TY - JOUR A1 - Zhou, Xiang A1 - Dierks, Alexander A1 - Kertels, Olivia A1 - Kircher, Malte A1 - Schirbel, Andreas A1 - Samnick, Samuel A1 - Buck, Andreas K. A1 - Knorz, Sebastian A1 - Böckle, David A1 - Scheller, Lukas A1 - Messerschmidt, Janin A1 - Barakat, Mohammad A1 - Kortüm, K. Martin A1 - Rasche, Leo A1 - Einsele, Hermann A1 - Lapa, Constantin T1 - 18F-FDG, 11C-Methionine, and 68Ga-Pentixafor PET/CT in patients with smoldering multiple myeloma: imaging pattern and clinical features JF - Cancers N2 - This study aimed to explore the correlation between imaging patterns and clinical features in patients with smoldering multiple myeloma (SMM) who simultaneously underwent 18F-FDG, 11C-Methionine, and 68Ga-Pentixafor positron emission tomography/computed tomography (PET/CT). We retrieved and analyzed clinical characteristics and PET imaging data of 10 patients with SMM. We found a significant correlation between bone marrow (BM) plasma cell (PC) infiltration and mean standardized uptake values (SUV\(_{mean}\)) of lumbar vertebrae L2-L4 on 11C-Methionine PET/CT scans (r = 0.676, p = 0.031) and 68Ga-Pentixafor PET/CT scans (r = 0.839, p = 0.002). However, there was no significant correlation between BM involvement and SUV\(_{mean}\) of lumbar vertebrae L2-L4 on 18F-FDG PET/CT scans (r = 0.558, p = 0.093). Similarly, mean target-to-background ratios (TBR\(_{mean}\)) of lumbar vertebrae L2-L4 also correlated with bone marrow plasma cell (BMPC) infiltration in 11C-Methionine PET/CT (r = 0.789, p = 0.007) and 68Ga-Pentixafor PET/CT (r = 0.724, p = 0.018) PET/CT. In contrast, we did not observe a significant correlation between BMPC infiltration rate and TBR\(_{mean}\) in 18F-FDG PET/CT (r = 0.355, p = 0.313). Additionally, on 11C-Methionine PET/CT scans, we found a significant correlation between BMPC infiltration and TBR\(_{max}\) of lumbar vertebrae L2-L4 (r = 0.642, p = 0.045). In conclusion, 11C-Methionine and 68Ga-Pentixafor PET/CT demonstrate higher sensitivity than 18F-FDG PET/CT in detecting BM involvement in SMM. KW - 18F-FDG PET/CT KW - 11C-Methionine PET/CT KW - 68Ga-Pentixafor PET/CT KW - smoldering myeloma Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-211240 SN - 2072-6694 VL - 12 IS - 8 ER - TY - JOUR A1 - Lückerath, Katharina A1 - Lapa, Constantin A1 - Malzahn, Uwe A1 - Samnick, Samuel A1 - Einsele, Herrmann A1 - Buck, Andreas K. A1 - Herrmann, Ken A1 - Knop, Stefan T1 - 18FDG-PET/CT for prognostic stratification of patients with multiple myeloma relapse after stem cell transplantation N2 - The aim of this study was to investigate the prognostic value of 18F-fluoro-deoxyglucose positron emission tomography–computed tomography (18F-FDG-PET/CT) in 37 patients with a history of multiple myeloma (MM) and suspected or confirmed recurrence after stem cell transplantation (SCT). All patients had been heavily pre-treated. Time to progression (TTP) and overall survival (OS) were correlated to a number of different PET-derived as well as clinical parameters. Impact on patient management was assessed. Absence of FDG-avid MM foci was a positive prognostic factor for both TTP and OS (p<0.01). Presence of >10 focal lesions correlated with both TTP (p<0.01) and OS (p<0.05). Interestingly, presence of >10 lesions in the appendicular skeleton proved to have the strongest association with disease progression. Intensity of glucose uptake and presence of extramedullary disease were associated with shorter TTP (p=0.037 and p=0.049, respectively). Manifestations in soft tissue structures turned out to be a strong negative predictor for both, TTP and OS (p<0.01, respectively). PET resulted in a change of management in 30% of patients. Our data underline the prognostic value of 18F-FDG-PET/CT in MM patients also in the setting of post-SCT relapse. PET/CT has a significant impact on patient management. KW - 18FDG-PET/CT KW - Multiple myeloma KW - molecular imaging KW - FDG-PET/CT Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-113107 ER - TY - JOUR A1 - Lapa, Constantin A1 - Schreder, Martin A1 - Schirbel, Andreas A1 - Samnick, Samuel A1 - Kortüm, Klaus Martin A1 - Herrmann, Ken A1 - Kropf, Saskia A1 - Einsele, Herrmann A1 - Buck, Andreas K. A1 - Wester, Hans-Jürgen A1 - Knop, Stefan A1 - Lückerath, Katharina T1 - [\(^{68}\)Ga]Pentixafor-PET/CT for imaging of chemokine receptor CXCR4 expression in multiple myeloma - comparison to [\(^{18}\)F]FDG and laboratory values JF - Theranostics N2 - Chemokine (C-X-C motif) receptor 4 (CXCR4) is a key factor for tumor growth and metastasis in several types of human cancer including multiple myeloma (MM). Proof-of-concept of CXCR4-directed radionuclide therapy in MM has recently been reported. This study assessed the diagnostic performance of the CXCR4-directed radiotracer [\(^{68}\)Ga]Pentixafor in MM and a potential role for stratifying patients to CXCR4-directed therapies. Thirty-five patients with MM underwent [\(^{68}\)Ga]Pentixafor-PET/CT for evaluation of eligibility for endoradiotherapy. In 19/35 cases, [\(^{18}\)F]FDG-PET/CT for correlation was available. Scans were compared on a patient and on a lesion basis. Tracer uptake was correlated with standard clinical parameters of disease activity. [\(^{68}\)Ga]Pentixafor-PET detected CXCR4-positive disease in 23/35 subjects (66%). CXCR4-positivity at PET was independent from myeloma subtypes, cytogenetics or any serological parameters and turned out as a negative prognostic factor. In the 19 patients in whom a comparison to [\(^{18}\)F]FDG was available, [\(^{68}\)Ga]Pentixafor-PET detected more lesions in 4/19 (21%) subjects, [\(^{18}\)F]FDG proved superior in 7/19 (37%). In the remaining 8/19 (42%) patients, both tracers detected an equal number of lesions. [\(^{18}\)F]FDG-PET positivity correlated with [\(^{68}\)Ga]Pentixafor-PET positivity (p=0.018). [\(^{68}\)Ga]Pentixafor-PET provides further evidence that CXCR4 expression frequently occurs in advanced multiple myeloma, representing a negative prognostic factor and a potential target for myeloma specific treatment. However, selecting patients for CXCR4 directed therapies and prognostic stratification seem to be more relevant clinical applications for this novel imaging modality, rather than diagnostic imaging of myeloma. KW - medicine KW - multiple myeloma KW - FDG KW - molecular imaging KW - CXCR4 KW - PET KW - radionuclide therapy KW - theranostics Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-172106 VL - 7 IS - 1 ER - TY - JOUR A1 - Lapa, Constantin A1 - Garcia-Velloso, Maria J. A1 - Lückerath, Katharina A1 - Samnick, Samuel A1 - Schreder, Martin A1 - Otero, Paula Rodriguez A1 - Schmid, Jan-Stefan A1 - Herrmann, Ken A1 - Knop, Stefan A1 - Buck, Andreas K. A1 - Einsele, Hermann A1 - San-Miguel, Jesus A1 - Kortüm, Klaus Martin T1 - \(^{11}\)C-methionine-PET in multiple myeloma: a combined study from two different institutions JF - Theranostics N2 - \(^{11}\)C-methionine (MET) has recently emerged as an accurate marker of tumor burden and disease activity in patients with multiple myeloma (MM). This dual-center study aimed at further corroboration of the superiority of MET as positron emission tomography (PET) tracer for staging and re-staging MM, as compared to \(^{18}\)F-2`-deoxy-2`-fluoro-D-glucose (FDG). 78 patients with a history of solitary plasmacytoma (n=4), smoldering MM (SMM, n=5), and symptomatic MM (n=69) underwent both MET- and FDG-PET/computed tomography (CT) at the University Centers of Würzburg, Germany and Navarra, Spain. Scans were compared on a patient and on a lesion basis. Inter-reader agreement was also evaluated. In 2 patients, tumor biopsies for verification of discordant imaging results were available. MET-PET detected focal lesions (FL) in 59/78 subjects (75.6%), whereas FDG-PET/CT showed lesions in only 47 patients (60.3%; p<0.01), accordingly disease activity would have been missed in 12 patients. Directed biopsies of discordant results confirmed MET-PET/CT results in both cases. MET depicted more FL in 44 patients (56.4%; p<0.01), whereas in two patients (2/78), FDG proved superior. In the remainder (41.0%, 32/78), both tracers yielded comparable results. Inter-reader agreement for MET was higher than for FDG (κ = 0.82 vs κ = 0.72). This study demonstrates higher sensitivity of MET in comparison to standard FDG to detect intra- and extramedullary MM including histologic evidence of FDG-negative, viable disease exclusively detectable by MET-PET/CT. MET holds the potential to replace FDG as functional imaging standard for staging and re-staging of MM. KW - medicine KW - PET/CT KW - \(^{11}\)C-methionine KW - multiple myeloma KW - FDG Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-172038 VL - 7 IS - 11 ER - TY - JOUR A1 - Morales-Lozano, Maria I. A1 - Viering, Oliver A1 - Samnick, Samuel A1 - Rodriguez-Otero, Paula A1 - Buck, Andreas K. A1 - Marcos-Jubilar, Maria A1 - Rasche, Leo A1 - Prieto, Elena A1 - Kortüm, K. Martin A1 - San-Miguel, Jesus A1 - Garcia-Velloso, Maria J. A1 - Lapa, Constantin T1 - \(^{18}\)F-FDG and \(^{11}\)C-methionine PET/CT in newly diagnosed multiple myeloma patients: comparison of volume-based PET biomarkers JF - Cancers N2 - \(^{11}\)C-methionine (\(^{11}\)C-MET) is a new positron emission tomography (PET) tracer for the assessment of disease activity in multiple myeloma (MM) patients, with preliminary data suggesting higher sensitivity and specificity than \(^{18}\)F-fluorodeoxyglucose (\(^{18}\)F-FDG). However, the value of tumor burden biomarkers has yet to be investigated. Our goals were to corroborate the superiority of \(^{11}\)C-MET for MM staging and to compare its suitability for the assessment of metabolic tumor burden biomarkers in comparison to \(^{18}\)F-FDG. Twenty-two patients with newly diagnosed, treatment-naïve symptomatic MM who had undergone \(^{11}\)C-MET and \(^{18}\)F-FDG PET/CT were evaluated. Standardized uptake values (SUV) were determined and compared with total metabolic tumor volume (TMTV) for both tracers: total lesion glycolysis (TLG) and total lesion \(^{11}\)C-MET uptake (TLMU). PET-derived values were compared to Revised International Staging System (R-ISS), cytogenetic, and serologic MM markers such as M component, beta 2 microglobulin (B2M), serum free light chains (FLC), albumin, and lactate dehydrogenase (LDH). In 11 patients (50%), \(^{11}\)C-MET detected more focal lesions (FL) than FDG (p < 0.01). SUVmax, SUVmean, SUVpeak, TMTV, and TLMU were also significantly higher in \(^{11}\)C-MET than in \(^{18}\)F-FDG (p < 0.05, respectively). \(^{11}\)C-MET PET biomarkers had a better correlation with tumor burden (bone marrow plasma cell infiltration, M component; p < 0.05 versus p = n.s. respectively). This pilot study suggests that \(^{11}\)C-MET PET/CT is a more sensitive marker for the assessment of myeloma tumor burden than \(^{18}\)F-FDG. Its implications for prognosis evaluation need further investigation. KW - multiple myeloma KW - methionine KW - total lesion glycolysis (TLG) KW - metabolic tumor volume (MTV) KW - total lesion methionine uptake (TLMU) Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-203686 SN - 2072-6694 VL - 12 IS - 4 ER - TY - JOUR A1 - White, P. Lewis A1 - Springer, Jan A1 - Wise, Matt P. A1 - Einsele, Hermann A1 - Löffler, Claudia A1 - Seif, Michelle A1 - Prommersberger, Sabrina A1 - Backx, Matthijs A1 - Löffler, Jürgen T1 - A clinical case of COVID-19-associated pulmonary aspergillosis (CAPA), illustrating the challenges in diagnosis (despite overwhelming mycological evidence) JF - Journal of Fungi N2 - The COVID-19 pandemic has resulted in large numbers of patients requiring critical care management. With the established association between severe respiratory virus infection and invasive pulmonary aspergillosis (7.6% for COVID-19-associated pulmonary aspergillosis (CAPA)), the pandemic places a significant number of patients at potential risk from secondary invasive fungal disease. We described a case of CAPA with substantial supporting mycological evidence, highlighting the need to employ strategic diagnostic algorithms and weighted definitions to improve the accuracy in diagnosing CAPA. KW - COVID-19 KW - CAPA KW - diagnostics KW - Aspergillus Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-302438 SN - 2309-608X VL - 8 IS - 1 ER - TY - JOUR A1 - Sander, Bodo A1 - Xu, Wenshan A1 - Eilers, Martin A1 - Popov, Nikita A1 - Lorenz, Sonja T1 - A conformational switch regulates the ubiquitin ligase HUWE1 JF - eLife N2 - The human ubiquitin ligase HUWE1 has key roles in tumorigenesis, yet it is unkown how its activity is regulated. We present the crystal structure of a C-terminal part of HUWE1, including the catalytic domain, and reveal an asymmetric auto-inhibited dimer. We show that HUWE1 dimerizes in solution and self-associates in cells, and that both occurs through the crystallographic dimer interface. We demonstrate that HUWE1 is inhibited in cells and that it can be activated by disruption of the dimer interface. We identify a conserved segment in HUWE1 that counteracts dimer formation by associating with the dimerization region intramolecularly. Our studies reveal, intriguingly, that the tumor suppressor p14ARF binds to this segment and may thus shift the conformational equilibrium of HUWE1 toward the inactive state. We propose a model, in which the activity of HUWE1 underlies conformational control in response to physiological cues—a mechanism that may be exploited for cancer therapy. KW - Medicine KW - Structural Biology KW - Molecular Biophysics KW - HUWE1 KW - HECT Ligase KW - Ubiquitin KW - P14ARF KW - X-Ray Chrystallography KW - Enzyme Regulation Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-171862 VL - 6 ER - TY - JOUR A1 - Bäuerlein, Carina A. A1 - Riedel, Simone S. A1 - Baker, Jeanette A1 - Brede, Christian A1 - Jordán Garrote, Ana-Laura A1 - Chopra, Martin A1 - Ritz, Miriam A1 - Beilhack, Georg F. A1 - Schulz, Stephan A1 - Zeiser, Robert A1 - Schlegel, Paul G. A1 - Einsele, Hermann A1 - Negrin, Robert S. A1 - Beilhack, Andreas T1 - A diagnostic window for the treatment of acute graft-versus-host disease prior to visible clinical symptoms in a murine model JF - BMC Medicine N2 - Background Acute graft-versus-host disease (aGVHD) poses a major limitation for broader therapeutic application of allogeneic hematopoietic cell transplantation (allo-HCT). Early diagnosis of aGVHD remains difficult and is based on clinical symptoms and histopathological evaluation of tissue biopsies. Thus, current aGVHD diagnosis is limited to patients with established disease manifestation. Therefore, for improved disease prevention it is important to develop predictive assays to identify patients at risk of developing aGVHD. Here we address whether insights into the timing of the aGVHD initiation and effector phases could allow for the detection of migrating alloreactive T cells before clinical aGVHD onset to permit for efficient therapeutic intervention. Methods Murine major histocompatibility complex (MHC) mismatched and minor histocompatibility antigen (miHAg) mismatched allo-HCT models were employed to assess the spatiotemporal distribution of donor T cells with flow cytometry and in vivo bioluminescence imaging (BLI). Daily flow cytometry analysis of peripheral blood mononuclear cells allowed us to identify migrating alloreactive T cells based on homing receptor expression profiles. Results We identified a time period of 2 weeks of massive alloreactive donor T cell migration in the blood after miHAg mismatch allo-HCT before clinical aGVHD symptoms appeared. Alloreactive T cells upregulated α4β7 integrin and P-selectin ligand during this migration phase. Consequently, targeted preemptive treatment with rapamycin, starting at the earliest detection time of alloreactive donor T cells in the peripheral blood, prevented lethal aGVHD. Conclusions Based on this data we propose a critical time frame prior to the onset of aGVHD symptoms to identify alloreactive T cells in the peripheral blood for timely and effective therapeutic intervention. KW - Allogeneic stem cell transplantation KW - Graft-versus-host disease KW - Minor histocompatibility antigen mismatch transplantation Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96797 UR - http://www.biomedcentral.com/1741-7015/11/134 ER - TY - JOUR A1 - Karunakaran, Mohindar M. A1 - Subramanian, Hariharan A1 - Jin, Yiming A1 - Mohammed, Fiyaz A1 - Kimmel, Brigitte A1 - Juraske, Claudia A1 - Starick, Lisa A1 - Nöhren, Anna A1 - Länder, Nora A1 - Willcox, Carrie R. A1 - Singh, Rohit A1 - Schamel, Wolfgang W. A1 - Nikolaev, Viacheslav O. A1 - Kunzmann, Volker A1 - Wiemer, Andrew J. A1 - Willcox, Benjamin E. A1 - Herrmann, Thomas T1 - A distinct topology of BTN3A IgV and B30.2 domains controlled by juxtamembrane regions favors optimal human γδ T cell phosphoantigen sensing JF - Nature Communications N2 - Butyrophilin (BTN)–3A and BTN2A1 molecules control the activation of human Vγ9Vδ2 T cells during T cell receptor (TCR)-mediated sensing of phosphoantigens (PAg) derived from microbes and tumors. However, the molecular rules governing PAg sensing remain largely unknown. Here, we establish three mechanistic principles of PAg-mediated γδ T cell activation. First, in humans, following PAg binding to the intracellular BTN3A1-B30.2 domain, Vγ9Vδ2 TCR triggering involves the extracellular V-domain of BTN3A2/BTN3A3. Moreover, the localization of both protein domains on different chains of the BTN3A homo-or heteromers is essential for efficient PAg-mediated activation. Second, the formation of BTN3A homo-or heteromers, which differ in intracellular trafficking and conformation, is controlled by molecular interactions between the juxtamembrane regions of the BTN3A chains. Finally, the ability of PAg not simply to bind BTN3A-B30.2, but to promote its subsequent interaction with the BTN2A1-B30.2 domain, is essential for T-cell activation. Defining these determinants of cooperation and the division of labor in BTN proteins improves our understanding of PAg sensing and elucidates a mode of action that may apply to other BTN family members. KW - gammadelta T cells KW - immunosurveillance Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-358179 VL - 14 ER - TY - JOUR A1 - Groeber, Florian A1 - Engelhardt, Lisa A1 - Lange, Julia A1 - Kurdyn, Szymon A1 - Schmid, Freia F. A1 - Rücker, Christoph A1 - Mielke, Stephan A1 - Walles, Heike A1 - Hansmann, Jan T1 - A First Vascularized Skin Equivalent as an Alternative to Animal Experimentation JF - ALTEX - Alternatives to Animal Experimentation N2 - Tissue-engineered skin equivalents mimic key aspects of the human skin, and can thus be employed as wound coverage for large skin defects or as in vitro test systems as an alternative to animal models. However, current skin equivalents lack a functional vasculature limiting clinical and research applications. This study demonstrates the generation of a vascularized skin equivalent with a perfused vascular network by combining a biological vascularized scaffold (BioVaSc) based on a decellularized segment of a porcine jejunum and a tailored bioreactor system. Briefly, the BioVaSc was seeded with human fibroblasts, keratinocytes, and human microvascular endothelial cells. After 14 days at the air-liquid interface, hematoxylin & eosin and immunohistological staining revealed a specific histological architecture representative of the human dermis and epidermis including a papillary-like architecture at the dermal-epidermal-junction. The formation of the skin barrier was measured non-destructively using impedance spectroscopy. Additionally, endothelial cells lined the walls of the formed vessels that could be perfused with a physiological volume flow. Due to the presence of a complex in-vivo-like vasculature, the here shown skin equivalent has the potential for skin grafting and represents a sophisticated in vitro model for dermatological research. KW - alternative to animal testing KW - skin equivalents KW - tissue engineering KW - vascularization Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-164438 VL - 33 IS - 4 ER - TY - JOUR A1 - Hofgaard, Peter O. A1 - Jodal, Henriette C. A1 - Bommert, Kurt A1 - Huard, Bertrand A1 - Caers, Jo A1 - Carlsen, Harald A1 - Schwarzer, Rolf A1 - Schünemann, Nicole A1 - Jundt, Franziska A1 - Lindeberg, Mona M. A1 - Bogen, Bjarne T1 - A Novel Mouse Model for Multiple Myeloma (MOPC315.BM) That Allows Noninvasive Spatiotemporal Detection of Osteolytic Disease JF - PLoS One N2 - Multiple myeloma (MM) is a lethal human cancer characterized by a clonal expansion of malignant plasma cells in bone marrow. Mouse models of human MM are technically challenging and do not always recapitulate human disease. Therefore, new mouse models for MM are needed. Mineral-oil induced plasmacytomas (MOPC) develop in the peritoneal cavity of oil-injected BALB/c mice. However, MOPC typically grow extramedullary and are considered poor models of human MM. Here we describe an in vivo-selected MOPC315 variant, called MOPC315.BM, which can be maintained in vitro. When injected i.v. into BALB/c mice, MOPC315.BM cells exhibit tropism for bone marrow. As few as 10\(^4\) MOPC315.BM cells injected i.v. induced paraplegia, a sign of spinal cord compression, in all mice within 3-4 weeks. MOPC315.BM cells were stably transfected with either firefly luciferase (MOPC315.BM.Luc) or DsRed (MOPC315.BM.DsRed) for studies using noninvasive imaging. MOPC315.BM.Luc cells were detected in the tibiofemoral region already 1 hour after i.v. injection. Bone foci developed progressively, and as of day 5, MM cells were detected in multiple sites in the axial skeleton. Additionally, the spleen (a hematopoietic organ in the mouse) was invariably affected. Luminescent signals correlated with serum myeloma protein concentration, allowing for easy tracking of tumor load with noninvasive imaging. Affected mice developed osteolytic lesions. The MOPC315.BM model employs a common strain of immunocompetent mice (BALB/c) and replicates many characteristics of human MM. The model should be suitable for studies of bone marrow tropism, development of osteolytic lesions, drug testing, and immunotherapy in MM. KW - resistance KW - CD4(+) T-cells KW - tumor specific antigen KW - plasma cells KW - B cell KW - C57BL/KALWRIJ mouse KW - bone disease KW - scid mice KW - idiotype KW - differentiation Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-131117 VL - 7 IS - 12 ER - TY - JOUR A1 - Gerner, Bettina A1 - Aghai-Trommeschlaeger, Fatemeh A1 - Kraus, Sabrina A1 - Grigoleit, Götz Ulrich A1 - Zimmermann, Sebastian A1 - Kurlbaum, Max A1 - Klinker, Hartwig A1 - Isberner, Nora A1 - Scherf-Clavel, Oliver T1 - A physiologically-based pharmacokinetic model of ruxolitinib and posaconazole to predict CYP3A4-mediated drug–drug interaction frequently observed in graft versus host disease patients JF - Pharmaceutics N2 - Ruxolitinib (RUX) is approved for the treatment of steroid-refractory acute and chronic graft versus host disease (GvHD). It is predominantly metabolized via cytochrome P450 (CYP) 3A4. As patients with GvHD have an increased risk of invasive fungal infections, RUX is frequently combined with posaconazole (POS), a strong CYP3A4 inhibitor. Knowledge of RUX exposure under concomitant POS treatment is scarce and recommendations on dose modifications are inconsistent. A physiologically based pharmacokinetic (PBPK) model was developed to investigate the drug–drug interaction (DDI) between POS and RUX. The predicted RUX exposure was compared to observed concentrations in patients with GvHD in the clinical routine. PBPK models for RUX and POS were independently set up using PK-Sim\(^®\) Version 11. Plasma concentration-time profiles were described successfully and all predicted area under the curve (AUC) values were within 2-fold of the observed values. The increase in RUX exposure was predicted with a DDI ratio of 1.21 (C\(_{max}\)) and 1.59 (AUC). Standard dosing in patients with GvHD led to higher RUX exposure than expected, suggesting further dose reduction if combined with POS. The developed model can serve as a starting point for further simulations of the implemented DDI and can be extended to further perpetrators of CYP-mediated PK-DDIs or disease-specific physiological changes. KW - physiologically based pharmacokinetic (PBPK) modeling KW - ruxolitinib KW - posaconazole KW - drug–drug interactions (DDIs) KW - graft versus host disease KW - cytochrome P450 3A4 (CYP3A4) KW - pharmacokinetics Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-297261 SN - 1999-4923 VL - 14 IS - 12 ER - TY - JOUR A1 - Krenzer, Adrian A1 - Banck, Michael A1 - Makowski, Kevin A1 - Hekalo, Amar A1 - Fitting, Daniel A1 - Troya, Joel A1 - Sudarevic, Boban A1 - Zoller, Wolfgang G. A1 - Hann, Alexander A1 - Puppe, Frank T1 - A real-time polyp-detection system with clinical application in colonoscopy using deep convolutional neural networks JF - Journal of Imaging N2 - Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. The best method to prevent CRC is with a colonoscopy. During this procedure, the gastroenterologist searches for polyps. However, there is a potential risk of polyps being missed by the gastroenterologist. Automated detection of polyps helps to assist the gastroenterologist during a colonoscopy. There are already publications examining the problem of polyp detection in the literature. Nevertheless, most of these systems are only used in the research context and are not implemented for clinical application. Therefore, we introduce the first fully open-source automated polyp-detection system