homeostatic model assessment of insulin resistance index (HOMA-IR). Most metabolic parameters significantly improved in the LCD group. SD participants ended with remarkably low cholesterol levels but did not improve triglyceride/HDL or HOMA-IR. In conclusion, both well-defined KDs and LCDs are safe and beneficial for BC patients and can be recommended during the rehabilitation phase. KW - breast cancer KW - rehabilitation KW - ketogenic diet KW - low carb diet KW - supportive care Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234209 SN - 2072-6643 VL - 13 IS - 3 ER - TY - JOUR A1 - Herbert, S. L. A1 - Wöckel, A. A1 - Kreienberg, R. A1 - Kühn, T. A1 - Flock, F. A1 - Felberbaum, R. A1 - Janni, W. A1 - Curtaz, C. A1 - Kiesel, M. A1 - Stüber, T. A1 - Diessner, J. A1 - Salmen, J. A1 - Schwentner, L. A1 - Fink, V. A1 - Bekes, I. A1 - Leinert, E. A1 - Lato, K. A1 - Polasik, A. A1 - Schochter, F. A1 - Singer, S. T1 - To which extent do breast cancer survivors feel well informed about disease and treatment 5 years after diagnosis? JF - Breast Cancer Research and Treatment N2 - Objective In this study, we investigated to which extent patients feel well informed about their disease and treatment, which areas they wish more or less information and which variables are associated with a need for information about the disease, medical tests and treatment. Methods In a German multi-centre prospective study, we enrolled 759 female breast cancer patients at the time of cancer diagnosis (baseline). Data on information were captured at 5 years after diagnosis with the European Organisation for Research and Treatment of Cancer (EORTC) Information Module (EORTC QLQ-INFO24). Good information predictors were analysed using linear regression models. Results There were 456 patients who participated at the 5-year follow-up. They reported to feel well informed about medical tests (mean score 78.5) and the disease itself (69.3) but relatively poorly about other services (44.3) and about different places of care (31.3). The survivors expressed a need for more information concerning: side effects and long-term consequences of therapy, more information in general, information about aftercare, prognosis, complementary medicine, disease and therapy. Patients with higher incomes were better informed about medical tests (β 0.26, p 0.04) and worse informed with increasing levels of fear of treatment (β − 0.11, p 0.02). Information about treatment was reported to be worse by survivors > 70 years old (β -0.34, p 0.03) and by immigrants (β -0.11, p 0.02). Survivors who had received additional written information felt better informed about disease, medical tests, treatment and other services (β 0.19/0.19/0.20/0.25; each p < 0.01). Conclusion Health care providers have to reconsider how and what kind of information they provide. Providing written information, in addition to oral information, may improve meeting those information needs. KW - breast cancer KW - survivors KW - unmet needs KW - health care providers Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232356 SN - 0167-6806 VL - 185 ER - TY - JOUR A1 - Wischnewsky, Manfred A1 - Schwentner, Lukas A1 - Diessner, Joachim A1 - De Gregorio, Amelie A1 - Joukhadar, Ralf A1 - Davut, Dayan A1 - Salmen, Jessica A1 - Bekes, Inga A1 - Kiesel, Matthias A1 - Müller-Reiter, Max A1 - Blettner, Maria A1 - Wolters, Regine A1 - Janni, Wolfgang A1 - Kreienberg, Rolf A1 - Wöckel, Achim A1 - Ebner, Florian T1 - BRENDA-Score, a hghly significant, internally and externally validated prognostic marker for metastatic recurrence: analysis of 10,449 primary breast cancer patients JF - Cancers N2 - Background Current research in breast cancer focuses on individualization of local and systemic therapies with adequate escalation or de-escalation strategies. As a result, about two-thirds of breast cancer patients can be cured, but up to one-third eventually develop metastatic disease, which is considered incurable with currently available treatment options. This underscores the importance to develop a metastatic recurrence score to escalate or de-escalate treatment strategies. Patients and methods Data from 10,499 patients were available from 17 clinical cancer registries (BRENDA-project. In total, 8566 were used to develop the BRENDA-Index. This index was calculated from the regression coefficients of a Cox regression model for metastasis-free survival (MFS). Based on this index, patients were categorized into very high, high, intermediate, low, and very low risk groups forming the BRENDA-Score. Bootstrapping was used for internal validation and an independent dataset of 1883 patients for external validation. The predictive accuracy was checked by Harrell's c-index. In addition, the BRENDA-Score was analyzed as a marker for overall survival (OS) and compared to the Nottingham prognostic score (NPS). Results: Intrinsic subtypes, tumour size, grading, and nodal status were identified as statistically significant prognostic factors in the multivariate analysis. The five prognostic groups of the BRENDA-Score showed highly significant (p < 0.001) differences regarding MFS:low risk: hazard ratio (HR) = 2.4, 95%CI (1.7–3.3); intermediate risk: HR = 5.0, 95%CI.(3.6–6.9); high risk: HR = 10.3, 95%CI (7.4–14.3) and very high risk: HR = 18.1, 95%CI (13.2–24.9). The external validation showed congruent results. A multivariate Cox regression model for OS with BRENDA-Score and NPS as covariates showed that of these two scores only the BRENDA-Score is significant (BRENDA-Score p < 0.001; NPS p = 0.447). Therefore, the BRENDA-Score is also a good prognostic marker for OS. Conclusion: The BRENDA-Score is an internally and externally validated robust predictive tool for metastatic recurrence in breast cancer patients. It is based on routine parameters easily accessible in daily clinical care. In addition, the BRENDA-Score is a good prognostic marker for overall survival. Highlights: The BRENDA-Score is a highly significant predictive tool for metastatic recurrence of breast cancer patients. The BRENDA-Score is stable for at least the first five years after primary diagnosis, i.e., the sensitivities and specificities of this predicting system is rather similar to the NPI with AUCs between 0.76 and 0.81 the BRENDA-Score is a good prognostic marker for overall survival. KW - breast cancer KW - risk KW - prediction KW - BRENDA KW - score KW - follow up Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-241064 SN - 2072-6694 VL - 13 IS - 13 ER - TY - THES A1 - Bahlke, Katrin T1 - Wachstumsverhalten, Chemo- und Radiosensitivität ausgewählter Brustkrebszellen werden durch Betahydroxybutyrat nicht beeinflusst. T1 - Proliferation, chemo- and radiosensitivity of selected breast cancer cells are not influenced by Beta-hydroxybutyrate. N2 - Brustkrebs ist die häufigste maligne Erkrankung der Frau. Die Therapie setzt sich in der Regel individuell aus den Bausteinen der chirurgischen Tumorexzision, der Bestrahlung und der systemischen Therapie zusammen. Daneben gewinnt die ketogene Diät als supportiver Therapieansatz immer mehr an Aufmerksamkeit und Forschungsinteresse. Diese Ernährungsform imitiert durch starke Restriktion der Kohlenhydratzufuhr den Fastenstoffwechsel, da Blutzucker- und konsekutiv auch Insulinspitzen im Blut vermieden werden. Eine tragende Rolle kommt dabei der Bildung von Ketonkörpern, allen voran Betahydroxybutyrat, zu, die sowohl in den Tumorstoffwechsel als auch in immunologische Prozesse eingreifen können. In dieser Arbeit wurde ausgewählten Brustkrebszellen 3 mM Betahydroxybutyrat zugesetzt und ihr Wachstumsverhalten, ihre Chemo- und Radiosensitivität im Vergleich zu Kontrollzellen erfasst. Die Kontrollzellen wurden identisch behandelt, jedoch wurde Ihnen kein Betahydroxybutyrat zugefügt. Es zeigte sich dabei kein statistisch signifikanter Unterschied zwischen den beiden Zellgruppen. N2 - Breast cancer is the most common malignant disease in women. The therapy usually includes surgical tumor excision, radiation and systemic therapy. In addition, the ketogenic diet is gaining more and more attention as a supportive therapeutic approach. This form of nutrition mimics the fasting metabolism by strongly restricting the carbohydrate intake, since peaks in blood glucose levels and consequently in insulin levels are avoided. The formation of ketone bodies, especially Beta-hydroxybutyrate, plays a key role in this, since ketone bodies can intervene both in tumor metabolism and in immunological processes. In our experiment, selected breast cancer cells were treated with 3 mM Beta-hydroxybutyrate and their proliferation, chemo- and radiosensitivity compared to control cells were examined. Control cells were treated identically but were not exposed to Beta-hydroxybutyrate. It can be stated that there was no statistically significant difference between the two groups. KW - Ketogene Kost KW - Brustkrebs KW - Strahlensensibilität KW - Hydroxybutyrat <3-> KW - Ketogene Diät KW - Chemosensititvität KW - Radiosensitivität Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-238666 ER - TY - JOUR A1 - Kühnemundt, Johanna A1 - Leifeld, Heidi A1 - Scherg, Florian A1 - Schmitt, Matthias A1 - Nelke, Lena C. A1 - Schmitt, Tina A1 - Bauer, Florentin A1 - Göttlich, Claudia A1 - Fuchs, Maximilian A1 - Kunz, Meik A1 - Peindl, Matthias A1 - Brähler, Caroline A1 - Kronenthaler, Corinna A1 - Wischhusen, Jörg A1 - Prelog, Martina A1 - Walles, Heike A1 - Dandekar, Thomas A1 - Dandekar, Gudrun A1 - Nietzer, Sarah L. T1 - Modular micro-physiological human tumor/tissue models based on decellularized tissue for improved preclinical testing JF - ALTEX N2 - High attrition-rates entailed by drug testing in 2D cell culture and animal models stress the need for improved modeling of human tumor tissues. In previous studies our 3D models on a decellularized tissue matrix have shown better predictivity and higher chemoresistance. A single porcine intestine yields material for 150 3D models of breast, lung, colorectal cancer (CRC) or leukemia. The uniquely preserved structure of the basement membrane enables physiological anchorage of endothelial cells and epithelial-derived carcinoma cells. The matrix provides different niches for cell growth: on top as monolayer, in crypts as aggregates and within deeper layers. Dynamic culture in bioreactors enhances cell growth. Comparing gene expression between 2D and 3D cultures, we observed changes related to proliferation, apoptosis and stemness. For drug target predictions, we utilize tumor-specific sequencing data in our in silico model finding an additive effect of metformin and gefitinib treatment for lung cancer in silico, validated in vitro. To analyze mode-of-action, immune therapies such as trispecific T-cell engagers in leukemia, as well as toxicity on non-cancer cells, the model can be modularly enriched with human endothelial cells (hECs), immune cells and fibroblasts. Upon addition of hECs, transmigration of immune cells through the endothelial barrier can be investigated. In an allogenic CRC model we observe a lower basic apoptosis rate after applying PBMCs in 3D compared to 2D, which offers new options to mirror antigen-specific immunotherapies in vitro. In conclusion, we present modular human 3D tumor models with tissue-like features for preclinical testing to reduce animal experiments. KW - modular tumor tissue models KW - invasiveness KW - bioreactor culture KW - combinatorial drug predictions KW - immunotherapies Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231465 VL - 38 ER - TY - JOUR A1 - Stangl, Stephanie A1 - Rauch, Sebastian A1 - Rauh, Jürgen A1 - Meyer, Martin A1 - Müller‐Nordhorn, Jacqueline A1 - Wildner, Manfred A1 - Wöckel, Achim A1 - Heuschmann, Peter U. T1 - Disparities in Accessibility to Evidence-Based Breast Cancer Care Facilities by Rural and Urban Areas in Bavaria, Germany JF - Cancer N2 - Background Breast cancer (BC), which is most common in elderly women, requires a multidisciplinary and continuous approach to care. With demographic changes, the number of patients with chronic diseases such as BC will increase. This trend will especially hit rural areas, where the majority of the elderly live, in terms of comprehensive health care. Methods Accessibility to several cancer facilities in Bavaria, Germany, was analyzed with a geographic information system. Facilities were identified from the national BC guideline and from 31 participants in a proof‐of‐concept study from the Breast Cancer Care for Patients With Metastatic Disease registry. The timeframe for accessibility was defined as 30 or 60 minutes for all population points. The collection of address information was performed with different sources (eg, a physician registry). Routine data from the German Census 2011 and the population‐based Cancer Registry of Bavaria were linked at the district level. Results Females from urban areas (n = 2,938,991 [ie, total of females living in urban areas]) had a higher chance for predefined accessibility to the majority of analyzed facilities in comparison with females from rural areas (n = 3,385,813 [ie, total number of females living in rural areas]) with an odds ratio (OR) of 9.0 for cancer information counselling, an OR of 17.2 for a university hospital, and an OR of 7.2 for a psycho‐oncologist. For (inpatient) rehabilitation centers (OR, 0.2) and genetic counselling (OR, 0.3), women from urban areas had lower odds of accessibility within 30 or 60 minutes. Conclusions Disparities in accessibility between rural and urban areas exist in Bavaria. The identification of underserved areas can help to inform policymakers about disparities in comprehensive health care. Future strategies are needed to deliver high‐quality health care to all inhabitants, regardless of residence. KW - accessibility KW - breast cancer KW - evidence‐based medicine KW - geographic information science KW - health care service research Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239854 VL - 127 IS - 13 SP - 2319 EP - 2332 ER - TY - JOUR A1 - Stangl, Stephanie A1 - Haas, Kirsten A1 - Eichner, Felizitas A. A1 - Grau, Anna A1 - Selig, Udo A1 - Ludwig, Timo A1 - Fehm, Tanja A1 - Stübner, Tanja A1 - Rashid, Asarnusch A1 - Kerscher, Alexander A1 - Bargou, Ralf A1 - Hermann, Silke A1 - Arndt, Volker A1 - Meyer, Martin A1 - Wildner, Manfred A1 - Faller, Hermann A1 - Schrauder, Michael G. A1 - Weigel, Michael A1 - Schlembach, Ulrich A1 - Heuschmann, Peter U. A1 - Wöckel, Achim T1 - Development and proof-of-concept of a multicenter, patient-centered cancer registry for breast cancer patients with metastatic disease — the “Breast cancer care for patients with metastatic disease” (BRE-4-MED) registry JF - Pilot and Feasibility Studies N2 - Background: Patients with metastatic breast cancer (MBC) are treated with a palliative approach with focus oncontrolling for disease symptoms and maintaining high quality of life. Information on individual needs of patients andtheir relatives as well as on treatment patterns in clinical routine care for this specific patient group are lacking or arenot routinely documented in established Cancer Registries. Thus, we developed a registry concept specifically adaptedfor these incurable patients comprising primary and secondary data as well as mobile-health (m-health) data. Methods: The concept for patient-centered “Breast cancer care for patients with metastatic disease”(BRE-4-MED)registry was developed and piloted exemplarily in the region of Main-Franconia, a mainly rural region in Germanycomprising about 1.3 M inhabitants. The registry concept includes data on diagnosis, therapy, progression, patient-reported outcome measures (PROMs), and needs of family members from several sources of information includingroutine data from established Cancer Registries in different federal states, treating physicians in hospital as well as inoutpatient settings, patients with metastatic breast cancer and their family members. Linkage with routine cancerregistry data was performed to collect secondary data on diagnosis, therapy, and progression. Paper and online-basedquestionnaires were used to assess PROMs. A dedicated mobile application software (APP) was developed to monitorneeds, progression, and therapy change of individual patients. Patient’s acceptance and feasibility of data collection inclinical routine was assessed within a proof-of-concept study. Results: The concept for the BRE-4-MED registry was developed and piloted between September 2017 and May 2018.In total n= 31 patients were included in the pilot study, n= 22 patients were followed up after 1 month. Recordlinkage with the Cancer Registries of Bavaria and Baden-Württemberg demonstrated to be feasible. The voluntary APP/online questionnaire was used by n= 7 participants. The feasibility of the registry concept in clinical routine waspositively evaluated by the participating hospitals. Conclusion: The concept of the BRE-4-MED registry provides evidence that combinatorial evaluation of PROMs, needsof family members, and raising clinical parameters from primary and secondary data sources as well as m-healthapplications are feasible and accepted in an incurable cancer collective. KW - Metastatic breast cancer KW - Patient-centered registry KW - Patient’s needs KW - m-Health KW - Health care service research Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229149 VL - 6 ER - TY - JOUR A1 - Balafoutas, Dimitrios A1 - Wöckel, Achim A1 - Wulff, Christine A1 - Joukhadar, Ralf T1 - Implementation of robotic gynecological surgery in a German University Hospital: patient safety after 110 procedures JF - Archives of Gynecology and Obstetrics N2 - Purpose Robotic surgery represents the latest development in the field of minimally invasive surgery and offers many technical advantages. Despite the higher costs, this novel approach has been applied increasingly in gynecological surgery. Regarding the implementation of a new operative method; however, the most important factor to be aware of is patient safety. In this study, we describe our experience in implementing robotic surgery in a German University Hospital focusing on patient safety after 110 procedures. Methods We performed a retrospective analysis of 110 consecutive robotic procedures performed in the University Hospital of Würzburg between June 2017 and September 2019. During this time, 37 patients were treated for benign general gynecological conditions, 27 patients for gynecological malignancies, and 46 patients for urogynecological conditions. We evaluated patient safety through standardized assessment of intra- and postoperative complications, which were categorized according to the Clavien–Dindo classification. Results No complications were recorded in 90 (81.8%) operations. We observed Clavien–Dindo grade I complications in 8 (7.3%) cases, grade II complications in 5 (4.5%) cases, grade IIIa complications in 1 case (0.9%), and grade IIIb complications in 6 (5.5%) cases. No conversion to laparotomy or blood transfusion was needed. Conclusion Robotic surgery could be implemented for complex gynecological operations without relevant problems and was accompanied by low complication rates. KW - robotic hysterectomy KW - robotic sacrocolpopexy KW - implementation KW - robotic complications KW - polyvinylidene fluoride (PVDF) Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232650 SN - 0932-0067 VL - 302 ER - TY - JOUR A1 - Curtaz, Carolin J. A1 - Schmitt, Constanze A1 - Herbert, Saskia-Laureen A1 - Feldheim, Jonas A1 - Schlegel, Nicolas A1 - Gosselet, Fabien A1 - Hagemann, Carsten A1 - Roewer, Norbert A1 - Meybohm, Patrick A1 - Wöckel, Achim A1 - Burek, Malgorzata T1 - Serum-derived factors of breast cancer patients with brain metastases alter permeability of a human blood-brain barrier model JF - Fluids and Barriers of the CNS N2 - Background The most threatening metastases in breast cancer are brain metastases, which correlate with a very poor overall survival, but also a limited quality of life. A key event for the metastatic progression of breast cancer into the brain is the migration of cancer cells across the blood-brain barrier (BBB). Methods We adapted and validated the CD34\(^+\) cells-derived human in vitro BBB model (brain-like endothelial cells, BLECs) to analyse the effects of patient serum on BBB properties. We collected serum samples from healthy donors, breast cancer patients with primary cancer, and breast cancer patients with, bone, visceral or cerebral metastases. We analysed cytokine levels in these sera utilizing immunoassays and correlated them with clinical data. We used paracellular permeability measurements, immunofluorescence staining, Western blot and mRNA analysis to examine the effects of patient sera on the properties of BBB in vitro. Results The BLECs cultured together with brain pericytes in transwells developed a tight monolayer with a correct localization of claudin-5 at the tight junctions (TJ). Several BBB marker proteins such as the TJ proteins claudin-5 and occludin, the glucose transporter GLUT-1 or the efflux pumps PG-P and BCRP were upregulated in these cultures. This was accompanied by a reduced paracellular permeability for fluorescein (400 Da). We then used this model for the treatment with the patient sera. Only the sera of breast cancer patients with cerebral metastases had significantly increased levels of the cytokines fractalkine (CX3CL1) and BCA-1 (CXCL13). The increased levels of fractalkine were associated with the estrogen/progesterone receptor status of the tumour. The treatment of BLECs with these sera selectively increased the expression of CXCL13 and TJ protein occludin. In addition, the permeability of fluorescein was increased after serum treatment. Conclusion We demonstrate that the CD34\(^+\) cell-derived human in vitro BBB model can be used as a tool to study the molecular mechanisms underlying cerebrovascular pathologies. We showed that serum from patients with cerebral metastases may affect the integrity of the BBB in vitro, associated with elevated concentrations of specific cytokines such as CX3CL1 and CXCL13. KW - Metastatic breast cancer KW - Blood–brain barrier KW - In vitro models KW - CX3CL1 KW - CXCL13 Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229940 VL - 17 ER - TY - JOUR A1 - Schlesinger, Tobias A1 - Weißbrich, Benedikt A1 - Wedekink, Florian A1 - Notz, Quirin A1 - Herrmann, Johannes A1 - Krone, Manuel A1 - Sitter, Magdalena A1 - Schmid, Benedikt A1 - Kredel, Markus A1 - Stumpner, Jan A1 - Dölken, Lars A1 - Wischhusen, Jörg A1 - Kranke, Peter A1 - Meybohm, Patrick A1 - Lotz, Christpher T1 - Biodistribution and serologic response in SARS-CoV-2 induced ARDS: A cohort study JF - PLoS One N2 - Background The viral load and tissue distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain important questions. The current study investigated SARS-CoV-2 viral load, biodistribution and anti-SARS-CoV-2 antibody formation in patients suffering from severe corona virus disease 2019 (COVID-19) induced acute respiratory distress syndrome (ARDS). Methods This is a retrospective single-center study in 23 patients with COVID-19-induced ARDS. Data were collected within routine intensive care. SARS-CoV-2 viral load was assessed via reverse transcription quantitative polymerase chain reaction (RT-qPCR). Overall, 478 virology samples were taken. Anti-SARS-CoV-2-Spike-receptor binding domain (RBD) antibody detection of blood samples was performed with an enzyme-linked immunosorbent assay. Results Most patients (91%) suffered from severe ARDS during ICU treatment with a 30-day mortality of 30%. None of the patients received antiviral treatment. Tracheal aspirates tested positive for SARS-CoV-2 in 100% of the cases, oropharyngeal swabs only in 77%. Blood samples were positive in 26% of the patients. No difference of viral load was found in tracheal or blood samples with regard to 30-day survival or disease severity. SARS-CoV-2 was never found in dialysate. Serologic testing revealed significantly lower concentrations of SARS-CoV-2 neutralizing IgM and IgA antibodies in survivors compared to non-survivors (p = 0.009). Conclusions COVID-19 induced ARDS is accompanied by a high viral load of SARS-CoV-2 in tracheal aspirates, which remained detectable in the majority throughout intensive care treatment. Remarkably, SARS-CoV-2 RNA was never detected in dialysate even in patients with RNAemia. Viral load or the buildup of neutralizing antibodies was not associated with 30-day survival or disease severity. KW - viral load Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231348 VL - 15, 2020 IS - 11 ER - TY - JOUR A1 - Notz, Quirin A1 - Schmalzing, Marc A1 - Wedekink, Florian A1 - Schlesinger, Tobias A1 - Gernert, Michael A1 - Herrmann, Johannes A1 - Sorger, Lena A1 - Weismann, Dirk A1 - Schmid, Benedikt A1 - Sitter, Magdalena A1 - Schlegel, Nicolas A1 - Kranke, Peter A1 - Wischhusen, Jörg A1 - Meybohm, Patrick A1 - Lotz, Christopher T1 - Pro- and Anti-Inflammatory Responses in Severe COVID-19-Induced Acute Respiratory Distress Syndrome—An Observational Pilot Study JF - Frontiers in Immunology N2 - Objectives The severity of Coronavirus Disease 2019 (COVID-19) is largely determined by the immune response. First studies indicate altered lymphocyte counts and function. However, interactions of pro- and anti-inflammatory mechanisms remain elusive. In the current study we characterized the immune responses in patients suffering from severe COVID-19-induced acute respiratory distress syndrome (ARDS). Methods This was a single-center retrospective study in patients admitted to the intensive care unit (ICU) with confirmed COVID-19 between March 14th and May 28th 2020 (n = 39). Longitudinal data were collected within routine clinical care, including flow-cytometry of lymphocyte subsets, cytokine analysis and growth differentiation factor 15 (GDF-15). Antibody responses against the receptor binding domain (RBD) of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Spike protein were analyzed. Results All patients suffered from severe ARDS, 30.8% died. Interleukin (IL)-6 was massively elevated at every time-point. The anti-inflammatory cytokine IL-10 was concomitantly upregulated with IL-6. The cellular response was characterized by lymphocytopenia with low counts of CD8+ T cells, natural killer (NK) and naïve T helper cells. CD8+ T and NK cells recovered after 8 to 14 days. The B cell system was largely unimpeded. This coincided with a slight increase in anti-SARS-CoV-2-Spike-RBD immunoglobulin (Ig) G and a decrease in anti-SARS-CoV-2-Spike-RBD IgM. GDF-15 levels were elevated throughout ICU treatment. Conclusions Massively elevated levels of IL-6 and a delayed cytotoxic immune defense characterized severe COVID-19-induced ARDS. The B cell response and antibody production were largely unimpeded. No obvious imbalance of pro- and anti-inflammatory mechanisms was observed, with elevated GDF-15 levels suggesting increased tissue resilience. KW - Coronavirus Disease 2019 KW - acute respiratory distress syndrome KW - Severe Acute Respiratory Syndrome Coronavirus 2 KW - cytokines KW - inflammation KW - growth differentiation factor 15 KW - immune response Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-212815 SN - 1664-3224 VL - 11 ER - TY - JOUR A1 - Ebner, Florian A1 - Wöckel, Achim A1 - Schwentner, Lukas A1 - Blettner, Maria A1 - Janni, Wolfgang A1 - Kreienberg, Rolf A1 - Wischnewsky, Manfred T1 - Does the number of removed axillary lymphnodes in high risk breast cancer patients influence the survival? JF - BMC Cancer N2 - Background The decision making process for axillary dissection has changed in recent years for patients with early breast cancer and positive sentinel lymph nodes (LN). The question now arises, what is the optimal surgical treatment for patients with positive axillary LN (pN+). This article tries to answer the following questions: (1) Is there a survival benefit for breast cancer patients with 3 or more positive LN (pN3+) and with more than 10 removed LN? (2) Is there a survival benefit for high risk breast cancer patients (triple negative or Her2 + breast cancer) and with 3 or more positive LN (pN3+) with more than 10 removed LN? (3) In pN + patients is the prognostic value of the lymph node ratio (LNR) of pN+/pN removed impaired if 10 or less LN are removed? Methods A retrospective database analysis of the multi center cohort database BRENDA (breast cancer under evidence based guidelines) with data from 9625 patients from 17 breast centers was carried out. Guideline adherence was defined by the 2008 German