scoring best on current benchmark data and implementing it ready for clinical application. To create the polyp-detection system (ENDOMIND-Advanced), we combined our own collected data from different hospitals and practices in Germany with open-source datasets to create a dataset with over 500,000 annotated images. ENDOMIND-Advanced leverages a post-processing technique based on video detection to work in real-time with a stream of images. It is integrated into a prototype ready for application in clinical interventions. We achieve better performance compared to the best system in the literature and score a F1-score of 90.24% on the open-source CVC-VideoClinicDB benchmark. KW - machine learning KW - deep learning KW - endoscopy KW - gastroenterology KW - automation KW - object detection KW - video object detection KW - real-time Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304454 SN - 2313-433X VL - 9 IS - 2 ER - TY - JOUR A1 - Bäuerlein, Carina A. A1 - Qureischi, Musga A1 - Mokhtari, Zeinab A1 - Tabares, Paula A1 - Brede, Christian A1 - Jordán Garrote, Ana-Laura A1 - Riedel, Simone S. A1 - Chopra, Martin A1 - Reu, Simone A1 - Mottok, Anja A1 - Arellano-Viera, Estibaliz A1 - Graf, Carolin A1 - Kurzwart, Miriam A1 - Schmiedgen, Katharina A1 - Einsele, Hermann A1 - Wölfl, Matthias A1 - Schlegel, Paul-Gerhardt A1 - Beilhack, Andreas T1 - A T-Cell Surface Marker Panel Predicts Murine Acute Graft-Versus-Host Disease JF - Frontiers in Immunology N2 - Acute graft-versus-host disease (aGvHD) is a severe and often life-threatening complication of allogeneic hematopoietic cell transplantation (allo-HCT). AGvHD is mediated by alloreactive donor T-cells targeting predominantly the gastrointestinal tract, liver, and skin. Recent work in mice and patients undergoing allo-HCT showed that alloreactive T-cells can be identified by the expression of α4β7 integrin on T-cells even before manifestation of an aGvHD. Here, we investigated whether the detection of a combination of the expression of T-cell surface markers on peripheral blood (PB) CD8\(^+\) T-cells would improve the ability to predict aGvHD. To this end, we employed two independent preclinical models of minor histocompatibility antigen mismatched allo-HCT following myeloablative conditioning. Expression profiles of integrins, selectins, chemokine receptors, and activation markers of PB donor T-cells were measured with multiparameter flow cytometry at multiple time points before the onset of clinical aGvHD symptoms. In both allo-HCT models, we demonstrated a significant upregulation of α4β7 integrin, CD162E, CD162P, and conversely, a downregulation of CD62L on donor T-cells, which could be correlated with the development of aGvHD. Other surface markers, such as CD25, CD69, and CC-chemokine receptors were not found to be predictive markers. Based on these preclinical data from mouse models, we propose a surface marker panel on peripheral blood T-cells after allo-HCT combining α4β7 integrin with CD62L, CD162E, and CD162P (cutaneous lymphocyte antigens, CLA, in humans) to identify patients at risk for developing aGvHD early after allo-HCT. KW - acute graft-versus-host disease KW - alloreactive T cells KW - transplantation KW - prediction KW - mouse models Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-224290 SN - 1664-3224 VL - 11 ER - TY - JOUR A1 - Fischer, Roman A1 - Maier, Olaf A1 - Siegemund, Martin A1 - Wajant, Harald A1 - Scheurich, Peter A1 - Pfizenmaier, Klaus T1 - A TNF Receptor 2 Selective Agonist Rescues Human Neurons from Oxidative Stress-Induced Cell Death JF - PLoS ONE N2 - Tumor necrosis factor (TNF) plays a dual role in neurodegenerative diseases. Whereas TNF receptor (TNFR) 1 is predominantly associated with neurodegeneration, TNFR2 is involved in tissue regeneration and neuroprotection. Accordingly, the availability of TNFR2-selective agonists could allow the development of new therapeutic treatments of neurodegenerative diseases. We constructed a soluble, human TNFR2 agonist (TNC-scTNF(R2)) by genetic fusion of the trimerization domain of tenascin C to a TNFR2-selective single-chain TNF molecule, which is comprised of three TNF domains connected by short peptide linkers. TNC-scTNFR2 specifically activated TNFR2 and possessed membrane-TNF mimetic activity, resulting in TNFR2 signaling complex formation and activation of downstream signaling pathways. Protection from neurodegeneration was assessed using the human dopaminergic neuronal cell line LUHMES. First we show that TNC-scTNF(R2) interfered with cell death pathways subsequent to H(2)O(2) exposure. Protection from cell death was dependent on TNFR2 activation of the PI3K-PKB/Akt pathway, evident from restoration of H(2)O(2) sensitivity in the presence of PI3K inhibitor LY294002. Second, in an in vitro model of Parkinson disease, TNC-scTNFR(2) rescues neurons after induction of cell death by 6-OHDA. Since TNFR2 is not only promoting anti-apoptotic responses but also plays an important role in tissue regeneration, activation of TNFR2 signaling by TNC-scTNF(R2) appears a promising strategy to ameliorate neurodegenerative processes. KW - Tumor-necrosis-factor KW - Glutamate-induced excitotoxicity KW - Single-chain TNF KW - Kappa-B pathway KW - Parkinsons-disease KW - Signaling complex KW - Activation KW - Apoptosis KW - Dopamine KW - Ligand Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-133552 VL - 6 IS - 11 ER - TY - JOUR A1 - Vargas, Juan Gamboa A1 - Wagner, Jennifer A1 - Shaikh, Haroon A1 - Lang, Isabell A1 - Medler, Juliane A1 - Anany, Mohamed A1 - Steinfatt, Tim A1 - Mosca, Josefina Peña A1 - Haack, Stephanie A1 - Dahlhoff, Julia A1 - Büttner-Herold, Maike A1 - Graf, Carolin A1 - Viera, Estibaliz Arellano A1 - Einsele, Hermann A1 - Wajant, Harald A1 - Beilhack, Andreas T1 - A TNFR2-Specific TNF fusion protein with improved in vivo activity JF - Frontiers in Immunology N2 - Tumor necrosis factor (TNF) receptor-2 (TNFR2) has attracted considerable interest as a target for immunotherapy. Indeed, using oligomeric fusion proteins of single chain-encoded TNFR2-specific TNF mutants (scTNF80), expansion of regulatory T cells and therapeutic activity could be demonstrated in various autoinflammatory diseases, including graft-versus-host disease (GvHD), experimental autoimmune encephalomyelitis (EAE) and collagen-induced arthritis (CIA). With the aim to improve the in vivo availability of TNFR2-specific TNF fusion proteins, we used here the neonatal Fc receptor (FcRn)-interacting IgG1 molecule as an oligomerizing building block and generated a new TNFR2 agonist with improved serum retention and superior in vivo activity. Methods Single-chain encoded murine TNF80 trimers (sc(mu)TNF80) were fused to the C-terminus of an in mice irrelevant IgG1 molecule carrying the N297A mutation which avoids/minimizes interaction with Fcγ-receptors (FcγRs). The fusion protein obtained (irrIgG1(N297A)-sc(mu)TNF80), termed NewSTAR2 (New selective TNF-based agonist of TNF receptor 2), was analyzed with respect to activity, productivity, serum retention and in vitro and in vivo activity. STAR2 (TNC-sc(mu)TNF80 or selective TNF-based agonist of TNF receptor 2), a well-established highly active nonameric TNFR2-specific variant, served as benchmark. NewSTAR2 was assessed in various in vitro and in vivo systems. Results STAR2 (TNC-sc(mu)TNF80) and NewSTAR2 (irrIgG1(N297A)-sc(mu)TNF80) revealed comparable in vitro activity. The novel domain architecture of NewSTAR2 significantly improved serum retention compared to STAR2, which correlated with efficient binding to FcRn. A single injection of NewSTAR2 enhanced regulatory T cell (Treg) suppressive activity and increased Treg numbers by > 300% in vivo 5 days after treatment. Treg numbers remained as high as 200% for about 10 days. Furthermore, a single in vivo treatment with NewSTAR2 upregulated the adenosine-regulating ectoenzyme CD39 and other activation markers on Tregs. TNFR2-stimulated Tregs proved to be more suppressive than unstimulated Tregs, reducing conventional T cell (Tcon) proliferation and expression of activation markers in vitro. Finally, singular preemptive NewSTAR2 administration five days before allogeneic hematopoietic cell transplantation (allo-HCT) protected mice from acute GvHD. Conclusions NewSTAR2 represents a next generation ligand-based TNFR2 agonist, which is efficiently produced, exhibits improved pharmacokinetic properties and high serum retention with superior in vivo activity exerting powerful protective effects against acute GvHD. KW - agonist KW - GvHD KW - regulatory T cells KW - serum retention KW - TNF KW - TNFR2 Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-277436 SN - 1664-3224 VL - 13 ER - TY - JOUR A1 - Garitano-Trojaola, Andoni A1 - Sancho, Ana A1 - Götz, Ralph A1 - Eiring, Patrick A1 - Walz, Susanne A1 - Jetani, Hardikkumar A1 - Gil-Pulido, Jesus A1 - Da Via, Matteo Claudio A1 - Teufel, Eva A1 - Rhodes, Nadine A1 - Haertle, Larissa A1 - Arellano-Viera, Estibaliz A1 - Tibes, Raoul A1 - Rosenwald, Andreas A1 - Rasche, Leo A1 - Hudecek, Michael A1 - Sauer, Markus A1 - Groll, Jürgen A1 - Einsele, Hermann A1 - Kraus, Sabrina A1 - Kortüm, Martin K. T1 - Actin cytoskeleton deregulation confers midostaurin resistance in FLT3-mutant acute myeloid leukemia JF - Communications Biology N2 - The presence of FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) is one of the most frequent mutations in acute myeloid leukemia (AML) and is associated with an unfavorable prognosis. FLT3 inhibitors, such as midostaurin, are used clinically but fail to entirely eradicate FLT3-ITD+AML. This study introduces a new perspective and highlights the impact of RAC1-dependent actin cytoskeleton remodeling on resistance to midostaurin in AML. RAC1 hyperactivation leads resistance via hyperphosphorylation of the positive regulator of actin polymerization N-WASP and antiapoptotic BCL-2. RAC1/N-WASP, through ARP2/3 complex activation, increases the number of actin filaments, cell stiffness and adhesion forces to mesenchymal stromal cells (MSCs) being identified as a biomarker of resistance. Midostaurin resistance can be overcome by a combination of midostaruin, the BCL-2 inhibitor venetoclax and the RAC1 inhibitor Eht1864 in midostaurin-resistant AML cell lines and primary samples, providing the first evidence of a potential new treatment approach to eradicate FLT3-ITD+AML. Garitano-Trojaola et al. used a combination of human acute myeloid leukemia (AML) cell lines and primary samples to show that RAC1-dependent actin cytoskeleton remodeling through BCL2 family plays a key role in resistance to the FLT3 inhibitor, Midostaurin in AML. They showed that by targeting RAC1 and BCL2, Midostaurin resistance was diminished, which potentially paves the way for an innovate treatment approach for FLT3 mutant AML. KW - actin KW - acute myeloid leukaemia Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260709 VL - 4 IS - 1 ER - TY - THES A1 - Steimer, Ann-Kathrin T1 - Adhärenz bei oraler Capecitabin-Therapie - Zusammenhänge mit Angststörungen T1 - Adherence to oral capecitabine therapy - Relation to anxiety disorders N2 - Laut Schätzungen des Robert Koch-Instituts erkranken jährlich fast 500.000 Personen an einer Krebserkrankung, mit steigender Tendenz. Durch stetige Fortschritte in der Forschung kam es durch die Entwicklung einer Chemotherapie in Tablettenform zu einem Paradigmenwechsel in der Krebstherapie. Für ein optimales Therapie-Outcome ist es von großer Bedeutung, dass die Patienten ein adhärentes Verhalten zeigen. Weiterhin zeigt sich in der bisherigen Literatur, dass psychische Komorbiditäten die Adhärenz und damit den Behandlungserfolg gleichermaßen beeinflussen können. Dies wurde in der vorliegenden Arbeit evaluiert. Die Studie umfasste insgesamt 69 Krebspatientinnen und -Patienten, die eine Chemotherapie mit Capecitabin erhielten. Untersucht wurden Gruppenunterschiede zwischen soziodemografischen und klinischen Variablen auf der einen Seite und Adhärenz auf der anderen Seite sowie die klinisch relevante Belastung durch Angstsymptome. Zur Datenerhebung wurden zum einen der MARS-Fragebogen zur Erfassung der Adhärenz und zum anderen der GAD-7 zur Erfassung der Angstsymptomatik verwendet. Adhärentes Verhalten in Bezug auf die Einnahme von Capecitabin zeigte sich bei 75.4% der Personen im untersuchten Studienkollektiv. Dieses Ergebnis steht in Einklang mit bisherigen Publikationen, die ebenfalls den Zusammenhang zwischen Adhärenz bei Capecitabin untersuchten. Die weitere Hypothese war, dass höhere Angstbelastungen unter Patienten signifikant mit einer verminderten Adhärenz in Zusammenhang stehen. Dies konnte in der vorliegenden Studie jedoch nicht festgestellt werden. Einerseits zeigte zwar nur ein geringer Anteil der untersuchten Patienten Hinweise einer Angststörung (7%), andererseits wurde festgestellt, dass nicht alle dieser Patienten eine psychotherapeutische Behandlung erhielten. Für zukünftige Forschungen wäre zu überlegen, weitere Messinstrumente zur Diagnostik einer niederschwelligen Angst einzusetzen. Weiterhin wären ein größeres Therapieangebot und umfassendere psychosoziale Unterstützung dringend erforderlich. Abschließend bleibt festzuhalten, dass in Zukunft weitere Studien, v.a. auch mit größeren Fallzahlen sowie Längsschnitt- oder Follow-up-Studien zu diesem Forschungsthema dringend indiziert sind. N2 - According to estimates by The Robert Koch Institute, almost 500,000 people are diagnosed with cancer every year, and the numbers are rising. Steady progress in research has led to a paradigm shift in cancer therapy with the development of chemotherapy in tablet form. For an optimal therapy outcome, it is of great importance that patients show adherent behavior. Furthermore, previously published literature shows that psychological comorbidities can equally influence adherence and thus treatment success. This is what has been evaluated and is presented in this paper. The study included a total number of 69 cancer patients receiving chemotherapy with capecitabine. Group differences were investigated between sociodemographic and clinical variables as well as adherence and the clinically relevant impact of anxiety symptoms. For data collection, the MARS questionnaire was used to assess adherence and the GAD-7 to assess anxiety symptoms. Adherence to capecitabine was shown in 75.4% of individuals in the study population examined. This result is consistent with previous publications that also examined the relationship between adherence to capecitabine. A further hypothesis was that higher anxiety levels amongst patients are significantly associated with reduced adherence. However, this could not be established in the present study. Although only a small proportion of the patients studied showed evidence of an anxiety disorder (7%), it was found that not all of these patients received psychotherapeutic treatment. For future research, it would be worth considering the use of additional measurement instruments for the diagnosis of low-threshold anxiety. Furthermore, a more extensive range of therapies and more comprehensive psychosocial support are urgently needed. In conclusion, further studies on this research topic should be conducted, particularly with a greater number of cases as well as longitudinal or follow-up studies. KW - Capecitabin KW - Generalisierte Angststörung KW - Compliance KW - Adhärenz KW - orale Chemotherapie Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-249647 ER - TY - THES A1 - Berberich, Sara T1 - Adhärenz bei oraler Capecitabin-Therapie : Zusammenhänge mit Progredienzangst T1 - Adherence to oral capecitabine therapy : connections with fear of progression N2 - Krebserkrankungen stellen eine lebensverändernde und potentiell letale Diagnose dar. Orale Zytostatika stellen eine vielversprechende Therapiemöglichkeit dar. Ein häufig eingesetztes orales Zytostatikum ist Capecitabin. Durch den Einsatz von oralen Chemotherapeutika ergeben sich viele Vorteile. Grundlegende Voraussetzung für den Einsatz der Tablettenform ist allerdings eine äquivalente Wirksamkeit. Diese hängt entscheidend von ausreichender Adhärenz der Patienten ab. In dieser Studie konnte bei der Auswertung des MARS-D gezeigt werden, dass 25 % der Studienteilnehmer nicht ausreichend adhärent waren. Häufigster Grund für Nicht-Adhärenz war das Vergessen der Medikamenteneinnahme. Ein weiteres, wichtiges Ergebnis dieser Pilotstudie war, dass die Probanden ihre Adhärenz subjektiv deutlich höher einschätzten (M im VAS 97,72) als sich bei der Auswertung des MARS-D bestätigen ließ. Die Erkennung und Behandlung psychischer Beeinträchtigungen und Erkrankungen ist bei der Betreuung von Krebspatienten entscheidend. Fear of progression (FOP) ist die am häufigsten geäußerte Angst von Krebspatienten. Diese Studie konnte die Bedeutung von FOP deutlich zeigen: bei 38 % der Probanden konnte eine dysfunktionale Form der FOP nachgewiesen werden. Nur vier Studienteilnehmer nutzten allerdings psychosomatische/psychiatrische Unterstützungmöglichkeiten. Die Single-Item Analyse des PA-F-KF zeigten sich Ängste im Vordergrund stehend, welche den Bereich Familie betrafen. Überraschenderweise ließ sich zwischen der häufigsten Nebenwirkung Hand-Fuß-Syndrom und FOP kein signifikanter Zusammenhang nachweisen. Dagegen konnten stark signifikante Zusammenhänge zwischen dem Auftreten von Diarrhoen, Übelkeit, Erschöpfung und dysfunktionaler FOP gezeigt werden. N2 - Cancer is life changing and possibly deadly. Oral anticancer drugs are promising. A common anticancer drug is Capecitabine. The use of oral chemotherapeutic medication results in many advantages. Precondition for similar effectiveness of tablets is good adherence. In this study the analysis of the MARS-D showed, that 25 % of the participants were non-adherent. The most important reason was forgetting to take the medication. Another important result of this study was, that subjective adherence was much higher than the objective MARS-D showed. Recognizing and treating psychological burdens and diseases of cancer patient is crucial. Fear of progression (FOP) is the most common fear of cancer patients. This study showed the importance of FOP: 38 % of the participants showed a dysfunctional FOP. Only four patients used psychosomatic/psychiatric support possibilities. The single-item analysis of the PA-F-KF showed, that the most important fears were about family. Surprisingly, there was no correlation found between the most common side effect hand foot syndrome and FOP. But we could show a strong significant correlation between diarrhea, nausea, fatigue and dysfunctional FOP. KW - Zukunftsangst KW - Adhärenz KW - Progredienzangst KW - Capecitabin KW - adherence KW - fear of progression KW - fear of cancer KW - recurrence KW - capecitabine Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-209800 ER - TY - THES A1 - Csef, Eva-Johanna T1 - Adhärenz zu oralen Tyrosinkinaseinhibitoren bei chronischer myeloischer Leukämie - Querschnittsstudie in einer universitären Spezialambulanz T1 - Adherence to oral tyrosine kinase inhibitors in patients with chronic myeloid leukemia – a cross-sectional study in a university-based outpatient clinic N2 - Der orale Tyrosinkinaseinhibitor (TKI) Imatinib wurde 2002 zur Behandlung der chronischen myeloischen Leukämie (CML) zugelassen und ist als „targeted therapy“, die sich gegen das die Erkrankung in den meisten Fällen verursachende BCR/ABL1-Fusionsprotein richtet, als Meilenstein in der Therapie der CML zu sehen. Neben verschiedenen unerwünschten Arzneimittelwirkungen (UAW) stellt auch eine niedrige Rate der Adhärenz, also der Übereinstimmung des Patientenverhaltens mit den Empfehlungen der behandelnden Ärzte, ein entscheidendes Problemfeld im klinischen Einsatz von Imatinib dar. Zusätzlich zu persönlichen Eigenschaften des Patienten und speziellen Merkmalen der Erkrankung spielt hierbei unter anderem auch die Interaktion zwischen Arzt und Patient eine herausragende Rolle. Fälschlicherweise wird bei Patienten mit einer malignen Neoplasie prinzipiell von adhärentem Verhalten ausgegangen; mangelnde Patientenschulung oder Arzneimittelinteraktionen führen jedoch häufig zu Nonadhärenz mit zum Teil lebensbedrohlichen Folgen. So postuliert etwa die 2009 von Noens et al. veröffentlichte ADAGIO-Studie bei lediglich 14,2 % der Patienten unter TKI Therapie bei CML ein absolut adhärentes Verhalten. Die vorliegende Arbeit beschäftigt sich in diesem Kontext schwerpunktmäßig mit steuerbaren Einflussfaktoren wie Copingstrategien und dem Wissensstand der Patienten über die Therapie ihrer Erkrankung. Hierzu wurde bei 37 in einer universitären Spezialambulanz behandelten CML-Patienten (21 Männer und 16 Frauen mit einem mittleren Alter von 59 Jahren) zunächst mittels des „Basel Assessment of Adherence Scale with Immunosuppressive Medication“ (BAASIS) die Adhärenz unter Imatinib erhoben. Dabei ergab sich eine Adhärenzrate von 49 %, die niedrig, aber tendenziell höher als erwartet ausfiel. Bei einer moderateren Definition von adhärentem Verhalten zeigt sich sogar eine Adhärenzrate von 84 %. Eine Auswertung des „Freiburger Fragebogens zur Krankheitsverarbeitung“ im selben Patientenkollektiv verdeutlicht wie wichtig ein stabiles Arzt-Patienten-Verhältnis ist, auch wenn keine signifikante Korrelation zwischen positivem Coping und adhärentem Verhalten gezeigt werden konnte. Bisher in diesem Rahmen wenig erforscht ist die Angst vor einem Fortschreiten der Erkrankung, die mit dem Progredienzangst-Fragebogen von Herschbach erfasst werden kann. Von dieser Angst ist die Mehrheit der Studienteilnehmer betroffen (73 % mittleres Ausmaß, 16 % hohes Ausmaß an Progredienzangst). Vermutlich bedingt durch die kleine Stichprobengröße ließ sich auch hier keine signifkante Korrelation zur Adhärenz herstellen. Mit einem p-Wert von 0,003 zeigt sich jedoch ein statistisch signifikanter Zusammenhang zwischen maladaptiven Copingstrategien („Bagatellisierung und Wunschdenken“) und verstärkter Progredienzangst. Auch bei depressiven Verarbeitungsstrukturen lässt sich die Tendenz zu einer Korrelation erkennen (p-Wert 0,06). Neben einem Progress der Erkrankung ist die Angst vor unerwünschten Nebenwirkungen für Patienten von großer Bedeutung. Insbesondere bei den – selbst in der moderateren Auslegung des BAASIS – nonadhärenten Patienten zeigt sich eine signifikante Korrelation (p-Wert 0,023). Dadurch wird der Stellenwert einer guten Aufklärung und Schulung der Patienten deutlich, vor allem da Patienten ihr konkretes Wissen bezüglich Krankheit und Therapie oft zu überschätzen scheinen. Abschließend bleibt festzuhalten, dass eine Förderung adhärenten Verhaltens auch bei onkologischen Patienten von enormer Bedeutung ist. Besonders zu berücksichtigende Themen sind Verarbeitungsstrategien, der Umgang mit Ängsten sowie die Information und Schulung der Patienten. N2 - The oral tyrosine kinase inhibitor imatinib was approved for the treatment of chronic myeloid leukemia (CML) in 2002 and is said to be a milestone in the treatment of CML, as it is a targeted therapy that addresses the BCR/ABL1 fusion protein which causes the disease in most cases. Besides unwanted side effects a low rate of adherence, i.e. the correspondence of a patient’s behaviour with recommendations of the attending physicians, are important themes in the clinical use of imatinib. In addition to personal traits of the patient and special characteristics of the disease, the interaction between physician and patient plays an outstanding role. Misleadingly one tends to assume adherent behaviour in patients with a malignant neoplasia; a lack of patients’ education or drug interactions often lead to nonadherence with to some extent life-threatening consequences. Noens and colleagues postulate perfectly adherent behaviour regarding the TKI therapy only for 14.2 % of CML patients in their 2009 published ADAGIO study. In this context the present work deals mainly with modifiable parameters like coping strategies and the patients’ knowledge about the treatment of their disease. For this the adherence to imatinib was measured with the “Basel Assessment of Adherence Scale with Immunosuppressive Medication” (BAASIS) in 37 outpatients (21 men and 16 women with a mean age of 59 years) treated for CML. The result was an adherence rate of 49 %, which was low but tended to be higher than expected. Applying a more moderate definition of adherent behaviour we even got an adherence rate of 84 %. The analysis of the “Freiburg Questionnaire on Coping with Illness” among these patients makes clear how important a stable relationship between patient and physician is, even though no significant correlation between positive coping and adherent behaviour could be demonstrated. So far there is little research about the fear of progression, which can be assessed with the “Fear of Progression Questionnaire” by Herschbach. This fear affects the majority of the study’s participants (73 % moderate level, 16 % high level of fear of progression). Probably because of the small sample size no significant correlation to adherence could be shown also in this case. However with a p-value of 0.003 there was a statistically significant correlation between maladaptive coping strategies (“extenuation and wishful thinking”) and increased fear of progression. Also for depressive coping a tendency to association can be seen (p-value 0.06). Besides the progress of the disease the fear of unwanted side effects is of big importance to the patients. Particularly for the – even with the moderate interpretation of the BAASIS – nonadherent patients a significant correlation is shown (p-value 0.023). Thereby the value of good education and instructions becomes apparent, especially as patients seem to overestimate their precise knowledge about the disease and the treatment. It remains to be noted that encouragement to adherent behaviour is of enormous relevance also with oncological patients. In particular to consider are coping strategies, dealing with fears as well as the information and education of the patients. KW - Therapietreue KW - Chronisch-myeloische Leukämie KW - Adhärenz KW - TKI KW - CML Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-159852 ER - TY - THES A1 - Lindner, Andreas T1 - Aktivierung und Zytotoxizität von gamma delta T-Lymphozyten gegenüber Tumorzellen hämatologischen Ursprungs - Untersuchungen in vitro T1 - Activation and cytotoxicity of gamma delta T lymphocytes against tumor cells of hematological origin N2 - Auf der Suche nach neuen Therapiemöglichkeiten für Tumorpatienten stellt die Immuntherapie mit gd T-Lymphozyten einen innovativen Ansatz dar. In vitro Zytotoxizität von Vg9Vd2 T-Lymphozyten wurde gegen eine Vielzahl von Tumorzellen belegt. Mit den Aminobisphosphonaten steht eine Reihe zugelassener und langjährig erprobter Medikamente zur Verfügung, die im Bereich therapeutisch verwendeter Dosierungen Vg9Vd2 T-Lymphozyten auch in vivo aktivieren können. Zudem ist Bromohydrin (BrHPP) als hochaffines synthetisches Phosphoantigen ein weiterer attraktiver Kandidat zur Aktivierung von gd T-Zellen und befindet sich am Menschen bereits in klinischen Studien. Strategien einer auf gd T-Zellen beruhenden Immuntherapie umfassen zum einen die in vitro Expansion von gd T-Lymphozyten mittels BrHPP oder Aminobisphosponaten mit anschließendem Transfer, dem so genannten adoptiven Zelltransfer auf den Patienten. Zum anderen kann die Anti-Tumoraktivität von Vg9Vd2 T-Lymphozyten auch direkt in vivo mittels Bisphosphonaten induziert werden, wie in einer Pilotstudie mit einem Anti-Lymphom- bzw. Anti-Myelom-Effekt bis hin zu einer klinischen partiellen Remission durch die Therapie mit einem Bisphosphonat (Pamidronat) und IL-2 eindrucksvoll gezeigt werden konnte. In der hier vorliegenden Arbeit wurde eine effektive Methode zur in vitro Proliferation von Vg9Vd2 T-Zellen mit Ausbildung ihrer Anti-Tumoraktivität durch BrHPP und durch das Bisphosphonat Zoledronat in Anwesenheit von IL-2 gezeigt. Weitergehend konnte mit Zytotoxizitätstestungen – basierend auf der Messung der Laktatdehydrogenase-Aktivität – die zytolytische Aktivität dieser expandierten gd T-Zellen gegenüber den primären Tumorzellen von insgesamt 8 Leukämie-Patienten, sowie je einem Patienten mit einem Lymphom und einem Plasmozytom nachgewiesen werden. Dadurch wurde einerseits das besondere Potential der gd T-Lymphozyten gegenüber hämatologischen Neoplasien unterstrichen, andererseits konnte ein Testverfahren gezeigt werden, mit dem das Spektrum empfindlicher Tumorzellen und Einflussgrößen untersucht werden können. In einem Experiment wurde dargestellt, wie die myelomonozytäre Zelllinie THP1 im Gegensatz zu ihrer sonst vorliegenden Anergie nach Vorbehandlung mit Zoledronat durch gd T-Zellen lysiert werden konnte. In einem autologen Versuchsansatz konnte die Anti-Tumoraktivität der gd T-Zellen eines Patienten mit der Diagnose eines follikuläres B-NHL durch Vorbehandlung der Lymphomzellen mit Zoledronat noch gesteigert werden. gd T-Zellen unterliegen als Teil des komplexen Immunsystems verschiedenen Regulationsmechanismen, die auch manipuliert werden können. In vitro Testverfahren – wie in dieser Arbeit – sind die Voraussetzung für eine Grundlagenforschung, mit deren Hilfe man in Zukunft zu einer hoffnungsvollen, auf gd T-Zellen basierenden Immuntherapie maligner Erkrankungen gelangen könnte. N2 - During the last few years, knowledge about the innate effector lymphocytes – such as natural killer (NK) cells, NK T cells and gd T cells – has advanced enormously, while immunotherapeutic strategies based on gd T cells have received increasingly more attention. The main subset of gd T cells in the human peripheral blood – the Vg9Vd2 T cells – possess a cytotoxic effector activity against a variety of tumor cells in vitro. Aminobisphosphonates – licensed and widely used antiresorptive drugs in malignant and nonmalignant bone disease – have been identified as potent synthetic stimulators of Vg9Vd2 T cells in vitro and in vivo. Furthermore, bromohydrin pyrophosphate (BrHPP) is another highly potent synthetic phosphoantigen for gd T cells. Two strategies for the potential use of gd T cells in tumor immunotherapy are presently being envisaged. On one hand, in vitro expansion of gd T cells by aminobisphosphonates (ABP) or BrHPP in the presence of IL-2 with a resultant cell transfer – the so-called adoptive transfer – to the patient, has shown promising results in animal models. On the other hand, there is the possibility of in vivo therapeutic administration of gd-stimulating synthetical phosphoantigens (ABP or BrHPP) in combination with low dose IL-2 in cancer therapy. In a pioneer pilot study, treatment with a second-generation ABP, Pamidronate, in combination with IL- 2 induced an objective antitumor activity in patients with low-grade non-Hodgkin lymphoma or multiple myeloma. The correlation of expansion of gd T cells in vivo with the clinical response (tumor stabilization or partial remission) demonstrated in this study the feasability of gd T-cell immunotherapy. Phase 1 clinical trials designed to evaluate BrHPP combined with low-dose IL-2 in patients with renal cell carcinoma and relapsed lymphoma are ongoing. In the presented medical thesis, peripheral Vg9Vd2 T cells were activated and expanded to large in vitro clones by stimulation of peripheral blood mononuclear cells (PBMCs) with BrHPP in the presence of low-dose IL-2. After 12 to 16 days, cultures derived from patient’s PBMCs contained a percentage of gd T cells ranging between 75 % and 92 % (from an initial 4 % – 6 %) with an accompanying 2 to 4-fold increase in the absolute cell counts. Through this protocol, numerous gd T cells can be made available for in vitro experiments or for potential adoptive cell transfers. Furthermore, the capacity of expanded gd T cells from healthy donors to lyse primary tumor cells from patients were analysed with a cytotoxicity assay, based on the release of the enzyme lactate dehydrogenase (LDH). Our examinations displayed a strong cytotoxic effector activity of gd T cells against tumor cells from eight patients with acute myeloid and acute lymphocytic leukemia. The CD69 expression – as an early activation marker – of native gd T-cells induced through the tumor cells was not correlated to the antitumor effect of BrHPP-activated gd T cells against these tumor cells. This may be a consequence of distinct pathways – a TCR-dependent pathway and a natural killer-like pathway - for antitumor immunity. In an autologous experiment, gd T cells of a patient with a non-Hodgkin’s lymphoma showed cytotoxicity against the malignant cells. Additionally, the gd T-cells from this patient exhibited a markedly enhanced cytotoxicity against lymphoma cells pretreated with Zoledronate – currently the most potent third-generation ABP – as compared with untreated lymphoma cells. Further, we showed that the THP-1 tumorline (myelomonocytic leukemia) became susceptible to gd T cell-mediated cytotoxicity following pretreatment with Zoledronate, while normal THP-1 cells remained resistant. These observations outline the critical role of gd T cell population in immune surveillance, particularly against hematopoietic malignancies and the possibility to benefit from synthetical phosphoantigens for this immunotherapeutic approach. In vitro analysis – as demonstrated here – are the presupposition for evaluating future immunotherapeutic strategies with gd T lymphocytes. KW - gamma delta T-Zellen KW - Zytotoxizität KW - Tumor Immuntherapie KW - bromohydrin pyrophosphat KW - zoledronat KW - gamma delta T cells KW - lactate dehydrogenase cytotoxicity assay KW - cancer immunotherapy KW - bromohydrin pyrophosphate KW - zoledronate Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-23447 ER - TY - THES A1 - Hornbach, Anke T1 - Aktivierungsmuster humaner neutrophiler Granulozyten nach Kontakt mit den pathogenen Pilzen Candida albicans und Aspergillus fumigatus T1 - Activation patterns of human neutrophils after contact with the pathogenic fungi Aspergillus fumigatus und Candida albicans N2 - Humane neutrophile Granulozyten spielen eine wichtige Rolle in der Immunabwehr invasiver Infektionen durch die humanpathogenen Pilze Candida albicans und Aspergillus fumigatus. Das Ziel der hier vorliegenden Arbeit bestand in einer Charakterisierung der Interaktion beider Pilzspezies mit neutrophilen Granulozyten, mit Fokussierung auf die unterschiedlichen Effektormechanismen dieser Zellen. C. albicans exprimiert eine Reihe von Aspartatproteasen, welche mit der Virulenz des Erregers assoziiert sind und zu Adhäsion, Gewebeinvasion und Immunevasion beitragen können. In dieser Arbeit wurde die Rolle der Aspartatproteasen Sap1-6, Sap9 und Sap10 in der Interaktion mit neutrophilen Granulozyten analysiert. Es konnte gezeigt werden, dass, im Gegensatz zu anderen Aspartatproteasen, das zelloberflächenassoziierte GPI-verankerte Enzym Sap9 einen maßgeblichen Einfluss auf die Erkennung von C. albicans durch neutrophile Granulozyten hat. SAP9-Expression ist erforderlich, um die gerichtete Motilität (Chemotaxis) neutrophiler Granulozyten zu C. albicans-Keimschläuchen hin zu induzieren. Dieser Prozess stellt eine Grundvoraussetzung zur effektiven Aktivierung neutrophiler Granulozyten darstellt. Die Chemotaxis neutrophiler Granulozyten kann durch autologe Sekretion des Zytokins IL-8 verstärkt werden. Es konnte jedoch kein Einfluss von SAP9 auf die IL-8 Sekretion beobachtet werden. Allerdings führte die Deletion von SAP9 zu reduzierter Freisetzung von reaktiven Sauerstoffspezies (engl. reactive oxygen species, ROS) in neutrophilen Granulozyten. Die mit der ROS-Generierung in Verbindung stehende und durch C. albicans induzierte Apoptose neutrophiler Granulozyten war ebenfalls vermindert. In Konfrontationsassays war die Abtötung einer SAP9-Deletionsmutante verglichen mit dem Wildtyp reduziert. Die Degranulation stellt neben der Produktion von ROS einen weiteren wichtigen Effektormechanismus zur Abtötung von Mikroben dar, jedoch verlief die Freisetzung von Elastase ebenso unabhängig von SAP9 wie die durch neutrophile Granulozyten ausgelöste Wachstumsinhibition von Keimschläuchen. Die hier präsentierten Daten verbinden die Aktivität der Protease Sap9, der zuvor bereits eine Rolle in der Immunevasion von C. albicans zugeschrieben wurde, mit der Initiation der protektiven angeborenen Immunität. Wie C. albicans stimuliert auch A. fumigatus die Aktivität der neutrophilen Granulozyten. Microarray- Analysen mit Fokus auf dem Zytokinprofil neutrophiler Granulozyten während der Interaktion mit A. fumigatus-Hyphen offenbarten, dass nur wenige Zytokine im Lauf der Infektion hochreguliert wurden. Zusammenfassend konnte gezeigt werden, dass die Sap-Granulozyten-Interaktion neue molekulare Mechanismen zur Aktivierung dieser Zellen birgt. Zudem brachten die Microarray Analysen die Erkenntnis, dass die de novo-Zytokinsynthese durch A. fumigatus nur geringfügig beeinflusst wird und eine schnelle Abtötung des Pilzes offenbar im Vordergrund steht. N2 - Human polymorphonuclear neutrophils (PMNs) play a major role in the immune defence against invasive infections caused by the pathogenic fungi Candida albicans and Aspergillus fumigatus. The aim of this work was to further characterize the interaction of both fungi with PMNs with a focus on diverse PMN effector functions. C. albicans expresses a set of aspartic proteases which are associated with virulence and can contribute to adhesion, tissue invasion and immune evasion. Here, the role of the aspartic proteases Sap1-6, Sap9 and Sap10 in the interaction with human neutrophils was analysed. It could be demonstrated that, in contrast to other aspartic proteases, the cell surface associated GPI-anchored enzyme Sap9 has a major impact on recognition of C. albicans by PMNs. SAP9 expression is required for the effective induction of PMN chemotaxis towards C. albicans filaments, an essential prerequisite of effective PMN activation. Targeted motility can be enhanced by autologous secretion of IL-8, but no influence of SAP9 on the process of IL-8 secretion could be observed here. However, deletion of SAP9 led to a mitigated release of reactive oxygen intermediates (ROI) in human PMNs. Likewise, C. albicans induced apoptosis triggered by ROI formation was decreased. In confrontation assays, killing of a SAP9 deletion mutant was reduced in comparison to the wild-type. Beside ROI production, degranulation represents an additional important effector mechanism contributing to microbial killing, however, the release of elastase in response to C. albicans was found to be not dependent on SAP9, as well as the PMN-mediated growth inhibition of germ tubes. The data presented here clearly implicate Sap9 protease activity, which was already attributed to immune evasion before, with the initiation of protective innate immunity. Like C. albicans, A. fumigatus evokes PMN antifungal activity. Custom-made microarray analyses focusing on the cytokine profile of PMNs during interaction with A. fumigatus hyphae revealed that only few cytokines are upregulated during the course of infection. In summary it could be demonstrated that the interaction between Saps and PMNs is revealing novel molecular mechanisms which lead to an activation of these cells. Furthermore, microarray analyses lead to the awareness that de novo cytokine synthesis of PMNs is barely influenced by A. fumigatus, pointing out that instant killing of the fungus might be of higher importance. KW - Neutrophile Granulozyten KW - Aspergillus fumigatus KW - Candida albicans KW - Immunreaktion KW - neutrophile Granulozyten KW - Aspergillus fumigatus KW - Candida albicans KW - neutrophils KW - Aspergillus fumigatus KW - Candida albicans Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-53520 ER - TY - THES A1 - Rosler, Eduard T1 - Allelische Verlustanalyse der chromosomalen Regionen 8p22 und 18q21.1 bei kolorektalen Karzinomen T1 - Analysis of allelic loss of the chromosomal regions 8p22 and 18q21.1 in colorectal carcinomas N2 - In dieser Arbeit wurden 169 kolorektale Karzinome auf das Vorhandensein eines allelischen Verlustes (LOH - "loss of heterozygosity")der Region 8p22 um den Marker D8S254 sowie der Region 18q21.1 um den Marker D18S474 untersucht. Es konnte gezeigt werden, dass ein allelischer Verlust des Mikrosatellitenmarkers D18S474 signifikant mit einer schlechteren Patientenprognose bei Patienten mit kolorektalen Karzinomen im Stadium I-IV korreliert ist. Neben der prognostischen Bedeutung könnte ein LOH 18q21.1 auch einen Einfluß auf die Therapie der Patienten haben. Patienten im Stadium II mit LOH D18S474 könnten beispielsweise von einer adjuvanten Chemotherapie eher profitieren als Patienten ohne LOH D18S474. Im Gegensatz zu anderen Arbeitsgruppen konnte keine Korrelation eines allelischen Verlustes des Mikrosatellitenmarkers D8S254 oder einer Kombination von LOH D8S254 und D18S474 bei Patienten mit kolorektalen Karzinomen im Stadium I-IV mit der Patientenprognose gezeigt werden. Es fanden sich im Rahmen dieser Studie geschlechtsspezifische Unterschiede für die Tumoreigenschaften und die Prognose sowohl für Tumoren mit einem allelischen Verlust im Mikrosatellitenmarker D8S254 und D18S474. Ein LOH des Markers D8S254 bei Frauen scheint signifikant häufiger mit einem Stadium IV-Tumor, bei Männern jedoch signifikant häufiger mit einem Tumor des Stadium II korreliert zu sein. Frauen mit einem LOH des Markers D18S474 weisen signifikant weniger Stadium I-Tumore auf, jedoch signifikant häufiger Stadium IV-Tumore. Bei Männern hingegen zeigt sich kein Zusammenhang. Diese Unterschiede in der Verteilung spiegeln sich auch in der durchschnittlichen Überlebenszeit wieder. Demnach haben Frauen mit einem LOH sowohl der Region 8p22 als auch der Region 18q21.1 und noch deutlicher in Kombination eine signifikant schlechtere Prognose als Patientinnen mit einem kolorektalen Karzinom ohne chromosomalen Verlust einer dieser beiden Regionen. N2 - In this study 169 colorectal Carcinomas were testes for an allelic loss (LOH - "loss of heterozygosity")of the region 8p22 and the marker D8S254 and the region 18q21.1 and the marker D18S474. A LOH of the region 18g21.1 could be correlated with a poor prognosis in every stage. In addition a LOH in this region could have influence on the therapy descision. Patients with stage II Carcinomas and LOH 18q21.1 could benefit from a chemotherapy in opposite to those without this allelic loss. A LOH of the region 8p22 and a combined loss of both chromosomal regions stood in no correlation with a poor survival outcome. But for female patients a loss of heterozygosity of both regions could be found more often in stage IV colorectal ccarcinomas. According to this it could be correlated with a poor outcome especially in a combination of both allelic losses. KW - Kolon KW - Dickdarmkrebs KW - Chromosom 8 KW - Chromosomenanalyse KW - LOH KW - chromosomale Verlustanalyse KW - Allelische Verlustanalyse KW - 8p22 KW - 18q21.1 KW - Loss of heterozygosity KW - colorectal carcinoma Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-29361 ER - TY - THES A1 - Reiter, Constantin Wei-te Caspar T1 - Allelotypisierung und prognostische Relevanz der Regionen 1p32-36, 4p14-16 und 17p12 beim kolorektalen Karzinom T1 - Allelotyping and prognostic relevance of the regions 1p-36, 4p14-16 and 17p12 in colorectal carcinoma N2 - Die Karzinomentstehung im Kolon lässt sich entsprechend der Adenom-Karzinom-Sequenz u.a. auf die Inaktivierung von Tumorsuppressorgenen zurückführen. Loss of heterozygosity (LOH) in verschiedenen chromosomalen Bereichen konnten bereits mit einer signifikant schlechteren Patientenprognose oder einem schlechteren Ansprechen einer Chemotherapie korreliert werden. Im Rahmen dieser Arbeit wurden 2 Multiplex-PCR Reaktionen zur Untersuchung von DNA-Proben etabliert. Anschließend wurden 100 Tumoren in den chromosomalen Regionen 1p32-36, 4p14-16 und 17p12 auf allelische Deletionen untersucht und diese mit der Patientenprognose korreliert. Es konnte ein signifikant schlechteres Überleben bei einem gleichzeitigen Vorliegen von LOH auf den Regionen 4p15.2 (D4S2397) und 17p12 (D17S1303) gefunden werden (p=0,0367). Ferner konnte ein Trend zur schlechteren Prognose bei einem gleichzeitigen Auftreten von LOH in den Regionen 17p12 (D17S1303) und 1p32-36 (HY-TM1) gezeigt werden (p=0,15). Um klinisch nutzbare Untersuchungsverfahren zur Prognosebestimmung bei Patienten mit Kolonkarzinom entwickeln zu können, werden noch weitere molekulargenetische Folgestudien nötig sein. N2 - According to the adenoma-carcinoma-sequence, the carcinogenesis of the colon can be ascribed among other things to the inactivation of tumor suppressor genes. Loss of heterozygosity (LOH) in various chromosomal areas were shown as being associated with a significant worse patient prognosis or a reduced response to chemotherapy. In this work 2 multiplex-PCRs were established to analyze DNA-samples. 100 tumor-samples were scanned for allelic deletions of the chromosomal regions 1p32-36, 4p14-16 and 17p12 and correlated with the prognosis of the patients. There was a significant worse survival when having a coexistent LOH at the regions 4p15.2 (D4S2397) and 17p12 (D17S1303) (p=0,0367). Furthermore there was a trend found for a worse prognosis for patients with a coexistent LOH at 17p12 (D17S1303) and 1p32-36 (HY-TM1) (p=0,15). There are further molecular genetic studies necessary to develop clinical useful tests to estimate the prognosis of a patient with colorectal cancer. KW - Colonkrebs KW - Polymerase-Kettenreaktion KW - Tumorsuppressor-Gen KW - Überlebenszeit KW - Loss of heterozygosity KW - Mikrosatelliten KW - Adenom-Karzinom-Sequenz KW - Multiplex-PCR KW - loss of heterozygosity KW - microsatellite KW - adenoma-carcinoma-sequence KW - multiplex-PCR Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-24673 ER - TY - JOUR A1 - Roy, Denis Claude A1 - Lachance, Sylvie A1 - Cohen, Sandra A1 - Delisle, Jean-Sébastien A1 - Kiss, Thomas A1 - Sauvageau, Guy A1 - Busque, Lambert A1 - Ahmad, Imran A1 - Bernard, Lea A1 - Bambace, Nadia A1 - Boumédine, Radia S. A1 - Guertin, Marie-Claude A1 - Rezvani, Katayoun A1 - Mielke, Stephan A1 - Perreault, Claude A1 - Roy, Jean T1 - Allodepleted T-cell immunotherapy after haploidentical haematopoietic stem cell transplantation without severe acute graft-versus-host disease (GVHD) in the absence of GVHD prophylaxis JF - British Journal of Haematology N2 - Graft-versus-host disease (GVHD) is a major cause of transplant-related mortality (TRM) after allogeneic haematopoietic stem cell transplantation (HSCT) and presents a challenge in haploidentical HSCT. GVHD may be prevented by ex vivo graft T-cell depletion or in vivo depletion of proliferating lymphocytes. However, both approaches pose significant risks, particularly infections and relapse, compromising survival. A photodepletion strategy to eliminate alloreactive T cells from mismatched donor lymphocyte infusions (enabling administration without immunosuppression), was used to develop ATIR101, an adjunctive therapy for use after haploidentical HSCT. In this phase I dose-finding study, 19 adults (median age: 54 years) with high-risk haematological malignancies were treated with T-cell-depleted human leucocyte antigen-haploidentical myeloablative HSCT followed by ATIR101 at doses of 1 x 10(4)-5 x 10(6) CD3(+) cells/kg (median 31 days post-transplant). No patient received post-transplant immunosuppression or developed grade III/IV acute GVHD, demonstrating the feasibility of ATIR101 infusion for evaluation in two subsequent phase 2 studies. Additionally, we report long-term follow -up of patients treated with ATIR101 in this study. At 1 year, all 9 patients receiving doses of 0 center dot 3-2 x 10(6) CD3(+) cells/kg ATIR101 remained free of serious infections and after more than 8 years, TRM was 0%, relapse-related mortality was 33% and overall survival was 67% in these patients. KW - haematopoietic stem cell KW - stem cell transplantation KW - graft-versus-host-disease KW - cell therapy and immunotherapy Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227075 VL - 186 IS - 5 ER - TY - JOUR A1 - Fuji, Shigeo A1 - Kapp, Markus A1 - Einsele, Hermann T1 - Alloreactivity of virus-specific T cells: possible implication of graft-versus-host disease and graft-versus-leukemia effects JF - Frontiers in Immunology N2 - Immune reconstitution of functional virus-specific T cells after allogeneic hematopoietic stem cell transplantation (HSCT) has been intensively investigated. However, the possible role of crossreactivity of these virus-specific T cells against allogeneic targets is still unclear. Theoretically, as in the field of organ transplantation, virus-specific T cells possess crossreactivity potential after allogeneic HSCT. Such crossreactivity is assumed to play a role in graft-versus-host disease and graft-versus-leukemia effects. In this article, we aim to give a comprehensive overview of current understanding about crossreactivity of virus-specific T cells. KW - mismatch KW - allogeneic stem cell transplantation KW - GVHD KW - HLA antigens KW - GVL KW - virus-specific T-cell Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-129260 VL - 4 IS - 330 ER - TY - THES A1 - Decker, Christina T1 - Analyse der in-vitro Aktivität neutrophiler Granulozyten gegenüber Aspergillus fumigatus unter dem Einfluss von Antimykotika und Immunsuppressiva T1 - Analysis of the in vitro activity of human neutrophils against Aspergillus fumigatus in presence of antifungal and immunosuppressive agents N2 - Der ubiquitär vorkommende Schimmelpilz Aspergillus fumigatus (A. fumigatus) ist Haupterreger der invasiven Aspergillose (IA). Diese invasive Pilzinfektion tritt gehäuft bei Patienten mit immunsuppressiver Langzeit-Therapie z. B. nach allogener Stammzelltransplantation zur Prophylaxe und Therapie der Graft-versus-Host-Disease (GvHD) auf. Trotz der in-vitro-Suszeptibilität der Pilze gegenüber verschiedenen Antimykotika ist die Erkrankung in diesem Patientenkollektiv weiterhin mit einer hohen Letalität assoziiert. Neben ihren direkten, antifungalen Eigenschaften wurden durch Antimykotika auch indirekte, modulierende Wirkungen auf die Funktionalität von Immunzellen beschrieben, die damit möglicherweise das therapeutische Ansprechen dieser Erkrankung beeinflussen. Insbesondere neutrophile Granulozyten (PMN) spielen als Teil der angeborenen Immunität durch ihre Vielzahl an Abwehrmechanismen eine essentielle Rolle für die Bekämpfung von invasiven Pilzinfektionen und damit der IA. Von zusätzlicher Bedeutung und bislang kaum untersucht ist das kombinierte Einwirken von Antimykotika und Immunsuppressiva auf die Funktionalität dieser Zellen. In dieser Arbeit wurde daher in-vitro der Einfluss klinisch eingesetzter Antimykotika zur Therapie der IA (liposomales Amphotericin B bzw. Amphotericin B – Desoxycholat, Voriconazol) auf wichtige Effektorfunktionen humaner neutrophiler Granulozyten nach Exposition gegenüber A. fumigatus untersucht. Im Fokus stand hierbei die Analyse des oxidativen Burst, der Interleukin (IL)-8-Freisetzung, der Bildung von neutrophil extracellular traps (NETs) sowie der Phagozytose-Aktivität dieser Immunzellen. Außerdem