National consensus guidelines. Results 2992 out of 9625 patients had histological confirmed positive lymph nodes. The most important factors for survival were intrinsic sub types, tumor size and guideline adherent chemo- and hormonal treatment (and age at diagnosis for overall survival (OAS)). Uni-and multivariable analyses for recurrence free survival (RFS) and OAS showed no significant survival benefit when removing more than 10 lymph nodes even for high-risk patients. The mean and median of LNR were significantly higher in the pN+ patients with ≤10 excised LN compared to patients with > 10 excised LN. LNR was in both, uni-and multivariable, analysis a highly significant prognostic factor for RFS and OAS in both subgroups of pN + patients with less respective more than 10 excised LN. Multivariable COX regression analysis was adjusted by age, tumor size, intrinsic sub types and guideline adherent adjuvant systemic therapy. Conclusion The removal of more than 10 LN did not result in a significant survival benefit even in high risk pN + breast cancer patients. KW - advanced breast cancer KW - axillary dissection KW - lymph nodes KW - number of KW - sentinel KW - survival KW - guideline adherent treatment Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-226445 VL - 19 ER - TY - JOUR A1 - Bekes, Inga A1 - Löb, Sanja A1 - Holzheu, Iris A1 - Janni, Wolfgang A1 - Baumann, Lisa A1 - Wöckel, Achim A1 - Wulff, Christine T1 - Nectin‐2 in ovarian cancer: how is it expressed and what might be its functional role? JF - Cancer Science N2 - Nectin‐2 is an adhesion molecule that has been reported to play a role in tumor growth, metastasis and tumor angiogenesis. Herein, we investigated Nectin‐2 in ovarian cancer patients and in cell culture. Tumor as well as peritoneal biopsies of 60 ovarian cancer patients and 22 controls were dual stained for Nectin‐2 and CD31 using immunohistochemistry. Gene expression of Nectin‐2 was quantified by real‐time PCR and differences analyzed in relation to various tumor characteristics. In the serum of patients, vascular endothelial growth factor (VEGF) was quantified by ELISA. Effect of VEGF on Nectin‐2 expression as well as permeability was investigated in HUVEC. In tumor biopsies, Nectin‐2 protein was mainly localized in tumor cells, whereas in peritoneal biopsies, clear colocalization was found in the vasculature. T3 patients had a significantly higher percentage of positive lymph nodes and this correlated with survival. Nectin‐2 was significantly upregulated in tumor biopsies in patients with lymph node metastasis and with residual tumor >1 cm after surgery. Nectin‐2 expression was significantly suppressed in the peritoneal endothelium of patients associated with significantly increased VEGF serum levels. In cell culture, VEGF stimulation led to a significant downregulation of Nectin‐2 which was reversed by VEGF‐inhibition. In addition, Nectin‐2 knockdown in endothelial cells was associated with significantly increased endothelial permeability. Nectin‐2 expression in ovarian cancer may support tumor cell adhesion, leading to growth and lymph node metastasis. In addition, VEGF‐induced Nectin‐2 suppression in peritoneal endothelium may support an increase in vascular permeability leading to ascites production. KW - metastasis KW - ovarian cancer KW - survival KW - Nectin‐2 KW - VEGF Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-202748 VL - 110 IS - 6 ER - TY - THES A1 - Quenzer, Anne T1 - Der antiproliferative Effekt des Multidrug resistance-Protein 1 (MRP1)-Inhibitors Reversan und der Laktatdehydrogenase (LDH)-Inhibitoren Natriumoxamat und Galloflavin an kolorektalen Karzinomzellen bei tumorphysiologischen Sauerstoffkonzentrationen T1 - Antiproliferative effects of multidrug resistance protein 1 (MRP1) inhibitor Reversan and lactate dehydrogenase (LDH) inhibitors Natriumoxamat and Galloflavin in human colorectal cells exposed to oxygen levels characteristic for tumor oxygenation N2 - Ziel der vorliegenden Arbeit waren pharmakologische Untersuchungen zum antiproliferativen Effekt der beiden Laktatdehydrogenase (LDH)-Inhibitoren Natriumoxamat und Galloflavin sowie des MRP1-Inhibitors Reversan einzeln und in Kombination bei verschiedenen Sauerstoffkonzentrationen in vitro zu untersuchen. Zusätzlich wurde der antiproliferative Effekt der drei Inhibitoren mit dem antiproliferativen Effekt von 5-FU verglichen. Das Konzept zu dieser Arbeit basiert auf Gemeinsamkeiten zwischen LDH und MRP1 in malignen Zellen. Eine ist, dass beide Moleküle von zahlreichen Tumoren überexprimiert werden. Weiter sind beide an der Ausbildung von Chemoresistenz beteiligt und beide werden auch in Hypoxie exprimiert. Zudem wird das für die Funktion von MRP1 notwendige ATP in malignen Zellen hauptsächlich mit der hyperaktiven Glykoloyse gebildet, deren Stoffumsatz auch von der LDH-Aktivität abhängig ist. Eine kombinierte Inhibition beider Zielstrukturen scheint somit geeignet zu sein, um die Proliferation maligner Zellen gezielt zu hemmen. Da in großen Teilen solider Tumoren hypoxische bzw. anoxische Bedingungen vorherrschen, wurde die Wirksamkeit der drei Inhibitoren auch bei 5 % und 1 % Sauerstoff, die als tumorphysiologisch gelten, untersucht. Die wichtigsten Ergebnisse aus dieser Arbeit sind, dass die beiden LDH-Inhibitoren Natriumoxamat und Galloflavin und der MRP1-Inhibitor Reversan einen antiproliferativen Effekt bei kolorektalen Karzinomzellen auslösen, der auch für tumorphysiologische Sauerstoffkonzentrationen nachzuweisen war. So verringerte sich durch Natriumoxamat bzw. Galloflavin der Anteil vitaler Zellen um bis zu 45 % und durch Reversan um bis zu 60 % bei 5 % und 1 % Sauerstoff im Vergleich zur unbehandelten Kontrolle. Auch unterschiedliche Kombination aus Natriumoxamat, Galloflavin und Reversan führten zu einer Steigerung des antiproliferativen Effektes, der auch immer bei tumorphysiologischen Konzentrationen nachzuweisen war. Den stärksten antiproli-ferativen Effekt wies die Dreifachkombination aus Galloflavin, Natriumoxamat und Reversan auf. So verringerte sich der Anteil vitaler Zellen bei 1 % Sauerstoff durch diese Kombination auf bis zu 28 % bei vier der fünf kolorektalen Karzinomzelllinien. Die Dreifachkombination wies einen gleichstarken bzw. stärkeren antiproliferativen Effekt auf als das Chemotherapeutikum 5-FU und zwar ebenfalls bei 5 % und 1 % Sauerstoff. Die Ergebnisse der vorliegenden Arbeit zum antiproliferativen Effekt von Natriumoxamat, Galloflavin (beides LDH-Inhibitoren) und Reversan (MRP1-Inhibitor) in vitro lassen den Schluss zu, dass das Konzept der Arbeit, einen antiproliferativen Effekt auch bei tumorphysiologischen Sauerstoffkonzentrationen zu induzieren, grundsätzlich bestätigt wurde. Auch löste die gemeinsame Hemmung von LDH und MRP1 einen teilweise stärkeren antiproliferativen Effekt aus als 5-FU. Weitere Untersuchungen sind aber ohne Frage nötig, um die molekularen Interaktion zwischen LDH und MRP1 sowie ihrer Inhibition im Detail zu verstehen. N2 - The aim of the present study was to investigate the antiproliferative effect of the two lactate dehydrogenase (LDH) inhibitors sodium oxamate and galloflavin and the MRP1 inhibitor reversan at different oxygen concentrations in vitro. The inhibitors were used individually and in combination. In addition, the antiproliferative effect of the three inhibitors was compared with the antiproliferative effect of 5-FU. The concept of this study is based on similarities between LDH and MRP1 in malignant cells: their overexpression by numerous tumors; their contribution to chemoresistance and their expression in hypoxia. In addition, the ATP necessary for the function of MRP1 is mainly formed in malignant cells by an increased turnover of the hyperactive glycolysis, which also depends on the LDH activity. Thus, a combined inhibition of both targets appears to inhibit tumor cell proliferation effectively. Since hypoxic or anoxic conditions prevail in large parts of solid tumors, the efficacy of the three inhibitors was also investigated at 5% and 1% oxygen, which are considered to be physiological for solid tumors. The most important results of the study are that both sodium oxamate and galloflavin, as well as reversan trigger an antiproliferative effect in colorectal carcinoma cells, even in the presence of tumor physiological oxygen concentrations. For example, the pro-portion of viable cells decreased up to 45% with sodium oxamate or galloflavin and up to 60% with reversan, even at 5% and 1% oxygen compared to untreated control cells. Different combinations of sodium oxamate, galloflavin and reversan resulted in en-hanced antiproliferative effects, which were also demonstrated at tumor physiological oxygen concentrations. The strongest antiproliferative effects were observed with the triple combination of galloflavin, sodium oxamate and reversan. In this combination, the proportion of viable cells decreased to 28% at 1% oxygenation in four of the five colorectal carcinoma cell lines. The triple combination caused an antiproliferative effect that was equal to or even more potent than the antiproliferative effect of the chemotherapeutic agent 5-FU also at 5% and 1% oxygen. The results of this study on the antiproliferative effect of sodium oxamate, galloflavin (both LDH inhibitors) and reversan (MRP1 inhibitor) in vitro seems to confirm the aim of the study, which was to induce an antiproliferative effect even in tumor physiologi-cal oxygen concentrations. In part, the combined inhibition of LDH and MRP1 caused a stronger antiproliferative effect than 5-FU. However, further investigations are neces-sary to comprehend the molecular interaction between LDH and MRP1 as well as its inhibition in detail. KW - Lactatdehydrogenase KW - 5-FU KW - Multidrug-Resistance-Related Proteine KW - Inhibition KW - Metabolismus KW - Tumorzellen KW - Tumormetabolismus KW - Chemoresistenz KW - tumorspezifische Therapie KW - Intratumorale Heterogenität Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-156051 ER - TY - THES A1 - Hahn, Niklas T1 - Auswirkungen physiologischer Konzentrationen von Beta-Hydroxybutyrat auf vaskuläre Endothelzellen T1 - Effects of physiological concentrations of Beta-Hydroxybutyrate on vascular endothelial cells N2 - Die endotheliale Dysfunktion beatmeter Intensivpatienten stellt ein signifikantes klinisches Problem dar. Flüssigkeitsaustritte durch die Gefäßwand können zur Bildung von lebensbedrohlichen Ödemen führen. Forschungsergebnisse zeigen einen Einfluss der lokalen Sauerstoffkonzentration sowie der Stoffwechsellage auf die endotheliale Zellhomöostase sowie die Angiogenesekapazität. In der vorliegenden Arbeit wurde der Einfluss unterschiedlicher Sauerstoffkonzentrationen sowie der Exposition gegenüber Ketonkörpern auf die Expression zentraler Stoffwechselenzyme, die Freisetzung von Zytokinen, die endotheliale Migrations- und Angiogenesekapazität sowie die Freisetzung von Angiogenesefaktoren an kultivierten humanen Nabelschnurendothelien (HUVEC) untersucht. Unterschiedliche Sauerstoffkonzentrationen führten zu keiner wesentlichen Änderung der mRNA- oder Proteinexpression von Stoffwechselenzymen. Im Hinblick auf die Zytokinfreisetzung zeigten sich hingegen deutliche Expressionsänderungen unter Hypoxie bzw. Hyperoxie, welche jedoch in der Zusammenschau kein eindeutig proangiogenetisches Profil zeigten. Hypoxie und Hyperoxie sowie die Exposition gegenüber Ketonkörpern (β-Hydroxybutyrat) verlangsamten die endotheliale Zellmigration; im Gegensatz hierzu führte die Ketose im Angiogeneseassay zu einer signifikant erhöhten Gefäßdichte und Anzahl an Verzweigungspunkten, einhergehend mit erhöhter Freisetzung des potenten Angiogenesefaktors Angiopoietin-1. Somit zeigen die Ergebnisse dieser Arbeit, dass eine ketogene Stoffwechsellage – mutmaßlich über eine gesteigerte endotheliale Zellproliferation – zu einer gesteigerten Angiogenese führt, wogegen eine Änderung der Sauerstoffkonzentration im Modell keine eindeutig positiven Effekte zeigte. Eine physiologische Ketose könnte somit bei Intensivpatienten der Entstehung einer endothelialen Dysfunktion mit Entwicklung eines Capillary-leak-Syndroms entgegenwirken. N2 - The endothelial Dysfunction of respirated Intensiv Care Patients poses a significant clinical Problem. Vascular leaks may cause life threatening edemas. Results of the research show an influence of the local oxygen concentration as well as the metabolism situation on endothelial homöostase and Angiogenesis. This work researched the influence of different Oxygen konzentrations and the Exposition of Ketone-bodies on the Expression of different metabolism enzymes, the Emission of zytokines, the endothelial Migration- and Angiogenese capacity as well as the Emission of Angiogenesefactors in HUVEC Cells. KW - Ketonkörper KW - Angiogenese KW - Endothelzelle KW - Beta-Hydroxybutyrat KW - Angiogenese KW - Capillary leak Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157286 ER - TY - THES A1 - Becker, Kathrin T1 - NK-Zell-vermittelte Dedifferenzierung von Brustkrebszellen als neuer Resistenzmechanismus T1 - NK Cell mediated dedifferentiation of breast cancer cells as a new resistance mechanism N2 - Tumorstammzellen scheinen das Triebwerk für die Initiierung und Progression des Mammakarzinoms zu sein. Durch ihr Potential zur Proliferation von Tumorgewebe, zur Metastasierung und zur Bildung von Rezidiven bestimmen sie maßgeblich die Prognose und Mortalität von Brustkrebspatientinnen. Diese Arbeit demonstriert, welche Mechanismen sich Brustkrebsstammzellen zu Nutze machen, um einer Immunantwort durch NK Zellen zu entkommen. Mittels durchflusszytometrischer Analysen konnte innerhalb der Gesamtpopulation an MCF 7-Brustkrebszellen eine CD44highCD24low-Subpopulation, die dem Tumorstammzellanteil entspricht, abgegrenzt werden. Im Vergleich zur Ausgangspopulation war nach einer Kokultur mit aktivierten NK Zellen gesunder menschlicher Spender eine Anreicherung von Tumorstammzellen in vitro zu verzeichnen. Die Inkubation von Brustkrebszellen mit NK Zell-Überstand führte zu keiner wesentlichen Veränderung der Tumorstammzellpopulation, was die Notwendigkeit eines direkten Zell-Zell-Kontakts impliziert. Diese Tumorstammzellen könnten nach einem Angriff durch NK Zellen einerseits durch Selektion übrig geblieben sein oder andererseits durch epithelial-mesenchymale Transition (EMT) neu entstanden sein. Hinweise auf einen Selektionsprozess ließen sich anhand der verminderten Oberflächenexpression von NK Zell-Liganden auf Tumorstammzellen im Vergleich zu Nichtstammzellen finden. Die untersuchten Brustkrebszelllinien (MCF 7, SKBR 3, BT 474 und MDA MB 231) besaßen ein jeweils individuell reguliertes Muster der aktivierenden NKG2D Liganden (MICA, MICB, ULBP1, ULBP2, ULBP3), DNAM 1-Liganden (CD112, CD155) und von MHC1-Molekülen auf Tumorstammzellen und Nichtstammzellen. Die niedrigere Expression von NK Zell-Liganden auf Tumorstammzellen lässt auf eine verminderte Angreifbarkeit durch NK Zellen schließen. Eine Induktion von Tumorstammzellen aus differenzierten epithelialen Tumorzellen via EMT nach einer Kokultur mit NK Zellen konnten wir beweisen. Aus einer stammzelldepletierten MCF 7-Population gingen nach dem Kontakt zu NK Zellen Tumorzellen mit dem Phänotyp CD44highCD24low de novo hervor. Die Herunterregulation des epithelialen Adhäsionsmoleküls E-Cadherin sowie die Hochregulation mesenchymaler Marker wie des Strukturproteins Vimentin, der EMT-auslösenden Transkriptionsfaktoren Slug, Snail und Twist, und der stammzelltypischen Transkriptionsfaktoren Oct4, KLF4 und cMyc auf mRNA-Ebene sprachen für eine EMT-getriggerte Induktion von Tumorstammzellen nach einer Kokultur von MCF 7-Zellen mit NK Zellen. Desweiteren stellten wir fest, dass der direkte Kontakt zwischen Tumorzellen und NK Zellen für die Induktion von Tumorstammzellen von großer Bedeutung ist, und zwar auch nach Inhibition des zytotoxischen Effektorpotentials der NK Zellen. Diese Zell-Zell-Interaktionen scheinen von NKG2D und DNAM 1 abhängig zu sein und eine konsekutive Stammzellinduktion via EMT zu beinhalten. Da aus einer nativen Population nach dem Kontakt zu NK-Zellen ein doppelt so hoher Anteil an Tumorstammzellen hervorging wie aus einer ebenso mit NK-Zellen behandelten stammzelldepletierten Fraktion, ist davon auszugehen, dass ein überdurchschnittlich gutes Überleben von Tumorstammzellen unter NK-Zell-vermitteltem Selektionsdruck auch zum „Immune Escape“ beitragen kann. Hinsichtlich ihrer Klonogenität gab es zwischen bestehenden und induzierten Tumorstammzellen keinen Unterschied. Beide Fraktionen waren in gleichem Ausmaß in der Lage neue Kolonien zu bilden. Es konnte also gezeigt werden, dass eine EMT-getriggerte Induktion im Sinne eines „Immune Escapes“ von Brustkrebszellen nach dem Kontakt zu NK Zellen maßgeblich zur Tumorstammzellanreicherung beiträgt. Ein zusätzlicher Selektionsprozess bestehender Tumorstammzellen kann als wahrscheinlich angenommen werden. Interaktionen über die NK Zell-Rezeptoren NKG2D und DNAM 1 bzw. deren Liganden auf Tumorzellen scheinen eine Schlüsselrolle zu spielen. Sie könnten als Ansatzpunkt für medizinische Interventionen dienen, die zur Verhinderung einer Tumorstammzellanreicherung im Mammakarzinom beitragen und somit die Prognose von Brustkrebspatientinnen verbessern. N2 - Tumor stem cells seem to be the engine for initiation and progression of breast cancer. By their potential for unlimited proliferation, dissemination and relapse they largely determine the prognosis and mortality of breast cancer patients. This thesis shows mechanisms breast cancer (stem) cells use to escape from an immune response by NK cells. Using flow cytometry analysis, we defined a subpopulation of CD44highCD24low cells corresponding to the tumor stem cell fraction of MCF-7 breast cancer cells. Compared to the native MCF-7 cell population we observed an enrichment of tumor stem cells in vitro after co-culture with activated NK cells from healthy human donors. Incubation of breast cancer cells with NK cell supernatant resulted in no significant change, which implies that the observed NK cell-mediated enrichment of the cancer stem cell population depends on direct cell-cell contact. One possibility is that these tumor stem cells could be enriched by selection, i.e. by preferential killing of their more differentiated counterparts. Alternatively, they could arise de novo via epithelial to mesenchymal transition (EMT). A selection process was supported by data showing reduced surface expression of NK cell ligands on tumor stem cells compared to non-stem cells. The investigated breast cancer cell lines (MCF-7, SKBR 3, BT 474 and MDA MB 231) showed a distinctly regulated pattern of activating NKG2D-ligands (MICA, MICB, ULBP1, ULBP2, ULBP3) and DNAM 1-ligands (CD112, CD155) and of MHC1-molecules on tumor stem cells and non-stem cells. The comparatively lower expression of NK cell ligands suggests a reduced vulnerability of tumor stem cells towards NK cells. However, we also showed the induction of tumor stem cells from differentiated epithelial tumor cells via EMT. Tumor cells with the phenotype CD44highCD24low arose de novo from a stem cell depleted MCF-7 tumor cell population which was then co-incubated with NK cells. Downregulation of the epithelial cell adhesion molecule E-cadherin as well as upregulation of mesenchymal markers such as the structural protein vimentin, the EMT-inducing transcription factors Slug, Snail and Twist and the stem cell-typical transcription factors Oct4, KLF4 and cMyc on mRNA level indicate an EMT-triggered induction of tumor stem cells after co-culture of MCF-7 with NK cells. We also found that the direct contact between tumor cells and non-lytic NK cells is of vital importance for the induction of tumor stem cells. These cell-cell interactions appeared to depend on NKG2D and DNAM-1 and to include a consecutive stem cell induction via EMT. As the proportion of tumor stem cells after co-culture of native MCF-7 cells and NK cells was almost twice the number of stem cells arisen from an equally treated stem cell depleted fraction we can assume that an above-average survival of tumor stem cells due to selection stress can also contribute to immune escape. Regarding their clonogenicity we noticed no difference between pre-existent and induced tumor stem cells. Both fractions possessed the ability to generate new colonies of similar quantity. Thus, we showed that upon exposure to NK cells EMT-triggered induction considerably contributes to the enrichment of breast cancer stem cells. An additional process of stem cell selection seems to be realistic. Interactions of the NK cell receptors NKG2D and DNAM 1 and its ligands on tumor cells respectively seem to play a key role. The recognition that de-differentiation may represent a previously unrecognized immune escape mechanism of breast cancer cells could serve as a starting point for medical interventions, with the aim of preventing stem cell accumulation in breast cancer and thus improving the prognosis of breast cancer patients. KW - Brustkrebs KW - Natürliche Killerzelle KW - Resistenz KW - Stammzelle KW - Dedifferenzierung KW - Tumorstammzellen KW - Induktion KW - Selektion KW - NKG2D / DNAM-1 KW - Cancer stem cells Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-159885 ER - TY - JOUR A1 - Bartmann, Catharina A1 - Janaki Raman, Sudha R. A1 - Flöter, Jessica A1 - Schulze, Almut A1 - Bahlke, Katrin A1 - Willingstorfer, Jana A1 - Strunz, Maria A1 - Wöckel, Achim A1 - Klement, Rainer J. A1 - Kapp, Michaela A1 - Djuzenova, Cholpon S. A1 - Otto, Christoph A1 - Kämmerer, Ulrike T1 - Beta-hydroxybutyrate (3-OHB) can influence the energetic phenotype of breast cancer cells, but does not impact their proliferation and the response to chemotherapy or radiation JF - Cancer & Metabolism N2 - Background: Ketogenic diets (KDs) or short-term fasting are popular trends amongst supportive approaches for cancer patients. Beta-hydroxybutyrate (3-OHB) is the main physiological ketone body, whose concentration can reach plasma levels of 2–6 mM during KDs or fasting. The impact of 3-OHB on the biology of tumor cells described so far is contradictory. Therefore, we investigated the effect of a physiological concentration of 3 mM 3-OHB on metabolism, proliferation, and viability of breast cancer (BC) cells in vitro. Methods: Seven different human BC cell lines (BT20, BT474, HBL100, MCF-7, MDA-MB 231, MDA-MB 468, and T47D) were cultured in medium with 5 mM glucose in the presence of 3 mM 3-OHB at mild hypoxia (5% oxygen) or normoxia (21% oxygen). Metabolic profiling was performed by quantification of the turnover of glucose, lactate, and 3-OHB and by Seahorse metabolic flux analysis. Expression of key enzymes of ketolysis as well as the main monocarboxylic acid transporter MCT2 and the glucose-transporter GLUT1 was analyzed by RT-qPCR and Western blotting. The effect of 3-OHB on short- and long-term cell proliferation as well as chemo- and radiosensitivity were also analyzed. Results: 3-OHB significantly changed the oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) in BT20 cells resulting in a more oxidative energetic phenotype. MCF-7 and MDA-MB 468 cells had increased ECAR only in response to 3-OHB, while the other three cell types remained uninfluenced. All cells expressed MCT2 and GLUT1, thus being able to uptake the metabolites. The consumption of 3-OHB was not strongly linked to mRNA overexpression of key enzymes of ketolysis and did not correlate with lactate production and glucose consumption. Neither 3-OHB nor acetoacetate did interfere with proliferation. Further, 3-OHB incubation did not modify the response of the tested BC cell lines to chemotherapy or radiation. Conclusions: We found that a physiological level of 3-OHB can change the energetic profile of some BC cell lines. However, 3-OHB failed to influence different biologic processes in these cells, e.g., cell proliferation and the response to common breast cancer chemotherapy and radiotherapy. Thus, we have no evidence that 3-OHB generally influences the biology of breast cancer cells in vitro. KW - ketogenic diet KW - β-Hydroxybutyrate KW - ketone bodies KW - breast cancer KW - seahorse KW - metabolic profile KW - chemotherapy KW - ionizing radiation Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175607 VL - 6 IS - 8 ER - TY - JOUR A1 - Zeiner, P. S. A1 - Zinke, J. A1 - Kowalewski, D. J. A1 - Bernatz, S. A1 - Tichy, J. A1 - Ronellenfitsch, M. W. A1 - Thorsen, F. A1 - Berger, A. A1 - Forster, M. T. A1 - Muller, A. A1 - Steinbach, J. P. A1 - Beschorner, R. A1 - Wischhusen, J. A1 - Kvasnicka, H. M. A1 - Plate, K. H. A1 - Stefanović, S. A1 - Weide, B. A1 - Mittelbronn, M. A1 - Harter, P. N. T1 - CD74 regulates complexity of tumor cell HLA class II peptidome in brain metastasis and is a positive prognostic marker for patient survival JF - Acta Neuropathologica Communications N2 - Abstract Despite multidisciplinary local and systemic therapeutic approaches, the prognosis for most patients with brain metastases is still dismal. The role of adaptive and innate anti-tumor response including the Human Leukocyte Antigen (HLA) machinery of antigen presentation is still unclear. We present data on the HLA class II-chaperone molecule CD74 in brain metastases and its impact on the HLA peptidome complexity. We analyzed CD74 and HLA class II expression on tumor cells in a subset of 236 human brain metastases, primary tumors and peripheral metastases of different entities in association with clinical data including overall survival. Additionally, we assessed whole DNA methylome profiles including CD74 promoter methylation and differential methylation in 21 brain metastases. We analyzed the effects of a siRNA mediated CD74 knockdown on HLA-expression and HLA peptidome composition in a brain metastatic melanoma cell line. We observed that CD74 expression on tumor cells is a strong positive prognostic marker in brain metastasis patients and positively associated with tumor-infiltrating T-lymphocytes (TILs). Whole DNA methylome analysis suggested that CD74 tumor cell expression might be regulated epigenetically via CD74 promoter methylation. CD74\(^{high}\) and TIL\(^{high}\) tumors displayed a differential DNA methylation pattern with highest enrichment scores for antigen processing and presentation. Furthermore, CD74 knockdown in vitro lead to a reduction of HLA class II peptidome complexity, while HLA class I peptidome remained unaffected. In summary, our results demonstrate that a functional HLA class II processing machinery in brain metastatic tumor cells, reflected by a high expression of CD74 and a complex tumor cell HLA peptidome, seems to be crucial for better patient prognosis. KW - CD74 KW - HLA class II KW - brain metastasis KW - HLA peptidome KW - tumor infiltrating lymphocytes Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-233882 VL - 6 ER - TY - THES A1 - Demirhan, Attila T1 - Korrelation zwischen blutrheologischen Parametern und Blutkörper-Indizes von Erythrozyten bei gesunden Frauen vor elektiven gynäkologischen Eingriffen T1 - Correlation between Blood Rheological Properties and Red Blood Cell Indices in Healty Women befor gynecological elective interventions N2 - Die vorliegende Arbeit quantifiziert die Korrelationen zwischen blutrheologischen Parametern und Erythrozyten-Indizes an einem repräsentativen und gut definierten Kollektiv gesunder Frauen im Vorfeld eines elektiven gynäkologischen Eingriffes. Gemäß der erhobenen Resultate besteht bei 286 gesunden Frauen mittleren Alters zwischen der Verformbarkeit, dem MCV und dem MCH der Erythrozyten eine statistisch signifikante Korrelation, die in Gegenwart hoher Scherkräfte an Ausprägung zunimmt. Gleichzeitig vermindert sich mit zunehmender MCHC die Erythrozytenverformbarkeit stetig und statistisch signifikant, wobei dieser Effekt am deutlichsten in Gegenwart hoher Scherkräfte, wie diese beispielsweise in den Kapillaren der Endstrombahn anzunehmen sind, nachweisbar ist. N2 - The physiological association between blood rheological parameters and red blood cell indices was investigated in otherwise healthy unselected women prior to elective gynaecological surgery. In a total of 286 healthy women was the RBCdeformability statically significantly positive correlated with MCV and MCH but statically significantly inversely correlated with MCHC. The correlation between RBC Indices and RBC deformability was most remarkable during moderate shear force exposure. KW - Red cell deformability KW - Verformbarkeit KW - Erythrozyten Verformbarkeit bei gesunden Frauen KW - Erythrocyte deformability in