wurde der Effekt einer zusätzlichen Gabe klinisch relevanter Immunsuppressiva (Ciclosporin A / Mycophenolat-Mofetil, Prednisolon), die zur Prophylaxe und Therapie der akuten GvHD eingesetzt werden, auf diese vier Funktionen evaluiert. Zusammenfassend ergaben unsere Analysen keinen Anhalt für eine relevante Beeinflussung des oxidativen Burst, der IL-8-Freisetzung und der Phagozytose-Aktivität neutrophiler Granulozyten durch die untersuchten Antimykotika, insbesondere gegenüber A. fumigatus. Weiterhin wurden in dieser Arbeit keine signifikanten Differenzen zwischen dem Einfluss von liposomalem Amphotericin B und Amphotericin B - Desoxycholat beobachtet. Durch Prednisolon konnten überwiegend bereits bekannte, immunsuppressive Wirkungen auf PMN bestätigt sowie zusätzlich Hinweise auf eine Modulation Antimykotika-vermittelter Immuneffekte durch Immunsuppressiva gewonnen werden. Die kurze Exposition der PMN gegenüber Ciclosporin A / Mycophenolat-Mofetil ergab keine signifikanten Veränderungen der Sekretion von reaktiven Sauerstoffspezies. Des Weiteren unterstützen unsere Daten Hinweise auf differente Aktivierungsmechanismen von verschiedenen Effektorfunktionen der PMN. Im Gegensatz zu den anderen untersuchten Funktionen konnte in dieser Arbeit eine signifikant verminderte Bildung von NETs durch liposomales Amphotericin B, Amphotericin B - Desoxycholat und auch Voriconazol beobachtet werden. Damit geben unsere Ergebnisse Anlass zu tiefergehenden Analysen des Zusammenspiels von Antimykotika insbesondere mit dem noch immer wenig verstandenen Mechanismus der Auslösung und Bildung von NETs. Zudem wären weitere Studien wünschenswert, um einen umfassenderen Überblick und ein besseres Verständnis auch hinsichtlich anderer invasiver Pilzinfektionen sowie weiterer Abwehrmechanismen zu erhalten. N2 - Aspergillus fumigatus (A. fumigatus), an opportunistic pathogenic mould, is the most common pathogen to cause invasive aspergillosis (IA). This invasive fungal infection occurs primarily in patients with long-term immunosuppressive therapy, e.g. after haematopoetic stem cell transplantation during prophylaxis and treatment of graft-versus-host-disease (GvHD). Despite in vitro susceptibility to different antifungal drugs, IA is still associated with significant morbidity and mortality. Besides their well-known, direct antifungal properties, antifungal drugs have been reported to interfere with immune response mechanisms, thereby possibly affecting therapeutic outcome. In particular, neutrophils with their broad arsenal of antifungal mechanisms are essential in the innate immune response against invasive fungal infections, including IA. The combined influence of antifungal and immunosuppressive agents is of additional importance and has not been subject to much investigation. Therefore, this study aimed to characterize the in vitro influence of clinically relevant antifungal agents for therapy of IA (liposomal amphotericin B, amphotericin B deoxycholate, voriconazole) on major effector functions of human neutrophils in response to A. fumigatus, particularly oxidative burst, release of interleukin-8 (IL-8), formation of neutrophil extracellular traps (NETs) and phagocytic activity. Moreover, we assessed the combined effects of antifungals and clinically relevant immunosuppressive agents commonly used for prophylaxis and treatment of GvHD (ciclosporin A / mycophenolate-mofetil, prednisolone) on these four effector functions. In conclusion, our findings are not indicative of major impairment or enhancement of oxidative burst, IL-8-release or phagocytosis response of neutrophils to A. fumigatus in presence of the studied antifungal agents. Our results did not show significant differences between liposomal and conventional amphotericin B. We were able to confirm immunosuppressive effects of prednisolone on neutrophils, and observe a modulation of antifungal-mediated immunological effects through prednisolone. Short-time exposure of neutrophils to ciclosporin A / mycophenolate-mofetil did not cause significant alterations in oxidative burst response to A. fumigatus. However, our data provide indications of different activation patterns for distinct effector functions of neutrophils. In contrast to the other effector functions, this study reports a significantly lowered formation of NETs in presence of LAmB, d-AmB, or voriconazole. Therefore, these findings should give rise to a more in-depth analysis of the interference of these antifungal drugs with the still poorly understood mechanisms of NEToses induction and trap formation. Further research is necessary to acquire a deeper knowledge of other invasive fungal infections and further effector mechanisms. KW - Aspergillus fumigatus KW - Granulozyt KW - Antimykotika KW - Immunsuppressiva KW - Effektorfunktionen Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-209983 ER - TY - THES A1 - Halbing, Carolin T1 - Analyse der Interaktion humaner dendritischer Zellen und natürlicher Killerzellen mit dem Schimmelpilz \(Aspergillus\) \(fumigatus\) mittels Echtzeitmikroskopie T1 - Analysis of the interaction of human dendritic cells and natural killer cells with \(Aspergillus\) \(fumigatus\) using real-time microscopy N2 - Der humanpathogene Schimmelpilz A. fumigatus ist ein opportunistischer Krankheitserreger, der ein hohes Risiko eines letalen Krankheitsverlaufs durch das Auslösen einer invasiven Aspergillose (IA) birgt. Bei der IA handelt es sich um eine Infektion des Lungengewebes, welche hauptsächlich immunsupprimierte Menschen befällt. A. fumigatus stellt die Ursache für diese infektiöse Komplikation dar, welche von einem intakten Immunsystem in der Regel problemlos abgewehrt wird. Eine wichtige Abwehrbarriere gegen den Pilz setzt sich aus Zellen des angeborenen Immunsystems zusammen. In der vorliegenden Arbeit waren in diesem Zusammenhang natürliche Killerzellen (NK-Zellen) und dendritische Zellen (DCs) von besonderer Relevanz. NK- Zellen schütten lösliche Faktoren aus, welche als antifungale Mediatoren agieren. DCs besitzen hingegen die Fähigkeit, Pilzmorphologien zu phagozytieren. Im Anschluss an die Interaktion mit dem Pilz sekretieren beide Zelltypen Zytokine, welche wiederum weitere Immunzellen stimulieren. Besonders den DCs wird eine wichtige Funktion in der Immunabwehr gegen A. fumigatus zugeschrieben, da ihre Fähigkeit, das angeborene mit dem adaptiven Immunsystem zu verknüpfen, von großer Bedeutung ist. Ziel dieser Arbeit war es, die Interaktionen von primären Monozyten abgeleiteten DCs (moDCs) und NK-Zellen mit dem Pilz A. fumigatus in vitro zu charakterisieren. Hierfür wurden mit der Methode des Live-imaging verschiedene Experimente durchgeführt, um den reziproken Einfluss der zwei Immunzellarten in Anwesenheit von A. fumigatus zu analysieren. Es konnte gezeigt werden, dass sowohl moDCs, als auch NK-Zellen mit dem Pilz interagieren. Neben NK-Zell-moDC-Interaktionen wurden auch Interaktionen mit den einzelnen Immunzelltypen und A. fumigatus beobachtet. Zusätzlich konnte nachgewiesen werden, dass die NK-Effektormoleküle IFN-ɣ, Granzym B und Perforin stimulierend auf moDCs wirken, was in einer erhöhten Zellaktivierung und einer in der Folge gesteigerten Kontaktanzahl zum Pilz resultierte. N2 - The human pathogenic mould A. fumigatus is an opportunistic pathogen that carries a high risk of lethal disease progression due to the triggering of invasive aspergillosis (IA). IA is an infection of the lung tissue that mainly affects immunosuppressed people. A. fumigatus is the cause of this infectious complication, which is usually fended off by an intact immune system without any problems. An important defence barrier against the fungus consists of cells of the innate immune system. In the present work, natural killer cells (NK cells) and dendritic cells (DCs) were of particular relevance in this context. NK cells secrete soluble factors which act as antifungal mediators. DCs, on the other hand, have the ability to phagocytise fungal morphologies. Following interaction with the fungus, both cell types secrete cytokines, which in turn stimulate further immune cells. DCs in particular are thought to play an important role in the immune defence against A. fumigatus, as their ability to link the innate with the adaptive immune system is of great importance. The aim of this work was to characterize the interactions of primary monocyte-derived DCs (moDCs) and NK cells with the fungus A. fumigatus in vitro. To this end, various experiments were performed using the live imaging method to analyze the reciprocal influence of the two immune cell species in the presence of A. fumigatus. It was shown that both moDCs and NK cells interact with the fungus. In addition to NK cell-moDC interactions, interactions with the individual immune cell types and A. fumigatus were also observed. In addition, the NK effector molecules IFN-ɣ, Granzyme B and Perforin were shown to stimulate moDCs, resulting in increased cell activation and consequently increased contact with the fungus. KW - Aspergillus fumigatus KW - Dendritische Zellen KW - Natürliche Killerzellen Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-171026 ER - TY - THES A1 - Ok, Michael T1 - Analyse der Interaktion und die gezielte Modifikation von angeborener Immunantwort gegenüber Aspergillus fumigatus T1 - Analysis of the interaction and the targeted modification of innate immune response toward Aspergillus fumigatus N2 - Die invasive Aspergillose stellt eine ersthafte Erkrankung sowie auch eine signifikante Ursache von Morbidität und Mortalität bei verschiedenen Patientengruppen dar. Dabei tritt sie hauptsächlich durch den opportunistischen Pathogen Aspergillus fumigatus hervorgerufen mit einer Inzidenz von 4% bis 15% vorwiegend bei immunsupprimierten Patienten nach allogenen hämatopoetischer Stammzelltransplantationen (HSCT) oder Organtransplantationen auf und führt bei 40% bis 90% der Fälle zum Tod des Patienten. Die Behandlung dieser Hochrisikogruppe erfolgt bestenfalls mit Antimykotika prophylaktisch, denn eine schnelle sowie auch verlässliche Diagnose von invasiver Aspergillose läßt sich aufgrund der hohen zeitlichen Latenz des Pilzes und dem Defizit an Sensitivität bzw. Spezifität in vielen Fällen nicht ermitteln. Zusätzlich steigt die Zahl der Resistenzen von Aspergillus-Stämmen gegen die verschiedenen Antimykotika stetig an, so dass klinische und ökonomische Nebenwirkungen unvermeidbar sind. Als Alternative zur konventionellen Behandlung mit Azolen stellt eine Immuntherapie mittels Antigen-behandelten dendritischen Zellen (DCs) dar, welche durch Präsentation von Aspergillus fumigatus-Antigenepitopen eine spezifische ex vivo T-Zellenexpansion von allogenen CD8+CD3+ T-Zellen bewirken kann und damit ein schonenderes Mittel für den Patienten ist. Dazu wurden sieben verschiedene rekombinante Proteine aus A. fumigatus in dieser Arbeit charakterisiert und deren Potential ermittelt, bei DCs eine pro-inflammatische Immunantwort auszulösen. Es stellte sich heraus, dass sowohl die Ribonuklease Mitogillin (Aspf1) als auch die myceliale Katalase Cat1 in der Lage waren, den nukleären Faktor kappa B (NFκB) zu aktivieren und eine Translokation der Untereinheit p65 in den Nukleus zu induzieren, woraufhin Gene von pro-inflammatorischen Zytokine und Chemokine sowie auch von Aktivierungs- und Reifungsmarker der DCs exprimiert wurden. Im Gegensatz zum Aspf1, war es beim Cat1 zusätzlich auch möglich gewesen eine Verifizierung auf Proteinebene für segregierte Zytokine und Chemokine bzw. Oberflächenmarker zu erhalten. Darüber hinaus konnte festgestellt werden, dass die Zytotoxizität von Cat1 entsprechend der unbehandelten Zellen gewesen ist und dass es den Cat1-behandelten moDCs gelang nach der Aufnahme des Antigens und dessen Prozessierung durch die darauffolgende Präsentation der Proteinepitope über den MHC II Komplex eine ex vivo-Aktivierung von autologen zytotoxischen T-Zellen zu erreichen. Damit ist nun ein potentieller Kandidat für eine auf Immuneffektorzellen basierte Immuntherapie gegen invasive Aspergillose für immungeschwächte Patienten gefunden. Ergänzt wurde diese Arbeit mit der experimentellen Untersuchung von Hämostase während einer invasiven Aspergillose, da gehäuft pathologische Beobachtungen von lokalen Einblutungen bei Patienten mit pulmonaler Aspergillose verzeichnet wurden. Es stellte sich heraus, dass die durch Collagen induzierte Aggregation sich durch aktive Pilzmorphologien beeinträchtigen läßt, wohingegen die untersuchten Gerinnungsparameter nicht betroffen gewesen sind. Dies verdeutlicht neben der bereits bekannten Bedeutung der Thrombozyten als antimikrobielle Komponente im Blut nun auch ihrer Empfindlichkeit gegenüber sezernierten oder Zellwand-gebundenen Aspergillus fumigatus-Faktoren während der invasiven Aspergillose. N2 - Invasive Aspergillosis is a serious fungal disease and contributes significantly to morbidity and mortality in different patient cohorts. Predominantly caused by one major opportunistic pathogen named Aspergillus fumigatus, the incidence for invasive aspergillosis of 4% to 15% can be found mainly in immunocompromised patients after allogeneic hematopoetic stem cell transplantations (HSCT) or solid organ transplantations and leads in 40% to 90% of all affected cases to death. The clinical approach for this high risk group consists at the best of the treatment with antimycotics in a prophylactic way. Furthermore, fast and reliable diagnostic analysis for invasive aspergillosis misses the detection of A. fumigatus in many cases and therefore is still problematic, which is mainly caused due to the high latency of time for the fungal growth and the deficit in sensitivity and specificity, respecively. Additionally, steadily increasing numbers of resistant Aspergillus-strains against the different antimycotics complicate the situation so that clinical and economic side effects are unavoidable. Alternatively to conventional treatment with azoles is the immunotherapy with antigen-treated dendritic cells, which can be instrumentalized for a specific ex vivo T-cell expansion of allogenic CD8+CD3+ T-cells mediated by presentation of antigen epitopes and is a gently approach for patient’s care. Therefore, seven different recombinant A. fumigatus proteins were characterized in this thesis and their potential of inducing DCs immune response in a pro-inflammatory fashion was determined. It could be shown that the ribonuclease Mitogillin (Aspf1) as well as the mycelial catalase Cat1 was able to activate the nuclear factor kappa B (NFκB) and induced afterwards the translocation of subunit p65 into the nucleus, whereupon genes of pro-inflammatory cytokines and chemokines as well as activation and maturation marker of DCs were expressed. In contrast to Aspf1, Cat1 finally caused the segregation of cytokines and chemokines in DCs and furthermore the upregulation of cell surface marker. Moreover, lower cytotoxicity was determined in experiments with Cat1 and also moDCs, which were treated with the recombinant antigen, were able to internalize the protein, processed it and afterwards to activate ex vivo autologic cytotoxic T-cells by presentation of protein epitopes over MHC II complex coupling. Thus, a potential candidate for an immune effector cell-based immunotherapy for invasive aspergillosis in human patients has been found. This work was complemented by the experimental investigation of hemostasis during invasive aspergillosis because of the strong impact of observed local bleeding in patients with pulmonary aspergillosis. It exposed that Collagen-induced aggregation was impaired by active fungal morphologies, whereas analysed coagulation parameters in sera were not affected. Beside the already known meaning of thrombocytes as antimycotic component in human blood, this impact elucidate also the sensitivity of platelets to segregated or cell wall-accociated Aspergillus fumigatus factors during invasive aspergillosis. KW - Immunstimulation KW - Antigen KW - Aspergillus fumigatus KW - Dendritische Zelle KW - Invasive Aspergillose KW - Aspergillus fumigatus KW - Antigene KW - Hämostase KW - Aspergillose KW - Antigenpräsentation KW - Impfung KW - Blutstillung KW - Invasive aspergillosis KW - Aspergillus fumigatus antigens KW - human dendritic cells KW - innate immune response KW - hemostasis Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-56866 ER - TY - THES A1 - Ketz, Verena T1 - Analyse der relevanten Parameter bei der Nachsorge der akuten myeloischen Leukämie T1 - Analysis of relevant parameters during follow-up of acute myeloid leukemia N2 - In dieser Arbeit wurde untersucht, ob es bei der Nachsorge von Patienten in erster kompletter Remission (CR) einer akuten myeloischen Leukämie (AML) Parameter gibt, deren Veränderung ein Rezidiv ankündigen und ob die Struktur des Nachsorgeprogramms geeignet ist, ein Rezidiv frühzeitig zu erkennen. Bei 29 Patienten der 52 analysierten Patienten kam es zu einem Rezidiv. Bei 48% dieser Patienten war der Rezidivverdacht bereits aufgrund klinischer Beschwerden wie Leistungsabfall und Dyspnoe oder durch ein pathologisches Blutbild bei der hausärztlichen Kontrolle zu stellen. Am Rezidivtermin zeigten alle Rezidivpatienten pathologische Veränderungen von LDH, Hämoglobin, Leuko- oder Thrombozyten. Der Rezidivverdacht wurde also nicht erst durch eine Knochenmarkpunktion gestellt. Für viele AML Patienten in erster CR sind regelmäßige Kontrolluntersuchungen beim Hausarzt ausreichend, eine Knochenmarkpunktion ist nicht routinemäßig erforderlich. N2 - This analysis surveyed follow up parameters of patients with acute myeloid leukemia in first remission. The goal was to find parameters, indicating a relaps and to survey the value of follow up programs. 29 of the 52 analyzed patients got a relaps. In 48% of these patients a relaps was suspected due to clinical compliants (like weakness, dyspnea) or abnormal blood cell count during routine lab testing by family doctor.The remaining patients with relaps showed abnormal LDH, hemoglobin or blood cell count. The bone marrow examination was not nessesary to suspect the relaps. Thus for many patients in first remission bone marrow examinations are not routinely necessary. The routine blood testing and follow up examinations by the family doctor seem to be sufficient. KW - Akute Leukämie KW - Akute myeloische Leukämie KW - Myelose KW - Nachsorge KW - Rezidiv KW - Knochenmarkbiopsie KW - Molekulare Diagnostik KW - Blutuntersuchung KW - acute myeloid leukemia KW - follow-up KW - bone marrow exam KW - relaps KW - blood count Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-29428 ER - TY - THES A1 - Bolay-Gehrig, Sandra Jasmin T1 - Analyse von Kontaminationen mit Körperflüssigkeiten bei - vom Betriebsärztlichen Dienst der Universität Würzburg betreuten - Beschäftigten und Studierenden im Zeitraum 2010-2014 T1 - Analysis of contamination with body fluids among employees and students during the period 2010-2014 - supervised by the Institutional Medicine Service of the University of Wuerzburg N2 - Hintergrund: Für Beschäftigte im Gesundheitswesen besteht die Gefahr einer Kontamination und folgenden Infektion durch Blut übertragbare Krankheitserreger, insbesondere durch Hepatitis B, C und das Humane Immundefizienz-Virus. Die Kontaminationshäufigkeiten und -hergänge sind unter den Beschäftigten allerdings nicht gleich verteilt. Ziel der Arbeit: Identifikation von Risikogruppen für Kontaminationsereignisse mit potentiell infektiösen Körpermaterialien durch detaillierte Subgruppenanalysen. Material und Methoden: Retrospektive Studie an einer deutschen Universitätsklinik im Zeitraum 2010 bis 2014. Die Datenerhebung erfolgte mittels standardisierter Checklisten. Abweichungen der absoluten bzw. relativen Häufigkeiten wurden mittels Kontingenzanalysen, Fishers exaktem Test sowie Kaplan-Meier-Survival-Funktionen untersucht. Ergebnisse: Kontaminationsereignisse mit potentiell infektiösen Körpermaterialien stellen mit knapp einem Ereignis pro Tag an einem deutschen Universitätsklinikum häufige Arbeitsunfälle dar. Ein erhöhtes Kontaminationsrisiko scheint unter Beschäftigten der operativen Fächer, der Desinfektion/Sterilisation, Hebammen und Kardiotechniker zu bestehen. Niedrige Hepatitis B-Impfraten fanden sich unter Zahnmedizinstudierenden. Diskussion: Anhand der insgesamt niedrigen Kontaminations- und hohen Hepatitis B-Durchimpfungsraten kann auf sichere Arbeitsbedingungen geschlossen werden, vorbehaltlich niedriger Dunkelziffern. Allerdings sollte aufgrund der teils geringen Kopfzahlen in den Risikoberufsgruppen eine besonders tiefgreifende Evaluation der Arbeitsbedingungen zur Risikoreduktion von Kontaminationsereignissen mit potentiell infektiösen Körpermaterialien erfolgen. N2 - Background: Healthcare workers are at risk of contamination and subsequent infection by blood-borne pathogens. Particularly common are hepatitis B, C and the human immunodeficiency virus. However, risk constellations for contamination are unevenly distributed among employees. Objectives: Identification of risk groups for contamination with potentially infectious body fluids through detailed subgroup analyses. Materials and methods: Retrospective study at a German university hospital, from 2010 to 2014. Data has been collected using standardized checklists. Deviations in both absolute and relative frequencies were examined by means of contingency analyse, Fisher's exact test and Kaplan-Meier Survival analyse. Results: Contaminations with potentially infectious body fluids are frequent occupational accidents with an average of incidence of one per day. Particularly at risk appear employees in the operational subjects, disinfection/sterilization, midwives and perfusionists. Low vaccination rates for hepatitis B were found among dental students. Conclusions: Based on overall low exposure and high hepatitis B vaccination rates, the working conditions can be regarded as safe – subject to low numbers of unreported cases. However, due to small numbers of subjects in the observed risk groups, in-depth evaluations of working conditions for the identification of possible countermeasures to reduce infections are warranted. These evaluations should be carried out with a specific aim: continuously reducing the risk of exposure. KW - Kontamination KW - Blutkontakt KW - Körperflüssigkeit KW - Nadelstichverletzungen KW - Infektion KW - Prävention Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-178324 ER - TY - THES A1 - Merker, Katharina T1 - Analyse zur Kreuzreaktivität von CMV IE-1 VLEETSVML (316-324) spezifischen T-Zellen gegen hämatologische Neoplasien in gesunden Spendern T1 - Analysis of cross-reactivity of CMV IE-1 VLEETSVML (316-324) specific T-cells against hematologic neoplasms in healthy donors N2 - Früher bedeutete eine maligne hämatologische Erkrankung immer den sicheren Tod. Heutzutage haben viele Patienten mit einer entsprechenden Erkrankung eine realistische Chance auf ein Leben, dank der Stammzelltransplantation. Doch die Stammzelltransplantation birgt auch Risiken. Viele der Patienten kämpfen mit der Graft-versus-Host Erkrankung. Bei dieser Erkrankung erkennen die übertragenen Lymphozyten des Spenders das Gewebe des Empfängers als fremd und es kommt zur Abstoßung des transplantierten Organs bzw. zu Entzündungen und pathologischen Veränderungen an Haut, Leber und im Magen-Darm-Trakt. Die Spenderlymphozyten sind jedoch auch in der Lage, die noch verbliebenen malignen Tumorzellen des Empfängers zu erkennen und zu eliminieren. Dieser Effekt wird als Graft-versus-Leukämie Reaktion bezeichnet. Neben den Abstoßungsreaktionen spielen Infektionen nach einer Stammzelltransplantation eine große Rolle, da das Immunsystem supprimiert ist. Eine sehr häufige Infektionserkrankung bei stammzelltransplantierten Patienten ist die Cytomegalovirus Infektion. Die weltweite Durchseuchung bei gesunden Menschen liegt bei 40-90 %. Auch wenn die CMV Infektion bei den meisten immunkompetenten Menschen asymptomatisch verläuft, kann sie bei Patienten mit Immundefekten schwerwiegende Folgen haben. Neben den vielen negativen Folgen, die dieses Virus mit sich bringt, zeigen neuere Studien, dass stammzelltransplantierte Patienten mit einer Cytomegalovirus Reaktivierung eine längere Überlebenszeit, aufgrund der Senkung der Rezidivrate, haben. Eine mögliche Erklärung für diesen Effekt könnte eine virusinduzierte Graft-versus-Leukämie Reaktion sein, bei der die CMV-spezifischen Lymphozyten die Tumorantigene erkennen und eliminieren. In dieser Arbeit wurde die Kreuzreaktivität von den CMV IE-1 VLEETSVML spezifischen T-Zellen mit verschiedenen Tumor assoziierten Antigenen (PRAME, NY-ESO, bcl-2, Proteinase 3, MUC-1 und WT1) analysiert. Hierfür wurden gesunde, CMV seropositive Spender herangezogen, die IE-1 VLEETSVML T-Zellen hatten, und mit dem IE-1-A2 VLEETSVML Peptid expandiert werden konnten. Nach Anreicherung der spezifischen Lymphozyten über mehrere Wochen, erfolgte ein Funktionalitätstest, mit dem Nachweis von IFNγ und CD107a, als Zeichen der spezifischen Aktivierung der IE-1 VLEETSVML HLA-A*0201 T-Lymphozyten durch die Tumor assoziierten Antigene. Bei keinem der eingesetzten Tumor assoziierten Antigene fand eine Aktivierung des T-Zell-Rezeptors der CMV IE-1 spezifischen T-Lymphozyten statt. N2 - The detection of a malignant hematologic disease was in former times a death sentence. Today, stem cell transplantation make such a disease treatable, with a real chance of survival. A major risk of stem cell transplantation is the graft-versus-host reaction. This reaction is specified by inflammation of the recipients tissue induced by donor