Healthy Women Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-155633 ER - TY - THES A1 - Duch, Tabea T1 - Die Bedeutung von Gonadotropin-Releasing-Hormon-Agonisten in der Fertilitätsprotektion von Frauen während einer zytotoxischen Therapie: eine prospektive Kohortenstudie T1 - Gonadotropin-releasing-hormone agonists in the protection of fertility of women undergoing cytotoxic therapy: a prospective cohort study N2 - Eine Chemotherapie-induzierte Infertilität bedingt bei vielen betroffenen Patientinnen eine verminderte Lebensqualität sowie eine erhebliche psychische Belastung. Daher ist die Forschung an verschiedenen Maßnahmen der Fertilitätsprotektion von Patientinnen im reproduktionsfähigen Alter, die eine zytotoxische Therapie benötigen, von großer Bedeutung. Bislang gibt es keine ideale Methode der Ovarprotektion während einer gonadotoxischen Therapie. Nicht-medikamentöse Maßnahmen zum Fertilitätserhalt haben den Nachteil der Invasivität und des hierzu häufig notwendigen Zeitfensters von mindestens zwei Wochen. Außerdem bleiben die Kryokonservierung von Ovargewebe, die In-vitro-Maturation und die Kryokonservierung von unreifen Oozyten bislang aufgrund der geringen Erfahrung nur experimentell. Bezüglich der Wirksamkeit einer medikamentösen Fertilitätsprotektion mittels GnRH-Agonisten bleibt die Evidenz kontrovers. Anhand der hier vorgestellten prospektiven Kohortenstudie mit 116 prämenopausalen Chemotherapie-Patientinnen im Alter von 13‑40 Jahren sollte die Wirksamkeit einer Fertilitätsprotektion mittels GnRH-a überprüft werden. Bei der Beurteilung der ovariellen Reserve lag der Fokus auf der Bestimmung des Anti-Müller-Hormons, welches nach aktueller Evidenz die ovarielle Reserve am genausten wiederspiegelt, jedoch bisher nur in wenigen Studien zu dieser Thematik untersucht wurde. In unserem Patientenkollektiv waren die erhobenen Fertilitätsparameter (Zyklus und serologische Marker: AMH, FSH, E2) nach der Chemotherapie im Vergleich zu vorher größtenteils signifikant verändert, entsprechend einer verminderten ovariellen Reserve. Die Anti-Müller-Hormon-Serumspiegel waren im Gesamtkollektiv nach der Chemotherapie signifikant gesunken (p < 0,001) und die FSH-Serumspiegel waren signifikant angestiegen (p = 0,023). Ferner hatten nach der Chemotherapie nur noch 61,3 % der Patientinnen einen regelmäßigen Zyklus, im Gegensatz zu 100 % vor der Chemotherapie. Aus diesen Ergebnissen lässt sich ableiten, dass in unserem Patientenkollektiv trotz der GnRH-a-Therapie die Entwicklung einer Chemotherapie-induzierten ovariellen Insuffizienz nicht verhindert werden konnte. Besondere Berücksichtigung bei der Auswertung der Ergebnisse fanden der Einfluss des Alters und des Body-Mass-Index sowie die Verwendung einer hormonellen Konzeption auf die Fertilitätsparameter. Aufgrund der hohen Zahl an Drop-outs (n = 81) sind die Ergebnisse dieser Studie jedoch nur eingeschränkt generalisierbar. Auch wäre der Vergleich mit einer Kontrollgruppe von größerer Aussagekraft gewesen. Eine mögliche Erklärung für die weiterhin kontroverse Datenlage bezüglich der Wirksamkeit von GnRH-Agonisten in der Fertilitätsprotektion ist die schlechte Vergleichbarkeit der bisher durchgeführten Studien. Dies liegt unter anderem an den heterogenen Patientengruppen (Erkrankungsart, Therapieart und -dosis, Altersunterschied), den unterschiedlichen Definitionen ovarieller Insuffizienz, den teilweise sehr kurzen Follow-up-Zeiträumen sowie daran, dass der Großteil der Studien bislang nicht Placebo-kontrolliert durchgeführt wurde. Insgesamt besteht daher der Bedarf an weiteren randomisiert-kontrollierten Studien mit großen Patientenkollektiven und genauen Methoden der Beurteilung der ovariellen Reserve, idealerweise mittels AMH-Wert-Bestimmung kombiniert mit der sonographischen Ermittlung der Anzahl antraler Follikel (AFC). In der klinischen Praxis wird die Anwendung von GnRH-Agonisten in der Fertilitätsprotektion aufgrund der unklaren Datenlage nur in Kombination mit anderen Maßnahmen empfohlen. N2 - Due to improving overall survival in cancer patients long-term side effects of chemotherapy are becoming more important. Gonadotoxicity is a severe side-effect of many cytotoxic therapies. We designed a prospective cohort study to test whether GnRH-a have a protective effect on fertility in women during chemotherapy. To evaluate fertility we used anti-mullerian-hormone (AMH) levels. Furthermore we investigated on possible factors influencing hormone levels (BMI, hormonal contraceptives). In our cohort study (n=116) there was no protective effect of GnRH-a on fertility in women undergoing cytotoxic therapy. There was also no effect of contraceptives or BMI on AMH-levels. However, we had a very large drop out rate (68,8%) To evaluate the protective effect of GnRH on the ovaries and possible influencing factors on AMH, more large RCT’s with long-term follow up are needed. KW - Fertilitätsprotektion KW - Fertilität KW - Chemotherapie KW - Gonadotropin-Releasinghormon-Analoga KW - GnRH-Agonisten Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-150786 ER - TY - JOUR A1 - Harter, Philipp A1 - Hauke, Jan A1 - Heitz, Florian A1 - Reuss, Alexander A1 - Kommoss, Stefan A1 - Marmé, Frederik A1 - Heimbach, André A1 - Prieske, Katharina A1 - Richters, Lisa A1 - Burges, Alexander A1 - Neidhardt, Guido A1 - de Gregorio, Nikolaus A1 - El-Balat, Ahmed A1 - Hilpert, Felix A1 - Meier, Werner A1 - Kimmig, Rainer A1 - Kast, Karin A1 - Sehouli, Jalid A1 - Baumann, Klaus A1 - Jackisch, Christian A1 - Park-Simon, Tjoung-Won A1 - Hanker, Lars A1 - Kröber, Sandra A1 - Pfisterer, Jacobus A1 - Gevensleben, Heidrun A1 - Schnelzer, Andreas A1 - Dietrich, Dimo A1 - Neunhöffer, Tanja A1 - Krockenberger, Mathias A1 - Brucker, Sara Y. A1 - Nürnberg, Peter A1 - Thiele, Holger A1 - Altmüller, Janine A1 - Lamla, Josefin A1 - Elser, Gabriele A1 - du Bois, Andreas A1 - Hahnen, Eric A1 - Schmutzler, Rita T1 - Prevalence of deleterious germline variants in risk genes including \(BRCA1/2\) in consecutive ovarian cancer patients (AGO-TR-1) JF - PLoS ONE N2 - Background Identification of families at risk for ovarian cancer offers the opportunity to consider prophylactic surgery thus reducing ovarian cancer mortality. So far, identification of potentially affected families in Germany was solely performed via family history and numbers of affected family members with breast or ovarian cancer. However, neither the prevalence of deleterious variants in \(BRCA1/2\) in ovarian cancer in Germany nor the reliability of family history as trigger for genetic counselling has ever been evaluated. Methods Prospective counseling and germline testing of consecutive patients with primary diagnosis or with platinum-sensitive relapse of an invasive epithelial ovarian cancer. Testing included 25 candidate and established risk genes. Among these 25 genes, 16 genes (\(ATM\), \(BRCA1\), \(BRCA2\), \(CDH1\), \(CHEK2\), \(MLH1\), \(MSH2\), \(MSH6\), \(NBN\), \(PMS2\), \(PTEN\), \(PALB2\), \(RAD51C\), \(RAD51D\), \(STK11\), \(TP53\)) were defined as established cancer risk genes. A positive family history was defined as at least one relative with breast cancer or ovarian cancer or breast cancer in personal history. Results In total, we analyzed 523 patients: 281 patients with primary diagnosis of ovarian cancer and 242 patients with relapsed disease. Median age at primary diagnosis was 58 years (range 16–93) and 406 patients (77.6%) had a high-grade serous ovarian cancer. In total, 27.9% of the patients showed at least one deleterious variant in all 25 investigated genes and 26.4% in the defined 16 risk genes. Deleterious variants were most prevalent in the \(BRCA1\) (15.5%), \(BRCA2\) (5.5%), \(RAD51C\) (2.5%) and \(PALB2\) (1.1%) genes. The prevalence of deleterious variants did not differ significantly between patients at primary diagnosis and relapse. The prevalence of deleterious variants in \(BRCA1/2\) (and in all 16 risk genes) in patients <60 years was 30.2% (33.2%) versus 10.6% (18.9%) in patients \(\geq\)60 years. Family history was positive in 43% of all patients. Patients with a positive family history had a prevalence of deleterious variants of 31.6% (36.0%) versus 11.4% (17.6%) and histologic subtype of high grade serous ovarian cancer versus other showed a prevalence of deleterious variants of 23.2% (29.1%) and 10.2% (14.8%), respectively. Testing only for \(BRCA1/2\) would miss in our series more than 5% of the patients with a deleterious variant in established risk genes. Conclusions 26.4% of all patients harbor at least one deleterious variant in established risk genes. The threshold of 10% mutation rate which is accepted for reimbursement by health care providers in Germany was observed in all subgroups analyzed and neither age at primary diagnosis nor histo-type or family history sufficiently enough could identify a subgroup not eligible for genetic counselling and testing. Genetic testing should therefore be offered to every patient with invasive epithelial ovarian cancer and limiting testing to \(BRCA1/2\) seems to be not sufficient. KW - medicine KW - Genetic causes of cancer KW - ovarian cancer KW - cancer risk factors KW - histology KW - cancer detection and diagnosis KW - breast cancer KW - genetic testing KW - human genetics Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-173553 VL - 12 IS - 10 ER - TY - JOUR A1 - Abu-Halima, Masood A1 - Häusler, Sebastian A1 - Backes, Christina A1 - Fehlmann, Tobias A1 - Staib, Claudia A1 - Nestel, Sigrun A1 - Nazarenko, Irina A1 - Meese, Eckart A1 - Keller, Andreas T1 - Micro-ribonucleic acids and extracellular vesicles repertoire in the spent culture media is altered in women undergoing \(In\) \(Vitro\) Fertilization JF - Scientific Reports N2 - MicroRNAs (miRNAs) are class of small RNA molecules with major impact on gene regulation. We analyzed the potential of miRNAs secreted from pre-implantation embryos into the embryonic culture media as biomarkers to predict successful pregnancy. Using microarray analysis, we profiled the miRNome of the 56 spent culture media (SCM) after embryos transfer and found a total of 621 miRNAs in the SCM. On average, we detected 163 miRNAs in SCM of samples with failed pregnancies, but only 149 SCM miRNAs of embryos leading to pregnancies. MiR-634 predicted an embryo transfer leading to a positive pregnancy with an accuracy of 71% and a sensitivity of 85%. Among the 621 miRNAs, 102 (16.4%) showed a differential expression between positive and negative outcome of pregnancy with miR-29c-3p as the most significantly differentially expressed miRNA. The number of extracellular vehicles was lower in SCM with positive outcomes (3.8 × 10\(^9\)/mL EVs), as compared to a negative outcome (7.35 × 10\(^9\)/mL EVs) possibly explaining the reduced number of miRNAs in the SCM associated with failed pregnancies. The analysis of the miRNome in the SCM of couples undergoing fertility treatment lays the ground towards development of biomarkers to predict successful pregnancy and towards understanding the role of embryonic miRNAs found in the SCM. KW - Medicine KW - miRNAs KW - Molecular biology KW - Non-coding RNAs Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-173632 VL - 7 ER - TY - THES A1 - Künzel, Elena Carolin T1 - Zeitliche Untersuchung von Adipositas-Prävalenz und assoziierten Risikofaktoren während der Schwangerschaft T1 - Prevalence and Associated Risk Factors for Obesity During Pregnancy Over Time N2 - Einleitung: Die steigende Prävalenz adipöser Menschen führt weltweit zu einer relevanten Morbidität, die auch junge Frauen im geschlechtsreifen Alter betrifft. Damit gerät der Themenkomplex Adipositas und assoziierte Komplikationen auch im Hinblick auf die Versorgung Schwangerer in den Fokus. Das Ziel dieser Arbeit war es deshalb, die Adipositasprävalenz und hiermit assoziierte maternale und fetale Risikofaktoren zwischen 2006 und 2011 in einem lokalen Kollektiv zu untersuchen. Material und Methoden: Die retrospektive Analyse umfasste alle maternalen und fetalen Daten von Patientinnen, die 2006 und 2011 an der Universitätsfrauenklinik Würzburg von einem Einling entbunden wurden. Die deskriptive Statistik umfasste die Prävalenz von Adipositas und Gewichtszunahme, maternale Risikofaktoren, Schwangerschaftskomplikationen und fetales Outcome. Ergebnisse: Unsere Analyse umfasste 2838 Patientinnen mit Einlingsgraviditäten, die in den Jahren 2006 (n=1292) und 2011 (n=1545) an der Uniklinik Würzburg entbunden haben. Es zeigte sich, dass weder der initiale BMI noch die Gewichtszunahme während der Schwangerschaft zwischen 2006 und 2011 signifikant anstiegen. Die Mehrheit der übergewichtigen (71%) oder adipösen (60,4%) Patientinnen überstieg die empfohlene Gewichtszunahme. Die Prävalenz von adipositasassoziierten Erkrankungen wie Gestationsdiabetes und Präeklampsie stiegen signifikant an und waren mit einem hohen initialen BMI assoziiert. Während Übergewichtigkeit nicht mit einer Terminüberschreitung assoziiert war, wurden adipöse Patientinnen signifikant häufiger per Sectio caesarea entbunden. Das Geburtsgewicht war 2011 signifikant höher als 2006, wobei keine signifikanten Änderungen im fetalen Outcome dargestellt werden konnten. Schlussfolgerung: Es gibt einen Trend zu vermehrter Gewichtszunahme während der Schwangerschaft. Assoziierte Risikofaktoren wie Gestationsdiabetes und Präeklampsie sind erhöht. N2 - Objective: To compare prevalence and associated risk factors of obesity during pregnancy in 2006 and 2011 Study Design: Maternal and fetal records of women who delivered at the University of Wuerzburg after a 5-year-period (2006 and 2011) were retrospectively analyzed concerning the prevalence of obesity and associated maternal and fetal complications Results: Our analyses included 2838 mothers with singleton pregnancies who delivered in 2006 (n=1293) or 2011 (n=1545) in our department. We observed that neither pre-pregnancy BMI nor weight gain increased significantly over time. But especially the majority of all included overweight (71%) or obese (60.4%) mothers gained more weight than recommended by the Institute of Medicine (IOM). Obesity-associated illnesses such as gestational diabetes and pre-existing hypertension increased significantly over time and were shown to be associated with high pre-pregnancy BMI as well as preeclampsia and gestational hypertension. Obesity was not associated with prolonged pregnancy but was significantly associated with cesarean section. Fetal birth weight was significantly increased in 2011 when compared to 2006, while fetal outcome for term infants did not seem to be impaired by maternal overweight or obesity. Conclusion: There is a trend to increasing weight gain during pregnancy and a majority of mothers especially those with a high pre-pregnancy BMI exceed weight gain recommendations. Associated risk factors such as gestational diabetes, hypertension and delivery by cesarean section are increased. KW - Fettsucht KW - Gestationsdiabetes KW - Eklampsie KW - Gestationsdiabetes KW - IOM-Kriterien KW - Adipositas KW - Kaiserschnitt KW - Makrosomie KW - gestational diabetes KW - obesity KW - Weight Gain During Pregnancy KW - macrosomia KW - cesarean section Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-155544 ER - TY - JOUR A1 - Appelt-Menzel, Antje A1 - Cubukova, Alevtina A1 - Günther, Katharina A1 - Edenhofer, Frank A1 - Piontek, Jörg A1 - Krause, Gerd A1 - Stüber, Tanja A1 - Walles, Heike A1 - Neuhaus, Winfried A1 - Metzger, Marco T1 - Establishment of a Human Blood-Brain Barrier Co-culture Model Mimicking the Neurovascular Unit Using Induced Pluri- and Multipotent Stem Cells JF - Stem Cell Reports N2 - In vitro models of the human blood-brain barrier (BBB) are highly desirable for drug development. This study aims to analyze a set of ten different BBB culture models based on primary cells, human induced pluripotent stem cells (hiPSCs), and multipotent fetal neural stem cells (fNSCs). We systematically investigated the impact of astrocytes, pericytes, and NSCs on hiPSC-derived BBB endothelial cell function and gene expression. The quadruple culture models, based on these four cell types, achieved BBB characteristics including transendothelial electrical resistance (TEER) up to 2,500 Ω cm\(^{2}\) and distinct upregulation of typical BBB genes. A complex in vivo-like tight junction (TJ) network was detected by freeze-fracture and transmission electron microscopy. Treatment with claudin-specific TJ modulators caused TEER decrease, confirming the relevant role of claudin subtypes for paracellular tightness. Drug permeability tests with reference substances were performed and confirmed the suitability of the models for drug transport studies. KW - blood-brain barrier (BBB) model KW - human induced pluripotent stem cells (hiPSCs)human induced pluripotent stem cells (hiPSCs) KW - multipotent fetal neural stem cells (fNSCs) KW - neurovascular unit in vitro Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-170982 VL - 8 IS - 4 ER - TY - JOUR A1 - Bekes, Inga A1 - Friedl, Thomas W. P. A1 - Köhler, Tanja A1 - Möbus, Volker A1 - Janni, Wolfgang A1 - Wöckel, Achim A1 - Wulff, Christine T1 - Does VEGF facilitate local tumor growth and spread into the abdominal cavity by suppressing endothelial cell adhesion, thus increasing vascular peritoneal permeability followed by ascites production in ovarian cancer? JF - Molecular Cancer N2 - Background Ovarian cancer is mostly associated with pathologically regulated permeability of peritoneal vessels, leading to ascites. Here, we investigated the molecular regulation of endothelial permeability by the vascular endothelial growth factor (VEGF) and both tight and adherens junction proteins (VE-cadherin and claudin 5) with regards to the tumor biology of different ovarian cancer types. Methods Serum and ascites samples before and after surgery, as well as peritoneal biopsies of 68 ovarian cancer patients and 20 healthy controls were collected. In serum and ascites VEGF protein was measured by ELISA. In peritoneal biopsies co-localization of VE-cadherin and claudin 5 was investigated using immunohistochemical dual staining. In addition, the gene expression of VE-cadherin and claudin 5 was quantified by Real-time PCR. Differences in VEGF levels, VE-cadherin and claudin 5 gene expression were analyzed in relation to various tumor characteristics (tumor stage, grading, histological subtypes, resection status after surgery) and then compared to controls. Furthermore, human primary ovarian cancer cells were co-cultured with human umbilical vein endothelial cells (HUVEC) and changes in VE-cadherin and claudin 5 were investigated after VEGF inhibition. Results VEGF was significantly increased in tumor patients in comparison to controls and accumulates in ascites. The highest VEGF levels were found in patients diagnosed with advanced tumor stages, with tumors of poor differentiation, or in the group of solid / cystic-solid tumors. Patients with residual tumor after operation showed significantly higher levels of VEGF both before and after surgery as compared to tumor-free resected patients. Results of an immunohistochemical double-staining experiment indicated co-localization of VE-cadherin and claudin 5 in the peritoneal vasculature. Compared to controls, expression of VE-cadherin and claudin 5 was significantly suppressed in peritoneal vessels of tumor patients, but there were no significant differences regarding VE-cadherin and claudin 5 expression in relation to different tumor characteristics. A significant positive correlation was found between VE-cadherin and claudin 5 expression. VEGF inhibition in vitro was associated with significant increase in VE-cadherin and claudin 5. Conclusions Our results indicate that increased peritoneal permeability in ovarian cancer is due to down-regulation of adhesion proteins via tumor derived VEGF. Advanced ovarian cancer with aggressive tumor biology may be associated with early dysregulation of vascular permeability leading to ascites. These patients may benefit from therapeutic VEGF inhibition. KW - ovarian cancer KW - vascular permeability KW - ascites KW - VEGF KW - claudin 5 KW - VE-cadherin Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-169298 VL - 15 IS - 13 ER - TY - JOUR A1 - Joukhadar, R. A1 - Wöckel, A. A1 - Herr, D. A1 - Paulus, V. A1 - Radosa, J. A1 - Hamza, A. A1 - Solomayer, E. A1 - Baum, S. T1 - Challenges of Longevity: Safety of Vaginal and Laparoscopic Urogynecological Procedures in Septuagenarians and Older Patients JF - BioMed Research International N2 - Introduction. Pelvic organ prolapse (POP) and urinary incontinence (UI) have increasing prevalence in the elderly population. The aim of this study was to compare the comorbidities of these procedures between <70 y/o and ≥70 y/o patients. Materials and Methods. In our retrospective study over a period of 2.5 years, 407 patients had received an urogynecological procedure. All patients with POP were treated by reconstructive surgery. Complications were reported using the standardized classification of Clavien-Dindo (CD). The study can be assigned to stage 2b Exploration IDEAL (Idea, Development, Exploration, Assessment, Long-term study)-system of surgical innovation. Results. Operation time, blood loss, and intraoperative complications have not been more frequent in the elderly, whereas hospital stay was significantly longer in ≥70 y/o patients. Regarding postoperative complications, we noticed that ≥70 y/o patients had an almost threefold risk to develop mild early postoperative complications compared to younger patients (OR: 2.86; 95% CI: 1.76–4.66). On the contrary, major complications were not more frequent. No case of life-threatening complication or the need for blood transfusion was reported. Conclusion. After urogynecological procedures, septuagenarians and older patients are more likely to develop mild postoperative complications but not more intraoperative or severe postoperative complications compared to younger patients. KW - gynecologic surgical procedures/methods KW - postoperative complications/epidemiology KW - vagina/surgery KW - pelvic organ prolapse/surgery KW - middle Aged KW - laparoscopy/methods KW - uterine prolapse/surgery KW - urinary incontinence/surgery KW - surgical Mesh KW - retrospective Studies KW - age factors KW - aged KW - aged 80 and over KW - female KW - reconstructive surgical procedures/methods Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-161005 VL - 2016 IS - Article ID 5184595 ER - TY - JOUR A1 - Montalbán del Barrio, Itsaso A1 - Penski, Cornelia A1 - Schlahsa, Laura A1 - Stein, Roland G. A1 - Diessner, Joachim A1 - Wöckel, Achim A1 - Dietl, Johannes A1 - Lutz, Manfred B. A1 - Mittelbronn, Michel A1 - Wischhusen, Jörg A1 - Häusler, Sebastian F. M. T1 - Adenosine-generating ovarian cancer cells attract myeloid cells which differentiate into adenosine-generating tumor associated macrophages - a self-amplifying, CD39- and CD73-dependent mechanism for tumor immune escape JF - Journal for ImmunoTherapy of Cancer N2 - Background Ovarian cancer (OvCA) tissues show abundant expression of the ectonucleotidases CD39 and CD73 which generate immunomodulatory adenosine, thereby inhibiting cytotoxic lymphocytes. Little, however, is known about the effect of adenosine on myeloid cells. Considering that tumor associated macrophages (TAM) and myeloid-derived suppressor cells (MDSC) constitute up to 20 % of OvCA tissue, we investigated the effect of adenosine on myeloid cells and explored a possible contribution of myeloid cells to adenosine generation in vitro and ex vivo. Methods Monocytes were used as human blood-derived myeloid cells. After co-incubation with SK-OV-3 or OAW-42 OvCA cells, monocyte migration was determined in transwell assays. For conversion into M2-polarized “TAM-like” macrophages, monocytes were co-incubated with OAW-42 cells. Ex vivo TAMs were obtained from OvCA ascites. Macrophage phenotypes were investigated by intracellular staining for IL-10 and IL-12. CD39 and CD73 expression were assessed by FACS analysis both on in vitro-induced TAM-like macrophages and on ascites-derived ex situ-TAMs. Myeloid cells in solid tumor tissue were analyzed by immunohistochemistry. Generation of biologically active adenosine by TAM-like macrophages was measured in luciferase-based reporter assays. Functional effects of adenosine were investigated in proliferation-experiments with CD4+ T cells and specific inhibitors. Results When CD39 or CD73 activity on OvCA cells were blocked, the migration of monocytes towards OvCA cells was significantly decreased. In vivo, myeloid cells in solid ovarian cancer tissue were found to express CD39 whereas CD73 was mainly detected on stromal fibroblasts. Ex situ-TAMs and in vitro differentiated TAM-like cells, however, upregulated the expression of CD39 and CD73 compared to monocytes or M1 macrophages. Expression of ectonucleotidases also translated into increased levels of biologically active adenosine. Accordingly, co-incubation with these TAMs suppressed CD4+ T cell proliferation which could be rescued via blockade of CD39 or CD73. Conclusion Adenosine generated by OvCA cells likely contributes to the recruitment of TAMs which further amplify adenosine-dependent immunosuppression via additional ectonucleotidase activity. In solid ovarian cancer tissue, TAMs express CD39 while CD73 is found on stromal fibroblasts. Accordingly, small molecule inhibitors of CD39 or CD73 could improve immune responses in ovarian cancer. KW - ovarian cancer KW - adenosine KW - CD39 KW - tumor associated macrophages KW - immune escape KW - CD73 Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146624 VL - 4 IS - 49 ER - TY - JOUR A1 - Otto, Christoph A1 - Hahlbrock, Theresa A1 - Eich, Kilian A1 - Karaaslan, Ferdi A1 - Jürgens, Constantin A1 - Germer, Christoph-Thomas A1 - Wiegering, Armin A1 - Kämmerer, Ulrike T1 - Antiproliferative and antimetabolic effects behind the anticancer property of fermented wheat germ extract JF - BMC Complementary and Alternative Medicine N2 - Background Fermented wheat germ extract (FWGE) sold under the trade name Avemar exhibits anticancer activity in vitro and in vivo. Its mechanisms of action are divided into antiproliferative and antimetabolic effects. Its influcence on cancer cell metabolism needs further investigation. One objective of this study, therefore, was to further elucidate the antimetabolic action of FWGE. The anticancer compound 2,6-dimethoxy-1,4-benzoquinone (DMBQ) is the major bioactive compound in FWGE and is probably responsible for its anticancer activity. The second objective of this study was to compare the antiproliferative properties in vitro of FWGE and the DMBQ compound. Methods The IC\(_{50}\) values of FWGE were determined for nine human cancer cell lines after 24 h of culture. The DMBQ compound was used at a concentration of 24 μmol/l, which is equal to the molar concentration of DMBQ in FWGE. Cell viability, cell cycle, cellular redox state, glucose consumption, lactic acid production, cellular ATP levels, and the NADH/NAD\(^+\) ratio were measured. Results The mean IC\(_{50}\) value of FWGE for the nine human cancer cell lines tested was 10 mg/ml. Both FWGE (10 mg/ml) and the DMBQ compound (24 μmol/l) induced massive cell damage within 24 h after starting treatment, with changes in the cellular redox state secondary to formation of intracellular reactive oxygen species. Unlike the DMBQ compound, which was only cytotoxic, FWGE exhibited cytostatic and growth delay effects in addition to cytotoxicity. Both cytostatic and growth delay effects were linked to impaired glucose utilization which influenced the cell cycle, cellular ATP levels, and the NADH/NAD\(^+\) ratio. The growth delay effect in response to FWGE treatment led to induction of autophagy. Conclusions FWGE and the DMBQ compound both induced oxidative stress-promoted cytotoxicity. In addition, FWGE exhibited cytostatic and growth delay effects associated with impaired glucose utilization which led to autophagy, a possible previously unknown mechanism behind the influence of FWGE on cancer cell metabolism. KW - cytostatic KW - FWGE KW - benzoquinone KW - cancer cells KW - reactive oxygen species KW - autophagy KW - cytotoxicity Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146013 VL - 16 IS - 160 ER - TY - JOUR A1 - Schlagenhauf, Ulrich A1 - Jakob, Lena A1 - Eigenthaler, Martin A1 - Segerer, Sabine A1 - Jockel-Schneider, Yvonne A1 - Rehn, Monika T1 - Regular consumption of Lactobacillus reuteri-containing lozenges reduces pregnancy gingivitis: an RCT JF - Journal of Clinical Periodontology N2 - Aim: This randomized controlled trial assessed the impact of Lactobacillus reuteri on pregnancy gingivitis in healthy women. Materials and Methods: Forty-five healthy women (24 test/21 placebo) with pregnancy gingivitis in the third trimester of pregnancy were enrolled. At baseline Gingival Index (GI) and Plaque Index (PlI) were assessed at the Ramfjord teeth and venous blood taken for TNF-alpha analysis. Subsequently participants were randomly provided with lozenges to be consumed 2 9 daily until birth (approx. 