lymphocytes. This may lead to rejection of the transplant or to pathologic changes in skin, liver or the gatrointestinal tract. However, the donor lymphocytes are capable to track and eliminate the remaining malignant tumor cells of the recipient. This is called graft-versus-leukemia reaction. The main problems after a stem cell transplantation are graft rejection, GvHD and infections. An increased rate of infections occur because of the suppression of hots immune system. A major cause of infection upon the group of stem cell transplanted patients is cytomegalovirus (CMV). The global infection rate in healthy subjects is between 40 and 90%. The infection is in the most immunocompetent humans asymptomatic, but in immunodeficient humans CMV may cause fatal complications. On the other hand new studies showed that stem cell transplanted patients with a cytomegalovirus reactivation have a longer survival, because of a reduced relapse rate. A possible explantation could be a virus inducted graft-versus-leukemia reaction: The CMV-specific lymphocytes recognize and eliminate the tumor antigens. In this thesis I tested the cross-reaction of CMV IE-1 VLEETSVML specific T-cells with different tumor associated antigens (PRAME, NY-ESO, bcl-2, proteinase 3, MUC-1 and WT-1). For this purpose healthy donors, which were CMV seropositive and have IE-1 VLEETSVML T-cells were analyzed. The IE-1 specific T-cells were expanded with the IE-1 VLEETSMVL HLA-A*0201 peptide. After enrichment, the T-cells, were analyzed for the presence of IFNγ and CD107a after stimulation with the relevant peptides. To none of the investigated tumor antigens an activation of the IE-1 VLEETSVML specific T-cells could be proved. In conclusion, crossreactivity at least of IE-1 VLEETSVML specific T-cells does not contribute to graft versus leukemia effect. KW - Kreuzreaktivität KW - CMV T-Zellen KW - Stammzelltransplantation KW - GvL Effekt Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-177766 ER - TY - THES A1 - Pohlmann, Sabrina T1 - Analysen zur zellulären Immunrekonstitution nach allogener Stammzelltransplantation T1 - Analysis to cellular Immunreconstitution after allogenic Stemm Cell Transplantation N2 - Für viele hämatopoetische Erkrankungen, wie Lymphome oder Leukämien, stellt die allogene Stammzelltransplantation auch heute noch die einzige Heilungschance dar. Dabei ist der Wiederaufbau des Immunsystems nach der Transplantation von essentieller Bedeutung für das Überleben der Patienten. In dieser Arbeit wurden 27 Patienten nach allogener Stammzelltransplantation an vier definierten Messzeitpunkten (Tag 30, 60, 90 und 120 nach Transplantation) auf ihre Immunrekonstitution hin untersucht und die dabei erhobenen Daten auf gemeinsame Verläufe und eine mögliche Korrelation zur Klinik der Patienten untersucht. Die Zellen wurden dabei anhand ihrer Oberflächenmarker gefärbt und mittels Durchflusszytometrie gemessen. Um spezifische T-Zellen zu detektieren, wurden die Zellen zusätzlich vor dem Färben über Nacht mit spezifischen Peptiden stimuliert und dann ihre IFNgamma – Produktion gemessen. Zur Messung der Tregs wurde ein spezielles Kit zur Färbung des Markers Foxp3 verwendet. Es zeigte sich dabei, dass die NK-Zellen die „erste Welle“ der Immunrekonstitution darstellen, die T-Zellen erholen sich dagegen erst später als eine Art „zweite Welle“. CD8+ zytotoxische T-Zellen sind bei den Patienten gegenüber CD4+ T – Helferzellen über den gesamten Beobachtungszeitraum hinweg dominant, genau umgekehrt zu Gesunden. Die B-Zellen stellten konstant die niedrigste und sich am langsamsten regenerierende Population dar, bei kleineren untersuchten Zellpopulationen war kein einheitlicher Verlauf erkennbar. Diese Daten zeigen, dass das angeborene Immunsystem im Zeitraum nach Transplantation den Hauptschutz für die Patienten bietet, während sich das adaptive Immunsystem in seiner Größe und Funktionsfähigkeit erst über eine sehr viel längere Zeit hinweg erholt und erst später wieder die Hauptschutzfunktion für den Organismus übernehmen kann. Gängige Beschreibungen von T – Zellsubpopulationen, den central und effector memory T-Zellen nach Sallusto und Rezvani, die in der Literatur gleichbedeutend verwendet werden, lassen sich in einem Kollektiv mit stammzelltransplantierten Patienten nicht zur Deckung bringen. Bei der Rekonstitution von spezifischen T-Zellen konnten im Beobachtungszeitraum von 120 Tagen keine Antworten auf die Stimulation mit tumorspezifischen Peptiden gezeigt werden, eine Reaktion auf die Stimulation mit CMV – Peptiden war bei fünf Patienten zu erkennen, wobei dies nur bei Patienten der Fall war, die einen CMV positiven Stammzellspender aufwiesen, was als Voraussetzung für eine schnelle CMV spezifische T-Zellimmunrekonstitution anzusehen ist. Deshalb sollte zukünftig noch stärker auf die Auswahl der Stammzellspender bei der allogenen Stammzelltransplantation geachtet werden, um den Empfängern möglichst optimale Voraussetzungen für eine schnelle T – Zellrekonstitution und so einen möglichenen Schutz gegen eine CMV-Reaktivierung zu bieten. Bei der Rekonstitution der Tregs konnte in diesem Patientenkollektiv keine Korrelation zwischen ihrem Verlauf oder ihrer Anzahl und der Entwicklung einer GvHD oder Infektion gezeigt werden. Diese Tatsache deutet darauf hin, dass die bisher erhobenen Daten, die stets in Kollektiven mit engen Einschlusskriterien und oft ähnlichen Konstellationen was Spender und Empfänger angeht, nicht auf alle Stammzelltransplantationspatienten und Spender übertragbar sind. Es sollte daher zukünftig in größeren repräsentativen Kollektiven eine erneute Untersuchung der regulatorischen T-Zellen erfolgen. Auch zukünftig wird die Immunrekonstitution nach Stammzelltransplantation Gegenstand vieler Studien bleiben, um so die Voraussetzungen für und das Outcome nach der Transplantation für die Patienten ständig zu verbessern. In der vorgelegten Arbeit konnte gezeigt werden, dass die bisher in der Literatur erhobenen Ergebnisse auf ein heterogenes Fremdspenderkollektiv ohne spezielle Einschlusskriterien, wie es also der Situation im klinischen Alltag am nächsten kommt, nicht übertragbar sind, sondern sich vielmehr wesentliche Unterschiede ergeben. Es sollte daher in zukünftigen Untersuchungen ein Augenmerk auf die Verwendung repräsentativerer Kollektive für die klinische Realität geachtet werden. N2 - Analysis to cellular Immunreconstitution after allogenic Stemm Cell Transplantation KW - Stammzelltransplantation KW - Immunrekonstitution KW - allogene Stammzelltransplantation Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-130695 ER - TY - THES A1 - Das Gupta, Mithun T1 - Analyse von MicroRNA-Profilen in humanen dendritischen Zellen T1 - Analysis of microRNA-profiles in human dendritic cells N2 - The field of microRNA research has gained enormous significance during recent years. Current studies have shown that microRNAs play an important role in many biological processes via posttranscriptional gene regulation. This also applies for the TLR-mediated recognition of pathogens by immune cells. Among others, the microRNAs miR-132, miR-146a and miR-155 have been characterized by various authors. However, the specific role of microRNAs in the defense against fungal infections by Aspergillus fumigatus has not been investigated so far, although this ubiquitous mold causes severe infections in immuno-compromised patients. As dendritic cells play a pivotal part in the in vivo recognition of A. fumigatus, the present study investigates the reaction of these cells to A. fumigatus and other pathogens on the microRNA level. For this purpose, dendritic cells were incubated with different forms of A. fumigatus and other pathogens for up to twelve hours. Subsequently, the expression of miR-132, miR-146a and miR-155 was quantified by real-time PCR. Levels of miR-132 in dendritic cells were significantly increased after stimulation with living germ tubes of A. fum, but showed no change after treatment with LPS. Relative expression level of miR-146a was moderately elevated upon stimulation with LPS, but did not respond to co-cultivation with living germ tubes. MiR-155 was highly induced by both stimuli. These results show, that dependent on the stimulus, microRNAs are differentially regulated in dendritic cells. Among the tested microRNAs, miR-155 showed the strongest and most stable expression values. Therefore, further experiments focused on this mircoRNA. It was shown, that the up-regulation of miR-155 is dependent on the germination stage of the fungus. Induction of miR-155 was low with conidia, moderate with hyphae and high with germ tubes. The extent of miR-155 induction also corresponded with the multiplicity of infection (MOI), with higher MOIs triggering a stronger miR-155 response. These results suggest that miR-132 and miR-155 play an important role in the immunologic reaction of DCs against A. fumigatus and that a further characterization of these microRNA, especially with respect to their specific function in DCs, could contribute to the understanding of the biological mechanisms of Aspergillosis. N2 - Die Erforschung von MicroRNAs gewinnt zunehmend an Bedeutung. Aktuelle Arbeiten zeigen, dass MicroRNAs an der Regulation vieler biologischer Prozesse beteiligt sind, indem sie in die posttranskriptionelle Genregulation eingreifen. Dies betrifft auch die TLR-vermittelte Erkennung von Pathogenen durch Immunzellen. Hierbei wurden u.a. die MikroRNAs miR-132, miR-146a und miR-155 von verschiedenen Autoren charakterisiert. Die spezielle Rolle von MikroRNAs bei der Abwehr von Pilzinfektionen durch Aspergillus fumigatus ist bisher allerdings kaum untersucht, obwohl dieser ubiquitär vorkommende Schimmelpilz häufig schwere Infektionen bei immunsupprimierten Patienten auslöst. Da in vivo den dendritischen Zellen eine entscheidende Rolle bei der Erkennung von A. fumigatus zukommt, wurde in der vorliegenden Arbeit die Reaktion dieser Zellen auf A. fumigatus und andere Pathogene auf MikroRNA Ebene untersucht. Dazu wurden dendritische Zellen mit verschiedenen Formen von A. fumigatus und LPS über Zeiträume von bis zu zwölf Stunden stimuliert. Anschließend wurde die Expression von miR-132, miR-146a und miR-155 mittels Real-Time PCR bestimmt. Dabei zeigte sich, dass nach Stimulation mit A. fumigatus die miR-132 Level in dendritischen Zellen deutlich anstiegen, wohingegen eine Inkubation mit LPS keinen Einfluss auf diese MicroRNA hatte. Die relative Expression von miR-146a war nach Stimulation mit LPS leicht erhöht, zeigte allerdings keine Veränderung nach Ko-Kultur mit A. fumigatus. Die Expression von miR-155 wurde durch beide Stimuli stark induziert. Diese Ergebnisse zeigen, dass abhängig vom Stimulus eine differentielle Expression von MicroRNAs in dendritischen Zellen stattfindet. Unter den drei untersuchten MicroRNAs, zeigte miR-155 die höchsten und stabilsten Expressionswerte. Daher wurde der Schwerpunkt weiterer Experimente auf diese MicroRNA gesetzt. Dabei ergab sich, dass das Ausmaß der miR-155 Induktion vom Entwicklungsstadium des Pilzes abhängig ist. Konidien von A. fumigatus führten lediglich zu einer schwachen Hochregulation von miR-155, wohingegen Hyphen und insbesondere Keimschläuche ein starke Induktion von miR-155 verursachten. Die Dynamik der miR-155 Hochregulation korrelierte außerdem mit der multiplicity of infection (MOI), wobei eine höhere MOI mit einer stärkeren miR-155 Antwort einherging. Die dargestellten Ergebnisse legen nahe, dass miR-132 und miR-155 eine wichtige Rolle bei der Immunreaktion von DCs gegen A. fumigatus spielen und eine weitere Charakterisierung dieser MicroRNAs v.a. im Hinblick auf ihre spezielle Funktion in DCs einen wichtigen Beitrag zum Verständnis der biologischen Grundlagen der Aspergillosen erbringen könnte. KW - Aspergillus fumigatus KW - microRNA KW - Dendritische Zelle KW - miR-132 KW - miR-155 KW - miR-146 KW - A. fumigatus KW - dendritic cell Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-108326 ER - TY - JOUR A1 - Rieger, C. T. A1 - Liss, B. A1 - Mellinghoff, S. A1 - Buchheidt, D. A1 - Cornely, O. A. A1 - Egerer, G. A1 - Heinz, W. J. A1 - Hentrich, M. A1 - Maschmeyer, G. A1 - Mayer, K. A1 - Sandherr, M. A1 - Silling, G. A1 - Ullmann, A. A1 - Vehreschild, M. J. G. T. A1 - von Lilienfeld-Toal, M. A1 - Wolf, H. H. A1 - Lehners, N. T1 - Anti-infective vaccination strategies in patients with hematologic malignancies or solid tumors-Guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) JF - Annals of Oncology N2 - Infectious complications are a significant cause of morbidity and mortality in patients with malignancies specifically when receiving anticancer treatments. Prevention of infection through vaccines is an important aspect of clinical care of cancer patients. Immunocompromising effects of the underlying disease as well as of antineoplastic therapies need to be considered when devising vaccination strategies. This guideline provides clinical recommendations on vaccine use in cancer patients including autologous stem cell transplant recipients, while allogeneic stem cell transplantation is subject of a separate guideline. The document was prepared by the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) by reviewing currently available data and applying evidence-based medicine criteria. KW - infection KW - anti-infective vaccination KW - cancer KW - immunosuppression KW - autologous stem cell transplantation Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-226196 VL - 29 IS - 6 ER - TY - JOUR A1 - Zaitseva, Olena A1 - Hoffmann, Annett A1 - Löst, Margaretha A1 - Anany, Mohamed A. A1 - Zhang, Tengyu A1 - Kucka, Kirstin A1 - Wiegering, Armin A1 - Otto, Christoph A1 - Wajant, Harald T1 - Antibody-based soluble and membrane-bound TWEAK mimicking agonists with FcγR-independent activity JF - Frontiers in Immunology N2 - Fibroblast growth factor (FGF)-inducible 14 (Fn14) activates the classical and alternative NFκB (nuclear factor ‘kappa-light-chain-enhancer’ of activated B-cells) signaling pathway but also enhances tumor necrosis factor (TNF)-induced cell death. Fn14 expression is upregulated in non-hematopoietic cells during tissue injury and is also often highly expressed in solid cancers. In view of the latter, there were and are considerable preclinical efforts to target Fn14 for tumor therapy, either by exploiting Fn14 as a target for antibodies with cytotoxic activity (e.g. antibody-dependent cellular cytotoxicity (ADCC)-inducing IgG variants, antibody drug conjugates) or by blocking antibodies with the aim to interfere with protumoral Fn14 activities. Noteworthy, there are yet no attempts to target Fn14 with agonistic Fc effector function silenced antibodies to unleash the proinflammatory and cell death-enhancing activities of this receptor for tumor therapy. This is certainly not at least due to the fact that anti-Fn14 antibodies only act as effective agonists when they are presented bound to Fcγ receptors (FcγR). Thus, there are so far no antibodies that robustly and selectively engage Fn14 signaling without triggering unwanted FcγR-mediated activities. In this study, we investigated a panel of variants of the anti-Fn14 antibody 18D1 of different valencies and domain architectures with respect to their inherent FcγR-independent ability to trigger Fn14-associated signaling pathways. In contrast to conventional 18D1, the majority of 18D1 antibody variants with four or more Fn14 binding sites displayed a strong ability to trigger the alternative NFκB pathway and to enhance TNF-induced cell death and therefore resemble in their activity soluble (TNF)-like weak inducer of apoptosis (TWEAK), one form of the natural occurring ligand of Fn14. Noteworthy, activation of the classical NFκB pathway, which naturally is predominately triggered by membrane-bound TWEAK but not soluble TWEAK, was preferentially observed with a subset of constructs containing Fn14 binding sites at opposing sites of the IgG scaffold, e.g. IgG1-scFv fusion proteins. A superior ability of IgG1-scFv fusion proteins to trigger classical NFκB signaling was also observed with the anti-Fn14 antibody PDL192 suggesting that we identified generic structures for Fn14 antibody variants mimicking soluble and membrane-bound TWEAK. KW - agonistic antibodies KW - cell death KW - FcγR KW - Fn14 KW - NFκB KW - TNF receptor superfamily KW - TWEAK Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-323116 VL - 14 ER - TY - JOUR A1 - Prommersberger, Sabrina A1 - Hudecek, Michael A1 - Nerreter, Thomas T1 - Antibody‐Based CAR T Cells Produced by Lentiviral Transduction JF - Current Protocols in Immunology N2 - One promising approach to treat hematologic malignancies is the usage of patient‐derived CAR T cells. There are continuous efforts to improve the function of these cells, to optimize their receptor, and to use them for the treatment of additional types of cancer and especially solid tumors. In this protocol, an easy and reliable approach for CAR T cell generation is described. T cells are first isolated from peripheral blood (here: leukoreduction system chambers) and afterwards activated for one day with anti‐CD3/CD28 Dynabeads. The gene transfer is performed by lentiviral transduction and gene transfer rate can be verified by flowcytometric analysis. Six days after transduction, the stimulatory Dynabeads are removed. T cells are cultured in interleukin‐2 conditioned medium for several days for expansion. There is an option to expand CAR T cells further by co‐incubation with irradiated, antigen‐expressing feeder cell lines. The CAR T cells are ready to use after 10 (without feeder cell expansion) to 24 days (with feeder cell expansion). KW - CAR T cells KW - chimeric antigen receptor KW - lentiviral transduction Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-215497 VL - 128 IS - 1 ER - TY - THES A1 - Schwab, Julia T1 - Antimikrobielle Aktivität humaner Kolonepithelzellen gegenüber E. coli Nissle unter besonderer Berücksichtigung des Cathelicidins LL-37 T1 - Antimicrobial activity of human colonocytes against E. coli Nissle with special regard to the cathelicidin LL-37 N2 - Antimikrobielle Peptide und Proteine spielen eine wichtige Rolle bei der angeborenen Immunabwehr. Sie sind auf verschiedenen Schleimhautoberflächen des Körpers zu finden, zum Beispiel auch in der Schleimschicht des Gastrointestinaltraktes. Beim Menschen sind drei Familien antimikrobiell wirksamer Peptide bekannt: die Defensine, die Cathelicidine und die Histatine. LL-37 ist das einzige Cathelicidin, das bisher beim Menschen gefunden wurde. Das Ziel der vorliegenden Arbeit war, den Effekt des probiotischen Bakteriums E. coli Nissle auf die LL-37-Genexpression in Kolonepithelzellen zu analysieren. Zunächst wurde hierfür die bakterizide Wirksamkeit von synthetischem LL-37 auf E. coli Nissle in vitro nachgewiesen. Anschließend wurde die antimikrobielle Aktivität verschiedener Kolonepithelzelllinien gegenüber E. coli Nissle untersucht und die LL-37-Genexpression in den Zelllinien bestimmt. Zwei der vier untersuchten Zelllinien (SW 620 und Geki-2) zeigten eine signifikante antimikrobielle Aktivität gegenüber E. coli Nissle. Die LL-37-Genexpression wurde in den Zelllinien T84 und Geki-2 gesteigert. Aus diesen Ergebnissen kann man folgern, dass die antimikrobielle Aktivität der Zelllinie Geki-2 auf eine erhöhte LL-37-Expression zurückzuführen ist, während die antimikrobielle Aktivität der Zelllinie SW 620 unabhängig von der LL-37-Expression ist. Die probiotische Wirksamkeit des Bakteriums E. coli Nissle könnte somit unter anderem durch eine Induktion der LL-37-Genexpression in differenzierten Kolonepithelzellen erklärt werden. N2 - Antimicrobial peptides have been shown to play an important role in innate immunity. They have been found in different epithelial tissues of the human body, e.g. the colonic epithelium. In humans, antimicrobial peptides of three families have been identified: the defensins, cathelicidins and histatins. LL-37 is the only cathelicidin found in humans. The aim of this study was to analyze the effect of the probiotic E. coli Nissle on LL-37 gene expression in colonocytes. For this purpose we first demonstrated the bactericidal activity of synthetic LL-37 against E. coli Nissle in vitro. Furthermore, we investigated the antimicrobial activity of different colorectal cell lines against E. coli Nissle and the LL-37 gene expression in the cell lines. Two of four investigated cell lines (SW 620 and Geki-2) showed a significant antimicrobial activity against E. coli Nissle. The LL-37 gene expression was increased in the T84- and the Geki-2 cell line. This indicates, that the antimicrobial activity of Geki-2 cells depends on LL-37 gene expression, whereas the antimicrobial activity of SW 620 cells does not depend on LL-37 gene expression. Thus, the probiotic effect of E. coli Nissle could be explained by an induction of LL-37 gene expression in differentiated colorectal cells. KW - LL-37 KW - Escherichia Coli KW - antimikrobielle Peptide KW - e. coli Nissle Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-105563 ER - TY - JOUR A1 - Solimando, Antonio G. A1 - Palumbo, Carmen A1 - Pragnell, Mary Victoria A1 - Bittrich, Max A1 - Argentiero, Antonella A1 - Krebs, Markus T1 - Aplastic anemia as a roadmap for bone marrow failure: an overview and a clinical workflow JF - International Journal of Molecular Sciences N2 - In recent years, it has become increasingly apparent that bone marrow (BM) failures and myeloid malignancy predisposition syndromes are characterized by a wide phenotypic spectrum and that these diseases must be considered in the differential diagnosis of children and adults with unexplained hematopoiesis defects. Clinically, hypocellular BM failure still represents a challenge in pathobiology-guided treatment. There are three fundamental topics that emerged from our review of the existing data. An exogenous stressor, an immune defect, and a constitutional genetic defect fuel a vicious cycle of hematopoietic stem cells, immune niches, and stroma compartments. A wide phenotypic spectrum exists for inherited and acquired BM failures and predispositions to myeloid malignancies. In order to effectively manage patients, it is crucial to establish the right diagnosis. New theragnostic windows can be revealed by exploring BM failure pathomechanisms. KW - hematopoietic stem cells KW - bone marrow immune-microenvironment KW - bone marrow failure KW - cytopenia KW - aplastic anemia Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-290440 SN - 1422-0067 VL - 23 IS - 19 ER - TY - JOUR A1 - Boch, Tobias A1 - Spiess, Birgit A1 - Heinz, Werner A1 - Cornely, Oliver A. A1 - Schwerdtfeger, Rainer A1 - Hahn, Joachim A1 - Krause, Stefan W. A1 - Duerken, Matthias A1 - Bertz, Hartmut A1 - Reuter, Stefan A1 - Kiehl, Michael A1 - Claus, Bernd A1 - Deckert, Peter Markus A1 - Hofmann, Wolf‐Karsten A1 - Buchheidt, Dieter A1 - Reinwald, Mark T1 - Aspergillus specific nested PCR from the site of infection is superior to testing concurrent blood samples in immunocompromised patients with suspected invasive aspergillosis JF - Mycoses N2 - Invasive aspergillosis (IA) is a severe complication in immunocompromised patients. Early diagnosis is crucial to decrease its high mortality, yet the diagnostic gold standard (histopathology and culture) is time‐consuming and cannot offer early confirmation of IA. Detection of IA by polymerase chain reaction (PCR) shows promising potential. Various studies have analysed its diagnostic performance in different clinical settings, especially addressing optimal specimen selection. However, direct comparison of different types of specimens in individual patients though essential, is rarely reported. We systematically assessed the diagnostic performance of an Aspergillus‐specific nested PCR by investigating specimens from the site of infection and comparing it with concurrent blood samples in individual patients (pts) with IA. In a retrospective multicenter analysis PCR was performed on clinical specimens (n = 138) of immunocompromised high‐risk pts (n = 133) from the site of infection together with concurrent blood samples. 38 pts were classified as proven/probable, 67 as possible and 28 as no IA according to 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group consensus definitions. A considerably superior performance of PCR from the site of infection was observed particularly in pts during antifungal prophylaxis (AFP)/antifungal therapy (AFT). Besides a specificity of 85%, sensitivity varied markedly in BAL (64%), CSF (100%), tissue samples (67%) as opposed to concurrent blood samples (8%). Our results further emphasise the need for investigating clinical samples from the site of infection in case of suspected IA to further establish or rule out the diagnosis. KW - antifungal KW - aspergillosis KW - BAL KW - blood KW - cerebrospinal fluid KW - comparison KW - PCR KW - Aspergillus Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-214065 VL - 62 IS - 11 SP - 1035 EP - 1042 ER - TY - JOUR A1 - Grunz, Jan-Peter A1 - Kunz, Andreas Steven A1 - Baumann, Freerk T. A1 - Hasenclever, Dirk A1 - Sieren, Malte Maria A1 - Heldmann, Stefan A1 - Bley, Thorsten Alexander A1 - Einsele, Hermann A1 - Knop, Stefan A1 - Jundt, Franziska T1 - Assessing osteolytic lesion size on sequential CT scans is a reliable study endpoint for bone remineralization in newly diagnosed multiple myeloma JF - Cancers N2 - Multiple myeloma (MM) frequently induces persisting osteolytic manifestations despite hematologic treatment response. This study aimed to establish a biometrically valid study endpoint for bone remineralization through quantitative and qualitative analyses in sequential CT scans. Twenty patients (seven women, 58 ± 8 years) with newly diagnosed MM received standardized induction therapy comprising the anti-SLAMF7 antibody elotuzumab, carfilzomib, lenalidomide, and dexamethasone (E-KRd). All patients underwent whole-body low-dose CT scans before and after six cycles of E-KRd. Two radiologists independently recorded osteolytic lesion sizes, as well as the presence of cortical destruction, pathologic fractures, rim and trabecular sclerosis. Bland–Altman analyses and Krippendorff’s α were employed to assess inter-reader reliability, which was high for lesion size measurement (standard error 1.2 mm) and all qualitative criteria assessed (α ≥ 0.74). After six cycles of E-KRd induction, osteolytic lesion size decreased by 22% (p < 0.001). While lesion size response did not correlate with the initial lesion size at baseline imaging (Pearson’s r = 0.144), logistic regression analysis revealed that the majority of responding osteolyses exhibited trabecular sclerosis (p < 0.001). The sum of osteolytic lesion sizes on sequential CT scans defines a reliable study endpoint to characterize bone remineralization. Patient level response is strongly associated with the presence of trabecular sclerosis. KW - multiple myeloma KW - bone remineralization KW - computed tomography KW - whole-body imaging Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-362526 SN - 2072-6694 VL - 15 IS - 15 ER - TY - JOUR A1 - Scharbatke, Eva C. A1 - Behrens, Frank A1 - Schmalzing, Marc A1 - Koehm, Michaela A1 - Greger, Gerd A1 - Gnann, Holger A1 - Burkhardt, Harald A1 - Tony, Hans-Peter T1 - Association of improvement in pain with therapeutic response as determined by individual improvement criteria in patients with rheumatoid arthritis JF - Arthritis Care & Research N2 - Objective To use statistical methods to establish a threshold for individual response in patient-reported outcomes (PROs) in patients with rheumatoid arthritis. Methods We used an analysis of variance model in patients on stable therapy (discovery cohort) to establish critical differences (d(crit)) for the minimum change associated with a significant individual patient response (beyond normal variation) in the PRO measures of pain (0-10), fatigue (0-10), and function (Funktionsfragebogen Hannover questionnaire; 0-100). We then evaluated PRO responses in patients initiating adalimumab in a noninterventional study (treatment cohort). Results In the discovery cohort (n=700), PROs showed excellent long-term retest reliability. The minimum change that exceeded random fluctuation was conservatively determined to be 3 points for pain, 4 points for fatigue, and 16 points for function. In the treatment cohort (n=2,788), 1,483 patients (53.2%) achieved a significant individual therapeutic response as assessed by Disease Activity Score in 28 joints (DAS28)-d(crit) (1.8 points) after 12 months of adalimumab treatment; 68.5% of patients with a DAS28-d(crit) response achieved a significant improvement in pain, whereas approximately 40% achieved significant improvements in fatigue or function. Significant improvements in all 3 PROs occurred in 22.7% of patients; 22.8% did not have any significant PRO responses. In contrast, significant improvements in all 3 PROs occurred in only 4.4% of 1,305 patients who did not achieve a DAS28-d(crit) response at month 12, and 59.1% did not achieve any significant PRO responses. Conclusion The establishment of critical differences in PROs distinguishes true responses from random variation and provides insights into appropriate patient management. KW - health-assessment questionnaire KW - minimally important difference KW - disease-activity score KW - reported outcomes KW - clinical-practice KW - fatigue KW - care KW - discordance KW - validation KW - physicians Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-186817 VL - 68 IS - 11 ER - TY - JOUR A1 - Kosmala, Aleksander A1 - Serfling, Sebastian E. A1 - Dreher, Niklas A1 - Lindner, Thomas A1 - Schirbel, Andreas A1 - Lapa, Constantin A1 - Higuchi, Takahiro A1 - Buck, Andreas K. A1 - Weich, Alexander A1 - Werner, Rudolf A. T1 - Associations between normal organs and tumor burden in patients imaged with fibroblast activation protein inhibitor-directed positron emission tomography JF - Cancers N2 - (1) Background: We aimed to quantitatively investigate [\(^{68}\)Ga]Ga-FAPI-04 uptake in normal organs and to assess a relationship with the extent of FAPI-avid tumor burden. (2) Methods: In this single-center retrospective analysis, thirty-four patients with solid cancers underwent a total of 40 [\(^{68}\)Ga]Ga-FAPI-04 PET/CT scans. Mean standardized uptake values (SUV\(_{mean}\)) for normal organs were established by placing volumes of interest (VOIs) in the heart, liver, spleen, pancreas, kidneys, and bone marrow. Total tumor burden was determined by manual segmentation of tumor lesions with increased uptake. For tumor burden, quantitative assessment included maximum SUV (SUV\(_{max}\)), tumor volume (TV), and fractional tumor activity (FTA = TV × SUV\(_{mean}\)). Associations between uptake in normal organs and tumor burden were investigated by applying Spearman's rank correlation coefficient. (3) Results: Median SUV\(_{mean}\) values were 2.15 in the pancreas (range, 1.05–9.91), 1.42 in the right (range, 0.57–3.06) and 1.41 in the left kidney (range, 0.73–2.97), 1.2 in the heart (range, 0.46–2.59), 0.86 in the spleen (range, 0.55–1.58), 0.65 in the liver (range, 0.31–2.11), and 0.57 in the bone marrow (range, 0.26–0.94). We observed a trend towards significance for uptake in the myocardium and tumor-derived SUV\(_{max}\) (ρ = 0.29, p = 0.07) and TV (ρ = −0.30, p = 0.06). No significant correlation was achieved for any of the other organs: SUV\(_{max}\) (ρ ≤ 0.1, p ≥ 0.42), TV (ρ ≤ 0.11, p ≥ 0.43), and FTA (ρ ≤ 0.14, p ≥ 0.38). In a sub-analysis exclusively investigating patients with high tumor burden, significant correlations of myocardial uptake with tumor SUV\(_{max}\) (ρ = 0.44; p = 0.03) and tumor-derived FTA with liver uptake (ρ = 0.47; p = 0.02) were recorded. (4) Conclusions: In this proof-of-concept study, quantification of [\(^{68}\)Ga]Ga-FAPI-04 PET showed no significant correlation between normal organs and tumor burden, except for a trend in the myocardium. Those preliminary findings may trigger future studies to determine possible implications for treatment with radioactive FAP-targeted drugs, as higher tumor load or uptake may not lead to decreased doses in the majority of normal organs. KW - PET KW - [\(^{68}\)Ga]Ga-FAPI KW - theranostics KW - radioligand therapy KW - fibroblast activation protein Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-275154 SN - 2072-6694 VL - 14 IS - 11 ER - TY - THES A1 - Strizek, Brigitte Sabine T1 - Assoziation der renalen Na+,K+-ATPase mit dem ERM-Protein Moesin T1 - Kidney Na+,K+-ATPase is associated with the ERM protein moesin N2 - Die Na+,K+-ATPase ist das wichtigste Na+ und K+ transportierende integrale Membranprotein des menschlichen Körpers. Es ist verantwortlich für die Ausbildung eines transmembranären Na+ und K+ Gradienten und die Aufrechterhaltung des Membranpotentials, das für die osmotische Stabilität der Zellen, Erregbarkeit von Nerven- und Muskelzellen und diverse Transportvorgänge unerlässlich ist. Die Beschränkung der Na+,K+-ATPase auf die basolateralen Zellwandabschnitte, ermöglichen den gerichteten Transport von NaCl und Wasser durch Epithelien von Darm und Niere. Die polare Verteilung der Na+,K+-ATPase scheint durch die Bindung über Ankyrin an das Spektrinzytoskelett zustande zu kommen. Außer mit Ankyrin konnte eine Assoziation der renalen Na+,K+-ATPase mit Aktin und zwei bis dahin unbekannten Proteinen Pasin 1 und 2 nachgewiesen werden. Ziel dieser Arbeit war es, zu untersuchen, ob es sich bei dem als Pasin 2 benannten Protein um Moesin, ein Mitglied der FERM Familie (Protein 4.1, Ezrin, Radixin, Moesin) handelt. Diese Proteine fungieren als Verbindungselemente zwischen integralen Membranproteinen und dem Aktinzytoskelett. Pasin 2 wurde aus Schweinenieren isoliert und massenspektrometrisch sequenziert. Anschließend wurde die Sequenz mit der von Moesin verglichen und die Identität der beiden Proteine bestätigt. Aus Schweinenieren isoliertes Pasin 2 reagierte zudem im Immunoblot spezifisch mit anti-Moesin Antikörpern und zeigte in der Immunfluoreszenz eine Kolokalisation mit der Na+,K+-ATPase. Anschließend konnte in vitro durch Kosedimentation eine direkte Bindung von rekombinantem Moesin an die Na+,K+-ATPase nachgewiesen werden. Da sich die Bindungsstelle für andere Membranproteine auf dem aminoterminalen Anteil der ERM Proteine befindet, wurde untersucht, ob dies auch für die Na+,K+-ATPase zutrifft. Durch Bindungsstudien mit rekombinanten N-terminalen Moesin konnte dies bestätigt werden. Dies legt die Vermutung nahe, dass die renale Na+,K+-ATPase neben Ankyrin auch über Moesin mit dem Zytoskelett verbunden ist. Zusätzlich zeigte sich, dass die Bindung von Moesin an die Na+,K+-ATPase durch einen Antikörper gegen die große zytoplasmatische Domäne der Na+,K+-ATPase verhindert werden kann, was die Moesinbindung an dieser Domäne wahrscheinlich macht. Da sich sowohl die Bindungsstelle für Ankyrin als auch das aktive Zentrum des Enzyms auf dieser Domäne befinden, könnte die Moesinbindung sowohl Einfluss auf die Aktivität als auch auf die Ankyrinbindung der Na+,K+-ATPase ausüben, wie auch die Bindung des erythrozytären Anionenaustauschers (AE1) an Ankyrin durch das Protein 4.1 verändert werden kann. N2 - Na+,K+-ATPase is a ubiquitous plasmalemmal membrane protein essential for generation and maintenance of transmembrane Na+ and K+ gradients in virtually all animal cell types. Activity and polarized distribution of renal Na+,K+-ATPase appears to depend on connection of ankyrin to the spectrinbased membrane cytoskeleton as well as on association with actin filaments. In a previous study we showed copurification and codistribution of renal Na+,K+-ATPase not only with ankyrin, spectrin and actin, but also with two further peripheral membrane proteins, pasin 1 and pasin 2. In this paper we show by sequence analysis through mass spectrometry as well as by immunoblotting that pasin 2 is identical to moesin, a member of the FERM (protein 4.1, ezrin, radixin, moesin) protein family, all members of which have been shown to serve as cytoskeletal adaptor molecules. Moreover, we show that recombinant full-length moesin as well as its FERM domain bind to Na+,K+-ATPase and that this binding can be inhibited by an antibody specific for the ATPase activity-containing cytoplasmic loop(domain 3) of the Na+,K+-ATPase α-subunit. This loop has previously been shown to be a site essential for ankyrin binding. These observations indicate that moesin might not only serve as a direct linker molecule of Na+,K+-ATPase to actin filaments but might also modify ankyrin binding at domain 3 of Na+,K+-ATPase in a similar way to protein 4.1 modifying the binding of ankyrin to the cytoplasmic domain of the erythrocyte anion exchanger AE1. KW - Moesin KW - ERM KW - Na+ KW - K+-ATPase KW - Aktin KW - Moesin KW - ERM KW - Na+ KW - K+-ATPase KW - actin Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-17842 ER - TY - THES A1 - Schloßer, Irmgard Juliane T1 - Auftreten von Clostridium difficile Infektionen bei AML-Patienten in der medizinischen Klinik und Poliklinik II von Januar 2000 bis Juni 2005 T1 - Occurence of infections with clostridium difficile in aml-patients at the " Medizinische Klinik und Poliklinik II" from january 2000 to june 2005 N2 - In der vorliegenden Arbeit wurde das Auftreten von Clostridium difficile Infektionen bei AML-Patienten in der medizinischen Klinik und Poliklinik II der Universität Würzburg zwischen Januar 2000 und Juni 2005 untersucht. Es wurden retrospektiv die Akten von 116 Patienten ausgewertet. Davon entwickelten 36 Patienten, als 31% mindestens einmal eine Infektion mit Clostridium difficile. Bei 329 verabreichten Zyklen Polychemotherapie kam es in 53 Fällen, also in 16% zu einer Infektion mit Clostridium difficile. In allen Fällen ging der Clostridium difficile Infektion zusätzlich zur Polychemotherpie auch eine Antibiotikatherapie voraus. Clostridium difficile Infektionen unabhängig von einer Antibiotikatherapie wurden nicht beobachtet. Insbesondere beim zweiten verabreichten Zyklus einer Chemotherapie kam es gehäuft zu Clostridium difficile Infektionen. Bei Patienten unter 60 Jahren kam es in 39% aller verabreichten Zyklen zu einer Clostridium difficile Infektion, bei Patienten, die älter waren als 60 Jahre, nur in 11%. Möglicherweise sind hier die intensiveren Chemotherapieschemata verantwortlich, die jüngeren Patienten verabreicht wird. Es konnten Schwankungen in der Inzidenz von Clostridium difficile in Abhängigkeit vom verwendeten Chemotherapieprotokoll festgestellt werden. Besonders deutlich zeigte sich dies beim Vergleich der Doppel-Induktion nach dem DA-Protokoll und der Induktion nach dem MAV-MAMAC Protokoll. Bei der Doppelinduktion nach dem DA-Protokolle kam es bei 15% der Patienten zu einer Clostridium difficile induzierten Diarrhö, bei Doppelinduktion nach dem MAV- MAMAC- Protokoll in 60% der Fälle. Rückfälle der Clostridium difficile Infektion stellen ein häufiges Problem dar. Bei einem Drittel der Patienten mit Clostridium difficile Infektion, die mehr als einen Zyklus Chemotherapie erhielten kam es zu einem erneuten Auftreten der Erkrankung. Die Inzidenz der Clostridium difficile Infektionen in den verschiedenen Jahren schwankte erheblich zwischen 4% und 32% der Fälle. Besonders auffällig war eine hohe Inzidenz im Jahr 2000. Dabei kann retrospektiv nicht mehr festgestellt werden, was die Ursache war. Möglicherweise handelte es sich hier um einen besonders virulenten Stamm. Eine weitere Ursache könnte sein, dass es im Jahr 2000 Probleme bei der Einhaltung der Hygienemaßnahmen gab. N2 - In this retrospective study we evaluated the incidence of infections with clostridium difficle in patients with acute myeloic leukemia, who were treated at the "Medizinische Klinik und Poliklinik II" of the university of Würzburg between january 2000 and june 2005. The occurence of infections with clostridium difficile patiens was with 31% of patients affected high. Recurrences of clostridium difficle infections were a frequent problem. Young patients were more often than elder patients affected by this infection. Subject to the chemotherapy protocol used,we found different incidence of clostridium difficle infections. There was a high fluctuance of infections between the different years. KW - Clostridium-difficile-Infektion KW - Akute myeloische Leukämie KW - Hospitalismus KW - Darminfektion KW - Promyelozytenleukämie KW - Akute Leukämie KW - clostridium difficile infection KW - acute myeloic leukemia KW - diarrhea Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-28343 ER - TY - THES A1 - Müller-Zentis, Ariane T1 - Auswirkungen von Distress auf den Transplantationsverlauf bei Patienten mit Multiplen Myelom während der autologen Stammzelltransplantation. Subanalyse von Zusammenhängen zwischen posttraumatischen Symptomen und klinischen Variablen T1 - Impacts of distress on the transplantation course in patients with multiple myeloma during autologous stem cell transplantation. Subanalysis of correlations between post-traumatic symptoms and clinical variables N2 - Ziel dieser Arbeit war es, den Einfluss psychosozialer Belastungsfaktoren auf den Verlauf einer Stammzelltransplantation zu untersuchen. Die primäre Fragestellung war, ob sich das Vorliegen einer posttraumatischen Belastungsstörung (PTSD) auf die Dauer der Immunrekonstitution, gemessen an der Aplasiezeit, auswirkt. Der Untersuchung liegen Daten aus der Medizinischen Klinik und Poliklinik II des Universitätsklinikums Würzburg zugrunde, die im Rahmen einer monozentrischen Querschnittsstudie erhoben wurden. An der Studie nahmen 50 Patienten mit der Diagnose eines Multiplen Myeloms teil, die am Tag ihrer ersten autologen Stammzelltransplantation befragt wurden. Anhand von Fragebögen konnten die Patienten Angaben zu ihrer individuellen psychischen Belastung machen. Für die statistische Auswertung wurden die Angaben aus dem NCCN-Distress-Thermometer und dem PCL-C ausgewertet. N2 - The aim of this study was to investigate the influence of psychosocial stress factors on the course of stem cell transplantation. The primary research question was whether the presence of post-traumatic stress disorder (PTSD) affects the duration of immune reconstitution, measured by the aplasia period. The study is based on data from the Medical Clinic and Polyclinic II of the University Hospital Würzburg, collected as part of a monocentric cross-sectional study. Fifty patients diagnosed with multiple myeloma, who were interviewed on the day of their first autologous stem cell transplantation, participated in the study. Using questionnaires, patients provided information about their individual psychological stress. The data from the NCCN Distress Thermometer and the PCL-C were analyzed for statistical evaluation KW - Distress KW - Psychoneuroimmunologie Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-345032 ER - TY - JOUR A1 - Gernert, Michael A1 - Tony, Hans-Peter A1 - Schwaneck, Eva Christina A1 - Gadeholt, Ottar A1 - Schmalzing, Marc T1 - Autologous hematopoietic stem cell transplantation in systemic sclerosis induces long-lasting changes in B cell homeostasis toward an anti-inflammatory B cell cytokine pattern JF - Arthritis Research & Therapy N2 - Background Autologous hematopoietic stem cell transplantation (aHSCT) is performed in patients with aggressive forms of systemic sclerosis (SSc). The profile of B cell reconstitution after aHSCT is not fully understood. The aim of this study was to investigate changes of B cell subsets and cytokine production of B cells in patients with SSc after aHSCT. Methods Peripheral blood of six patients with SSc was collected at defined intervals up to 16 months after aHSCT. Immunophenotyping was performed, and B cell function was determined by measuring cytokine secretion in supernatants of stimulated B cell cultures. Results Within 1 month after aHSCT, a peak in the percentage of CD38\(^{++}\)/CD10\(^+\)/IgD\(^+\) transitional B cells and CD38\(^{++}\)/CD27\(^{++}\)/IgD\(^−\) plasmablasts was detected. Long-term changes persisted up to 14 months after aHSCT and showed an increased percentage of total B cells; the absolute B cell number did not change significantly. Within the B cell compartment, an increased CD27/IgD\(^+\) naïve B cell percentage was found whereas decreased percentages of CD27\(^+\)/IgD\(^+\) pre-switched memory, CD27\(^+\)/IgD\(^−\) post-switched memory, and CD27\(^−\) /IgD\(^−\) double-negative B cells were seen after aHSCT. Cytokine secretion in B cell cultures showed significantly increased IL-10 concentrations 13 to 16 months after aHSCT. Conclusion A changed composition of the B cell compartment is present for up to 14 months after aHSCT indicating positive persisting effects of aHSCT on B cell homeostasis. The cytokine secretion profile of B cells changes in the long term and shows an increased production of the immune regulatory cytokine IL-10 after aHSCT. These findings might promote the clinical improvements after aHSCT in SSc patients. KW - Systemic sclerosis KW - B cells KW - Memory B cells KW - naïve B cells KW - Autologous hematopoietic stem cell transplantation KW - Interleukin-10 Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201004 VL - 21 ER - TY - JOUR A1 - Froehlich, Matthias A1 - Schwaneck, Eva C. A1 - Gernert, Michael A1 - Gadeholt, Ottar A1 - Strunz, Patrick-Pascal A1 - Morbach, Henner A1 - Tony, Hans-Peter A1 - Schmalzing, Marc T1 - Autologous Stem Cell Transplantation in Common Variable Immunodeficiency: A Case of Successful Treatment of Severe Refractory Autoimmune Encephalitis JF - Frontiers in Immunology N2 - Common variable immunodeficiency (CVID) is the most common primary immunodeficiency in adults. It is associated with hypogammaglobulinemia, recurring infections and autoimmune phenomena. Treatment includes immunoglobulin substitution and immunosuppressants. Autoimmune neurological manifestations of CVID are rare and occur predominantly as granulomatous disease. We report the case of a 35-year-old woman with CVID who developed autoimmune encephalitis as demonstrated by double cerebral biopsy. Infectious or malignant causes could be excluded. Despite intensive immunosuppressive therapy with common regimens no significant improvement could be achieved. Ultimately, an autologous hematopoietic stem cell transplantation (HSCT) was performed, resulting in lasting complete remission of the encephalitis. To our knowledge, this is the first report of refractory autoimmune phenomena in CVID treated by autologous HSCT. KW - common variable immunodeficiency KW - primary immunodeficiencies KW - autoimmunity KW - autologous stem cell transplantation KW - autoimmune encephalitis Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-206972 SN - 1664-3224 VL - 11 IS - 1317 ER - TY - JOUR A1 - Krenzer, Adrian A1 - Heil, Stefan A1 - Fitting, Daniel A1 - Matti, Safa A1 - Zoller, Wolfram G. A1 - Hann, Alexander A1 - Puppe, Frank T1 - Automated classification of polyps using deep learning architectures and few-shot learning JF - BMC Medical Imaging N2 - Background Colorectal cancer is a leading cause of cancer-related deaths worldwide. The best method to prevent CRC is a colonoscopy. However, not all colon polyps have the risk of becoming cancerous. Therefore, polyps are classified using different classification systems. After the classification, further treatment and procedures are based on the classification of the polyp. Nevertheless, classification is not easy. Therefore, we suggest two novel automated classifications system assisting gastroenterologists in classifying polyps based on the NICE and Paris classification. Methods We build two classification systems. One is classifying polyps based on their shape (Paris). The other classifies polyps based on their texture and surface patterns (NICE). A two-step process for the Paris classification is introduced: First, detecting and cropping the polyp on the image, and secondly, classifying the polyp based on the cropped area with a transformer network. For the NICE classification, we design a few-shot learning algorithm based on the Deep Metric Learning approach. The algorithm creates an embedding space for polyps, which allows classification from a few examples to account for the data scarcity of NICE annotated images in our database. Results For the Paris classification, we achieve an accuracy of 89.35 %, surpassing all papers in the literature and establishing a new state-of-the-art and baseline accuracy for other publications on a public data set. For the NICE classification, we achieve a competitive accuracy of 81.13 % and demonstrate thereby the viability of the few-shot learning paradigm in polyp classification in data-scarce environments. Additionally, we show different ablations of the algorithms. Finally, we further elaborate on the explainability of the system by showing heat maps of the neural network explaining neural activations. Conclusion Overall we introduce two polyp classification systems to assist gastroenterologists. We achieve state-of-the-art performance in the Paris classification and demonstrate the viability of the few-shot learning paradigm in the NICE classification, addressing the prevalent data scarcity issues faced in medical machine learning. KW - machine learning KW - deep learning KW - endoscopy KW - gastroenterology KW - automation KW - image classification KW - transformer KW - deep metric learning KW - few-shot learning Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357465 VL - 23 ER - TY - JOUR A1 - Zaitseva, Olena A1 - Anany, Mohamed A1 - Wajant, Harald A1 - Lang, Isabell T1 - Basic characterization of antibodies targeting receptors of the tumor necrosis factor receptor superfamily JF - Frontiers in Immunology N2 - Many new immunotherapeutic approaches aim on the stimulatory targeting of receptors of the tumor necrosis factor (TNF) receptor superfamily (TNFRSF) using antibodies with intrinsic or conditional agonism. There is an initial need to characterize corresponding TNFRSF receptor (TNFR)-targeting antibodies with respect to affinity, ligand binding, receptor activation and the epitope recognized. Here, we report a collection of simple and matched protocols enabling the detailed investigation of these aspects by help of Gaussia princeps luciferase (GpL) fusion proteins and analysis of interleukin-8 (IL8) production as an easily measurable readout of TNFR activation. In a first step, the antibodies and antibody variants of interest are transiently expressed in human embryonal kidney 293 cells, either in non-modified form or as fusion proteins with GpL as a reporter domain. The supernatants containing the antibody-GpL fusion proteins can then be used without further purification in cell-free and/or cellular binding studies to determine affinity. Similarly, binding studies with mutated TNFR variants enable the characterization of the antibody binding site within the TNFR ectodomain. Furthermore, in cellular binding studies with GpL fusion proteins of soluble TNFL molecules, the ability of the non-modified antibody variants to interfere with TNFL-TNFR interaction can be analyzed. Last but not least, we describe a protocol to determine the intrinsic and the Fc