7 weeks) containing >= 10(8) CFU L. reuteri ATCC PTA 5289 and >= 10(8) CFU L. reuteri DSM 17938 (test) or being devoid of L. reuteri (placebo). Within 2 days after birth recording of GI, PlI and blood sampling were repeated. Results: At baseline, mean GI and mean PlI did not differ significantly between both groups. In the test group mean TNF-alpha serum level was significantly (p < 0.02) lower than in the placebo group. At reevaluation, mean GI and mean PlI of the test group were both significantly (p < 0.0001) lower than in the placebo group. Mean TNF-alpha serum level did no longer differ significantly between the groups. Conclusions: The consumption of L. reuteri lozenges may be a useful adjunct in the control of pregnancy gingivitis. KW - chronic periodontitis KW - probiotic lozenges KW - subgingival KW - bacteria KW - postpartum KW - microbiota KW - disease KW - L. reuteri KW - plaque KW - pregnancy KW - pregnancy gingivitis Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-186783 VL - 43 IS - 11 ER - TY - JOUR A1 - Stein, Roland Gregor A1 - Wollschläger, Daniel A1 - Kreienberg, Rolf A1 - Janni, Wolfgang A1 - Wischnewsky, Manfred A1 - Diessner, Joachim A1 - Stüber, Tanja A1 - Bartmann, Catharina A1 - Krockenberger, Mathias A1 - Wischhusen, Jörg A1 - Wöckel, Achim A1 - Blettner, Maria A1 - Schwentner, Lukas T1 - The impact of breast cancer biological subtyping on tumor size assessment by ultrasound and mammography - a retrospective multicenter cohort study of 6543 primary breast cancer patients JF - BMC Cancer N2 - Background Mammography and ultrasound are the gold standard imaging techniques for preoperative assessment and for monitoring the efficacy of neoadjuvant chemotherapy in breast cancer. Maximum accuracy in predicting pathological tumor size non-invasively is critical for individualized therapy and surgical planning. We therefore aimed to assess the accuracy of tumor size measurement by ultrasound and mammography in a multicentered health services research study. Methods We retrospectively analyzed data from 6543 patients with unifocal, unilateral primary breast cancer. The maximum tumor diameter was measured by ultrasound and/or mammographic imaging. All measurements were compared to final tumor diameter determined by postoperative histopathological examination. We compared the precision of each imaging method across different patient subgroups as well as the method-specific accuracy in each patient subgroup. Results Overall, the correlation with histology was 0.61 for mammography and 0.60 for ultrasound. Both correlations were higher in pT2 cancers than in pT1 and pT3. Ultrasound as well as mammography revealed a significantly higher correlation with histology in invasive ductal compared to lobular cancers (p < 0.01). For invasive lobular cancers, the mammography showed better correlation with histology than ultrasound (p = 0.01), whereas there was no such advantage for invasive ductal cancers. Ultrasound was significantly superior for HR negative cancers (p < 0.001). HER2/neu positive cancers were also more precisely assessed by ultrasound (p < 0.001). The size of HER2/neu negative cancers could be more accurately predicted by mammography (p < 0.001). Conclusion This multicentered health services research approach demonstrates that predicting tumor size by mammography and ultrasound provides accurate results. Biological tumor features do, however, affect the diagnostic precision. KW - histopathology KW - breast cancer KW - ultrasound KW - mammography KW - tumor size Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-161050 VL - 16 IS - 549 ER - TY - JOUR A1 - Diessner, Joachim A1 - Wischnewsky, Manfred A1 - Blettner, Maria A1 - Häusler, Sebastian A1 - Janni, Wolfgang A1 - Kreienberg, Rolf A1 - Stein, Roland A1 - Stüber, Tanja A1 - Schwentner, Lukas A1 - Bartmann, Catharina A1 - Wöckel, Achim T1 - Do Patients with Luminal A Breast Cancer Profit from Adjuvant Systemic Therapy? A Retrospective Multicenter Study JF - PLoS ONE N2 - Background Luminal A breast cancers respond well to anti-hormonal therapy (HT), are associated with a generally favorable prognosis and constitute the majority of breast cancer subtypes. HT is the mainstay of treatment of these patients, accompanied by an acceptable profile of side effects, whereas the added benefit of chemotherapy (CHT), including anthracycline and taxane-based programs, is less clear-cut and has undergone a process of critical revision. Methods In the framework of the BRENDA collective, we analyzed the benefits of CHT compared to HT in 4570 luminal A patients (pts) with primary diagnosis between 2001 and 2008. The results were adjusted by nodal status, age, tumor size and grading. Results There has been a progressive reduction in the use of CHT in luminal A patients during the last decade. Neither univariate nor multivariate analyses showed any statistically significant differences in relapse free survival (RFS) with the addition of CHT to adjuvant HT, independent of the nodal status, age, tumor size or grading. Even for patients with more than 3 affected lymph nodes, there was no significant difference (univariate: p = 0.865; HR 0.94; 95% CI: 0.46–1.93; multivariate: p = 0.812; HR 0.92; 95% CI: 0.45–1.88). Conclusions The addition of CHT to HT provides minimal or no clinical benefit at all to patients with luminal A breast cancer, independent of the RFS-risk. Consequently, risk estimation cannot be the initial step in the decisional process. These findings–that are in line with several publications–should encourage the critical evaluation of applying adjuvant CHT to patients with luminal A breast cancer. KW - breast cancer KW - hormones KW - endocrine therapy KW - cancer detection and diagnosis KW - cancer treatment KW - cancer chemotherapy KW - lymph nodes KW - hormona therapy Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-178217 VL - 11 IS - 12 ER - TY - JOUR A1 - Klement, Rainer J. A1 - Champ, Colin E. A1 - Otto, Christoph A1 - Kämmerer, Ulrike T1 - Anti-Tumor Effects of Ketogenic Diets in Mice: A Meta-Analysis JF - PLoS ONE N2 - Background Currently ketogenic diets (KDs) are hyped as an anti-tumor intervention aimed at exploiting the metabolic abnormalities of cancer cells. However, while data in humans is sparse, translation of murine tumor models to the clinic is further hampered by small sample sizes, heterogeneous settings and mixed results concerning tumor growth retardation. The aim was therefore to synthesize the evidence for a growth inhibiting effect of KDs when used as a monotherapy in mice. Methods We conducted a Bayesian random effects meta-analysis on all studies assessing the survival (defined as the time to reach a pre-defined endpoint such as tumor volume) of mice on an unrestricted KD compared to a high carbohydrate standard diet (SD). For 12 studies meeting the inclusion criteria either a mean survival time ratio (MR) or hazard ratio (HR) between the KD and SD groups could be obtained. The posterior estimates for the MR and HR averaged over four priors on the between-study heterogeneity τ\(^{2}\) were MR = 0.85 (95% highest posterior density interval (HPDI) = [0.73, 0.97]) and HR = 0.55 (95% HPDI = [0.26, 0.87]), indicating a significant overall benefit of the KD in terms of prolonged mean survival times and reduced hazard rate. All studies that used a brain tumor model also chose a late starting point for the KD (at least one day after tumor initiation) which accounted for 26% of the heterogeneity. In this subgroup the KD was less effective (MR = 0.89, 95% HPDI = [0.76, 1.04]). Conclusions There was an overall tumor growth delaying effect of unrestricted KDs in mice. Future experiments should aim at differentiating the effects of KD timing versus tumor location, since external evidence is currently consistent with an influence of both of these factors. KW - anti-tumor effects KW - ketogenic dients KW - mice Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-167036 VL - 11 IS - 5 ER - TY - JOUR A1 - Diessner, Joachim A1 - Wischnewsky, Manfred A1 - Stüber, Tanja A1 - Stein, Roland A1 - Krockenberger, Mathias A1 - Häusler, Sebastian A1 - Janni, Wolfgang A1 - Kreienberg, Rolf A1 - Blettner, Maria A1 - Schwentner, Lukas A1 - Wöckel, Achim A1 - Bartmann, Catharina T1 - Evaluation of clinical parameters influencing the development of bone metastasis in breast cancer JF - BMC Cancer N2 - Background The development of metastases is a negative prognostic parameter for the clinical outcome of breast cancer. Bone constitutes the first site of distant metastases for many affected women. The purpose of this retrospective multicentre study was to evaluate if and how different variables such as primary tumour stage, biological and histological subtype, age at primary diagnosis, tumour size, the number of affected lymph nodes as well as grading influence the development of bone-only metastases. Methods This retrospective German multicentre study is based on the BRENDA collective and included 9625 patients with primary breast cancer recruited from 1992 to 2008. In this analysis, we investigated a subgroup of 226 patients with bone-only metastases. Association between bone-only relapse and clinico-pathological risk factors was assessed in multivariate models using the tree-building algorithms “exhausted CHAID (Chi-square Automatic Interaction Detectors)” and CART(Classification and Regression Tree), as well as radial basis function networks (RBF-net), feedforward multilayer perceptron networks (MLP) and logistic regression. Results Multivariate analysis demonstrated that breast cancer subtypes have the strongest influence on the development of bone-only metastases (χ2 = 28). 29.9 % of patients with luminal A or luminal B (ABC-patients) and 11.4 % with triple negative BC (TNBC) or HER2-overexpressing tumours had bone-only metastases (p < 0.001). Five different mathematical models confirmed this correlation. The second important risk factor is the age at primary diagnosis. Moreover, BC subcategories influence the overall survival from date of metastatic disease of patients with bone-only metastases. Patients with bone-only metastases and TNBC (p < 0.001; HR = 7.47 (95 % CI: 3.52–15.87) or HER2 overexpressing BC (p = 0.007; HR = 3.04 (95 % CI: 1.36–6.80) have the worst outcome compared to patients with luminal A or luminal B tumours and bone-only metastases. Conclusion The bottom line of different mathematical models is the prior importance of subcategories of breast cancer and the age at primary diagnosis for the appearance of osseous metastases. The primary tumour stage, histological subtype, tumour size, the number of affected lymph nodes, grading and NPI seem to have only a minor influence on the development of bone-only metastases. KW - BRENDA KW - breast cancer KW - bone metastases KW - skeleton KW - breast cancer subtypes Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-161173 VL - 16 IS - 307 ER - TY - JOUR A1 - Kumar, Praveen A1 - Naumann, Ulrike A1 - Aigner, Ludwig A1 - Wischhusen, Joerg A1 - Beier, Christoph P A1 - Beier, Dagmar T1 - Impaired TGF-β induced growth inhibition contributes to the increased proliferation rate of neural stem cells harboring mutant p53 JF - American Journal of Cancer Research N2 - Gliomas have been classified according to their histological properties. However, their respective cells of origin are still unknown. Neural progenitor cells (NPC) from the subventricular zone (SVZ) can initiate tumors in murine models of glioma and are likely cells of origin in the human disease. In both, p53 signaling is often functionally impaired which may contribute to tumor formation. Also, TGF-beta, which under physiological conditions exerts a strong control on the proliferation of NPCs in the SVZ, is a potent mitogen on glioma cells. Here, we approach on the crosstalk between p53 and TGF-beta by loss of function experiments using NPCs derived from p53 mutant mice, as well as pharmacological inhibition of TGF-beta signaling using TGF-beta receptor inhibitors. NPC derived from p53 mutant mice showed increased clonogenicity and more rapid proliferation than their wildtype counterparts. Further, NPC derived from p53\(^{mut/mut}\) mice were insensitive to TGF-beta induced growth arrest. Still, the canonical TGF-beta signaling pathway remained functional in the absence of p53 signaling and expression of key proteins as well as phosphorylation and nuclear translocation of SMAD2 were unaltered. TGF-beta-induced p21 expression could, in contrast, only be detected in p53\(^{wt/wt}\) but not in p53\(^{mut/mut}\) NPC. Conversely, inhibition of TGF-beta signaling using SB431542 increased proliferation of p53\(^{wt/wt}\) but not of p53\(^{mut/mut}\) NPC. In conclusion, our data suggest that the TGF-beta induced growth arrest in NPC depends on functional p53. Mutational inactivation of p53 hence contributes to increased proliferation of NPC and likely to the formation of hyperplasia of the SVZ observed in p53 deficient mice in vivo. KW - mouse brain KW - tumors KW - cancer KW - TGF-beta KW - glioblastoma stem cell KW - pathways KW - expression KW - astrocytoma KW - glioblastoma KW - transforming growth factor-beta-1 KW - neurogenesis KW - gliomas KW - neural stem cell KW - p53 KW - subventricular zone KW - premalignant lesion Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-144262 VL - 5 IS - 11 ER - TY - THES A1 - Bruttel, Valentin Stefan T1 - Soluble HLA-G binds to dendritic cells which likely suppresses anti-tumour immune responses in regional lymph nodes in ovarian carcinoma T1 - Lösliches HLA-G wird von dendritischen Zellen gebunden, was beim Ovarialkarzinom zur Hemmung von Immunraktionen in regionalen Lymphknoten führen kann N2 - Zusammenfassung Einleitung HLA-G, ein nicht-klassisches HLA bzw. MHC Klasse Ib Molekül, kann sowohl als membrangebundenes als auch als lösliches Molekül verschiedenste Immunzellpopulationen effektiv inhibieren. Unter physiologischen Bedingungen wird HLA-G vor allem in der Plazenta exprimiert, wo es dazu beiträgt den semiallogenen Embryo vor einer Abstoßung durch das mütterliche Immunsystem zu beschützen. Außerdem wird HLA-G in einer Vielzahl von Tumoren wie zum Beispiel in Ovarialkarzinomen überexprimiert. Ziel dieser Arbeit war es besonders die Rolle von löslichem HLA-G im Ovarialkarzinom und die Expression von HLA-G in verschiedenen Subtypen des Ovarialkarzinoms genauer zu untersuchen. Ergebnisse Anhand eines Tissue Microarrays wurde bestätigt dass HLA-G unter physiologischen Bedingungen nur in sehr wenigen Geweben wie Plazenta oder Testes exprimiert wird. Außerdem wurden erstmals auch im Nebennierenmark hohe Expressionslevel detektiert. Im Gegensatz zur physiologischen Expression wurde HLA-G in serösen, muzinösen, endometrioiden und Klarzellkarzinomen und somit in Tumoren aller untersuchten Subtypen des Ovarialkarzinoms detektiert. Am häufigsten war HLA-G in hochgradigen serösen Karzinomen überexprimiert. Hier konnte gezeigt werden dass auf Genexpressionslevel in Ovarialkarzinomen die Expression des immunsuppressiven HLA-G mit der Expression von klassischen MHC Molekülen wie HLA-A, -B oder -C hochsignifikant korreliert. Außerdem konnte in Aszitesproben von Patientinnen mit Ovarialkarzinomen hohe Konzentrationen von löslichem HLA-G nachgewiesen werden. Auch auf metastasierten Tumorzellen in regionalen Lymphknoten war HLA-G nachweisbar. Überraschenderweise wurde aber besonders viel HLA-G auf Dendritischen Zellen in Lymphknoten detektiert. Da in Monozyten und Dendritischen Zellen von gesunden Spendern durch IL-4 oder IL-10 im Gegensatz zu Literatur keine Expression von HLA-G induzierbar war, untersuchten wir ob Dendritische Zellen lösliches HLA-G binden. Es konnte gezeigt werden, dass besonders Dendritische Zellen die in Gegenwart von IL-4, IL-10 und GM-CSF aus Monozyten generiert wurden (DC-10) effektiv lösliches HLA-G über ILT Rezeptoren binden. In Abhängigkeit von ihrer Beladung mit HLA-G hemmen auch fixierte DC-10 Zellen noch die Proliferation von zytotoxischen CD8+ T Zellen. Zudem wurden regulatorische T Zellen induziert. Schlussfolgerungen Besonders in den am häufigsten diagnostizierten hochgradigen serösen Ovarialkarzinomen ist HLA-G in den meisten Fällen überexprimiert. Durch die Expression immunsuppressiver MHC Klasse Ib Moleküle wie HLA-G können wahrscheinlich auch Tumore wachsen, die noch klassische MHC Moleküle exprimieren und aufgrund ihrer Mutationslast eigentlich vom Immunsystem erkannt und eliminiert werden müssten. Lösliches HLA-G könnte zudem lokal Immunantworten gegen Tumorantigene unterdrücken indem es an Dendritische Zellen in regionalen Lymphknoten bindet. Diese Zellen präsentieren nomalerweise zytotoxischen T Zellen Tumorantigene und spielen daher eine entscheidende Rolle in der Entstehung von protektiven Immunantworten. Mit löslichem HLA-G beladene Dendritische Zellen hemmen jedoch die Proliferation von CD8+ T Zellen und induzieren regulatorische T Zellen. Dadurch könnten Ovarialkarzinome “aus der Ferne” auch in metastasenfreien Lymphknoten die Entstehung von gegen den Tumor gerichteten Immunantworten unterdrücken. Dieser erstmals beschriebene Mechanismus könnte auch in anderen malignen Erkrankungen eine Rolle spielen, da lösliches HLA-G in einer Vielzahl von Tumorindikationen nachgewiesen wurde. N2 - Abstract Background HLA-G is a non-classical MHC class I molecule which exerts strong immunosuppressive effects on various immune cells. Several membrane-bound and soluble isoforms are known. Physiologically, HLA-G is predominantly expressed in the placenta, where it contributes to protecting the semi-allogeneic embryo from rejection by the maternal immune system. However, HLA-G is also often upregulated during tumourigenesis, such as in ovarian cancer. The aim of this thesis is to investigate how soluble HLA-G may contribute to local immunosuppression in ovarian carcinomas, and to characterize HLA-G expression in different ovarian carcinoma subtypes and metastases. Results As reported by others, physiological HLA-G expression is restricted to few tissues, such as placenta and testes. Here, HLA-G was also detected in the medulla of the adrenal gland. In contrast, HLA-G expression was frequently detected in tumours of all assessed subtypes of ovarian carcinomas (serous, mucinous, endometrioid and clear cell). Highest expression levels were detected in high-grade serous carcinomas. In primary tumours, expression of HLA-G correlated with expression of classical MHC class I molecules HLA-A, -B and -C. Surprisingly, high levels of HLA-G were also detected on dendritic cells in local lymph nodes. As no expression of HLA-G was inducible in monocytes or dendritic cells from healthy donors in response to IL-10 or IL-4, we speculated that tumour-derived soluble HLA-G might be transferred to dendritic cells via the lymphatic system. Accordingly, high levels of tumour-derived soluble HLA-G were detected in ovarian cancer ascites samples. In vitro, dendritic cells expanded in the presence of IL-4, IL-10 and GM-CSF (DC-10) were particularly prone to binding high amounts of soluble HLA-G via ILT receptors. Furthermore, HLA-G loaded DC-10 cells inhibited the proliferation of CD8 effector cells and induced regulatory T cells, even when the DC-10 cells had been fixed with paraformaldehyde. Conclusion The immunosuppressive molecule HLA-G is overexpressed in high-grade serous ovarian carcinomas, which account for the majority of ovarian cancers. In particular tumours with a high mutational burden and intact expression of classical, immunogenic MHC class Ia molecules may use HLA-G to escape from immunosurveillance. Additionally, tumour-derived soluble HLA-G may inhibit adaptive immune responses by binding to dendritic cells in local lymph nodes. Dendritic cells usually play a decisive role in the initiation of adaptive anti-tumour immune responses by presenting tumour antigens to cytotoxic T cells. In contrast, dendritic cells loaded with soluble HLA-G inhibit the proliferation of effector T cells and promote the induction of regulatory T cells. Thus, soluble HLA-G that is transferred to dendritic cells via lymphatic vessels may enable ovarian carcinomas to remotely suppress anti-tumour immune responses in local lymph nodes. This novel immune-escape mechanism may also exist in other solid tumours that express HLA-G. KW - HLA-G KW - HLA-G KW - Dendritische Zelle KW - Eierstocktumor KW - ovarian cancer KW - ovarian carcinoma KW - transfer KW - dendritic cells KW - immune escape Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-127252 ER - TY - JOUR A1 - Kämmerer, Ulrike A1 - Gires, Olivier A1 - Pfetzer, Nadja A1 - Wiegering, Armin A1 - Klement, Rainer Johannes A1 - Otto, Christoph T1 - TKTL1 expression in human malign and benign cell lines JF - BMC Cancer N2 - Background Overexpression of transketolase-like 1 protein TKTL1 in cancer cells has been reported to correlate with enhanced glycolysis and lactic acid production. Furthermore, enhanced TKTL1 expression was put into context with resistance to chemotherapy and ionizing radiation. Here, a panel of human malign and benign cells, which cover a broad range of chemotherapy and radiation resistance as well as reliance on glucose metabolism, was analyzed in vitro for TKTL1 expression. Methods 17 malign and three benign cell lines were characterized according to their expression of TKTL1 on the protein level with three commercially available anti-TKTL1 antibodies utilizing immunohistochemistry and Western blot, as well as on mRNA level with three published primer pairs for RT-qPCR. Furthermore, sensitivities to paclitaxel, cisplatin and ionizing radiation were assessed in cell survival assays. Glucose consumption and lactate production were quantified as surrogates for the “Warburg effect”. Results Considerable amounts of tktl1 mRNA and TKTL1 protein were detected only upon stable transfection of the human embryonic kidney cell line HEK293 with an expression plasmid for human TKTL1. Beyond that, weak expression of endogenous tktl1 mRNA was measured in the cell lines JAR and U251. Western blot analysis of JAR and U251 cells did not detect TKTL1 at the expected size of 65 kDa with all three antibodies specific for TKTL1 protein and immunohistochemical staining was observed with antibody JFC12T10 only. All other cell lines tested here revealed expression of tktl1 mRNA below detection limits and were negative for TKTL1 protein. However, in all cell lines including TKTL1-negative HEK293-control cells, antibody JFC12T10 detected multiple proteins with different molecular weights. Importantly, JAR and U251 did neither demonstrate an outstanding production of lactic acid nor increased resistance against chemotherapeutics or to ionizing radiation, respectively. Conclusion Using RT-qPCR and three different antibodies we observed only exceptional occurrence of TKTL1 in a panel of malignant human cell lines in vitro. The presence of TKTL1 was unrelated to either the rate of glucose consumption/lactic acid production or resistance against chemo- and radiotherapy. KW - RT-qPCT KW - immunohistochemistry KW - TKTL1 KW - cancer cell lines Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-126397 VL - 15 IS - 2 ER - TY - THES A1 - Montalbán del Barrio, Itsaso T1 - Immunosuppressive role of adenosine produced by ectonucleotidases CD39 and CD73 in ovarian cancer, tumor associated macrophages and the host immune system T1 - Immunosuppressive Rolle von Adenosine produziert von Ectonukleotidasen CD39 und CD73 in Eierstockkrebs, Tumor assoziierten Makrophagen und den Wirtsimmunsystem N2 - Eierstockkrebs ist der Tumor mit der schlechtesten Heilungsprognose unter allen gynäkologischen Malignomen. Allein in Deutschland verursacht er über 6000 Tote pro Jahr. Patienten mit Ovarialkarzinom zeigen erst in einem sehr fortgeschrittenen Stadium charakteristische Symptome. Die einzig möglichen Behandlungsmethoden sind dann die operative Tumorentfernung und die Verabreichung von platinbasierter Chemotherapien sowie von Anthrazyklinen. Da die aktuelle 5-Jahres-Überlebensrate lediglich 20-40% beträgt, besteht ein dringender Bedarf an neuen therapeutischen Optionen. Seit herausgefunden wurde, dass immunologische Parameter das Überleben der Patienten beeinflussen, ist Immuntherapie zu einer der vielversprechendsten Behandlungsarten des Eierstockkrebs geworden. Das Ziel unserer Forschung ist die Überwindung der Immunevasion des Tumors durch ein Verhindern der immun-unterdrückenden Mechanismen des Tumors. Im Speziellen befasst sich diese Arbeit mit dem Einfluss von Adenosin, das durch die Ectonukleotidasen CD39 und CD73 in der Mikroumgebung des Tumors gebildet wird. Die CD39- und CD73-Expression der Zellen führt zu Immunosuppression da diese Ectonukleotidasen immun-stimulierendes, extrazelluläres ATP in immunsuppressives Adenosin umwandeln. Dies wurde zuerst als Effektormechanismus für regulatorische T-Zellen beschrieben, kann aber auch im Tumormikromilieu von Bedeutung sein. Mit dem Wissen, dass Tumorzellen von Eierstockkrebs-Patientinnen große Mengen der ATP-unterdrückenden Ectonukleotidasen CD39 und CD73 bilden, analysierten wir die adenosinvermittelte Unterdrückendung von Immunantwortenin der Mikroumgebung der Tumorzellen. Im Vergleich zu regulatorischen T Zellen konnten wir bei Eierstockkrebs-Zelllinien und bei aus Aszites gewonnenen Krebszellen eine 30- bis 60-fache Adenosinproduktion messen. Um diesen mutmaßlichen Immunevasions-Mechanismus zu bestätigen, untersuchten wir seine Auswirkungen auf mehrere Immunzellenpopulationen. CSFE-basierte Experimente zeigten zum Beispiel eine Hemmung der CD4+ T-Zell-Proliferation durch Adenosin, welches von Eierstockkrebs-Zellen produziert wurde. In diesem Zusammenhang haben wir auch eine in-vitro Methode entwickelt, mit der wir die Beeinflussung von Makrophagen durch Eierstockkrebszellen analysieren und modulieren konnten. Neben seiner suppressiven Wirkung übt Adenosin auch chemotaktische Effekte auf menschliche Monozyten aus und lockt wahrscheinlich myeloide Vorläuferzellen zum Tumorgewebe. Anschließend differenzieren sich menschliche Monozyten in einer von Eierstockkrebszellen geformten Mikroumgebung zu M2 Makrophagen oder tumor-assoziierten Makrophagen (TAMs), die ihrerseits erhebliche Mengen der Adenosin-produzierenden Ectonukleotidasen CD39 und CD73 bilden. Während wir die Regulierung der Ectonukleotidasen-Expression untersuchten, entdeckten wir auch, dass klinisch genutzte Techniken zur Behandlung von Eierstockkrebs (zum Beispiel die Anwendung von Doxorubicin oder Bestrahlung) in vitro das CD73- und CD39-Level von Eierstockkrebs- und Immunzellen beeinflussen. In dieser Studie zeigen wir, wie dieser behandlungsbedingte Wechsel des ATP/Adenosine-Verhältnisses die Effektorfunktion verschiedener Immunzellen moduliert. Darüber hinaus untersuchen wir den potentiellen Vorteil von klinisch verfügbaren, niedermolekularen Inhibitoren für CD39 und CD73, die die Immunsuppression in der Mikroumgebung des Tumors partiell aufheben könnten, und die vor allem in Kombination mit gängigen Behandlungsschemata von großem Interesse sein könnten. N2 - Ovarian cancer (OvCa) is the tumor with the most unfavourable prognosis among all gynaecological malignancies causing more than 6000 deaths per year in Germany alone. Patients with OvCa show symptoms at very advanced stages of tumor progression when the only available treatments consist on tumor debulking surgery and administration of platinum based chemotherapeutics and anthracyclins. There is an urgent need to develop new therapeutical strategies since the actual 5 year survival rate of OvCa patients does not exceed 20-40%. Immunotherapy is a promising approach for treatment of ovarian cancer, since it has been observed that immunological parameters can influence the outcome of the patient. The aim of our research is to overcome tumor immune escape by counteracting the immunosuppressive mechanisms developed by the tumor. In particular, this work studies the influence of adenosine generated by the ectonucleotidases CD39 and CD73 in the tumor microenvironment. Cellular