gamma receptor (FcγR)-dependent agonism of anti-TNFR antibodies which exploits i) the capability of TNFRs to trigger IL8 production in tumor cell lines lacking expression of FcγRs and ii) vector- and FcγR-transfected cells, which produce no or only very low amounts of human IL8. The presented protocols only require standard molecular biological equipment, eukaryotic cell culture and plate readers for the quantification of luminescent and colorimetric signals. KW - affinity KW - agonism KW - antibody KW - FcγR KW - Gaussia princeps luciferase (GpL) KW - immunotherapy KW - TNF receptor superfamily Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-311407 VL - 14 ER - TY - THES A1 - Attinger, Hannah Marie T1 - Bedeutung der nukleären Lokalisationssequenz (NLS) des Proteins p8 für die Kerntranslokation und seine Proliferation induzierende Wirkung T1 - The role of the nuclear localisation sequence (NLS) of the protein p8 concerning nuclear translocation and its proliferation inducing effect N2 - p8 ist ein erstmals im Zusammenhang mit akuter Pankreatitis beschriebenes Protein, das im exokrinen und endokrinen Pankreas mit vermehrtem Zellwachstum assoziiert ist. Bei der Analyse seiner Primärstruktur wurde ein speziesübergreifend hoch konservierter Abschnitt, eine sogenannte NLS, ausgemacht, der HMG-Y/I-Proteinen ähnelt. Da HMG-Proteine oft als Transkriptionsfaktoren wirken, wurde die Hypothese formuliert, auch p8 sei ein HMG-Y/I-Protein und wirke als Transkriptionsfaktor im Nukleus. Um die Bedeutung der rp8-NLS näher zu charakterisieren, wurde in INS-1 beta-Zellen ein rp8(NLS-)-EGFP Fusionsprotein ektopisch exprimiert, um dessen subzelluläre Lokalisation zu untersuchen. Es zeigte sich, ähnlich wie bei Kontrollzellen mit ektoper Expression von EGFP allein, eine gleichmäßige Verteilung von rp8(NLS-)-EGFP zwischen Zytoplasma und Nukleus. Da rp8(NLS-) trotz fehlender NLS dennoch in den Kern translozieren kann, scheint die NLS für diesen Vorgang nicht essentiell zu sein. Diese Annahme wird gestützt durch die Beobachtung, dass einzeln exprimiertes rp8(NLS-) seine Proliferation induzierende Wirkung nicht verliert. In Zellzählungsexperimenten zeigte sich, dass ein rp8- bzw. p8(NLS-)-EGFP Fusionsprotein keinen proliferationsfördernden Einfluss in INS-1 und hMSC-TERT Zellen hat. Bei ektoper Expression von rp8 bzw. rp8(NLS-) und hrGFP als Einzelproteine konnte jedoch eine zwischen beiden rp8-Varianten ähnliche und insgesamt signifikante Stimulation der Zellvermehrung beobachtet werden. Dies belegt, dass die Fusion von rp8 an EGFP dessen biologische Funktion inhibiert, während die Deletion der NLS keinen Einfluß darauf hat. Da der proliferative Stimulus von p8 in menschlichen hMSC-TERT Zellen unabhängig von der Herkunft von p8 aus Ratte oder Mensch ist, scheint p8 bei Säugern hoch konserviert zu sein und speziesübergreifend zu wirken. Aus der hier vorgestellten Arbeit geht hervor, dass der molekulare Mechanismus, über den p8 glukoseabhängig proliferationsinduzierend in INS-1 beta-Zellen wirkt, nicht über die NLS vermittelt wird. Weitere Untersuchungen der Wirkungsweise von p8 auf molekularer Ebene könnten in Zukunft einen Ansatz zur in vitro-Generierung ausreichender Mengen an beta-Zellen zur Zelltherapie des Diabetes mellitus bilden. N2 - The protein p8 was first described as a proliferative factor in the exocrine and endocrine pancreas during an acute pancreatitis. An analysis of the amino acid sequence showed a highly conserved area with strong similarities to a nuclear localisation sequence (NLS) of HMG-Y/I proteins. These proteins act very often as transcription factors and therefore it was hypothesized that p8 also acts as transcription factor. In order to explore the functionality of the rat p8 NLS sequence, an rp8(NLS-)-EGFP fusion protein was transfected into INS1 beta cells and the sub cellular localisation of the protein analyzed. This experiment showed an equal distribution of the fusion protein between nucleus and cytoplasm as it was also observed for control cells which were only transfected with EGFP. It seems that the NLS sequence is not essential for the translocation of rp8 to the nucleus. This is also supported by the observation that rp8(NLS-) still has its proliferative function. Cell counting experiments showed that rp8 and rp8(NLS-)-EGFP fusion proteins had no proliferative effect in INS-1 or hMSC-TERT cells whereas the expression of rp8 and rp8(NLS-) as single proteins caused a significant proliferation augmentation. This led to the conclusion that the fusion protein of p8 and EGFP has lost its biological function whereas the NLS is not essential for the function of p8 as a single protein. The independence of the proliferative effect in hMSC-TERT cells from rat or human p8 may indicate a highly conserved role for p8 in mammals. This work showed that the proliferative effect of p8 in glucose stimulated INS-1 beta cells is independent of its supposed nuclear localisation sequence. The molecular mechanisms of p8 function has still to be revealed by further experiments but once elucidated it may lead to in-vitro generation of beta cells for a cell therapy of diabetes mellitus. KW - Diabetes mellitus KW - Proliferation KW - Transkriptionsfaktor KW - Kernproteine KW - Protein p8 KW - subzelluläre Lokalisation KW - nukleäre Lokalisationssequenz KW - beta-Zellproliferation KW - protein p8 KW - subcellular localisation KW - nuclear localisation sequence KW - proliferation of beta-cells Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-47534 ER - TY - THES A1 - Dissen, Lea Kristin T1 - Bedeutung des seriell bestimmten Spender-Chimärismus nach allogener Stammzelltransplantation beim Multiplen Myelom T1 - The significance of serially determined donor chimerism after hematopoietic cell transplantation in multiple myeloma N2 - Die Bedeutung des seriell bestimmten Spender-Chimärismus nach allogener Stammzelltransplantation beim Multiplen Myelom wurde in der vorliegenden Arbeit analysiert. Die Analyse der Spenderchimärismen nach einer allogenen Stammzelltransplantation zur Messung der Krankheitslast und zur Detektion oder Prognose eines Rezidives wurde bereits in mehreren Studien für Leukämien und Lymphome untersucht, nun wurde erstmalig eine Patientengruppe mit Multiplen Myelom isoliert untersucht. Insgesamt waren von 155 Patienten aus drei Transplantationszentren (Uniklinikum Würzburg, Uniklinikum Dresden und HELIOS Klinik Wiesbaden) 2324 Chimärismusproben (2198 aus dem peripheren Blut und 126 aus dem Knochenmark) zur Auswertung verfügbar. Die Chimärismusanalyse wurde durch die AgenDix GmbH – Applied Genetic Diagnostics – in Dresden durchgeführt und freundlicherweise bereitgestellt. Abgesehen von der Überprüfung des Engraftments scheint die Analyse des seriell bestimmten Spender-Chimärismus nur einen begrenzten Aussagewert für das Krankheitsmanagement beim Multiplen Myelom zu haben. Durch die Analyse konnte nur in etwas mehr als einem Drittel der Fälle der Krankheitsprogress detektiert werden, obwohl knapp die Hälfte der Patienten einen Krankheitsprogress nach der allogenen Stammzelltransplantation aufwiesen. Insbesondere die Patienten mit einer extramedullären Manifestation als Rezidiv und einer geringen Knochenmarkfiltration wurden nicht ausreichend erfasst. N2 - The significance of serially determined donor chimerism after allogeneic hematopoietic cell transplantation by patients with multiple myeloma was analysed in this paper. This particulare analysis for monitoring of disease burden or detection of disease relapse was evaluated in several previous studies for patients with leukaemia or lymphoma. Ours was the first analysis of an isolated group with multiple myeloma. Altogether, 2324 analyses of donor chimerism (2198 in peripheral blood and 126 in bone marrow) of 155 consecutive patients from three German transplant centres (University Hospital Würzburg, University Hospital Dresden and HELIOS Hospital Wiesbaden) were available for the evaluation. The analyses of donor chimerism were realized and provided by AgenDix – Applied Genetic Diagnostics – in Dresden. Except for confirmation of engraftment, the value of the analysis of serially determined donor chimerism after allogeneic hematopoietic cell transplantation in patients with multiple myeloma appears to have a limited diagnostic value. By this analysis the progress of a little more than a third of the patients was detected, although nearly half of the patients were suffering from disease progression after allogeneic hematopoietic cell transplantation. Particularly patients with extramedullary disease or a low bone marrow infiltration are not well represented. KW - Multiples Myelom KW - Spender-Chimärismus KW - allogene Stammzelltransplantation Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-203887 ER - TY - THES A1 - Bauer, Jonas T1 - Bedeutung eines spezifischen Genpolymorphismus (IL28B) für die Verträglichkeit einer Interferontherapie bei Patienten mit chronischer Hepatitis-C-Infektion T1 - Importance of a specific gene polymorphism (IL28B) for the tolerability of interferon therapy in patients with chronic hepatitis C infection N2 - Vor Einführung der direkt antiviralen Kombinationstherapien war die Kombination aus pegyliertem Interferon plus Ribavirin die Standardbehandlung für Patienten mit chronischer Hepatitis-C-Infektion. Bei 30% der Patienten zeigten sich neurokognitive sowie depressive Nebenwirkungen, die das dauerhafte Therapieansprechen negativ beeinflussen können. Vor diesem Hintergrund untersuchten wir in unserer Arbeit bei 93 Patienten mit chronischer Hepatitis-C-Infektion den Zusammenhang zwischen drei Single Nucleotide Polymorphismen im Bereich des IL28B-Gens und der Verträglichkeit sowie dem Therapieerfolg einer interferonbasierten Behandlung. Der Vergleich zwischen den Ergebnissen im HADS-(Hospital Anxiety and Depression Scale) sowie TAPS- (Testbatterie zur Aufmerksamkeitsprüfung) Testverfahren mit den Genotypen der drei SNPs zeigte im Studienkollektiv keinen signifikanten Zusammenhang. Hinsichtlich des Therapieerfolges konnten wir bei einem der drei SNPs das C-Allel als positiven Prognosefaktor für das dauerhafte Therapieansprechen nachweisen. N2 - Prior to the introduction of direct antiviral combination therapies, the combination of pegylated interferon plus ribavirin was the standard treatment for patients with chronic hepatitis C infection. In 30% of the patients, neurocognitive and depressive side effects were observed, which could negatively influence the sustained virological response. Against this background, the central question that motivates our work was to investigate the association between three single nucleotide polymorphisms in the IL28B gene and the tolerability and therapeutic outcome of interferon-based treatment in 93 patients with chronic hepatitis C infection. The comparison between two test procedures, the HADS (hospital anxiety and depression scale) and TAPS (test battery for attention testing), with the genotypes of the three SNPs showed no significant association in the study population. In terms of therapeutic success, we were able to demonstrate the C allele in one of the three SNPs as a positive prognostic factor for the sustained virological response. KW - Interferon alpha KW - Verträglichkeit Interferon alpha KW - Nebenwirkungen interferonbasierte Hepatitis-C-Therapie KW - Neuropsychiatrische Nebenwirkungen Interferon alpha KW - Single Nucleotid Polymorphismus IL28B Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-178519 ER - TY - THES A1 - Freislederer, Kathrin T1 - Befunde und Wertigkeit der Kapselendoskopie : Auswertung der ersten Patienten an der Medizinischen Klinik I und II in Würzburg T1 - Findings and Valency of Wireless Capsule Endoscopy : evaluation of the first patients on the medical clinic in wuerzburg, germany N2 - Retrospektive Studie zur Wertigkeit und Befunden des Einsatzes der Kapselendoskopie bei unklaren gastrointestinalen Blutungen der Patienten an der medizinischen Klinik in Würzburg mit Erfahrungen der Patienten und guten Ergebnissen bei unklarer gastrointestinaler Blutung des Magen- Darm Traktes. N2 - Retrospective study about findings and valency of Wireless Capsule Endoscopy. Evaluation of the first patients on the medical clinic in wuerzburg, germany, by wireless capsule endoscopy with occult gastrointestinal bleeding in the run- up to. Experiences from the patients and good results of finding occult bleeding in the section of stomach and bowel KW - Videokapselendoskopie KW - Wireless capsule- endoscopy KW - results KW - occult gastrointestinal bleeding Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-30349 ER - TY - JOUR A1 - Jahn, Daniel A1 - Dorbath, Donata A1 - Kircher, Stefan A1 - Nier, Anika A1 - Bergheim, Ina A1 - Lenaerts, Kaatje A1 - Hermanns, Heike M. A1 - Geier, Andreas T1 - Beneficial effects of vitamin D treatment in an obese mouse model of non-alcoholic steatohepatitis JF - Nutrients N2 - Serum vitamin D levels negatively correlate with obesity and associated disorders such as non-alcoholic steatohepatitis (NASH). However, the mechanisms linking low vitamin D (VD) status to disease progression are not completely understood. In this study, we analyzed the effect of VD treatment on NASH in mice. C57BL6/J mice were fed a high-fat/high-sugar diet (HFSD) containing low amounts of VD for 16 weeks to induce obesity, NASH and liver fibrosis. The effects of preventive and interventional VD treatment were studied on the level of liver histology and hepatic/intestinal gene expression. Interestingly, preventive and to a lesser extent also interventional VD treatment resulted in improvements of liver histology. This included a significant decrease of steatosis, a trend towards lower non-alcoholic fatty liver disease (NAFLD) activity score and a slight non-significant decrease of fibrosis in the preventive treatment group. In line with these changes, preventive VD treatment reduced the hepatic expression of lipogenic, inflammatory and pro-fibrotic genes. Notably, these beneficial effects occurred in conjunction with a reduction of intestinal inflammation. Together, our observations suggest that timely initiation of VD supplementation (preventive vs. interventional) is a critical determinant of treatment outcome in NASH. In the applied animal model, the improvements of liver histology occurred in conjunction with reduced inflammation in the gut, suggesting a potential relevance of vitamin D as a therapeutic agent acting on the gut–liver axis. KW - vitamin D KW - obesity KW - NAFLD KW - NASH KW - inflammation KW - intestine KW - gut–liver axis Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-177222 VL - 11 IS - 1 ER - TY - THES A1 - Brückner, Anne Sophie T1 - Biomarker bei Immuntherapie: eine nicht-interventionelle klinische Studie zur Analyse von verschiedenen immunologischen Serumbiomarkern bei Patienten mit fortgeschrittenen malignen Tumorerkrankungen T1 - Biomarker for immunotherapy: a non interventional clinical study of analyzing different immune mediated serum biomarkers in patients with advanced solid tumors under treatment with immune checkpoint inhibition N2 - Ziel der Studie war es, potentielle Serumbiomarker für das Therapieansprechen auf Immuncheckpoint-Inhibition zu detektieren. Patienten, die der Gruppe Responder zugeordnet werden konnten, hatten ein deutlich längeres PFS. Hinzu kommt, dass im Fall der Gruppe Responder Median und Mittelwert der gemessenen Serumparameter Granzym A und B, Interferon Gamma und Perforin von BL zur 1. Messung post treatment ansteigen. Zusätzlich zeigt sich, dass IL-8 Potential als negativ prognostischer Marker hat. Trotz des kleinen und heterogenen Patientenkollektivs lassen sich Trends ableiten, die das Potential der untersuchten Mediatoren zytotoxischer T-Zellen als Serumbiomarker unterstreichen. N2 - Aim of the study was the detection of potential serum biomarkers for measuring therapy response under immune checkpoint inhibition. Patients assigned to group responder had a clearly extended PFS. Additionally patients of this group had an increase of median and mean value of granzyme A and B, interferon gamma and perforin from BL to first measure post treatment. In this study is shown, that IL-8 has potential to become a negative prognostic marker. Despite of the small and heterogeneous patient collective you can record interesting trends from the results. That underlines the potential of the tested mediators of cytotoxic T-cells to serve as serum biomarkers in future. KW - Serumbiomarker KW - Immuncheckpointinhibition Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-305385 ER - TY - JOUR A1 - Gökbuget, N. A1 - Kelsh, M. A1 - Chia, V. A1 - Advani, A. A1 - Bassan, R. A1 - Dombret, H. A1 - Doubek, M. A1 - Fielding, A. K. A1 - Giebel, S. A1 - Haddad, V. A1 - Hoelzer, D. A1 - Holland, C. A1 - Ifrah, N. A1 - Katz, A. A1 - Maniar, T. A1 - Martinelli, G. A1 - Morgades, M. A1 - O'Brien, S. A1 - Ribera, J.-M. A1 - Rowe, J. M. A1 - Stein, A. A1 - Topp, M. A1 - Wadleigh, M. A1 - Kantarjian, H. T1 - Blinatumomab vs historical standard therapy of adult relapsed/refractory acute lymphoblastic leukemia JF - Blood Cancer Journal N2 - We compared outcomes from a single-arm study of blinatumomab in adult patients with B-precursor Ph-negative relapsed/refractory acute lymphoblastic leukemia (R/R ALL) with a historical data set from Europe and the United States. Estimates of complete remission (CR) and overall survival (OS) were weighted by the frequency distribution of prognostic factors in the blinatumomab trial. Outcomes were also compared between the trial and historical data using propensity score methods. The historical cohort included 694 patients with CR data and 1112 patients with OS data compared with 189 patients with CR and survival data in the blinatumomab trial. The weighted analysis revealed a CR rate of 24% (95% CI: 20–27%) and a median OS of 3.3 months (95% CI: 2.8–3.6) in the historical cohort compared with a CR/CRh rate of 43% (95% CI: 36–50%) and a median OS of 6.1 months (95% CI: 4.2–7.5) in the blinatumomab trial. Propensity score analysis estimated increased odds of CR/CRh (OR=2.68, 95% CI: 1.67–4.31) and improved OS (HR=0.536, 95% CI: 0.394–0.730) with blinatumomab. The analysis demonstrates the application of different study designs and statistical methods to compare novel therapies for R/R ALL with historical data. KW - Acute lymphocytic leukaemia KW - Drug development Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-164495 VL - 6 ER - TY - JOUR A1 - McFleder, Rhonda L. A1 - Makhotkina, Anastasiia A1 - Groh, Janos A1 - Keber, Ursula A1 - Imdahl, Fabian A1 - Peña Mosca, Josefina A1 - Peteranderl, Alina A1 - Wu, Jingjing A1 - Tabuchi, Sawako A1 - Hoffmann, Jan A1 - Karl, Ann-Kathrin A1 - Pagenstecher, Axel A1 - Vogel, Jörg A1 - Beilhack, Andreas A1 - Koprich, James B. A1 - Brotchie, Jonathan M. A1 - Saliba, Antoine-Emmanuel A1 - Volkmann, Jens A1 - Ip, Chi Wang T1 - Brain-to-gut trafficking of alpha-synuclein by CD11c\(^+\) cells in a mouse model of Parkinson’s disease JF - Nature Communications N2 - Inflammation in the brain and gut is a critical component of several neurological diseases, such as Parkinson’s disease (PD). One trigger of the immune system in PD is aggregation of the pre-synaptic protein, α-synuclein (αSyn). Understanding the mechanism of propagation of αSyn aggregates is essential to developing disease-modifying therapeutics. Using a brain-first mouse model of PD, we demonstrate αSyn trafficking from the brain to the ileum of male mice. Immunohistochemistry revealed that the ileal αSyn aggregations are contained within CD11c+ cells. Using single-cell RNA sequencing, we demonstrate that ileal CD11c\(^+\) cells are microglia-like and the same subtype of cells is activated in the brain and ileum of PD mice. Moreover, by utilizing mice expressing the photo-convertible protein, Dendra2, we show that CD11c\(^+\) cells traffic from the brain to the ileum. Together these data provide a mechanism of αSyn trafficking between the brain and gut. KW - antigen-presenting cells KW - neuroimmunology KW - Parkinson's disease Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357696 VL - 14 ER - TY - JOUR A1 - Helaß, Madeleine A1 - Haag, Georg Martin A1 - Bankstahl, Ulli Simone A1 - Gencer, Deniz A1 - Maatouk, Imad T1 - Burnout among German oncologists: a cross-sectional study in cooperation with the Arbeitsgemeinschaft Internistische Onkologie Quality of Life Working Group JF - Journal of Cancer Research and Clinical Oncology N2 - Purpose Oncologists are at an increased risk of developing burnout, leading to negative consequences in patient care and in professional satisfaction and quality of life. This study was designed to investigate exhaustion and disengagement among German oncologists and assess the prevalence of burnout among oncologists within different professional settings. Furthermore, we wanted to examine possible relations between sociodemographic factors, the oncological setting, professional experience and different aspects of burnout. Methods In a cross-sectional study design, an Internet-based survey was conducted with 121 oncologists between April and July 2020 using the Oldenburg Burnout Inventory, which contains items on exhaustion, disengagement, and burnout. Furthermore, sociodemographic data of the participants were assessed. The participants were members of the Working Group Medical Oncology (Arbeitsgemeinschaft Internistische Onkologie) within the German Cancer Society. Results The survey showed a burnout prevalence of 43.8%, which correlated with age and professional experience; that is, the prevalence is particularly high among younger oncologists. Exhaustion is closely related to employment status; that is, it was significantly higher among employed oncologists. There were remarkably low levels of disengagement among oncologists, highlighting the own demand to fulfil job requirements despite imminent or actual overburdening in daily work. Conclusion More support is necessary to mitigate the professional stressors in the healthcare system. To ensure quality medical care, employees should be offered preventive mental health services early in their careers. KW - burnout KW - exhaustion KW - disengagement KW - Oldenburg burnout inventory KW - oncologist KW - prevalence Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324446 VL - 149 IS - 2 ER - TY - THES A1 - Neun, Tilmann Alexander T1 - Butyrateffekte auf die Adenom-Karzinom-Sequenz beim Kolonkarzinom - HDGF ("hepatoma derived growth factor") T1 - Effects of butyrate on adenom-carcinom-sequence in colon cancer - HDGF "hepatoma-derived growth factor") N2 - Untersuchung der Butyrateffekte auf die Genexpression von Zellkulturen während der Adenom-Karzinom-Sequenz mit Hilfe von Microarrays. Analyse des HDGF-Genclusters. Verwendete Zellkulturen Geki2, HT29 und SW620 N2 - Examination of butyrate effects on genexpression of cellculteres during adenom-carcinom-sequence by use of microarrays. Analysis of hdgf-gencluster. USed cellcultures Geki2, HT29 und SW620. KW - Butyrat KW - Kolonkarzinom KW - Adenom-Karzinom-Sequenz KW - Wachstumsfaktoren KW - HDGF KW - Hepatoma-derived growth factor KW - Adenom-carcinom-sequence KW - growthfactors KW - HDGF KW - butyrate KW - colon cancer Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-49177 ER - TY - JOUR A1 - Chiorean, E. G. A1 - Von Hoff, D. D. A1 - Reni, M. A1 - Arena, F. P. A1 - Infante, J. R. A1 - Bathini, V. G. A1 - Wood, T. E. A1 - Mainwaring, P. N. A1 - Muldoon, R. T. A1 - Clingan, P. R. A1 - Kunzmann, V. A1 - Ramanathan, R. K. A1 - Tabernero, J. A1 - Goldstein, D. A1 - McGovern, D. A1 - Lu, B. A1 - Ko, A. T1 - CA19-9 decrease at 8 weeks as a predictor of overall survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic cancer JF - Annals of Oncology N2 - Background A phase I/II study and subsequent phase III study (MPACT) reported significant correlations between CA19-9 decreases and prolonged overall survival (OS) with nab-paclitaxel plus gemcitabine (nab-P + Gem) treatment for metastatic pancreatic cancer (MPC). CA19-9 changes at week 8 and potential associations with efficacy were investigated as part of an exploratory analysis in the MPACT trial. Patients and methods Untreated patients with MPC (N = 861) received nab-P + Gem or Gem alone. CA19-9 was evaluated at baseline and every 8 weeks. Results Patients with baseline and week-8 CA19-9 measurements were analyzed (nab-P + Gem: 252; Gem: 202). In an analysis pooling the treatments, patients with any CA19-9 decline (80%) versus those without (20%) had improved OS (median 11.1 versus 8.0 months; P = 0.005). In the nab-P + Gem arm, patients with (n = 206) versus without (n = 46) any CA19-9 decrease at week 8 had a confirmed overall response rate (ORR) of 40% versus 13%, and a median OS of 13.2 versus 8.3 months (P = 0.001), respectively. In the Gem-alone arm, patients with (n = 159) versus without (n = 43) CA19-9 decrease at week 8 had a confirmed ORR of 15% versus 5%, and a median OS of 9.4 versus 7.1 months (P = 0.404), respectively. In the nab-P + Gem and Gem-alone arms, by week 8, 16% (40/252) and 6% (13/202) of patients, respectively, had an unconfirmed radiologic response (median OS 13.7 and 14.7 months, respectively), and 79% and 84% of patients, respectively, had stable disease (SD) (median OS 11.1 and 9 months, respectively). Patients with SD and any CA19-9 decrease (158/199 and 133/170) had a median OS of 13.2 and 9.4 months, respectively. Conclusion This analysis demonstrated that, in patients with MPC, any CA19-9 decrease at week 8 can be an