expression of CD39 and CD73 contributes to immunosupression as these ectonucleotidases convert immune-stimulatory extracellular ATP into immunosuppressive adenosine. This was primarily described as effector mechanism for regulatory T cells, but may also be important in the tumor microenvironment. Having found that tumor cells from OvCa-patients express high levels of ATP-depleting ectonucleotidases CD39 and CD73 we set out to investigate a potential immunosuppressive mechanism via adenosine production in the tumor microenvironment. We could measure 30-60 times higher adenosine production by OvCa cell lines and ascites-derived cancer cells as compared to physiological normal conditions. To confirm this putative immune escape mechanism we investigated its effect on several immune cell populations. CFSE-based assays, for example, showed an inhibition of CD4+ T cell proliferation by OvCA cell-derived adenosine. In this context, we have further established an in-vitro assay, where OvCa cells modulate the function of macrophages towards a M2 or tumor associated (TAM) phenotype. Together with the phenotype modulation adenosine exerts chemotactic effects on human monocytes and is thus likely to attract myeloid precursor cells towards the tumor tissue. Moreover, in a microenvironment that is shaped by OvCa cells, human monocytes differentiate into M2 macrophages or TAMs which themselves express significant levels of the adenosine-generating ectonucleotidases CD39 and CD73. Investigating the regulation of ectonucleotidase expression, we also observed that approaches clinically used to treat OvCa (namely application of doxorubicine or irradiation) influence CD73 and CD39 levels of OvCa and immune cells in vitro. In this study we show how this treatment-induced change in the ATP/adenosine ratio modulates the effector function of different immune cells. Furthermore, we investigate the potential benefit of clinically available small molecule inhibitors for CD39 and CD73 that could relieve immunosuppression in the tumor microenvironment especially in combination with common treatment regimes. KW - Eierstockkrebs KW - CD39 KW - CD73 KW - Adenosin KW - Immunsuppression Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-133268 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 - Hummel, Jonas Florian T1 - Hüllproteine endogener Retroviren interferieren mit der allostimulatorischen Aktivität dendritischer Zellen T1 - Human endogenous retrovirus envelope proteins target dendritic cells to modulate T-cell activation N2 - Das humane Genom besteht zu ungefähr 8 % aus humanen endogenen Retroviren (HERVs), jedoch sind viele aufgrund von Mutationen oder Deletionen nicht mehr funktionell. Trotzdem wurden funktionelle HERV-Proteine gefunden, welche offene Leserahmen (ORFs) besitzen und für funktionelle Hüll-Glykoproteine wie z.B. Syncytin-1, Syncytin-2 und HML-2 kodieren. Diese HERV-Hüllproteine beinhalten eine suppressive Domäne (SU) und induzieren möglicherweise eine Immunsuppression diverser Immunzellen während einer gesunden Schwangerschaft. In dieser Arbeit wurden spezifisch die modulatorischen Eigenschaften verschiedener HERVHüllproteine (Syncytin-1, -2 und HML-2) auf Immunzellen untersucht. Wir konnten zeigen, dass die HERV-Bindungsrezeptoren ASCT-1, -2 und MFSD2A auf der Oberfläche von T-Zellen und DCs exprimiert werden. Für funktionelle Experimente wurden HERV-Hüllproteine transgen in CHO-Zellen exprimiert, die als Effektorzellen in Ko-Kultur- Systemen verwendet wurden. Es konnte keine Hemmung der PMA/Ionomycin-stimulierten T-Zell-Proliferation durch die Effektorzellen gefunden werden. Darüber hinaus beeinträchtigten die Effektorzellen nicht die Expression von Reifungsmarkern auf DCs nach LPS-Aktivierung, induzierten jedoch die Produktion der pro-inflammatorischen Zytokine IL- 12 und TNF-α. Dagegen inhibierten die konstitutiv HERV-Hüllprotein-exprimierenden Chorionkarzinom-Zelllinien BeWo und JEG die PMA/Ionomycin-stimulierte T-Zell- Proliferation sehr effektiv. Die Chorionkarzinom-Zelllinien hatten ebenfalls keinen Einfluss auf die phänotypische LPS-DC-Reifung, modulierten aber die LPS-DC-Zytokin-Antwort sehr effektiv zu einem suppressiven Profil durch eine Inhibition der pro-inflammatorischen Zytokine IL-12 und TNF-α sowie einen Anstieg von anti-inflammatorischem IL-10. BeWound JEG-Zellen, aber auch HERV-Hüllprotein-exprimierende Effektorzellen verändern die durch LPS-DC-stimulierte allogene T-Zell-Proliferation. Dies war mit einer verringerten Bildung von DC/T-Zell-Konjugaten sowie mit einer Hemmung der IFN-γ-Sekretion und der Ca2+-Mobilisation dieser T-Zellen assoziiert. Des Weiteren wurden eine reduzierte p-Tyrosin- Akkumulation und kein Ausschluss des F-Aktin-Signals in der immunologischen Synapse, der Kontaktstelle dieser DC/T-Zell-Konjugate, gefunden. Zusammenfassend lassen diese Ergebnisse vermuten, dass HERV-Hüllproteine die T-Zell- Proliferation nicht direkt beeinflussen, sich aber modulierend auf DCs auswirken und dadurch mit deren allogene T-Zell-Proliferation interferieren. N2 - Human endogenous retroviruses (HERVs) comprise about 8 % of the human genome but many are not functional due to mutations or deletions. However, some HERVs have been reported to harbor open reading frames (ORFs) and are coding for functional envelope (env) glycoproteins (Syncytin-1, Syncytin-2 and HML-2). These HERV env glycoproteins have suppressive domains (SU) and may modulate immune cells especially in the placenta where they are highly expressed. In this work, we investigated the ability of different HERV envs (Syncytin-1, -2 and HML-2) to modulate immune cell function. We showed that HERV binding receptors ASCT-1, -2 and MFSD2A are expressed by T-cells and DCs. For functional analysis, HERV envs were transiently expressed in CHO-cells which were then used as effector cells for co-culture assays. We demonstrated that HERV env expressing CHO effector cells did not significantly inhibit PMA/Ionomycin stimulated T-cell proliferation, and did not prevent phenotypic maturation of DCs in response to LPS. However, they did strongly augment the release of the pro-inflammatory cytokines IL-12 and TNF-α from LPS-DCs. In contrast, BeWo and JEG choriocarcinoma cell-lines constitutively expressing HERV env proteins reduced the T-cell proliferation very effectively. These celllines did not prevent phenotypic maturation of LPS-DCs, but shifted their cytokine response towards an immune suppressive profile by inhibiting the pro-inflammatory cytokines IL-12 and TNF-α and enhancing the release of the anti-inflammatory cytokine IL-10. The choriocarcinoma cell-lines and CHO effector cells inhibited the LPS-DC induced allogenic Tcell- proliferation. This was associated with a loss of DC/T-cell conjugate frequency as well as with an impairment of IFN-γ release and Ca2+ mobilization in T-cells. In addition, we observed an aberrant pattern of p-tyrosine and F-actin signal in the interface of these DC/Tcell conjugates. Altogether, these findings suggest that HERV proteins do not target T-cell activation directly, but modulate the DCs' ability to promote T-cell expansion. KW - Syncytin KW - dendritische Zelle KW - T-Lymphozyt KW - HERV KW - immunologische Synapse KW - DC/T-Zell-Konjugate KW - T-Zelle Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-118964 ER - TY - JOUR A1 - Simon, Christian M. A1 - Rauskolb, Stefanie A1 - Gunnersen, Jennifer M. A1 - Holtmann, Bettina A1 - Drepper, Carsten A1 - Dombert, Benjamin A1 - Braga, Massimiliano A1 - Wiese, Stefan A1 - Jablonka, Sibylle A1 - Pühringer, Dirk A1 - Zielasek, Jürgen A1 - Hoeflich, Andreas A1 - Silani, Vincenzo A1 - Wolf, Eckhard A1 - Kneitz, Susanne A1 - Sommer, Claudia A1 - Toyka, Klaus V. A1 - Sendtner, Michael T1 - Dysregulated IGFBP5 expression causes axon degeneration and motoneuron loss in diabetic neuropathy JF - Acta Neuropathologica N2 - Diabetic neuropathy (DNP), afflicting sensory and motor nerve fibers, is a major complication in diabetes.The underlying cellular mechanisms of axon degeneration are poorly understood. IGFBP5, an inhibitory binding protein for insulin-like growth factor 1 (IGF1) is highly up-regulated in nerve biopsies of patients with DNP. We investigated the pathogenic relevance of this finding in transgenic mice overexpressing IGFBP5 in motor axons and sensory nerve fibers. These mice develop motor axonopathy and sensory deficits similar to those seen in DNP. Motor axon degeneration was also observed in mice in which the IGF1 receptor(IGF1R) was conditionally depleted in motoneurons, indicating that reduced activity of IGF1 on IGF1R in motoneurons is responsible for the observed effect. These data provide evidence that elevated expression of IGFBP5 in diabetic nerves reduces the availability of IGF1 for IGF1R on motor axons, thus leading to progressive neurodegeneration. Inhibition of IGFBP5 could thus offer novel treatment strategies for DNP. KW - Motor nerve biopsy KW - Diabetic polyneuropathy KW - Neuropathy KW - Neurotrophic factors KW - Axonal degeneration Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-154569 VL - 130 SP - 373 EP - 387 ER - TY - THES A1 - Kurz, Antje T1 - Hemmung des PI3K-Signalweges im Ovarialkarzinom T1 - Anti-tumour activity of phosphoinositide-3-kinase antagonist AEZS-126 in models of ovarian cancer N2 - Störungen des PI3K-AKT-Signalweges treten besonders häufig in Endometrium und Ovarialkarzinomen auf. Ursache kann eine Überaktivierung von Wachstumsfaktor-Rezeptoren, Mutationen oder der Funktionsverlust von PTEN sein, was zu einer Störung der Regulation und damit zu einer Überaktivierung des PI3K-AKTSignalweges führt und so das Einleiten autophagischer Prozesse verhindert. Hierauf kommt es zu unkontrollierter Zellvermehrung, welche zur Tumorentstehung und Tumorprogression beiträgt [12][23]. Die in dieser Arbeit durchgeführten Untersuchungen konnten zeigen, dass die Hemmung des PI3K-AKT-Signalweges durch den PI3K-Inhibitor AEZS-126 erfolgversprechende antiproliferative Effekte in in vitro-Modellen des Ovarialkarzinoms zeigte. In vitro konnte die niedermolekulare Pyridopyrazin-Verbindung AEZS-126 das Wachstum und die Progression von Zellen der parentalen Ovarialkarzinom-Zelllinie A2780, der daraus abgeleiteten cis-Platin-resistenten Tochterzelllinie Acis2780 und der aus einem Ovar-Adenokarzinom gewonnenen Zelllinie SKOV-3 signifikant hemmen. In Vitalitätsassays ermittelte IC50-Werte lagen im mikromolaren Bereich und zeigten konzentrationsabhängige Antitumor-Effekte. Neben den AEZS-126-abhängigen Effekten wurde auch die Wirksamkeit des mTOR-Inhibitors Rapamycin auf die Zelllinien A2780 und Acis2780 untersucht. Es zeigten sich ebenfalls konzentrationsabhängige antiproliferative Effekte. Durch die Kombination der beiden Inhibitoren AEZS-126 und Rapamycin konnte zusätzlich eine gesteigerte Wirksamkeit gegen die Tumorzellen erzielt werden und synergistische Effekte traten auf. ImWestern-Blot konnte nach Inkubation der Ovarialkarzinomzelllinien mit AEZS-126 durch den Einsatz von AEZS-126 eine verminderte Expression von pAKT nachgewiesen werden, welche insbesondere bei den cis-Platin-resistenten Acis2780-Zellen durch die Kombination mit Rapamycin noch verstärkt wurde. Durch FACS-Analysen konnte gezeigt werden, dass die Ovarialkarzinomzellen durch die Behandlung mit AEZS-126 im Wachstum gehemmt werden und unabhängig von ihrer Zellzyklusphase in den Zelltod geführt werden können. So zeigte sich in den Zellzyklusanalysen eine konzentrationsabhängige Verschiebung der Zellzahl von der G0/G1-Phase in die sub-G0-Phase, welche die Population der toten Zellen darstellt. Eine Spezifizierung des Zelltod-Mechanismuses erfolgte einerseits durch Annexin-V-FITC-FACS-Analysen und andererseits durch Vitalitätsassays mit Koinkubation von AEZS-126 mit dem Caspase-Inhibitor zVAD-fmk, dem Nekroptose-Inhibitor Necrostatin-1 und dem Nekrose-Inhibitor Necrox-2. Aus diesen Untersuchungen ging klar hervor, dass AEZS-126 in den Zelllinien A2780, Acis2780 und SKOV-3 Nekroptose induziert. Rapamycin alleine zeigte sowohl apoptotische als auch nekrotische Wirkmechanismen. Die Kombination der beiden Inhibitoren AEZS-126 und Rapamycin führte zu einer synergistischen Wirkverstärkung, was sich in einem verstärkten Absterben der Zellen schon bei geringeren eingesetzten Konzentrationen der beiden Inhibitoren zeigte. Auch hier traten hauptsächlich nekrotische Effekte auf. Von besonderem Interesse war die Interaktion von Ovarialkarzinomzellen (A2780, Acis2780), die mit AEZS-126 vorbehandelt worden waren, mit Zellen des Immunsystems. So konnte gezeigt werden, dass AEZS-126 eine verbesserte Zelllyse der Tumorzellen durch NK-Zellen ermöglicht. Zusätzlich konnten die cis-Platin-resistenten Acis2780-Zellen durch Vorbehandlung mit entsprechende Konzentrationen des PI3KInhibitors in vergleichbarem Ausmaß wie die parentalen A2780-Zellen für die Lyse durch NK-Zellen zugänglich gemacht werden. AEZS-126 scheint auf Grund dieser Ergebnisse und der schon nachgewiesenen guten antiproliferativen Wirkung von AEZS-126 auf verschiedene Zelllinien ein geeigneter Kandidat für weiterführende in vivo-Versuche zu sein. Zusätzlich sollte erwogen werden, neben der Inhibiton des PI3K-AKT-Signalweges eine zeitgleiche Hemmung des Ras-Raf-MEK-ERK-Signalweges in Betracht zu ziehen. Durch die Interaktionen der beiden Signalwege könnte es sonst bei der Inaktivierung des einen zur Aktivierung des anderen Signalweges kommen [143]. Durch eine Überexpression von pAKT durch eine PTEN-Mutation kommt es beispielsweise zur Inaktivierung von Ras und der darauf folgenden Signalkaskade, während ein erhöhtes Expressionsniveau an pAKT im PI3K-AKT-Signalweg zu einer Aktivierung von mTOR und damit zur Hemmung autophagischer Prozesse führt [23]. So kann die Phosphorylierung des Proteins p70S6K, dem Schlüsselmolekül zwischen den beiden Signalwegen, welches mTOR nachgeschaltet ist, durch Rapamycin gehemmt werden und damit zu einer erhöhten Aktivierung von AKT und ERK führen [143]. Durch die Kombinationsbehandlung mit Inhibitoren des PI3K-AKT-Signalweges, die an verschiedenen Stellen der Signalkaskade angreifen, kann, wie in dieser Arbeit gezeigt wurde, die Antitumorwirkung verstärkt werden. Die in dieser Arbeit untersuchten Inhibitoren AEZS-126 und Rapamycin zeigten bei den parentalen Ovarialkarzinom- zellen A2780 und den cis-Platin-resistenten Acis2780-Zellen in der Kombinationsbehandlung synergistische Effekte und führten schon bei geringen Konzentrationen zu verstärkter antiproliferativer Wirksamkeit. Aus den erzielten Ergebnissen geht hervor, dass die Kombinationsbehandlung mit AEZS-126 und Rapamycin geeignet wäre, in in vivo-Experimenten weiter untersucht zu werden. N2 - Purpose Platinum resistance is the most crucial problem for treatment of ovarian cancer. There is a clinical need for new treatment strategies which overcome platinum resistance. Recently high level of AKT was shown to be involved in platinum resistance and furthermore in resistance against Natural-killer (NK)-cell mediated killing in ovarian cancer. Methods Here, we investigate the ability of the PI3K/AKT inhibitor AEZS-126 alone and in combination with rapamycin to selectively target ovarian cancer cell proliferation and survival in vitro by MTT-assays and FACS based analysis. Furthermore the mechanism of cytotoxicity is analysed by FACS based assays. The NK-killing efficiency of ovarian cancer cells with and without pre-treatment with AEZS-126 was analysed. Results AEZS-126 showed good anti-tumour activity in in vitro models of ovarian cancer. Main mechanism of cytotoxicity seems to be necroptosis which could be abrogated by co-incubation with necrostatin-1. Furthermore pre-treatment of platinum resistant cells with AEZS-126 resulted in an increased accessibility of these tumour cells for killing by NK-cells. Conclusion We demonstrated the highly efficient anti-tumour activity of AEZS-126 in in vitro models of ovarian cancer. Due to the good anti-tumour activity and the expected increase in NK-cell mediated killing even of platinum resistant tumour cells, AEZS-126 seems to be a promising candidate for clinical testing in ovarian cancer. KW - pi3k-signalweg KW - Hemmung KW - PI3K-Signalweg KW - Ovarialkarzinom Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-103872 ER - TY - JOUR A1 - Wiegering, Armin A1 - Korb, Doreen A1 - Thalheimer, Andreas A1 - Kämmerer, Ulrike A1 - Allmanritter, Jan A1 - Matthes, Niels A1 - Linnebacher, Michael A1 - Schlegel, Nicolas A1 - Klein, Ingo A1 - Ergün, Süleyman A1 - Germer, Christoph-Thomas A1 - Otto, Christoph T1 - E7080 (Lenvatinib), a Multi-Targeted Tyrosine Kinase Inhibitor, Demonstrates Antitumor Activities Against Colorectal Cancer Xenografts N2 - Clinical prognosis of metastasized colorectal carcinoma (CRC) is still not at desired levels and novel drugs are needed. Here, we focused on the multi-tyrosine kinase inhibitor E7080 (Lenvatinib) and assessed its therapeutic efficacy against human CRC cell lines in vitro and human CRC xenografts in vivo. The effect of E7080 on cell viability was examined on 10 humanCRCcell lines and humanendothelial cells (HUVEC). The inhibitory effect of E7080 on VEGF-induced angiogenesis was studied in an ex vivo mouse aortic ring angiogenesis assay. In addition, the efficacy of E7080 against xenografts derived fromCRC cell lines and CRC patient resection specimenswithmutated KRASwas investigated in vivo. Arelatively low cytotoxic effect of E7080 on CRC cell viabilitywas observed in vitro. Endothelial cells (HUVEC)weremore susceptible to the incubation with E7080. This is in line with the observation that E7080 demonstrated an anti-angiogenic effect in a three-dimensional ex vivo mouse aortic ring angiogenesis assay. E7080 effectively disrupted CRC cell-mediated VEGF-stimulated growth of HUVEC in vitro. Daily in vivo treatment with E7080 (5 mg/kg) significantly delayed the growth of KRAS mutated CRC xenografts with decreased density of tumor-associated vessel formations and without tumor regression. This observation is in line with results that E7080 did not significantly reduce the number of Ki67-positive cells in CRC xenografts. The results suggest antiangiogenic activity of E7080 at a dosage thatwas well tolerated by nudemice. E7080 may provide therapeutic benefits in the treatment of CRC with mutated KRAS. KW - Chirurgie Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-111165 ER - TY - THES A1 - Döring, Christian T1 - Ergebnisse der gynäkologischen Descensuschirurgie unter Verwendung des GYNECARE PROLIFT® prolenemesh am Krankenhaus Agatharied T1 - Results of the gynaecological descensus surgery under application of GYNECARE PROLIFT® prolenemesh at Agatharied Hospital N2 - Ergebnisse der gynäkolgischen Descensuschirurgie unter Verwendung des GYNECARE PROLIFT® prolenemesh am Krankenhaus Agatharied Der Descensus genitalis ist eine der häufigsten gutartigen Erkrankungen der Frau, im Jahr 2010 waren mehr als 316 Millionen Frauen weltweit betroffen. Es besteht ein Lebensrisiko von 11,1% für eine chirurgische Intervention für eine 80jährige Frau. Die Gründe liegen v. a. in der Anzahl vaginaler (operativer) Geburten, Adiopsitas, Z.n. Hysterektomie, Überalterung und chronisch erhöhter intraabdominaler Druck. Die klinische Symptomatik besteht aus den typischen Senkungssymptomen wie Fremdkörper- und Druckgefühl, Ulcerationen mit Blutung, Fluor, Infektionen und Schmerzen. Außerdem kann es zu anorectaler Dysfunktion und Störungen der Blasenspeicher- und entleerungsfunktion kommen. Auch werden häufig Störungen der Sexualfunktion beschrieben. Die anatomiegerechte Beckenbodendefektbehebung mittels Polypropylene-Kunststoffnetzen (GYNECARE PROLIFT® prolenemesh) über den vaginalen Zugang wird zunehmend, neben den klassischen Descensusoperationen, zur Rekonstruktion des weiblichen Beckenbodens verwendet. Anhand der prä- und postoperativen Anamnese und Untersuchung nach dem POP-Q Schema einschließlich intra- und postoperativer Veräufe sowie 4 etablierter Fragebögen (PFDI-20, PFIQ-7, PISQ-12 und PGI-C) zu subjektiven Einschränkungen durch den Descensus erfolgt die Evaluation des Erfolges der Netzimplantation und ein Vergleich mit Ergebnissen anderer Methoden der Descensuschirurgie. Ergebnisse: Netzspezifische Komplikationen wie Exposition in die Scheide, Erosion in Nachbarorgane, Schrumpfung der Netze mit Schmerzen, Auftreten einer De Novo Belastungsinkontinenz oder einer Dyspareunie wurden im vorliegenden Kollektiv deutlich seltener als in der Literatur verzeichnet. Die Netzimplantation war in 81,5% (Stadium 0 oder 1) erfolgreich, es kam in 18,5% zu einem Rezidiv. Je nach Literatur und betroffenem Kompartiment liegen die Rezidivraten nach Mesheinlage zwischen 3,5 und 46% und bei 2 bis 42,5% nach klassischen Descensusoperationen. In allen 4 Fragebögen wurde eine Verbesserung der Lebensqualität, der sexuellen Zufriedenheit und der Speicher- und Entleerungsfunktion von Blase und Darm verzeichnet, jedoch war die Netzimplantation gleichwertig mit den klassischen Senkungsoperationen. N2 - Introduction: Descensus genitalis is one of women’s most frequent benign diseases. In 2010, more than 316 Million women world-wide were affected. There’s an 11.1 % risk for an 80 year-old woman to undergo surgery within her life span. Above all, reasons lie in the number of vaginal births (including surgical intervention), hysterectomy, adipositas, high age and elevated intraabdominal pressure. Typical clinical descensus symptoms include foreign body and pressure sensation, ulceration with bleeding, fluor, infections and pain. Furthermore, anorectal dysfunction, bladder storage and emptying problems. Sexual dysfunctions are also frequently described. Apart from the usual descensus operation for the reconstruction of the female pelvic floor, implementing polypropylene mesh (GYNECARE PROLIFT® prolenemesh) through vaginal access has increasingly become an alternative. Material and methods: Success of the mesh implantation was compared with results of other methods of descensus surgery, using pre- and post-operative medical history, examination based on the POP-Q scale including intra- and post-operative developments as well as on four established questionnaires (PFDI-20, PFIQ-7, PISQ-12 and PGI-C) describing subjective restrictions caused by the descensus. Results/discussion: Mesh-specific complications, such as exposition into the vagina, erosion into adjacent organs, painful shrinking of the mesh, de novo stress incontinence or a dyspareunia were detected much less frequently in the current cohort than described in literature. Mesh implantation was successful in 81.5 % (stage 0 or 1), a recrudescence occurred in 18.5 %. Depending on the respective literature and specific cohort, the rates for recrudescence after mesh implementation lie between 3.5 and 46 %, while they range between 2 and 42.5% after usual descensus surgery. Each of the four questionnaires reported improvement of life quality, of sexual satisfaction as well as better bowel and bladder storage and emptying ability. However, results of mesh implantation showed no significant difference to those of the conventional descensus surgery. KW - Descensus uteri KW - Beckenbodensenkung KW - Descensus vaginalis KW - Prolaps KW - Descensus KW - Mesh KW - Polypropylen-Netz KW - PROLIFT KW - Descensuschirurgie Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-111241 ER - TY - JOUR A1 - Bruttel, Valentin S. A1 - Wischhusen, Jörg T1 - Cancer Stem Cell Immunology: Key to Understanding Tumorigenesis and Tumor Immune Escape? JF - Frontiers in Immunology N2 - Cancer stem cell (CSC) biology and tumor immunology have shaped our understanding of tumorigenesis. However, we still do not fully understand why tumors can be contained but not eliminated by the immune system and whether rare CSCs are required for tumor propagation. Long latency or recurrence periods have been described for most tumors. Conceptually, this requires a subset of malignant cells which is capable of initiating tumors, but is neither eliminated by immune cells nor able to grow straight into overt tumors. These criteria would be fulfilled by CSCs. Stem cells are pluripotent, immune-privileged, and long-living, but depend on specialized niches. Thus, latent tumors may be maintained by a niche-constrained reservoir of long-living CSCs that are exempt from immunosurveillance while niche-independent and more immunogenic daughter cells are constantly eliminated. The small subpopulation of CSCs is often held responsible for tumor initiation, metastasis, and recurrence. Experimentally, this hypothesis was supported by the observation that only this subset can propagate tumors in non-obese diabetic/scid mice, which lack T and B cells. Yet, the concept was challenged when an unexpectedly large proportion of melanoma cells were found to be capable of seeding complex tumors in mice which further lack NK cells. Moreover, the link between stem cell-like properties and tumorigenicity was not sustained in these highly immunodeficient animals. In humans, however, tumor-propagating cells must also escape from immune-mediated destruction. The ability to persist and to initiate neoplastic growth in the presence of immunosurveillance - which would be lost in a maximally immunodeficient animal model - could hence be a decisive criterion for CSCs. Consequently, integrating scientific insight from stem cell biology and tumor immunology to build a new concept of "CSC immunology" may help to reconcile the outlined contradictions and to improve our understanding of tumorigenesis. KW - tumor immunology KW - tumor immunosurveillance KW - tumor-propagating cells KW - cancer stem cell immunology KW - cancer stem cells KW - latency KW - tumor dormancy KW - tumor immune escape Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-120699 SN - 1664-3224 VL - 5 IS - 360 ER - TY - JOUR A1 - Schmidt, Sebastian A1 - Liu, Guoxing A1 - Liu, Guilai A1 - Yang, Wenting A1 - Honisch, Sabina A1 - Pantelakos, Stavros A1 - Stournaras, Christos A1 - Hönig, Arnd A1 - Lang, Florian T1 - Enhanced Orai1 and STIM1 expression as well as store operated \(Ca^{2+}\) entry in therapy resistant ovary carcinoma cells JF - Oncotarget N2 - Mechanisms underlying therapy resistance of tumor cells include protein kinase Akt. Putative Akt targets include store-operated \(Ca^{2+}\)-entry (SOCE) accomplished by pore forming ion channel unit Orai1 and its regulator STIM1. We explored whether therapy resistant (A2780cis) differ from therapy sensitive (A2780) ovary carcinoma cells in Akt, Orai1, and STIM1 expression, \(Ca^{2+}\)-signaling and cell survival following cisplatin (100µM) treatment. Transcript levels were quantified with RT-PCR, protein abundance with Western blotting, cytosolic \(Ca^{2+}\)-activity ([\(Ca^{2+}\)]i) with Fura-2-fluorescence, SOCE from increase of [\(Ca^{2+}\)]i following \(Ca^{2+}\)-readdition after Ca2+-store depletion, and apoptosis utilizing flow cytometry. Transcript levels of Orai1 and STIM1, protein expression of Orai1, STIM1, and phosphorylated Akt, as well as SOCE were significantly higher in A2780cis than A2780 cells. SOCE was decreased by Akt inhibitor III (SH-6, 10µM) in A2780cis but not A2780 cells and decreased in both cell lines by Orai1 inhibitor 2-aminoethoxydiphenyl borate (2-ABP, 50µM). Phosphatidylserine exposure and late apoptosis following cisplatin treatment were significantly lower in A2780cis than A2780 cells, a difference virtually abolished by SH-6 or 2-ABP. In conclusion, Orai1/STIM1 expression and function are increased in therapy resistant ovary carcinoma cells, a property at least in part due to enhanced Akt activity and contributing to therapy resistance in those cells. KW - Ca2+ release activated Ca2+ channel KW - SOCE KW - Akt KW - SH-6 KW - 2-APB KW - apoptosis Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-121423 UR - www.impactjournals.com/oncotarget VL - 5 IS - 13 ER - TY - JOUR A1 - Rieger, Johannes A1 - Bähr, Oliver A1 - Maurer, Gabriele D. A1 - Hattingen, Elke A1 - Franz, Kea A1 - Brucker, Daniel A1 - Walenta, Stefan A1 - Kämmerer, Ulrike A1 - Coy, Johannes F. A1 - Weller, Michael A1 - Steinbach, Joachim P. T1 - ERGO: A pilot study of ketogenic diet in recurrent glioblastoma JF - International Journal of Oncology N2 - Limiting dietary carbohydrates inhibits glioma growth in preclinical models. Therefore, the ERGO trial (NCT00575146) examined feasibility of a ketogenic diet in 20 patients with recurrent glioblastoma. Patients were put on a low-carbohydrate, ketogenic diet containing plant oils. Feasibility was the primary endpoint, secondary endpoints included the percentage of patients reaching urinary ketosis, progression-free survival (PFS) and overall survival. The effects of a ketogenic diet alone or in combination with bevacizumab was also explored in an orthotopic U87MG glioblastoma model in nude mice. Three patients (15%) discontinued the diet for poor tolerability. No serious adverse events attributed to the diet were observed. Urine ketosis was achieved at least once in 12 of 13 (92%) evaluable patients. One patient achieved a minor response and two patients had stable disease after 6 weeks. Median PFS of all patients was 5 (range, 3-13) weeks, median survival from enrollment was 32 weeks. The trial allowed to continue the diet beyond progression. Six of 7 (86%) patients treated with bevacizumab and diet experienced an objective response, and median PFS on bevacizumab was 20.1 (range, 12-124) weeks, for a PFS at 6 months of 43%. In the mouse glioma model, ketogenic diet alone had no effect on median survival, but increased that of bevacizumab-treated mice from 52 to 58 days (p<0.05). In conclusion, a ketogenic diet is feasible and safe but probably has no significant clinical activity when used as single agent in recurrent glioma. Further clinical trials are necessary to clarify whether calorie restriction or the combination with other therapeutic modalities, such as radiotherapy or anti-angiogenic treatments, could enhance the efficacy of the ketogenic diet. KW - feasibility KW - glucose KW - glioma KW - metabolism KW - ketogenic diet Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-121170 VL - 44 IS - 6 ER - TY - JOUR A1 - Diessner, J. A1 - Bruttel, V. A1 - Stein, R. G. A1 - Horn, E. A1 - Häusler, S. F. M. A1 - Dietl, J. A1 - Hönig, A. A1 - Wischhusen, J. T1 - Targeting of preexisting and induced breast cancer stem cells with trastuzumab and trastuzumab emtansine (T-DM1) JF - Cell Death & Disease N2 - The antibody trastuzumab (Herceptin) has substantially improved overall survival for patients with aggressive HER2-positive breast cancer. However, about 70% of all treated patients will experience relapse or disease progression. This may be related to an insufficient targeting of the CD44(high)CD24(low) breast cancer stem cell subset, which is not only highly resistant to chemotherapy and radiotherapy but also a poor target for trastuzumab due to low HER2 surface expression. Hence, we explored whether the new antibody-drug conjugate T-DM1, which consists of the potent chemotherapeutic DM1 coupled to trastuzumab, could improve the targeting of these tumor-initiating or metastasis-initiating cells. To this aim, primary HER2-overexpressing tumor cells as well as HER2-positive and HER2-negative breast cancer cell lines were treated with T-DM1, and effects on survival, colony formation, gene and protein expression as well as antibody internalization were assessed. This revealed that CD44(high)CD24(low)HER2(low) stem cell-like breast cancer cells show high endocytic activity and are thus particularly sensitive towards the antibody-drug conjugate T-DM1. Consequently, preexisting CD44(high)CD24(low) cancer stem cells were depleted by concentrations of T-DM1 that did not affect the bulk of the tumor cells. Likewise, colony formation was efficiently suppressed. Moreover, when tumor cells were cocultured with natural killer cells, antibody-dependent cell-mediated cytotoxicity was enhanced, and EMT-mediated induction of stem cell-like properties was prevented in differentiated tumor cells. Thus our study reveals an unanticipated targeting of stem cell-like breast cancer cells by T-DM1 that may contribute to the clinical efficacy of this recently approved antibody-drug conjugate. KW - tumor stem cells KW - breast cancer KW - T-DM1 KW - HER2 KW - argeted therapy Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-119884 SN - 2041-4889 VL - 5 ER - TY - JOUR A1 - Häusler, Sebastian F. M. A1 - del Barrio, Itsaso Montalbán A1 - Diessner, Joachim A1 - Stein, Roland G. A1 - Strohschein, Jenny A1 - Hönig, Arnd A1 - Dietl, Johannes A1 - Wischhusen, Jörg T1 - Anti-CD39 and anti-CD73 antibodies A1 and 7G2 improve targeted therapy in ovarian cancer by blocking adenosine-dependent immune evasion JF - American Journal of Translational Research N2 - The ectonucleotidases CD39 and CD73 degrade ATP to adenosine which inhibits immune responses via the \(A_{2A}\) adenosine receptor (ADORA2A) on T and NK cells. The current study investigates the potential therapeutic use of the specific anti CD39- and anti CD73-antibodies A1 (CD39) and 7G2 (CD73) as these two ectonucleotidases are overexpressed in ovarian cancer (OvCA). As expected, NK cell cytotoxicity against the human ovarian cancer cell lines OAW-42 or SK-OV-3 was significantly increased in the presence of A1 or 7G2 antibody. While this might partly be due to antibody-dependent cell-mediated cytotoxicity, a luciferase-dependent assay for quantifying biologically active adenosine further showed that A1 and 7G2 can inhibit CD39 and CD73-dependent adenosine-generation. In turn, the reduction in adenosine levels achieved by addition of A1 and 7G2 to OAW-42 or SK-OV-3 cells was found to de-inhibit the proliferation of \(CD4^+\) T cells in coculture with OvCA cells. Likewise, blocking of CD39 and CD73 on OvCA cells via A1 and 7G2 led to an increased cytotoxicity of alloreactive primed T cells. Thus, antibodies like A1 and 7G2 could improve targeted therapy in ovarian cancer not only by specifically labeling overexpressed antigens but also by blocking adenosine-dependent immune evasion in this immunogenic malignancy. KW - ovarian cancer KW - immune escape KW - adenosine KW - CD39 KW - CD73 Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-120016 SN - 1943-8141 VL - 6 IS - 2 ER - TY - JOUR A1 - Keller, Andreas A1 - Leidinger, Petra A1 - Vogel, Britta A1 - Backes, Christina A1 - ElSharawy, Abdou A1 - Galata, Valentina A1 - Mueller, Sabine C. A1 - Marquart, Sabine A1 - Schrauder, Michael G. A1 - Strick, Reiner A1 - Bauer, Andrea A1 - Wischhusen, Jörg A1 - Beier, Markus A1 - Kohlhaas, Jochen A1 - Katus, Hugo A. A1 - Hoheisel, Jörg A1 - Franke, Andre A1 - Meder, Benjamin A1 - Meese, Eckart T1 - miRNAs can be generally associated with human pathologies as exemplified for miR-144* JF - BMC MEDICINE N2 - Background: miRNA profiles are promising biomarker candidates for a manifold of human pathologies, opening new avenues for diagnosis and prognosis. Beyond studies that describe miRNAs frequently as markers for specific traits, we asked whether a general pattern for miRNAs across many diseases exists. Methods: We evaluated genome-wide circulating profiles of 1,049 patients suffering from 19 different cancer and non-cancer diseases as well as unaffected controls. The results were validated on 319 individuals using qRT-PCR. Results: We discovered 34 miRNAs with strong disease association. Among those, we found substantially decreased levels of hsa-miR-144* and hsa-miR-20b with AUC of 0.751 ( 95% CI: 0.703-0.799), respectively. We also discovered a set of miRNAs, including hsa-miR-155*, as rather stable markers, offering reasonable control miRNAs for future studies. The strong downregulation of hsa-miR-144* and the less variable pattern of hsa-miR-155* has been validated in a cohort of 319 samples in three different centers. Here, breast cancer as an additional disease phenotype not included in the screening phase has been included as the 20th trait. Conclusions: Our study on 1,368 patients including 1,049 genome-wide miRNA profiles and 319 qRT-PCR validations further underscores the high potential of specific blood-borne miRNA patterns as molecular biomarkers. Importantly, we highlight 34 miRNAs that are generally dysregulated in human pathologies. Although these markers are not specific to certain diseases they may add to the diagnosis in combination with other markers, building a specific signature. Besides these dysregulated miRNAs, we propose a set of constant miRNAs that may be used as control markers. KW - peripheral blood KW - microna profiles KW - disease KW - signature KW - expression KW - miRNA KW - microarray KW - biomarker KW - bioinformatics KW - lung-cancer KW - multiple sclerosis KW - gene KW - serum Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-114349 SN - 1741-7015 VL - 12 ER - TY - JOUR A1 - Kuger, Sebastian A1 - Cörek, Emre A1 - Polat, Bülent A1 - Kämmerer, Ulrike A1 - Flentje, Michael A1 - Djuzenova, Cholpon S. T1 - Novel PI3K and mTOR Inhibitor NVP-BEZ235 Radiosensitizes Breast Cancer Cell Lines under Normoxic and Hypoxic Conditions N2 - In the present study, we assessed, if the novel dual phosphatidylinositol 3-kinase (PI3K)/mammalian target of rapamycin (mTOR) inhibitor NVP-BEZ235 radiosensitizes triple negative (TN) MDA-MB-231 and estrogen receptor (ER) positive MCF-7 cells to ionizing radiation under various oxygen conditions, simulating different microenvironments as occurring in the majority of breast cancers (BCs). Irradiation (IR) of BC cells cultivated in hypoxic conditions revealed increased radioresistance compared to normoxic controls. Treatment with NVP-BEZ235 completely circumvented this hypoxia-induced effects and radiosensitized normoxic, reoxygenated, and hypoxic cells to similar extents. Furthermore, NVP-BEZ235 treatment suppressed HIF-1α expression and PI3K/mTOR signaling, induced autophagy, and caused protracted DNA damage repair in both cell lines in all tested oxygen conditions. Moreover, after incubation with NVP-BEZ235, MCF-7 cells revealed depletion of phospho-AKT and considerable signs of apoptosis, which were signifi-cantly enhanced by radiation. Our findings clearly demonstrate that NVP-BEZ235 has a clinical relevant potential as a radiosensitizer in BC treatment. KW - Novel PI3K KW - NVP-BEZ235 KW - mTOR Inhibitor KW - radiosensibility KW - Akt KW - DNA repair protraction KW - apoptosis KW - hypoxia KW - autophagy Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-112708 ER - TY - JOUR A1 - Hagemann, Carsten A1 - Kessler, Almuth Friederike A1 - Wiesner, Miriam A1 - Denner, Joachim A1 - Kämmerer, Ulrike A1 - Vince, Giles Hamilton A1 - Linsenmann, Thomas A1 - Löhr, Mario A1 - Ernestus, Ralf-Ingo T1 - Expression-analysis of the human endogenous retrovirus HERV-K in human astrocytic tumors N2 - Background The human endogenous retrovirus K (HERV-K) has been acquired by the genome of human ancestors million years ago. It is the most complete of the HERVs with transcriptionally active gag, pol and env genes. Splice variants of env, which are rec, 1.5 kb transcript and Np9 have been suggested to be tumorigenic. Transcripts of HERV-K have been detected in a multitude of human cancers. However, no such reports are available concerning glioblastomas (GBM), the most common malignant brain tumor in adults. Patients have a limited prognosis of 14.6 months in median, despite standard treatment. Therefore, we elucidated whether HERV-K transcripts could be detected in these tumors and serve as new molecular target for treatment. Findings We analyzed human GBM cell lines, tissue samples from patients and primary cell cultures of different passages for HERV-K full length mRNA and env, rec and 1.5 kb transcripts. While the GBM cell lines U138, U251, U343 and GaMG displayed weak and U87 strong expression of the full length HERV-K, the splice products could not be detected, despite a weak expression of env mRNA in U87 cells. Very few tissue samples from patients showed weak expression of env mRNA, but none of the rec or 1.5 kb transcripts. Primary cells expressed the 1.5 kb transcript weakly in early passages, but lost HERV-K expression with extended culture time. Conclusions These data suggest that HERV-K splice products do not play a role in human malignant gliomas and therefore, are not suitable as targets for new therapy regimen. KW - Human endogenous retrovirus KW - HERV-K KW - Glioblastoma multiforme KW - Astrocytic tumor KW - Expression KW - Glioblastoma cell line KW - PCR analysis Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-110211 ER - TY - THES A1 - Sumski, Anna Magdalena T1 - Adenosinrezeptoren auf Zervix-, Uterus- und Mammakarzinomzellen T1 - Adenosine receptors in cervical, uterine and breast cancer cells N2 - Adenosinrezeptoren werden auf nahezu allen Körperzellen exprimiert und übernehmen dort vielfältige und wichtige Funktionen. Auch auf diversen Tumorzelllinien konnten bereits Adenosinrezeptoren nachgewiesen und – je nach Subtyp – mit Pro- oder Anti-tumor-Effekten in Zusammenhang gebracht werden. In dieser Arbeit wurden Gebärmutterhalskrebszellen sowie endometriale und triple-negative Brustkrebszellen auf Expression und mögliche Funktionen von Adenosinrezep-toren untersucht. Da spezifische Antikörper bis heute nicht verfügbar sind, wurde ein pharmakologischer Ansatz mit subtypspezifischen Agonisten und Antagonisten gewählt. In Radioliganden-Bindungsassays, konnte nachgewiesen werden, dass sich auf der Zer-vixkarzinom-Zelllinie SiHa und der Brustkrebs-Zelllinie HCC1806 Adenosinrezeptoren des Subtyps A1 befinden. Die endometrialen Krebszelllinien Ishikawa und HEC-1-A exprimieren Rezeptoren vom Subtyp A1 und A2A. A3-Adenosinrezeptoren wurden auf keiner der untersuchten Zelllinien gefunden. Der Nachweis von A2B-Rezeptoren kann mit dem Radioliganden-Bindungsassay nicht erbracht werden, da bislang kein Radioligand bekannt ist, der eine ausreichende Affini-tät besitzt, um diesen Subtyp zweifelsfrei nachweisen zu können. Obwohl die Mehrheit der untersuchten Zelllinien Adenosinrezeptoren exprimiert, konnte ein signifikanter Effekt auf die Adenylatcyclase bei Stimulation der auf den Zellen vorhandenen Adenosinrezeptoren nur bei den HEC-1-A-Zellen festgestellt werden. Auch auf funktionelle A2B-Rezeptoren fand sich im Adenylatcyclaseassy kein Hinweis. Im durchgeführten Kristallviolettassay zeigte sich ein proapoptotischer Effekt auf Ishi-kawa- und HEC-1-A-Zellen bei hohen Adenosin-Konzentrationen (100 µM). Die im BrdU-Assay gemessene Proliferationsrate hingegen änderte sich nach Vorbehandlung mit Adenosin nicht. Das metabolisch stabilere NECA (in Kombination mit ADA) hatte im Kristallviolettassay einen stärkeren Einfluss auf die Apoptoserate der jeweiligen Zelllinie als Adenosin und auch im BrdU-Assay sank die Menge an inkorporiertem BrdU. Ein Synergismus zwischen Stimulation von Adenosinrezeptoren und diversen Todesliganden bzw. Chemotherapeutika konnte nicht nachgewiesen werden. Freies extrazelluläres Adenosin kann auch aus dem Abbau von ATP generiert werden, wenn Zellen die Ektonukleotidasen CD39 und CD73 exprimieren. Aufgrund der im-munsuppressiven Wirkung von Adenosin können diese Enzyme T-Zell- und NK-Zellantworten im Mikromilieu von Tumoren hemmen. Die durchflusszytometrische Analyse von HEC-1-A- und Ishikawa-Zellen zeigte zwar, dass die Expression von CD39 und CD73 nach Stimulation der Adenosinrezeptoren unverändert blieb. Die Ex-pression von Enzymen, lässt aber vermuten, dass die Zellen in vivo von Adenosin profi-tieren könnten. Angesichts der in vitro Daten, die allenfalls einen wachstumshemmen-den Effekt von Adenosin zeigten, könnte die vorrangige Wirkung von Adenosin im Tumormikromilieu tatsächlich auf der Inhibition von Immunantworten beruhen. Mög-licherweise würden die Rezeptoren dann in erster Linie als Sensoren dienen. Weitere Forschungsarbeit wird helfen, die Rolle der Adenosinrezeptoren im Tumorge-schehen vollständig zu verstehen und möglicherweise für die Krebstherapie nutzbar zu machen. N2 - In this thesis, cell lines from cervical, endometrial and triple-negative breast cancer were investigated for expression and putative functions of adenosine receptors. Due to the lack of specific antibodies, a pharmacological approach using subtype-specific agonists and antagonists was taken. Radio ligand binding assays showed that adenosine receptors of the A1 subtype are expressed by SiHa cervical cancer and by HCC1806 breast cancer cells. Receptors of the A1 and A2A subtype are expressed by the endometrial cancer cell lines Ishikawa and HEC-1-A. A3 adenosine receptors could not be detected in any of the 5 investigated cell lines and the presence of receptors of the A2B subtype cannot be assessed with the available ligands. However, while the majority of the cell lines expressed adenosine receptors, a significant effect of adenosine receptor stimulation on adenylylcyclase activity was only detected in HEC-1-A cells. In crystal violet assays, high concentrations (100 µM) of adenosine showed a proapoptotic effect in Ishikawa- and HEC-1-A cells. The proliferation rate as measured by BrdU uptake was not affected by adenosine. The metabolically more stable adenosine receptor agonist NECA (in combination with ADA) had, in contrast, a stronger impact on the rate of apoptosis in the respective cell lines. Moreover, NECA also reduced BrdU uptake. Using various chemotherapeutics and death ligands, no synergy was observed between stimulation of adenosine receptors and further death stimuli. Free extracellular adenosine can also be generated from ATP when cells express the ectonucleotidases CD39 and CD73. Due to the immunosuppressive effect of adenosine, these enzymes can inhibit T cell and NK cell responses in the tumor microenvironment. Flow cytometry, however, showed that expression of CD39 and/or CD73 remained unaltered after stimulation of adenosine receptors. Thus, further investigations will be required to reveal the functional role of adenosine receptor expression on the investigated tumor cell lines. KW - Adenosinrezeptor KW - Rezeptor KW - Adenosin KW - Gebärmutterhalskrebs KW - Brustkrebs KW - Liganden KW - Adenylatcyclaseassay KW - FACS KW - Bindungsassay KW - BrdU Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-99332 ER - TY - THES A1 - Schuster, Ruth T1 - Die Auseinandersetzung um die moderne Fortpflanzungsmedizin in Deutschland und die Perspektiven des jüdischen Religionsgesetzes dazu T1 - The discussion about modern reproductive medicine in Germany and the point of view of Jewish religious law to it N2 - Die Felder und Techniken der modernen Fortpflanzungsmedizin sind im Laufe der Jahre weit fortgeschritten. Um dem Wunsch eines kinderlosen Ehepaares nach Nachwuchs nachzugehen, haben sich Methoden entwickelt, um diesen zu erfüllen. Hierbei haben sich die In-Vitro-Fertilisation und die daraus entwickelte Modifikation, die Intracytoplasmatische Spermieninjektion etabliert. Auch wenn die seit dem Jahre 2004 durchgeführten IVF-Geburten, aufgrund mangelnder Krankenkassenleistungen, entschieden gesunken sind und die kumulative Schwangerschaftsrate nach drei durchgeführten Embryotransfers maximal bei 50-70 % liegt, ist die In-Vitro-Fertilisation und mit ihr verwandten Intracytoplasmatischen Spermieninjektion (im Falle mangelnder Spermienqualität) neben der homologen und heterologen Insemination das älteste und das neuste reproduktionsmedizinische Verfahren, das zur Behandlung des unerfüllten Kinderwunsches eingesetzt wird. Des Weiteren haben sich die Präimplantations- und Pränataldiagnostik einen weit verbreiten Ruf verschafft, um Erbkrankheiten und Fehlentwicklungen des Embryos noch in frühester Entwicklungszeit aufzudecken. Dass hierbei der Embryo und das noch ungeborene Leben in eine Zwickmühle ethischer und rechtlicher Beurteilungen rutschen, scheint offensichtlich. Denn das seit 1990 in Kraft getretene Embryonenschutzgesetz regelt zwar weite Bereiche rund um den Schutz des Embryos, hinterlässt aber auch Lücken. Somit werden Rufe laut nach der Schaffung eines eigenen Fortpflanzungsmedizingesetzes, um die ungeregelten Aspekte der Fortpflanzungsmedizin zu klären [457]. Die rechtliche Lage der modernen Fortpflanzungsmedizin in Deutschland ist recht komplex. Für die vielen verschiedenen Methoden herrschen unterschiedlich rechtliche Regelungen. So wird zum Beispiel die In-Vitro-Fertilisation rechtlich anders geregelt als die Pränatal- und die Präimplantaionsdiagnostik. In Hinsicht auf die In-Vitro-Fertilisation dient als rechtliche Grundlage das Embryonenschutzgesetz, welches besagt, dass „bereits die befruchtete, entwicklungsfähige menschliche Eizelle vom Zeitpunkt der Kernverschmelzung an“ einem Embryo mit all seinen Rechten entspricht. Die Pränataldiagnostik stützt sich zum großen Teil auf die von der Bundesärztekammer verabschiedeten „Richtlinien zur pränatalen Diagnostik von Krankheiten und Krankheitsdispositionen“ sowie auf eine „Erklärung zum Schwangerschaftsabbruch nach Pränataldiagnostik“. In diesen Richtlinien wird darauf hingewiesen, dass zum einen das Lebensrecht des Ungeborenen, zum anderen die Handlungsfreiheit der Eltern in die jeweiligen Entscheidungen einbezogen werden muss. Die in Deutschland zwischen Zulassung und Nichtzulassung befindliche Präimplantationsdiagnostik beruft sich auf das Embryonenschutzgesetz, welches den Verbrauch von Embryonen verbietet, da nach dem Gesetz eine Blastomere einem ganzen Embryo gleichgestellt sei. Ebenso besagt das ESchG, dass eine Eizelle nur zum Zweck der Herbeiführung einer Schwangerschaft befruchtet werden darf, da aber die Präimplantationsdiagnostik die genetische Analyse beabsichtigt, steht dies in einem Widerspruch. Jedoch wird in und außerhalb von Europa der Umgang mit IVF, Präimplantations- und Pränataldiagnostik verschieden gehandhabt. Während sich Deutschland und Österreich für ein klares Verbot der Präimplantationsdiagnostik aussprechen, ist diese in Frankreich und Großbritannien grundsätzlich möglich. Wenn man sich die halachischen Grundlagen im Umgang mit der modernen Fortpflanzungsmedizin vor Augen führt, ist es im Kern der Status des Embryos, der Juden und Christen in zwei völlig verschiedene Richtungen laufen lässt. Die Halacha spricht von menschlichem Leben erst von der Geburt an und geht von mehreren unterscheidbaren Stadien in der Entwicklung des vorgeburtlichen Lebens im Mutterleib aus. Ganz anders die christliche Ethik, sie erkennt bereits dem Embryo die Schutzwürdigkeit menschlichen Lebens zu. Wenn das jüdische Recht die Schutzwürdigkeit eines Embryos nach der entscheidenden Frage differenziert, ob er jünger oder älter als vierzig Tage ist, wird deutlich, dass die IVF als grundsätzlich rechtmäßig gelten muss, da die Embryonen, die im Zuge jeder IVF zerstört oder weitergehend genutzt werden, keinen besonderen Schutz in Anspruch nehmen können. Ebenso fallen jene Vorgänge und Maßnahmen einer modernen PID in jenen Zeitraum von vierzig Tagen nach der Empfängnis, innerhalb dessen nach jahrtausendalter Einstellung des jüdischen Rechts noch kein menschliches Leben im Mutterleib existiert. Somit steht die Halacha einer begründeten PID nicht im Wege. Eine zweite große Kernaussage dieser Dissertation ist die, dass sich das jüdische Religionsgesetz (die Halacha), welche unter anderem die Anleitungen zum Umgang mit der modernen Reproduktionsmedizin liefert, stets darauf bedacht ist, neu ausgelegt zu werden. Die Halacha ist ein immerwährend andauernder Prozess von Erneuerung, welche sich den aktuellen und örtlichen Gegebenheiten kritisch anpassen muss. So auch der Umgang mit der modernen Fortpflanzungsmedizin, der einem immerwährenden Prozess von Erneuerungen unterlegen ist. N2 - The discussion about modern reproductive medicine in Germany and the point of view of Jewish religious law to it KW - Reproduktionsmedizin KW - Halacha KW - jüdisches Recht KW - Fortpflanzung Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-135701 N1 - Dieses Dokument wurde aus Datenschutzgründen - ohne inhaltliche Änderungen - erneut veröffentlicht. Die ursprüngliche Veröffentlichung war am: 07.04.2014 unter der URN http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-92822 ER - TY - JOUR A1 - Diessner, Joachim A1 - Bruttel, Valentin A1 - Becker, Kathrin A1 - Pawlik, Miriam A1 - Stein, Roland A1 - Häusler, Sebastian A1 - Dietl, Johannes A1 - Wischhusen, Jörg A1 - Hönig, Arnd T1 - Targeting breast cancer stem cells with HER2-specific antibodies and natural killer cells JF - American Journal of Cancer Research N2 - Breast cancer is the most common cancer among women worldwide. Every year, nearly 1.4 million new cases of breast cancer are diagnosed, and about 450.000 women die of the disease. Approximately 15-25% of breast cancer cases exhibit increased quantities of the trans-membrane receptor tyrosine kinase human epidermal growth factor receptor 2 (HER2) on the tumor cell surface. Previous studies showed that blockade of this HER2 proto-oncogene with the antibody trastuzumab substantially improved the overall survival of patients with this aggressive type of breast cancer. Recruitment of natural killer (NK) cells and subsequent induction of antibody-dependent cell-mediated cytotoxicity (ADCC) contributed to this beneficial effect. We hypothesized that antibody binding to HER2-positive breast cancer cells and thus ADCC might be further improved by synergistically applying two different HER2-specific antibodies, trastuzumab and pertuzumab. We found that tumor cell killing via ADCC was increased when the combination of trastuzumab, pertuzumab, and NK cells was applied to HER2-positive breast cancer cells, as compared to the extent of ADCC induced by a single antibody. Furthermore, a subset of \(CD44^{high}CD24^{low}HER2^{low}\) cells, which possessed characteristics of cancer stem cells, could be targeted more efficiently by the combination of two HER2-specific antibodies compared to the efficiency of one antibody. These in vitro results demonstrated the immunotherapeutic benefit achieved by the combined application of trastuzumab and pertuzumab. These findings are consistent with the positive results of the clinical studies, CLEOPATRA and NEOSPHERE, conducted with patients that had HER2-positive breast cancer. Compared to a single antibody treatment, the combined application of trastuzumab and pertuzumab showed a stronger ADCC effect and improved the targeting of breast cancer stem cells. KW - trastuzumab KW - breast cancer KW - tumor stem cells KW - ADCC KW - pertuzumab Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-128633 VL - 3 IS - 2 ER - TY - JOUR A1 - Palige, Katja A1 - Linde, Jörg A1 - Martin, Ronny A1 - Böttcher, Bettina A1 - Citiulo, Francesco A1 - Sullivan, Derek J. A1 - Weber, Johann A1 - Staib, Claudia A1 - Rupp, Steffen A1 - Hube, Bernhard A1 - Morschhäuser, Joachim A1 - Staib, Peter T1 - Global Transcriptome Sequencing Identifies Chlamydospore Specific Markers in Candida albicans and Candida dubliniensis JF - PLoS ONE N2 - Candida albicans and Candida dubliniensis are pathogenic fungi that are highly related but differ in virulence and in some phenotypic traits. During in vitro growth on certain nutrient-poor media, C. albicans and C. dubliniensis are the only yeast species which are able to produce chlamydospores, large thick-walled cells of unknown function. Interestingly, only C. dubliniensis forms pseudohyphae with abundant chlamydospores when grown on Staib medium, while C. albicans grows exclusively as a budding yeast. In order to further our understanding of chlamydospore development and assembly, we compared the global transcriptional profile of both species during growth in liquid Staib medium by RNA sequencing. We also included a C. albicans mutant in our study which lacks the morphogenetic transcriptional repressor Nrg1. This strain, which is characterized by its constitutive pseudohyphal growth, specifically produces masses of chlamydospores in Staib medium, similar to C. dubliniensis. This comparative approach identified a set of putatively chlamydospore-related genes. Two of the homologous C. albicans and C. dubliniensis genes (CSP1 and CSP2) which were most strongly upregulated during chlamydospore development were analysed in more detail. By use of the green fluorescent protein as a reporter, the encoded putative cell wall related proteins were found to exclusively localize to C. albicans and C. dubliniensis chlamydospores. Our findings uncover the first chlamydospore specific markers in Candida species and provide novel insights in the complex morphogenetic development of these important fungal pathogens. KW - NRG1 KW - staib agar KW - gene KW - morphogenesis KW - expression KW - regulator KW - virulence KW - growth KW - UME6 KW - epidemiology Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-131007 VL - 8 IS - 4 ER - TY - JOUR A1 - Klement, Rainer Johannes A1 - Frobel, Thomas A1 - Albers, Torsten A1 - Fikenzer, Sven A1 - Prinzhausen, Jan A1 - Kämmerer, Ulrike T1 - A pilot case study on the impact of a self-prescribed ketogenic diet on biochemical parameters and running performance in healthy and physically active individuals N2 - Background: Ketogenic diets (KDs) have gained some popularity not only as effective weight-loss diets and treatment options for several diseases, but also among healthy and physically active individuals for various reasons. However, data on the effects of ketosis in the latter group of individuals are scarce. We therefore collected pilot data on the physiological response to a self-prescribed ketogenic diet lasting 5-7 weeks in a small cohort of healthy and physically active individuals. Methods: Twelve subjects (7 males, 5 females, age 24-60 years) who followed moderate to intensive exercise routines underwent blood testing, bioelectrical impedance analysis (BIA) and spiroergometry during an incremental treadmill test. On the next day, they went on a self-prescribed KD for a median of 38 days (range 35-50 days), after which the same tests were performed again. Ketosis was self-monitored by urinary ketone strips. Subjective feeling during the diet was assessed by a questionnaire after the intervention. Due to the small and heterogenous sample, the results are interpreted in the context of the already existing literature. Results: The KDs were tolerated well by the majority of individuals. Impaired recovery from exercise remained the most frequently reported side effect until the end of the study. Most blood parameters remained stable during the intervention. However, there were significant elevations of total and LDL cholesterol concentrations (p<0.01) and a trend towards increased HDL-cholesterol (p=0.05). The drastic reduction of carbohydrates had no statistically significant influence on running performance judged by the time to exhaustion, VO2max and respiratory compensation points. BIA measurements showed significant increases in phase angle (p=0.01) indicating improvements of body composition with an estimated decrease of 3.4 kg of fat mass (p=0.002) and gain of 1.3 kg of fat free mass. We discuss the validity of these estimates taking into account a possibly altered hydration status due to the KD. Conclusions: Active healthy individuals will probably experience no major problems during a short term KD lasting several weeks. The drastically reduced carbohydrate content of the diet seems to be no limiting factor for running performance. In addition, improvements in body composition can be expected. While most biochemical parameters are not influenced by the diet, there seems to be an impact on the blood lipid profile that could be considered problematic with respect to cardiovascular disease risk. However, the predictive role of cholesterol levels alone in individuals undergoing regular physical activity remains to be elucidated. KW - Fettgehalt KW - Blut KW - Ketogene Kost KW - High fat diet KW - exercise KW - bioimpedance analysis KW - blood lipids; fat loss; running performance Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-78901 ER - TY - THES A1 - Heinlein, U-Ju T1 - Adenosinrezeptoren auf Ovarialkarzinomzellen T1 - adenosine receptors in ovarian cancer cells N2 - Seit der Entdeckung, dass Adenosin auch als Botenstoff dient, beschäftigen sich Forschungsgruppen mit Adenosinrezeptoren und ihrer möglichen therapeutischen Modulation, insbesondere in Zusammenhang mit Krebserkrankungen. Bislang sind die Rezeptoren auf diversen Krebszellen nachgewiesen worden. So konnten beispielsweise in einer Brustkrebszelllinie A2B Adenosinrezeptoren nachgewiesen werden, deren Stimulation zu einer Hemmung der wachstumsfördernden MAP Kinase führt. Pharmaka zur weitgehend selektiven Aktivierung oder Hemmung einzelner Adenosinrezeptor-Subtypen stehen ebenfalls zur Verfügung. Beim Ovarialkarzinom mit seiner leider meist erst spät auftretenden Symptomatik besteht derzeit noch keine Möglichkeit zur frühen Diagnosestellung, sodass die Prognose ausgesprochen ungünstig ausfällt und die Erkrankung bei Frauen eine der häufigsten krebsbedingten Todesursachen darstellt. Daher war es ein Ziel dieser Arbeit herauszufinden, ob Adenosinrezeptoren auf diesen Zellen einen möglichen therapeutischen Angriffspunkt bieten. Dazu untersuchten wir die vier Ovarialkarzinomzelllinien OVCAR-3, SK-OV-3, PA-1 und OAW-42 auf eine mögliche Expression von allen vier Adenosinrezeptorsubtypen. Zunächst wurden mit radioaktiv markierten Liganden ([3H]CCPA, [3H]NECA und [3H]HEMADO) Bindungsstudien für den A1-, A2A- und A3-Subtyp durchgeführt. Die Expression des A2B-Rezeptors wurde mithilfe eines funktionellen Nachweises, der Stimulation der Adenylylcyclase mithilfe von NECA (einem unspezifischen Adenosinrezeptoragonisten) analysiert. Im Anschluss daran untersuchten wir an OAW-42 und SK-OV-3 Zellen, ob sich ihr Proliferationsverhalten durch eine Stimulation mit NECA verändern ließe und ob sich das Ansprechen auf gängige Chemotherapeutika bzw. einen Todesliganden ändern würde. Trotz des erfolgreichen Nachweises von Adenosinrezeptoren auf allen Zelllinien waren die Ergebnisse der Proliferationsstudien aber nicht eindeutig. OAW-42 und SK-OV-3 Zellen reagierten zwar auf eine NECA-Stimulation mit sinkendem BrdU-Einbau, OAW-42 Zellen zeigten aber nach Behandlung mit NECA eine leicht erhöhte Resistenz gegenüber Cisplatin. NECA-behandelte SK-OV-3 Zellen reagierten hingegen etwas sensitiver auf Doxorubicin und Fas-Ligand. Die Unterschiede waren aber insgesamt sehr gering und wurden daher von uns als nicht entscheidender Effekt gewertet. Auch Untersuchungen zur Expression der Adenosin-generierenden Enzyme CD39 und CD73 vor und nach NECA-Stimulation blieben ohne erkennbare Veränderung. Insofern ergaben unsere Untersuchungen keine Hinweise darauf, dass Adenosinrezeptoren eine mögliche therapeutische Zielstruktur darstellen könnten. Zukünftige Studien können aber die gewonnenen Daten als Grundlage und Ausgangspunkt nützen, um auch andere Tumorzellarten zu untersuchen und im Kampf gegen den Krebs nach neuen potenziellen pharmakologischen Angriffspunkten zu suchen. N2 - Purpose of the study: Adenosine and adenosine receptors are widely distributed throughout the human body. While they are thought to be involved in many diseases, they seem to play a particularly important role in cancer. Adenosine receptors were already identified in many different cancer tissues. Moreover, extracellular adenosine accumulates in solid tumor masses as a consequence of poor blood supply leading to hypoxia, cell death and concomitant adenine nucleotide breakdown. From a pharmacological point-of-view, numerous tools for activating or inhibiting adenosine receptors have been developed which could be used as therapeutics to combat cancer.One such strategy, for instance, might be based on the identification of A2B adenosine receptors in a breast cancer cell line which mediate the inhibition of growth-promoting MAP kinase activity. Among genuinely gynecological cancers, ovarian carcinoma is associated with the highest mortality rate. Its poor prognosis is mostly due to late primary diagnosis caused by the absence of early symptoms and by the lack of suitable screening programs. As current therapies show limited efficacy against late-stage ovarian cancer, there is an unmet medical need to be addressed by scientists and physicians. In this study we investigated if the human ovarian cancer cell lines OVCAR-3, SK-OV-3, PA-1 and OAW-42 express adenosine receptors on their surfaces. We used binding assays with the help of tritiated radioligands ([3H]CCPA , [3H]NECA und [3H]HEMADO) to identify the A1, A2A, A3 subtype and used a functional assay, namely the stimulation of the adenylylcyclase to detect A2B adenosine receptors with [32P]ATP and the nonselective adenosine receptor agonist NECA. Furthermore we investigated whether stimulation of adenosine receptors with NECA had any effect on the proliferation of OAW-42 and SK-OV-3 cells or on their sensitivity towards chemotherapeutic agents like cisplatin and doxorubicin. Results: We found adenosine receptors in all of the screened ovarian cancer cells, but their effects on proliferation and survival were ambiguous. OAW-42 and SK-OV-3 cells slightly reduced the incorporation of BrdU after treatment with 10 µM NECA. However, OAW-42 cells also became more resistant to cisplatin after treatment with NECA. SK-OV-3 cells, in contrast, were sensitized to doxorubicin and Fas ligand after incubation with NECA. Flow cytometry (FACS) further showed that the cell surface expression for the adenosine-generating ectonucleotidases CD39 and CD73 remained unaltered after stimulation of the cells with NECA. Taken together, the observed effects were quite small and it is questionable whether adenosine receptors represent suitable targets in ovarian cancer. Nevertheless, adenosine receptors remain interesting targets for cancer therapy. Our studies may thus stimulate future research on different tumor entities, with the purpose of finding the best application for the available adenosine receptor-specific drugs. KW - Eierstockkrebs KW - Adenosin KW - Adenosinrezeptor KW - ovarian cancer KW - adenosine KW - adenosine receptor Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-81920 ER - TY - THES A1 - Schmidt, Heike T1 - Wirkung und Wirkmechanismus von AEZS 126 auf verschiedene Subentitäten des Mammakarzinoms T1 - Anti-tumour activity of phosphoinositide-3-kinase antagonist AEZS 126 in models of triple-negative breast cancer N2 - Untersuchung des Wirkmechanismus von AEZS 126 auf drei triple negative Mammakarzinomzelllinien HCC1937, HCC1806 und MDA-MB468 und eine Oestrogenrezeptor positive Zelllinie MCF-7 mittels Kristallviolett assay, FACS und Western Blot. Es konnte gute Antitumorwirkung des Inhibitors in vitro gezeigt werden. N2 - Of more than one million global cases of breastcancer diagnosed each year, a high percentage are characterized as triple-negative, lacking the oestrogen, progesterone and Her2/neu receptors. The incidence exceeds the incidence of malignancies like CML by far. Lack of effective therapies, younger age at onset and early metastatic spread have contributed to the poor prognosis and outcomes associated with these malignancies. Here, we investigate the ability of the PI3 K/AKT inhibitor AEZS 126 to selectively target the triple negative breast cancer (TNBC) cell proliferation and survival in vitro by MTT-assays and FACS-based analysis. Furthermore, the mechanism of cytotoxicity is analysed by FACS-based assays and Western blots. Results AEZS 126 showed good antitumour activity in in vitro models of TNBC as well as in MCF-7 cells. We demonstrated the highly efficient antitumour activity of AEZS 126 in in vitro models of TNBC. Due to the good anti-tumour activity and the expected favourable toxicity profile, AEZS 126 in combination with chemotherapy seems to be a promising candidate for clinical testing in TNBC especially in the basal-like subgroup of TNBC. KW - Brustkrebs KW - TNBC KW - PI3K/AKT Inhibitor KW - PARP KW - Nekroptose KW - Breast cancer KW - TNBC KW - PI3K/AKT inhibitor KW - PARP KW - Caspase KW - RIP-1 Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-81959 ER - TY - THES A1 - Forstner, Maria Elisabeth T1 - Einfluss des transmembranen Hüllproteins des humanen endogenen Retrovirus K (HERV-K) auf die Zytokinproduktion humaner in-vitro kultivierter unreifer und reifer dendritischer Zellen T1 - Influence of the transmembrane envelope protein of human endogenous retrovirus K (HERV-K) on the cytokine production of human in vitro cultured immature and mature dendritic cells N2 - Bei der Implantation des Fetus in den Uterus und während der Schwangerschaft kommt es zu einer Interaktion fetaler Trophoblastzellen mit dem mütterlichen Immunsystem. Trotz vieler verschiedener Studien ist bis heute nicht grundlegend geklärt, welche Mechanismen zur immunologischen Akzeptanz des (semi-)allogenen Fetus durch die Mutter beitragen. Zur wechselseitigen Kommunikation zwischen Kind und Mutter tragen Zytokine bei, die von allen immunkompetenten Zellen sezerniert werden können und regulatorisch auf die Immunantwort wirken. Eine Störung im Gleichgewicht der Zytokine kann zu Aborten, Präeklampsie oder anderen Pathologien führen. Eine wichtige Quelle von Zytokinen stellen u.a. die reifen und unreifen dendritischen Zellen (DC), die in der humanen Dezidua nachgewiesen wurden, dar. DC übernehmen als effiziente Antigen präsentierende Zellen eine entscheidende Funktion im Immunsystem und können inflammatorische Immunantworten induzieren. Jedoch spielen sie auch eine wichtige Rolle bei der Vermittlung immunologischer Toleranz. Die menschliche Plazenta weist eine auffällig starke Expression verschiedener humaner endogener Retroviren (HERV) auf. Immunmodulierende Eigenschaften von HERV wurden bereits beschrieben, jedoch nicht die direkte Wirkung von HERV-Proteinen der Plazenta auf Zellen des Immunsystems. Im Rahmen der Arbeit sollte daher die Wirkung des Hüllproteins des HERV-K, das in den Zytotrophoblastenzellen und in den Zellen des extravillösen Trophoblasten nachgewiesen wurde, auf die Zytokinproduktion unreifer (iDC) und reifer DC (mDC) untersucht werden. Als Modellsystem wurden in-vitro aus Monozyten des peripheren Blutes differenzierte DC gewählt. Die DC wurden in unreifem und reifem Zustand mit unterschiedlichen Konzentrationen von HERV-K-Peptiden (rekombinante Proteine (TM05.04 und TM12.12) bzw. Peptide aus 22 Aminosäuren (K120 und K177)) behandelt. Untersucht wurden die Veränderungen der Zytokinspiegel in den Zellkulturüberständen mittels Cytometric Bead Assay und Durchflusszytometrie. Die Messungen zeigten z.T. signifikante Veränderungen der Zytokinproduktion. So wurde die TNF-α-Sekretion der mDC durch K120 und K177 signifikant vermindert. Dieselben Peptide supprimierten ebenfalls signifikant die IL-8-Sekretion der mDC. Jedoch kam es durch alle vier HERV-Peptide (bei drei Peptiden signifikant) zu einer Steigerung der IL-8-Produktion in den iDC. Auch IL-6 wurde von den iDC durch HERV-K mehrheitlich signifikant vermehrt ausgeschüttet. Bzgl. IL-6 ergaben sich jedoch keine signifikanten Veränderungen in den mDC. In allen Ansätzen kam es zu einer konzentrationsabhängigen Stimulation der Sekretion des immunsuppressiven IL-10 (bei je drei Peptiden signifikante Ergebnisse). Keine signifikanten Veränderungen ergaben sich für IL1-β und IL-4. Die Erkenntnis, dass die HERV-Peptide die Zytokinproduktion der DC z.T. signifikant modulieren und diese Veränderung in den unterschiedlichen Reifestadien der DC variieren, lässt vermuten, dass die in der humanen Plazenta exprimierten Proteine einen Einfluss auf den Verlauf einer Schwangerschaft nehmen. Bei einer Schwangerschaft sind extrem fein abgestimmte, komplexe Vorgänge, bei denen viele verschiedene Faktoren eine Rolle spielen, für einen Erfolg vonnöten. Eine Übertragung der in-vitro-Ergebnisse auf in-vivo-Zustände ist nicht leicht zu vollziehen. Die vorliegenden Ergebnisse sprechen jedoch für einen Einfluss des HERV-K auf die Kommunikation zwischen Fetus und Mutter. Inwiefern genau und wie wichtig bzw. essentiell die Expression der HERV-K-Peptide für einen physiologischen Verlauf der Schwangerschaft ist, ob sie einen Einfluss auf Pathologien während der Gestation hat und ob dem HERV-K eine Bedeutung in der humanen Evolution zukommt, kann mit dieser Arbeit nicht geklärt werden. Jedoch gibt diese Arbeit Anlass dafür, den Einfluss des HERV-K auf die menschliche Fortpflanzung weitergehend zu untersuchen. N2 - During the implantation of the fetus in the uterus and during pregnancy fetal trophoblast cells interact with the maternal immune system. Despite a multitude of studies, so far it is not completely clear, which mechanisms contribute to the immunological acceptance of the (semi)allogeneic fetus by the mother. Cytokines are vital to an intact communication between child and mother. They have a significant regulatory influence on the maternal immune response. A disturbance in the balance of cytokines can lead to miscarriage, preeclampsia or other pathologies. Among others, an important source of cytokines are the mature and immature dendritic cells (DC), which were detected in the human decidua. DC have a crucial function in the immune system: They are efficient antigen presenting cells and are able to induce inflammatory immune responses. However, they also play an important role in the mediation of immunological tolerance. The human placenta shows a remarkably high expression of various human endogenous retroviruses (HERV). Immunomodulating properties of HERV have been described. The direct effect of placental HERV proteins on cells of the immune system, however, has not been analyzed yet. Hence this study examines the effect of the transmembrane envelope protein of HERV-K, which was detected in cytrophoblast and extravillous trophoblast cells, on the cytokine production of human immature (iDC) and mature (mDC) DC. The significant changes in cytokine release suggest that the expression of the HERV-K peptides have an influence on the course of human pregnancy. KW - Fetomaternal KW - Immunologie KW - Endogene Retroviren KW - Dendritische Zelle KW - Cytokine KW - Fetomaternale Immunologie KW - Plazenta KW - Dendritische Zellen KW - Humane endogene Retroviren KW - HERV-K KW - Fetomaternal immunology KW - Placenta KW - Human Endogenous Retrovirus - K KW - Dendritic cells Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-102506 ER - TY - THES A1 - Reischl, Manuela T1 - Therapie des immunologisch bedingten habituellen Aborts mit LeukoNorm CytoChemia® T1 - Treatment of immune mediated recurrent miscarriage with LeukoNorm CytoChemia® N2 - Wiederholte Abortgeschehen bedeuten für Frauen und deren Partner ein großes Trauma, Trauer und Verzweiflung nehmen mit jeder weiteren Fehlgeburt zu. Daraus ergibt sich in jeder Beziehung ein großer Handlungsbedarf, den man versuchte, in den letzten Jahrzehnten durch die Entwicklung zahlreicher Behandlungsansätze mehr oder minder gerecht zu werden. Eine dieser Behandlungsansätze ist das Leukozytenultrafiltrat LeukoNorm CytoChemia®, das aus Vollblut von Spendern gewonnen wird und bis Ende 2006 zur Behandlung des wiederholten Spontanaborts in Deutschland zugelassen war. In dieser Arbeit wurde der Einfluss von LeukoNorm CytoChemia® auf die Schwangerschaften von 108 Frauen untersucht, die bereits drei oder mehr Aborte durchlebt hatten. Insgesamt wurden 446 Schwangerschaften ohne und 170 Schwangerschaften mit LeukoNorm CytoChemia® untersucht. Eine placebokontrollierte randomisierte Doppelblindstudie schied aufgrund der gegebenen Datenlage und insbesondere aus ehtischen Gründen und auch wegen der mangelnden Patientencompliance aus. Es wurden die Abort- bzw. die Geburtenraten ohne und mit LeukoNorm CytoChemia® verglichen. Weiterhin wurden die Zeitpunkte der Aborte bzw. der Geburten auf möglicherweise vorhandene Unterschiede verglichen. Weitere Punkte waren die Geburtsparameter Größe, Gewicht und Kopfumfang der beiden Gruppen. Schließlich wurde noch untersucht, ob adjuvante Therapien zu LeukoNorm CytoChemia® wie ASS, niedermolekulares Heparin, Progesteron oder Folsäure einen Einfluss auf die Baby-Take-Home-Rate nahmen. Es zeigte sich, dass Frauen nach einer Therapie mit LeukoNorm CytoChemia® signifikant häufiger ein Kind lebend gebären als im Vergleich zu vor der Therapie. Ebenso wurde eine Zunahme der Mehrlingsrate unter LeukoNorm CytoChemia® festgestellt. Hinsichtlich der Zeitpunkte, in denen die Aborte und die Geburten auftraten, ergaben sich keine signifikanten Unterschiede. Auch bezüglich der Geburtsparameter ergaben sich keine wesentlichen Unterschiede zwischen der Behandlungs- und Beobachtungsgruppe. Es wurden keine schwereren, jedoch größere Kinder geboren. Dieses Ergebnis ist schwer nachvollziehbar und sollte aufgrund der geringen Anzahl der erfassten Parameter und der daraus resultierenden statistischen Ungenauigkeit zurückhaltend interpretiert werden. Eine zusätzliche Gabe von anderen Medikamenten zu LeukoNorm CytoChemia® erbrachte in unserer Studie keine weiteren Vorteile im Hinblick auf die Geburtenrate. Wir formulieren deshalb aus unseren Ergebnissen die These, dass LeukoNorm CytoChemia® insbesondere die Implantation und den Erhalt der Frühschwangerschaft unterstützt, nicht jedoch die späteren Stadien der Schwangerschaft. Der Wirkungsmechanismus von LeukoNorm CytoChemia® ist bis heute nicht wirklich bekannt. Trotz der methodischen Einschränkung durch das Fehlen einer Kontrollgruppe bzw. im Sinne einer Placebogruppe zeigt ein Vorher-Nachher-Vergleich eine deutliche Steigerung der Baby-Take-Home-Rate. Um die Höhe eines Placeboeffektes bzw. der Tender-Loving-Care zu erfassen, wäre eine prospektive randomisierte Doppelblindstudie wünschenswert, sobald das Medikament wieder auf dem europäischen Markt erhältlich ist. Auch in Anbetracht der hier dokumentierten positiven Ergebnisse bleibt es weiterhin sehr zweifelhaft, ob eine solche Studie eine ethische Zulassung bekäme, von der erforderlichen Patientencompliance einmal ganz abgesehen. N2 - Treatment of immune mediated recurrent miscarriage with LeukoNorm CytoChemia KW - Habitueller Abort KW - Habitueller Abort Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-92265 ER - TY - THES A1 - Schuster, Ruth T1 - Die Auseinandersetzung um die moderne Fortpflanzungsmedizin in Deutschland und die Perspektiven des jüdischen Religionsgesetzes dazu T1 - The discussion about modern reproductive medicine in Germany and the point of view of Jewish religious law to it N2 - Die Felder und Techniken der modernen Fortpflanzungsmedizin sind im Laufe der Jahre weit fortgeschritten. Um dem Wunsch eines kinderlosen Ehepaares nach Nachwuchs nachzugehen, haben sich Methoden entwickelt, um diesen zu erfüllen. Hierbei haben sich die In-Vitro-Fertilisation und die daraus entwickelte Modifikation, die Intracytoplasmatische Spermieninjektion etabliert. Auch wenn die seit dem Jahre 2004 durchgeführten IVF-Geburten, aufgrund mangelnder Krankenkassenleistungen, entschieden gesunken sind und die kumulative Schwangerschaftsrate nach drei durchgeführten Embryotransfers maximal bei 50-70 % liegt, ist die In-Vitro-Fertilisation und mit ihr verwandten Intracytoplasmatischen Spermieninjektion (im Falle mangelnder Spermienqualität) neben der homologen und heterologen Insemination das älteste und das neuste reproduktionsmedizinische Verfahren, das zur Behandlung des unerfüllten Kinderwunsches eingesetzt wird. Des Weiteren haben sich die Präimplantations- und Pränataldiagnostik einen weit verbreiten Ruf verschafft, um Erbkrankheiten und Fehlentwicklungen des Embryos noch in frühester Entwicklungszeit aufzudecken. Dass hierbei der Embryo und das noch ungeborene Leben in eine Zwickmühle ethischer und rechtlicher Beurteilungen rutschen, scheint offensichtlich. Denn das seit 1990 in Kraft getretene Embryonenschutzgesetz regelt zwar weite Bereiche rund um den Schutz des Embryos, hinterlässt aber auch Lücken. Somit werden Rufe laut nach der Schaffung eines eigenen Fortpflanzungsmedizingesetzes, um die ungeregelten Aspekte der Fortpflanzungsmedizin zu klären [457]. Die rechtliche Lage der modernen Fortpflanzungsmedizin in Deutschland ist recht komplex. Für die vielen verschiedenen Methoden herrschen unterschiedlich rechtliche Regelungen. So wird zum Beispiel die In-Vitro-Fertilisation rechtlich anders geregelt als die Pränatal- und die Präimplantaionsdiagnostik. In Hinsicht auf die In-Vitro-Fertilisation dient als rechtliche Grundlage das Embryonenschutzgesetz, welches besagt, dass „bereits die befruchtete, entwicklungsfähige menschliche Eizelle vom Zeitpunkt der Kernverschmelzung an“ einem Embryo mit all seinen Rechten entspricht. Die Pränataldiagnostik stützt sich zum großen Teil auf die von der Bundesärztekammer verabschiedeten „Richtlinien zur pränatalen Diagnostik von Krankheiten und Krankheitsdispositionen“ sowie auf eine „Erklärung zum Schwangerschaftsabbruch nach Pränataldiagnostik“. In diesen Richtlinien wird darauf hingewiesen, dass zum einen das Lebensrecht des Ungeborenen, zum anderen die Handlungsfreiheit der Eltern in die jeweiligen Entscheidungen einbezogen werden muss. Die in Deutschland zwischen Zulassung und Nichtzulassung befindliche Präimplantationsdiagnostik beruft sich auf das Embryonenschutzgesetz, welches den Verbrauch von Embryonen verbietet, da nach dem Gesetz eine Blastomere einem ganzen Embryo gleichgestellt sei. Ebenso besagt das ESchG, dass eine Eizelle nur zum Zweck der Herbeiführung einer Schwangerschaft befruchtet werden darf, da aber die Präimplantationsdiagnostik die genetische Analyse beabsichtigt, steht dies in einem Widerspruch. Jedoch wird in und außerhalb von Europa der Umgang mit IVF, Präimplantations- und Pränataldiagnostik verschieden gehandhabt. Während sich Deutschland und Österreich für ein klares Verbot der Präimplantationsdiagnostik aussprechen, ist diese in Frankreich und Großbritannien grundsätzlich möglich. Wenn man sich die halachischen Grundlagen im Umgang mit der modernen Fortpflanzungsmedizin vor Augen führt, ist es im Kern der Status des Embryos, der Juden und Christen in zwei völlig verschiedene Richtungen laufen lässt. Die Halacha spricht von menschlichem Leben erst von der Geburt an und geht von mehreren unterscheidbaren Stadien in der Entwicklung des vorgeburtlichen Lebens im Mutterleib aus. Ganz anders die christliche Ethik, sie erkennt bereits dem Embryo die Schutzwürdigkeit menschlichen Lebens zu. Wenn das jüdische Recht die Schutzwürdigkeit eines Embryos nach der entscheidenden Frage differenziert, ob er jünger oder älter als vierzig Tage ist, wird deutlich, dass die IVF als grundsätzlich rechtmäßig gelten muss, da die Embryonen, die im Zuge jeder IVF zerstört oder weitergehend genutzt werden, keinen besonderen Schutz in Anspruch nehmen können. Ebenso fallen jene Vorgänge und Maßnahmen einer modernen PID in jenen Zeitraum von vierzig Tagen nach der Empfängnis, innerhalb dessen nach jahrtausendalter Einstellung des jüdischen Rechts noch kein menschliches Leben im Mutterleib existiert. Somit steht die Halacha einer begründeten PID nicht im Wege. Eine zweite große Kernaussage dieser Dissertation ist die, dass sich das jüdische Religionsgesetz (die Halacha), welche unter anderem die Anleitungen zum Umgang mit der modernen Reproduktionsmedizin liefert, stets darauf bedacht ist, neu ausgelegt zu werden. Die Halacha ist ein immerwährend andauernder Prozess von Erneuerung, welche sich den aktuellen und örtlichen Gegebenheiten kritisch anpassen muss. So auch der Umgang mit der modernen Fortpflanzungsmedizin, der einem immerwährenden Prozess von Erneuerungen unterlegen ist. N2 - The discussion about modern reproductive medicine in Germany and the point of view of Jewish religious law to it KW - Reproduktionsmedizin KW - jüdisches Recht KW - Halacha KW - Fortpflanzung Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-92822 N1 - Aus datenschutzrechtlichen Gründen wurde der Zugriff auf den Volltext zu diesem Dokument gesperrt. Eine inhaltlich identische neue Version ist erhältlich unter: http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-135701 ER - TY - JOUR A1 - Kranke, Peter A1 - Girard, Thierry A1 - Lavand’homme, Patricia A1 - Melber, Andrea A1 - Jokinen, Johanna A1 - Muellenbach, Ralf M. A1 - Wirbelauer, Johannes A1 - Hönig, Arnd T1 - Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural” JF - BMC Pregnancy and Childbirth N2 - Background The epidural route is still considered the gold standard for labour analgesia, although it is not without serious consequences when incorrect placement goes unrecognized, e.g. in case of intravascular, intrathecal and subdural placements. Until now there has not been a viable alternative to epidural analgesia especially in view of the neonatal outcome and the need for respiratory support when long-acting opioids are used via the parenteral route. Pethidine and meptazinol are far from ideal having been described as providing rather sedation than analgesia, affecting the cardiotocograph (CTG), causing fetal acidosis and having active metabolites with prolonged half-lives especially in the neonate. Despite these obvious shortcomings, intramuscular and intravenously administered pethidine and comparable substances are still frequently used in delivery units. Since the end of the 90ths remifentanil administered in a patient-controlled mode (PCA) had been reported as a useful alternative for labour analgesia in those women who either don’t want, can’t have or don’t need epidural analgesia. Discussion In view of the need for conversion to central neuraxial blocks and the analgesic effect remifentanil has been demonstrated to be superior to pethidine. Despite being less effective in terms of the resulting pain scores, clinical studies suggest that the satisfaction with analgesia may be comparable to that obtained with epidural analgesia. Owing to this fact, remifentanil has gained a place in modern labour analgesia in many institutions. However, the fact that remifentanil may cause harm should not be forgotten when the use of this potent mu-agonist is considered for the use in labouring women. In the setting of one-to-one midwifery care, appropriate monitoring and providing that enough experience exists with this potent opioid and the treatment of potential complications, remifentanil PCA is a useful option in addition to epidural analgesia and other central neuraxial blocks. Already described serious consequences should remind us not refer to remifentanil PCA as a “poor man’s epidural” and to safely administer remifentanil with an appropriate indication. Summary Therefore, the authors conclude that economic considerations and potential cost-savings in conjunction with remifentanil PCA may not be appropriate main endpoints when studying this valuable method for labour analgesia. KW - Remifentanil KW - Epidural Analgesia KW - Labour Pain KW - Labour Analgesia KW - Patient Controlled Analgesia KW - Patient Satisfaction KW - Healthcare Cost KW - Healthcare Economics Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96262 UR - http://www.biomedcentral.com/1471-2393/13/139 ER - TY - THES A1 - Seida, Ahmed Adel T1 - The Immunomodulatory Role of Endogenous Glucocorticoids in Ovarian Cancer T1 - Die immunmodulatorische Bedeutung der lokalen Aktivierung von endogenem Cortison im Ovarialkarzinom N2 - Ovarian cancer currently causes ~6,000 deaths per year in Germany alone. Since only palliative treatment is available for ovarian carcinomas that have developed resistance against platinum-based chemotherapy and paclitaxel, there is a pressing medical need for the development of new therapeutic approaches. As survival is strongly influenced by immunological parameters, immunotherapeutic strategies appear promising. The research of our group thus aims at overcoming tumour immune escape by counteracting immunosuppressive mechanisms in the tumour microenvironment. In this context, we found that tumour-infiltrating myeloid-derived suppressor cells (MDSC) or tumour associated macrophages (TAM) which are abundant in ovarian cancer express high levels of the enzyme 11β-hydroxysteroid dehydrogenase1 (11-HSD1). This oxido-reductase enzyme is essential for the conversion of biologically inactive cortisone into active cortisol. In line with this observation, high endogenous cortisol levels could be detected in serum, ascitic fluid and tumour exudates from ovarian cancer patients. Considering that cortisol exerts strong anti-inflammatory and immunosuppressive effects on immune cells, it appears likely that high endogenous cortisol levels contribute to immune escape in ovarian cancer. We thus hypothesised that local activation of endogenous glucocorticoids could suppress beneficial immune responses in the tumour microenvironment and thereby prevent a successful immunotherapy. To investigate the in vivo relevance of this postulated immune escape mechanism, irradiated PTENloxP/loxP loxP-Stop-loxP-krasG12D mice were reconstituted with hematopoietic stem cells from either glucocorticoid receptor (GR) expressing mice (GRloxP/loxP) or from mice with a T cell-specific glucocorticoid receptor knock-out (lck-Cre GRloxP/loxP) mice. In the host mice, the combination of a conditional PTEN knock-out with a latent oncogenic kras leads to tumour development when a Cre-encoding adenovirus is injected into the ovarian bursa. Using this model, mice that had been reconstituted with GC-insensitive T cells showed better intratumoural T cell infiltration than control mice that had received functionally unaltered GRloxP/loxP cells via adoptive transfer. However, tumour-infiltrating T cells mostly assumed a Foxp3+ (regulatory) phenotype and survival was even shortened in mice with cortisol-insensitive T cells. Thus, endogenous cortisol seems to inhibit immune cell infiltration in ovarian cancer, but productive anti-tumour immune responses might still be prevented by further factors from the tumour microenvironment. Thus, our data did not provide a sufficiently strong rationale to further pursue the antagonisation of glucocorticoid signalling in ovarian cancer patients, Moreover, glucocorticoids are frequently administered to cancer patients to reduce inflammation and swelling and to prevent chemotherapy-related toxic side effects like nausea or hypersensitivity reactions associated with paclitaxel therapy. Thus, we decided to address the question whether specific signalling pathways in innate immune cells, preferentially in NK cells, could still be activated even in the presence of GC. A careful investigation of the various activating NK cell receptors (i.e. NKp30, NKp44, NKp46), DNAM-1 and NKG2D) was thus performed which revealed that NKp30, NKp44 and NKG2D are all down-regulated by cortisol whereas NKp46 is actually induced by cortisol. Interestingly, NKp46 is the only known receptor that is strictly confined to NK cells. Its activation via crosslinking leads to cytokine release and activation of cytotoxic activity. Stimulation of NK cells via NKp46 may contribute to immune-mediated tumour destruction by triggering the lysis of tumour cells and by altering the cytokine pattern in the tumour microenvironment, thereby generating more favourable conditions for the recruitment of antigen-specific immune cells. Accordingly, our observation that even cortisol-treated NK cells can still be activated via NKp46 and CD2 might become valuable for the design of immunotherapies that can still be applied in the presence of endogenous or therapeutically administered glucocorticoids. N2 - Ovarialkarzinome verursachen allein in Deutschland jährlich ca. 6.000 Todesfälle. Da bei Ovarialkarzinomen, die eine Resistenz gegen eine platinbasierte Chemotherapie mit cis-Platin und gegen Paclitaxel entwickelt haben, nur eine palliative Behandlung möglich ist, gibt esbesteht ein dringenden dringender Bedarf an der Entwicklung von neuen Therapieansätzen. Das Überleben der Patientinnen ist sehr stark von immunologischen Parametern beeinflusst, und somit erscheinensodass immuntherapeutische Strategien als ein vielversprechender Ansatzerscheinen. Das Ziel der Forschung in unserer Gruppe ist daher, dem „Tumor-Immun-Escape“ durch eine Verhinderung von immunosuppressiven Mechanismen in im der Tumormikromilieu-Mikroumgebung entgegenzuwirken. In diesem Zusammenhang haben wir gefundenentdeckt, dass Tumor-infiltrierende Suppressorzellen der myeloiden Ursprungsschen Reihe (MDSC) oder Tumor-assoziierte Makrophagen (TAM), die in Ovarialkarzinomen reichlich vorhanden sind, das Enzym 11β-Hydroxysteroid-Dehydrogenase 1 (11β-HSD1) in großer Menge exprimieren. Diese Oxido-Reduktase ist essentiell bei derfür die Umwandlung von biologisch inaktiven Cortison in biologisch aktives Cortisol. In Übereinstimmung damit, werden hohe endogene Cortisol Spiegel in Seren, Azites und Tumorsekreten von Ovarialkarzinom-Patientinnen gemessen. Unter Berücksichtigung der starken anti-inflammatorischen und immunsuppressiven Eigenschaften von Cortisol, erscheint es sehr wahrscheinlich, dass ein hoher endogener Cortisol-Spiegel zum „Immune-Escape“ von Ovarialkarzinomzellen beiträgt. Unsere Vermutung ist Wir stellten daher die Hypothese auf, dass die lokale Aktivierung von endogenen Glucocorticoiden zu einer Unterdrückung der nützlichen Immunantwort in der Tumor-Mikroumgebung führt und eine erfolgreiche Immuntherapie verhindert. Um die in vivo Relevanz dieses postulierten „Immune-Escape“ Mechanismuses zu untersuchen, wurden bestrahlte PTENloxP/loxP loxP-Stop-loxP-krasG12D Mäuse mit Hämatopoetischen hämatopoietischen Stammzellen entweder aus Glucocoprticoid-Rezeptor (GR) exprimierenden Mäusen (GRloxP/loxP) oder aus Mäusen mit einem T-Zell spezifischen Glucocoprticoid-Rezeptor knock-out (lck-Cre GRloxP/loxP) rekonstituiert. In diesen Mäusen führte die Kombination von konditionellem PTEN knock-out mit einer latenten Expression von oncogenen onkogenen Kras zur Tumorentwicklung sobald ein für Cre-Rekombinase codierendes Adenovirus in die Ovarien-ovarielle Bursa injiziert wurdewird. Mit Hilfe von diesesm Modells wurde gezeigt, dass Mäuse, die mit GC-unempfindlichen T-Zellen rekonstituiert worden waren eine bessere intratumorale T-Zell Infiltration zeigten im Vergleich zu Kontroll-Mäusen, die über einen adaptiven Transfer funktionell unveränderte GRloxP/loxP Zellen erhalten hatten. Tumor-infiltrierende T-Zellen haben aber in der Mehrzahl einen hauptsächlich angenommen Foxp3+ (regulatorischen) Phänotyp angenommen, sodass und das Überleben dieser Zellen war sogar verkürzt in Mäusen mit Cortisol-unempfindlichen T-Zellen sogar eine verkürzte Überlebenszeit aufwiesen. Somit scheint endogenes Cortisol die Infiltration von Immunzellen beim Ovarialkarzinom zu inhibieren, aber eine produktive antitumorale Immunantwort könnte scheint trotzdem verhindert werden durch andere Faktoren aus im Tumormikromilieu verhindert zu werden.der Tumor-Mikroumgebung. Somit bieten unsere Daten keine ausreichend starke Begründung, für eineum das Konzept der Antagonisierung endogener,der durch Glucocorticoide ausgelösten ausgelöster Signale in Ovarialkarzinom-Patientinnen weiter zu verfolgen. Des Weiteren werden Glucocorticoide oft Krebspatienten verabreicht, um Entzündungen und Schwellungen zu reduzieren sowie Chemotherapie. bedingte Nebeneffekte wie Übelkeit oder Überempfindlichkeitsreaktionen, die mit einer Paclitaxel-Therapy einhergehen, zu verhindern. Daher wurde der Frage nachgegangen, ob spezifische Signalwege im angeborenem Immunsystem, insbesondere in NK-Zellen, auch in Anwesenheit von GC noch aktiviert werden können. Eine Untersuchung der verschiedenen NK-Zellen aktivierenden Rezeptoren (NKp30, NKp44, NKp46, DNAM-1 und NKG2D) wurde durchgeführt. Dabei wurde eine Herunterregulation von NKp30, NKp44 und NKG2D sowie eine Induktion von NKp46 durch Cortisol festgestellt. Von besonderem Interesse ist, dass NKp46 der einzige bekannte Rezeptor ist, der nur von NK-Zellen exprimiert wird. Seine Aktivierung bewirkt eine Cytokinfreisetzung Zytokinfreisetzung und eine Aktivierung Induktion der zytotoxischen AktivitätNK Zell-Antwort. Eine Stimulation der NK-Zellen über NKp46 könnte zur immun-vermittelten Tumorzerstörung durch Auslösen der Tumorzell-Lyse und durch eine Veränderung des Cytokinexpressionsmusters Zytokinexpressionsmusters in im Tumormikromilieu der Tumor-Mikroumgebung beitragen. Somit würden verbesserte Bedingungen für die Rekrutierung von antigen-spezifischen Immunzellen generiert. Unsere Beobachtung, dass selbst Cortisol behandelte NK-Zellen immer noch über NKp46 und CD2 aktiviert werden können, könnten nützlich zur Entwicklung von Immuntherapien sein, die in Gegenwart von endogenen oder therapeutisch verabreichten Glucocorticoide angewendet werden sollen. KW - Cortison KW - Eierstockkrebs KW - Cortison KW - Ovarialkarzinom KW - Endogenous Glucocorticoids KW - Ovarian Cancer Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-73901 ER - TY - JOUR A1 - Hagemann, Carsten A1 - Anacker, Jelena A1 - Ernestus, Ralf-Ingo A1 - Vince, Giles H. T1 - A complete compilation of matrix metalloproteinase expression in human malignant gliomas JF - World Journal of Clinical Oncology N2 - Glioblastomas are characterized by an aggressive local growth pattern, a marked degree of invasiveness and poor prognosis. Tumor invasiveness is facilitated by the increased activity of proteolytic enzymes which are involved in destruction of the extracellular matrix of the surrounding healthy brain tissue. Elevated levels of matrix metalloproteinases (MMPs) were found in glioblastoma (GBM) cell-lines, as well as in GBM biopsies as compared with low-grade astrocytoma (LGA) and normal brain samples, indicating a role in malignant progression. A careful review of the available literature revealed that both the expression and role of several of the 23 human MMP proteins is controversely discussed and for some there are no data available at all. We therefore screened a panel of 15 LGA and 15 GBM biopsy samples for those MMPs for which there is either no, very limited or even contradictory data available. Hence, this is the first complete compilation of the expression pattern of all 23 human MMPs in astrocytic tumors. This study will support a better understanding of the specific expression patterns and interaction of proteolytic enzymes in malignant human glioma and may provide additional starting points for targeted patient therapy. KW - glioblastoma cell-lines KW - matrix metalloproteinase KW - glioblastoma multiforme KW - astrocytic tumor KW - expression pattern Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-123982 VL - 3 IS - 5 ER - TY - JOUR A1 - Klement, Rainer A1 - Kämmerer, Ulrike T1 - Is there a role for carbohydrate restriction in the treatment and prevention of cancer? N2 - Over the last years, evidence has accumulated suggesting that by systematically reducing the amount of dietary carbohydrates (CHOs) one could suppress, or at least delay, the emergence of cancer, and that proliferation of already existing tumor cells could be slowed down. This hypothesis is supported by the association between modern chronic diseases like the metabolic syndrome and the risk of developing or dying from cancer. CHOs or glucose, to which more complex carbohydrates are ultimately digested, can have direct and indirect effects on tumor cell proliferation: first, contrary to normal cells, most malignant cells depend on steady glucose availability in the blood for their energy and biomass generating demands and are not able to metabolize significant amounts of fatty acids or ketone bodies due to mitochondrial dysfunction. Second, high insulin and insulin-like growth factor (IGF)-1 levels resulting from chronic ingestion of CHO-rich Western diet meals, can directly promote tumor cell proliferation via the insulin/IGF1 signaling pathway. Third, ketone bodies that are elevated when insulin and blood glucose levels are low, have been found to negatively affect proliferation of different malignant cells in vitro or not to be usable by tumor cells for metabolic demands, and a multitude of mouse models have shown antitumorigenic properties of very low CHO ketogenic diets. In addition, many cancer patients exhibit an altered glucose metabolism characterized by insulin resistance and may profit from an increased protein and fat intake. In this review, we address the possible beneficial effects of low CHO diets on cancer prevention and treatment. Emphasis will be placed on the role of insulin and IGF1 signaling in tumorigenesis as well as altered dietary needs of cancer patients. KW - Medizin KW - Ketogenic diet KW - cancer KW - review KW - low carbohydrate diet KW - cachexia KW - insulin KW - insulin-like growth factor 1 (IGF1) Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-69178 ER - TY - THES A1 - Pfetzer, Nadja T1 - Identifizierung und Testung spezifischer Inhibitoren des Energiestoffwechsels von Tumorzellen T1 - Identification and testing of specific inhibitors of metabolism in tumour cells N2 - Charakteristisch für viele maligne Tumorzellen ist eine erhöhte Aufnahme von Glucose und die Bildung großer Mengen Milchsäure auch in Anwesenheit von Sauerstoff (Warburg Effekt) und eine verminderte Nutzung des Zitratzyklus. Als Grund werden Defekte in der mitochondrialen Atmungskette diskutiert. Aber auch eine durch Onkogene gesteigerte Glykolyserate, könnte ursächlich sein. Ein weiterer für Tumorzellen wichtiger Stoffwechselweg, in dem Glucose abgebaut wird, ist der Pentosephosphatweg, dessen Blockade das Wachstum der Krebszellen hemmen könnte. Zudem stellt die Manipulation derjenigen Signalwege, die in den Tumorstoffwechsel involviert und in Tumorzellen überaktiviert (Ras/PI3K/Akt/mTOR- und Raf/MEK/ERK-Signalweg) oder unterdrückt (oxidative Phosphorylierung) sind, mögliche Ansatzpunkte dar. In dieser Arbeit wurde daher in vitro die Wirkung von 15 Substanzen an drei verschiedenen Tumorzelllinien und vier verschiedenen benignen Zellen untersucht, welche in die oben genannten charakteristischen Stoffwechselwege von Tumorzellen eingreifen und gegenwärtig intensiv als mögliche Tumortherapeutika diskutiert werden. Ziel war es, geeignete Kandidaten für eine zielgerichtete Therapie zu identifizieren. Der Schwerpunkt dieser Arbeit war die Beeinflussung des Glucosestoffwechsels in Tumorzellen. Da Glucose sowohl aerob als auch anaerob verstoffwechselt werden kann, wurden in einem ersten Ansatz zum einen Substanzen gestestet, die die Glykolyse auf verschiedenen Ebenen hemmen, zum anderen wurden Substanzen untersucht, die den mitochondrialen Stoffwechsel beeinflussen. Die Wirkung aller 15 Substanzen wurde zunächst jeweils als Einzelbehandlung getestet. Hierbei führten nur sehr hohe Konzentrationen in Tumorzellen zu einem drastisch verminderten ATP-Gehalt, die für benigne Zellen aber ebenfalls toxisch waren. Daher wurde in einem zweiten Schritt untersucht, ob durch die gleichzeitige Manipulation des Glucosestoffwechsels und des mitochondrialen Stoffwechsels mit jeweils subtoxischen Konzentrationen eine tumorselektive Wirkung erreicht werden kann. Bei der Kombination der Substanzen Oxythiamin/NaDCA bzw. 2-DG/Rotenon ergaben sich zwar synergistische Effekte auf die Verminderung des ATP-Gehaltes in den getesteten Tumorzellen, eine generelle tumorselektive Wirkung konnte jedoch durch die kombinierte Behandlung nicht erreicht werden. In jüngster Zeit mehren sich die Hinweise, dass die Glutaminolyse einen sehr wichtigen Stoffwechselweg für Energiegewinnung und Syntheseprozesse von Tumorzellen darstellt. Deshalb wurde in einem dritten Schritt untersucht, ob durch die Hemmung der Glutaminolyse mit der Substanz 6-Diazo-5-oxo-L-norleuzin (DON) eine tumorspezifische Wirkung erreicht werden kann. In der Tat konnte durch DON eine andeutungsweise tumorselektive Wirkung auf den ATP-Gehalt der Zellen erzielt werden, jedoch war das therapeutische Fenster sehr eng. Durch die Hemmung der oxidativen Phosphorylierung wurde in allen drei untersuchten Tumorzelllinien eine gesteigerte Milchsäureproduktion nachgewiesen. Dies ist ein eindeutiger Hinweis dafür, dass in diesen Tumorzellen die Mitochondrien keine Defekte aufweisen. Die hier untersuchten benignen und malignen Zellen wurden hinsichtlich des Glucosestoffwechsels mit verschiedenen Methoden näher charakterisiert, um zu beurteilen, ob sich die Zellen in ihrem Stoffwechselphänotyp unterscheiden. Bei der Quantifizierung der Glucoseaufnahme wurde deutlich, dass auch manche benigne Zellen deutliche Mengen an Glucose aufnehmen, welche allerdings nur der Tumorzelllinie mit der niedrigsten Aufnahme glich. Mittels immunhistochemischer Färbungen wurden charakteristische Proteine des Zuckerstoffwechsels dargestellt. Zudem wurde die Expression von zentralen Genen des Stoffwechsels auf mRNA- bzw. Proteinebene untersucht. Hierbei wurde deutlich, dass sowohl Tumorzellen als auch manche benigne Zellen für die Glykolyse typische Proteine bzw. mRNA stark exprimieren. Fazit der Charakterisierung ist, dass es zwischen den hier verwendeten malignen und benignen Zellen keine eindeutige Differenzierung aufgrund des Stoffwechselprofils gibt, sondern sich die getesteten Zellen nur graduell unterscheiden. Dieses Ergebnis erklärt möglicherweise die geringe Tumorspezifität der getesteten Substanzen. Im Vergleich mit den vielversprechenden Ergebnissen aus der Literatur zeigten die hier gewonnenen in vitro-Daten eindeutig, dass die Wirkung von potenziell tumorhemmenden Substanzen je nach Tumorzelltyp extrem verschieden war. Dies beruht darauf, dass der vorherrschende Stoffwechseltyp (oxidativ bzw. glykolytisch) für jede Tumorentität verschieden ist. Daher muss vermutlich für jede Tumorentität bzw. sogar für jeden Patienten individuell die Wirkung und der Nutzen einer Hemmung des Tumorstoffwechsels untersucht werden, bevor künftig an eine zielgerichtete Therapie gedacht werden kann. N2 - A characteristic feature of aggressive tumour cells is a high uptake of glucose and enhanced lactic acid production even in the presence of oxygen (aerobic glycolysis, “Warburg effect”) with a reduced use of the tricarboxylic acid cycle. Defects in mitochondrial function and oncogene activation are supposed to contribute to increased glycolysis, that is not subjected to the Pasteur effect (reduced rate of glycolysis in the presence of oxygen). The pentose phosphate pathway (PPP) is an important metabolic pathway in cancer cells, supplying building blocks for nucleotide synthesis and NADPH for proper redox control. Hence, inhibition of the PPP might block tumour cell growth. Perturbation of signalling pathways that are involved in tumour cell metabolism and are hyperactivated (Ras/PI3K/Akt/mTOR- and Raf/MEK/ERK-pathway) or suppressed (oxidative phosphorylation, p53) in cancer cells are possible targets for anticancer drugs. Thus, in this work the effect of 15 substances highly discussed as potential anticancer agents which influence the aforementioned metabolic and signalling pathways was evaluated in vitro on three different tumour cells lines [two breast cancer cells lines with different metastatic phenotype (MDA-MB 231 and 468) and one gastric cancer cell line (23132/87)] and four normal cell types [endometrial fibroblasts, endothelial cells (HUVEC), peripheral blood leukocytes and skin keratinocytes]. Aim of the study was to identify suitable candidates for targeted therapies. ATP-level was measured as readout to determine the efficacy of the substances, because the ATP content of cells correlates well with cell viability. The main focus of this work was to selectively modulate the glucose metabolism of cancer cells. Because glucose can be metabolized aerobically and anaerobically, we first tested substances that inhibit glycolysis at different steps and substances that interfere with mitochondrial metabolism. All of the 15 substances were tested as single treatment. Here, only very high concentrations of the respective substance significantly decreased ATP-levels in cancer cells - but to a much greater extend in normal cells. Therefore, in the next step we determined if impairing glucose and mitochondrial metabolism simultaneously with less toxic drug concentrations would be more specific in targeting cancer cells. Although synergistic effects were observed by co-treatment with oyxthiamine/NaDCA and 2-DG/rotenone respectively on reducing ATP-levels, this effect was not selective for tumour cells too. Recently, evidence is coming up that glutaminolysis (degradation of glutamine) is an important metabolic pathway for cancer cells providing energy substrates and building blocks. Thus, we examined if a tumour-specific effect could be achieved by inhibition of glutaminolysis with 6-Diazo-5-oxo-L-norleuzin (DON). Actually, other than the substances interfering with glucose metabolism, DON showed a tumour-specific effect to some extent, although the therapeutical range was very small. Inhibition of oxidative mitochondrial metabolism with the substances rotenone, oligomycin, 2,4-dinitrophenol and rhodamine 123 increased lactic acid production in all three cancer cell lines. Thus, it was possible to impede oxidative phosphorylation and to force the cells to increase glycolysis, indicating that mitochondria had no defects. To determine if tumour cells and normal cells differ in regard of their metabolic phenotype, the cells were analyzed for parameters concerning glucose metabolism with different methods. Quantifying glucose uptake of the cells revealed that some normal cells (fibroblasts, T-cells) take up significant amounts of glucose that are similar to those of cancer cells (MDA-MB 231) which showed the lowest glucose uptake among the three tumour cell lines tested. Characteristic proteins of glucose metabolism were analyzed using immunohistochemistry. Furthermore expression patterns of crucial genes involved in glucose metabolism were analyzed on mRNA and protein level. Thereby, it became obvious that both tumour cells as well as normal cells have very similar expression patterns regarding these typical genes. In conclusion, the characterization of tumour and normal cells did not show any substantial but rather gradual differences concerning the metabolic phenotype. These results might explain the marginal tumour specific effect of the drugs tested herein Compared to the promising results from the literature our in vitro data clearly show that the effect of potential anticancer drugs is extremely different for several tumour cell types. This might be due to the predominant metabolic phenotype (oxidative or glycolytic) of different tumour entities. Thus, we suppose that inhibition of tumour cell metabolism has to be evaluated for every single cancer cell type or even every cancer patient on regard of effect and benefit for implementation of selective cancer pharmacotherapy. KW - Tumorzelle KW - Glykolyse KW - Inhibitor KW - Warburgeffekt KW - Stoffwechsel KW - Tumor KW - glycolysis KW - metabolism KW - tumour KW - glucose KW - Warburg effect Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-65406 ER - TY - THES A1 - Martens, Theresa Maria Christina T1 - Lobaplatin als Agens zur Induktion von Zelltod in triple-negativen Brustkrebszelllinien T1 - Lobaplatin as an agent for the induction of cell death in triple-negative breast cancer cells N2 - Das triple-negative Mammakarzinom ist Hormonrezeptor- und HER2 negativ und mit einer ungünstigen Prognose verbunden. Triple-negative Patientinnen sind unempfindlich gegen die endokrine Therapie und den HER-2/neu Antikörper Trastuzumab und deshalb auf die zytostatische Chemotherapie angewiesen. Lobaplatin ist ein Platinderivat mit wenigen Nebenwirkungen und guter Antitumorwirkung in vitro und deshalb möglicherweise auch für die Behandlung triple-negativer Tumoren geeignet. Für die vorliegende Arbeit haben wir zwei triple-negative und eine klassische Brustkrebszelllinie verwendet. Die beiden triple-negativen Zelllinien wurden anhand einer vorbeschriebenen Mutation identifiziert, um eine Verwechslung auszuschließen. Die Aktivität des p53 Gens wurde in allen drei Zelllinien überprüft, ein aktives p53 Gen jedoch nur in der hormonrezeptor-positiven MCF7 Zelllinie nachgewiesen. Ein Zusammenhang zwischen p53 Status und Ansprechen der Zellen auf Lobaplatin oder Cisplatin konnte nicht belegt werden. Wir haben die zytotoxische Wirkung von Lobaplatin und Cisplatin verglichen. Lobaplatin war in unseren Untersuchungen ähnlich wirksam wie Cisplatin und bei der Behandlung der MCF7 Zelllinie und einer Cisplatin-resistenten Ovarialkarzinomzelllinie sogar dem Cisplatin überlegen. Lobaplatin wies in diesen Zellen keine komplette Kreuzresistenz zu Cisplatin auf. In einem nächsten Schritt wurden unterschiedliche Zytostatika mit Lobaplatin kombiniert. Additive Synergien zwischen den einzelnen Substanzen konnten nicht bewiesen werden, jedoch war ein gutes Zusammenwirken von Lobaplatin und dem in der klinischen Erprobung befindlichen Todesliganden TRAIL zu erkennen. Mittels Nachweis von Spaltprodukten haben wir gezeigt, dass Lobaplatin und Cisplatin eine Aktivierung von Caspasen bewirken. Die aktivierte Caspase 3 konnte allerdings nicht dargestellt werden. Die Begriffe Apoptose und Nekroptose wurden diskutiert und eine Beteiligung beider Prozesse an der Wirkung von Lobaplatin und Cisplatin nachgewiesen. Veränderungen des Zellzyklus wurden untersucht. Die beiden Platinderivate führten zu einem Arrest in der G2-Phase und in höheren Konzentrationen teilweise zu einem G1-Arrest. Insgesamt sind an der zytotoxischen Wirkung von Lobaplatin und Cisplatin und der Entscheidung über Leben oder Tod viele wichtige Mechanismen in wechselnder Rangfolge beteiligt. In unseren Versuchen an zwei triple-negativen und einer klassischen Brustkrebszelllinie erweist sich Lobaplatin als ebenbürtiger Nachfahre des Cisplatin mit einer vergleichbaren Zytotoxizität, weniger schwerwiegenden Nebenwirkungen und der Fähigkeit, vorhandene Cisplatinresistenzen teilweise zu umgehen. Lobaplatin verspricht darüber hinaus in Kombination mit anderen Zytostatika interessante therapeutische Perspektiven, die bisher nur unzureichend erprobt sind. N2 - In this work Lobaplatin was investigated both as a single agent and in combination with other cytostatic drugs in in-vitro models of two triple-negative breast cancer cell lines and one oestrogen receptor-positive breast cancer cell line. KW - Brustkrebs KW - Chemotherapie KW - Platin KW - Zellkultur KW - Synergie KW - Triple-negativ KW - TRAIL KW - Breast cancer KW - triple-negative KW - cell death Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-71974 ER -