early marker for chemotherapy efficacy, including in those patients with SD. CA19-9 decrease identified more patients with survival benefit than radiologic response by week 8. KW - CA19-9 KW - pancreatic cancer KW - chemotherapy KW - nab-paclitaxel KW - MPACT Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-189659 VL - 27 IS - 4 ER - TY - JOUR A1 - Gernert, Michael A1 - Schmalzing, Marc A1 - Tony, Hans-Peter A1 - Strunz, Patrick-Pascal A1 - Schwaneck, Eva Christina A1 - Fröhlich, Matthias T1 - Calprotectin (S100A8/S100A9) detects inflammatory activity in rheumatoid arthritis patients receiving tocilizumab therapy JF - Arthritis Research & Therapy N2 - Background Assessing serological inflammation is difficult in tocilizumab (TCZ)-treated rheumatoid arthritis (RA) patients, as standard inflammation parameters, like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are influenced by interleukin-6-receptor inhibition. Calprotectin in the serum, also named S100A8/S100A9, might be a more useful inflammation parameter in TCZ-treated patients. Methods Sixty-nine RA patients taking TCZ were included. Serum-calprotectin levels were assessed, as well as ESR, CRP, need for a change in disease-modifying anti-rheumatic drugs due to RA activity (= active RA), and the RA clinical disease activity score (CDAI). Forty-five RA patients taking tumor-necrosis factor-inhibitors (TNFi) were investigated for the same parameters. Results TCZ-treated patients with active RA had higher calprotectin values than not active RA patients (4155.5 [inter quartile range 1865.3–6068.3] vs 1040.0 [676.0–1638.0] ng/ml, P < 0.001). A calprotectin cut-off value of 1916.5 ng/ml resulted in a sensitivity and specificity of 80.0 %, respectively, for the detection of RA disease activity. Calprotectin values correlated with CDAI-scores (r = 0.228; P = 0.011). ESR and CRP were less suitable to detect RA activity in TCZ-treated patients. Also TNFi-treated patients with active RA had higher calprotectin values compared to not active RA (5422.0 [3749.0–8150.8] vs 1845.0 [832.0–2569.0] ng/ml, P < 0.001). The calprotectin value with the best sensitivity and specificity for detecting RA activity was 3690.5 ng/ml among TNFi-treated patients. Conclusion Calprotectin in the serum can be a useful inflammation parameter despite TCZ-treatment. KW - calprotectin KW - inflammation marker KW - c-reactive protein KW - tocilizumab KW - rheumatoid arthritis KW - S100A8/S100A9 Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300523 VL - 24 IS - 1 ER - TY - JOUR A1 - Kretzschmar, Kai T1 - Cancer research using organoid technology JF - Journal of Molecular Medicine N2 - Organoid technology has rapidly transformed basic biomedical research and contributed to significant discoveries in the last decade. With the application of protocols to generate organoids from cancer tissue, organoid technology has opened up new opportunities for cancer research and therapy. Using organoid cultures derived from healthy tissues, different aspects of tumour initiation and progression are widely studied including the role of pathogens or specific cancer genes. Cancer organoid cultures, on the other hand, are applied to generate biobanks, perform drug screens, and study mutational signatures. With the incorporation of cellular components of the tumour microenvironment such as immune cells into the organoid cultures, the technology is now also exploited in the rapidly advancing field of immuno-oncology. In this review, I discuss how organoid technology is currently being utilised in cancer research and what obstacles are still to be overcome for its broader use in anti-cancer therapy. KW - cancer KW - organoids KW - 3D culture KW - pre-clinical models KW - personalised medicine KW - drug screening KW - immuno-oncology Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235377 SN - 0946-2716 VL - 99 ER - TY - JOUR A1 - Seif, Michelle A1 - Einsele, Hermann A1 - Löffler, Jürgen T1 - CAR T cells beyond cancer: hope for immunomodulatory therapy of infectious diseases JF - Frontiers in Immunology N2 - Infectious diseases are still a significant cause of morbidity and mortality worldwide. Despite the progress in drug development, the occurrence of microbial resistance is still a significant concern. Alternative therapeutic strategies are required for non-responding or relapsing patients. Chimeric antigen receptor (CAR) T cells has revolutionized cancer immunotherapy, providing a potential therapeutic option for patients who are unresponsive to standard treatments. Recently two CAR T cell therapies, Yescarta® (Kite Pharma/Gilead) and Kymriah® (Novartis) were approved by the FDA for the treatments of certain types of non-Hodgkin lymphoma and B-cell precursor acute lymphoblastic leukemia, respectively. The success of adoptive CAR T cell therapy for cancer has inspired researchers to develop CARs for the treatment of infectious diseases. Here, we review the main achievements in CAR T cell therapy targeting viral infections, including Human Immunodeficiency Virus, Hepatitis C Virus, Hepatitis B Virus, Human Cytomegalovirus, and opportunistic fungal infections such as invasive aspergillosis. KW - infectious diseases KW - mAb engineering KW - CAR T cells KW - HIV KW - HCV KW - CMV KW - invasive aspergillosis KW - HBV Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-195596 SN - 1664-3224 VL - 10 IS - 2711 ER - TY - JOUR A1 - Zhou, Xiang A1 - Flüchter, Patricia A1 - Nickel, Katharina A1 - Meckel, Katharina A1 - Messerschmidt, Janin A1 - Böckle, David A1 - Knorz, Sebastian A1 - Steinhardt, Maximilian Johannes A1 - Krummenast, Franziska A1 - Danhof, Sophia A1 - Einsele, Hermann A1 - Kortüm, K. Martin A1 - Rasche, Leo T1 - Carfilzomib based treatment strategies in the management of relapsed/refractory multiple myeloma with extramedullary disease JF - Cancers N2 - Published experience with carfilzomib in patients with relapsed/refractory multiple myeloma (RRMM) and extramedullary disease (EMD) is still limited. The current study aimed to assess the efficacy and safety of carfilzomib containing therapy regimens in EMD. We retrospectively analyzed 45 patients with extramedullary RRMM treated with carfilzomib from June 2013 to September 2019. The median age at the start of carfilzomib was 64 (range 40–80) years. Twenty (44%) and 25 (56%) patients had paraosseous manifestation and EMD without adjacency to bone, respectively. The serological overall response rate (ORR) was 59%. Extramedullary response was evaluable in 33 patients, nine (27%) of them achieved partial remission (PR) (ORR = 27%). In 15 (33%) patients, we observed no extramedullary response despite serological response. The median progression-free survival (PFS) and overall survival (OS) were five (95% CI, 3.5–6.5) and ten (95% CI, 7.5–12.5) months, respectively. EMD without adjacency to bone was associated with a significantly inferior PFS (p = 0.004) and OS (p = 0.04) compared to paraosseous lesions. Carfilzomib based treatment strategies showed some efficacy in heavily pretreated patients with extramedullary RRMM but could not overcome the negative prognostic value of EMD. Due to the discrepancy between serological and extramedullary response, evaluation of extramedullary response using imaging is mandatory in these patients. KW - carfilzomib KW - extramedullary disease KW - multiple myeloma KW - relapse KW - refractory Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-203704 SN - 2072-6694 VL - 12 IS - 4 ER - TY - JOUR A1 - Page, Lukas A1 - Wallstabe, Julia A1 - Lother, Jasmin A1 - Bauser, Maximilian A1 - Kniemeyer, Olaf A1 - Strobel, Lea A1 - Voltersen, Vera A1 - Teutschbein, Janka A1 - Hortschansky, Peter A1 - Morton, Charles Oliver A1 - Brakhage, Axel A. A1 - Topp, Max A1 - Einsele, Hermann A1 - Wurster, Sebastian A1 - Loeffler, Juergen T1 - CcpA- and Shm2-Pulsed Myeloid Dendritic Cells Induce T-Cell Activation and Enhance the Neutrophilic Oxidative Burst Response to Aspergillus fumigatus JF - Frontiers in Immunology N2 - Aspergillus fumigatus causes life-threatening opportunistic infections in immunocompromised patients. As therapeutic outcomes of invasive aspergillosis (IA) are often unsatisfactory, the development of targeted immunotherapy remains an important goal. Linking the innate and adaptive immune system, dendritic cells are pivotal in anti-Aspergillus defense and have generated interest as a potential immunotherapeutic approach in IA. While monocyte-derived dendritic cells (moDCs) require ex vivo differentiation, antigen-pulsed primary myeloid dendritic cells (mDCs) may present a more immediate platform for immunotherapy. To that end, we compared the response patterns and cellular interactions of human primary mDCs and moDCs pulsed with an A. fumigatus lysate and two A. fumigatus proteins (CcpA and Shm2) in a serum-free, GMP-compliant medium. CcpA and Shm2 triggered significant upregulation of maturation markers in mDCs and, to a lesser extent, moDCs. Furthermore, both A. fumigatus proteins elicited the release of an array of key pro-inflammatory cytokines including TNF-α, IL-1β, IL-6, IL-8, and CCL3 from both DC populations. Compared to moDCs, CcpA- and Shm2-pulsed mDCs exhibited greater expression of MHC class II antigens and stimulated stronger proliferation and IFN-γ secretion from autologous CD4\(^+\) and CD8\(^+\) T-cells. Moreover, supernatants of CcpA- and Shm2-pulsed mDCs significantly enhanced the oxidative burst in allogeneic neutrophils co-cultured with A. fumigatus germ tubes. Taken together, our in vitro data suggest that ex vivo CcpA- and Shm2-pulsed primary mDCs have the potential to be developed into an immunotherapeutic approach to tackle IA. KW - antigens KW - dendritic cells KW - cytokines KW - host defense KW - immunotherapy KW - Aspergillus Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239493 SN - 1664-3224 VL - 12 ER - TY - JOUR A1 - Mahmood, Zafar A1 - Muhammad, Khalid A1 - Schmalzing, Marc A1 - Roll, Petra A1 - Dörner, Thomas A1 - Tony, Hans-Peter T1 - CD27-IgD- memory B cells are modulated by in vivo interleukin-6 receptor (IL-6R) blockade in rheumatoid arthritis JF - Arthritis Research & Therapy N2 - Introduction Enhanced B cell activity, particularly memory B cells have gained interest in evaluating response during therapies with biologics. CD27-IgD- double-negative (DN) B cells lacking the conventional memory marker CD27 are reported to be part of the memory compartment, however, only scarce data is available for rheumatoid arthritis (RA). We therefore focused on DN B cells in RA, studied their isotypes and modulation during interleukin-6 receptor (IL-6R) inhibition by tocilizumab (TCZ). Methods DN B cells were phenotypically analyzed from 40 RA patients during TCZ at baseline week 12, week 24 and 1 year. A single B cell polymerase chain reaction (PCR) approach was used to study Ig receptors, VH gene rearrangements and specific isotypes. Results Phenotypic analysis showed a significantly expanded population of DN B cells in RA which contain a heterogeneous mixture of IgG-, IgA- and IgM-expressing cells with a clear dominance of IgG+ cells. DN B cells carry rearranged heavy chain gene sequences with a diversified mutational pattern consistent with memory B cells. In contrast to tumor necrosis factor alpha (TNF-α) inhibition, a significant reduction in mutational frequency of BCR gene rearrangements at week 12, 24 and 1 year (P <0.0001) was observed by in vivo IL-6R inhibition. These changes were observed for all BCR isotypes IgG, IgA and IgM at week 12, 24 and 1 year (P <0.0001). IgA-RF, IgA serum level and IgA+ DN B cells decreased significantly (P <0.05) at week 12 and week 24 during TCZ. Patients with a good European League Against Rheumatism (EULAR) response to TCZ had less DN B cells at baseline as compared to moderate responders (P = 0.006). Univariate logistic regression analysis revealed that the frequency of DN B cells at baseline is inversely correlated to a subsequent good EULAR response (P = 0.024) with an odds ratio of 1.48 (95% confidence interval as 1.05 to 2.06). Conclusions In RA, the heterogeneous DN B cell compartment is expanded and dominated by IgG isotype. TCZ can modulate the mutational status of DN Ig isotype receptors over 1 year. Interestingly, the frequency of DN B cells in RA may serve as a baseline predictor of subsequent EULAR response to TCZ. Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-126506 VL - 17 IS - 61 ER - TY - JOUR A1 - Lauruschkat, Chris David A1 - Muchsin, Ihsan A1 - Rein, Alice A1 - Erhard, Florian A1 - Grathwohl, Denise A1 - Dölken, Lars A1 - Köchel, Carolin A1 - Falk, Christine Susanne A1 - Einsele, Hermann A1 - Wurster, Sebastian A1 - Grigoleit, Götz Ulrich A1 - Kraus, Sabrina T1 - CD4+ T cells are the major predictor of HCMV control in allogeneic stem cell transplant recipients on letermovir prophylaxis JF - Frontiers in Immunology N2 - Introduction Human cytomegalovirus (HCMV) causes significant morbidity and mortality in allogeneic stem cell transplant (alloSCT) recipients. Recently, antiviral letermovir prophylaxis during the first 100 days after alloSCT replaced PCR-guided preemptive therapy as the primary standard of care for HCMV reactivations. Here, we compared NK-cell and T-cell reconstitution in alloSCT recipients receiving preemptive therapy or letermovir prophylaxis in order to identify potential biomarkers predicting prolonged and symptomatic HCMV reactivation. Methods To that end, the NK-cell and T-cell repertoire of alloSCT recipients managed with preemptive therapy (n=32) or letermovir prophylaxis (n=24) was characterized by flow cytometry on days +30, +60, +90 and +120 after alloSCT. Additionally, background-corrected HCMV-specific T-helper (CD4+IFNγ+) and cytotoxic (CD8+IFNγ+CD107a+) T cells were quantified after pp65 stimulation. Results Compared to preemptive therapy, letermovir prophylaxis prevented HCMV reactivation and decreased HCMV peak viral loads until days +120 and +365. Letermovir prophylaxis resulted in decreased T-cell numbers but increased NK-cell numbers. Interestingly, despite the inhibition of HCMV, we found high numbers of “memory-like” (CD56dimFcεRIγ- and/or CD159c+) NK cells and an expansion of HCMV-specific CD4+ and CD8+ T cells in letermovir recipients. We further compared immunological readouts in patients on letermovir prophylaxis with non/short-term HCMV reactivation (NSTR) and prolonged/symptomatic HCMV reactivation (long-term HCMV reactivation, LTR). Median HCMV-specific CD4+ T-cell frequencies were significantly higher in NSTR patients (day +60, 0.35 % vs. 0.00 % CD4+IFNγ+/CD4+ cells, p=0.018) than in patients with LTR, whereas patients with LTR had significantly higher median regulatory T-cell (Treg) frequencies (day +90, 2.2 % vs. 6.2 % CD4+CD25+CD127dim/CD4+ cells, p=0.019). ROC analysis confirmed low HCMV specific CD4+ (AUC on day +60: 0.813, p=0.019) and high Treg frequencies (AUC on day +90: 0.847, p=0.021) as significant predictors of prolonged and symptomatic HCMV reactivation. Discussion Taken together, letermovir prophylaxis delays HCMV reactivation and alters NK- and T-cell reconstitution. High numbers of HCMV-specific CD4+ T cells and low numbers of Tregs seem to be pivotal to suppress post-alloSCT HCMV reactivation during letermovir prophylaxis. Administration of more advanced immunoassays that include Treg signature cytokines might contribute to the identification of patients at high-risk for long-term and symptomatic HCMV reactivation who might benefit from prolonged administration of letermovir. KW - human cytomegalovirus (HCMV) KW - viral infection KW - allogeneic stem cell transplantation KW - T cells KW - NK cells Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-316982 VL - 14 ER - TY - JOUR A1 - Fuhr, Viktoria A1 - Heidenreich, Shanice A1 - Srivastava, Mugdha A1 - Riedel, Angela A1 - Düll, Johannes A1 - Gerhard-Hartmann, Elena A1 - Rosenwald, Andreas A1 - Rauert-Wunderlich, Hilka T1 - CD52 and OXPHOS-potential targets in ibrutinib-treated mantle cell lymphoma JF - Cell Death Discovery N2 - Altered features of tumor cells acquired across therapy can result in the survival of treatment-resistant clones that may cause minimal residual disease (MRD). Despite the efficacy of ibrutinib in treating relapsed/refractory mantle cell lymphoma, the obstacle of residual cells contributes to relapses of this mature B-cell neoplasm, and the disease remains incurable. RNA-seq analysis of an ibrutinib-sensitive mantle cell lymphoma cell line following ibrutinib incubation of up to 4 d, corroborated our previously postulated resistance mechanism of a metabolic switch to reliance on oxidative phosphorylation (OXPHOS) in surviving cells. Besides, we had shown that treatment-persisting cells were characterized by increased CD52 expression. Therefore, we hypothesized that combining ibrutinib with another agent targeting these potential escape mechanisms could minimize the risk of survival of ibrutinib-resistant cells. Concomitant use of ibrutinib with OXPHOS-inhibitor IACS-010759 increased toxicity compared to ibrutinib alone. Targeting CD52 was even more efficient, as addition of CD52 mAb in combination with human serum following ibrutinib pretreatment led to rapid complement-dependent-cytotoxicity in an ibrutinib-sensitive cell line. In primary mantle cell lymphoma cells, a higher toxic effect with CD52 mAb was obtained, when cells were pretreated with ibrutinib, but only in an ibrutinib-sensitive cohort. Given the challenge of treating multi-resistant mantle cell lymphoma patients, this work highlights the potential use of anti-CD52 therapy as consolidation after ibrutinib treatment in patients who responded to the BTK inhibitor to achieve MRD negativity and prolong progression-free survival. KW - cancer metabolism KW - cell death KW - target validation KW - targeted therapies Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300817 SN - 2058-7716 VL - 8 ER - TY - JOUR A1 - Ziegler, Sabrina A1 - Weiss, Esther A1 - Schmitt, Anna-Lena A1 - Schlegel, Jan A1 - Burgert, Anne A1 - Terpitz, Ulrich A1 - Sauer, Markus A1 - Moretta, Lorenzo A1 - Sivori, Simona A1 - Leonhardt, Ines A1 - Kurzai, Oliver A1 - Einsele, Hermann A1 - Loeffler, Juergen T1 - CD56 Is a Pathogen Recognition Receptor on Human Natural Killer Cells JF - Scientific Reports N2 - Aspergillus (A.) fumigatus is an opportunistic fungal mold inducing invasive aspergillosis (IA) in immunocompromised patients. Although antifungal activity of human natural killer (NK) cells was shown in previous studies, the underlying cellular mechanisms and pathogen recognition receptors (PRRs) are still unknown. Using flow cytometry we were able to show that the fluorescence positivity of the surface receptor CD56 significantly decreased upon fungal contact. To visualize the interaction site of NK cells and A. fumigatus we used SEM, CLSM and dSTORM techniques, which clearly demonstrated that NK cells directly interact with A. fumigatus via CD56 and that CD56 is re-organized and accumulated at this interaction site time-dependently. The inhibition of the cytoskeleton showed that the receptor re-organization was an active process dependent on actin re-arrangements. Furthermore, we could show that CD56 plays a role in the fungus mediated NK cell activation, since blocking of CD56 surface receptor reduced fungal mediated NK cell activation and reduced cytokine secretion. These results confirmed the direct interaction of NK cells and A. fumigatus, leading to the conclusion that CD56 is a pathogen recognition receptor. These findings give new insights into the functional role of CD56 in the pathogen recognition during the innate immune response. KW - pattern recognition receptors KW - fungal infection KW - Aspergillus fumigatus KW - natural killer cells Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-170637 VL - 7 IS - 6138 ER - TY - THES A1 - Trebing, Johannes T1 - CD70-abhängige und spezifische Aktivierung von TRAILR1 oder TRAILR2 durch scFv:CD70-TRAIL-Mutanten T1 - CD70-restricted specific activation of TRAILR1 or TRAILR2 using scFv:CD70-TRAIL mutants N2 - Das Ziel dieser Arbeit bestand darin, den T-Zell-inhibierenden Effekt eines CD70-blockierenden Antikörpers mit einer Fc-unabhängigen Zelltod-induzierenden Aktivität auf CD70-exprimierende Tumoren zu kombinieren. Dazu wurden Fusionsproteine hergestellt und untersucht, die aus einer CD70-bindenden scFv-Domäne sowie aus einer TRAIL-Domäne bestehen. Der CD70-spezifische monoklonale Antikörper lαhCD70 sowie der beretis bekannte hCD70-spezifische Antikörper 1F6 blockieren mit hoher Effizienz die CD27/CD70-Interaktion von CD70-exprimierenden Zelllinien (Mino, OVCAR-3, U-266) und inhibieren dadurch die Induktion der IL8-Produktion durch diese Zellen in kokultivierten HT1080-CD27-Zellen. IL8 wird durch den klassischen NFκB-Signalweg reguliert und ist für den pro-angiogenetischen Effekt von entscheidender Bedeutung (Abb. 2, 3). Mit Hilfe zellulärer Gleichgewichtsbindungsstudien mit mono- und trimeren scFv:lαhCD70-GpL-Fusionsproteinen (Abb. 4) auf Mino- und OVCAR-3-Zellen konnte gezeigt werden, dass die Trimerisierung in beiden Zelllinien zu einer Steigerung der apparenten Affinität der scFv:lαhCD70-CD70 Interaktion führt und damit einen Effekt auf die CD70-Belegung hat (Abb. 5). Für die Konstruktion der Fusionsproteine wurde sowohl Wildtyp-TRAIL als auch TRAIL-Mutanten mit Präferenz für den TRAILR1 oder TRAILR2 verwendet. Die TRAILR-Präferenz der verwendeten TRAIL-Mutanten (wt, mutR1, mutR2) wurde nicht nur in zellulären GpL-Bindungsstudien (Abb. 7) sondern zusätzlich auch in TRAILR Immobilisierungsexperimenten (Abb. 8) bewiesen. Hier zeigte sich, dass bei TRAILR1 keine Interaktion mit TRAILmutR2, so wie bei TRAILR2 keine signifikante Bindung mit TRAILmutR1 erfolgte. Nur der TRAIL-Wildtyp band signifikant an beide TRAIL-Todesrezeptoren. Vitalitätsexperimente (Abb. 10) und Western-Blot Analysen der Caspase-Prozessierung (Abb. 11) bestätigten die starke TRAILR1- bzw. TRAILR2-Spezifität der TRAILmutR1- und TRAILmutR2-Varianten. Im Gegensatz zu den unvernetzten löslichen TRAIL-Trimeren waren nur die quervernetzten TRAIL-TNC-Varianten in der Lage, eine signifikante Apoptose-Signalkaskade bei relativ geringen Konzentrationen zu induzieren. Die toxischen ED50-Konzentrationen der unoligomerisierten TRAIL-Formen lagen um einen Faktor 100 höher als die der oligomerisierten Varianten. Zusammenfassend zeigten die ED50-Werte der Zytotoxizitätsexperimente von M2-oligomerisierten zu -unoligomerisierten trimeren TRAIL-Varianten bei allen Fusionskonstrukten und Zelllinien eine eindeutige Verstärkung der Apoptoseinduktion durch die M2-Quervernetzung. Bei Jurkat- und Mino-Zellen konnte größtenteils erst nach Oligomerisierung überhaupt eine Bioaktivität bzw. eine Zelltodinduktion beobachtet werden. In OVCAR-3-Zellen zeigte sich eine 100-1000 fache apoptotische Verstärkung durch die Oligomerisierung (Abb. 10). Weiterhin zeigten Zytotoxizitätsexperimente, dass sich durch Bindung an hCD70 das Ausmaß der Toxizität der Fusionsproteine auf allen CD70-exprimierenden Zelllinien 10-100x verstärkte (Abb. 15, 17). In Übereinstimmung mit der verstärkten TRAIL-Todesrezeptor-Aktivierung durch die CD70-Bindung der scFv-TRAIL-Fusionsproteine, konnte durch eine CD70-Blockade die Caspase-8 Aktivierung und die Prozessierung von Caspase-3 signifikant unterbunden werden (Abb. 18). Die Trimerisierung des scFv:lαhCD70-Antikörpers führte zu keiner Apoptose und beeinflußte auch nicht die Aktivität von TRAIL (Abb. 19) was belegt, dass die beobachteten Effekte auf einer stärkeren TRAIL-induzierten Apoptose nach CD70-Bindung der Konstrukte beruhen muss. Die Fusionsproteine beseitigen somit nachweislich einerseits das Problem der limitierenden Aktivität von löslichem TRAIL über ihre Verankerung an CD70 (Abb. 15-20) und anderseits die potentielle unerwünschte CD70-vermittelte protumorale CD27-Stimulation (Abb. 3). Darüber hinaus könnten die TRAILR-spezifischen TRAIL-Mutanten helfen, Nebeneffekte zu reduzieren, die primär durch den jeweils anderen TRAIL-Todesrezeptor vermittelt werden. Jedoch sind weiter Forschungen insbesondere in vivo Experimente notwendig, um Aussagen über Funktionalität, Halbwertszeiten, sowie Effektivität und Verträglichkeit treffen zu können. N2 - The aim of this work was to generate constructs that combine the CD27 stimulation inhibitory effect of blocking CD70 antibodies with an antibody-dependent cellular cytotoxicity(ADCC)-independent, cell death inducing molecule. To reach this goal we generated fusion proteins consisting of the apoptosis-inducing TNF family member TRAIL and a single-chain variable fragment (scFv) derived from a high affinity lama anti-human CD70 antibody (lαhCD70). A fusion protein of scFv:lαhCD70 and TNC-TRAIL, a stabilized form of soluble TRAIL, showed strongly enhanced apoptosis induction upon CD70 binding. In addition, this construct efficiently interfered with the CD70-CD27 interaction. The introduction of recently identified TRAIL-mutations that discriminate between TRAILR1 and TRAILR2 binding into the TRAIL-part of scFv:lαhCD70-TNC-TRAIL resulted in the TRAIL death receptor-specific fusion proteins with CD70-dependent activity. The fusion proteins eliminate on the one hand the problem of the limited activity of soluble TRAIL by anchoring to CD70 what confers membrane TRAIL-like activity to the constructs (Fig. 15-20). On the other hand, the constructs have the potential to block the unwanted CD70-mediated protumorale CD27 stimulation (Fig. 3). In addition, the TRAILR1-specific TRAIL mutant (Fig. 7, 8) could reduce unrecognized side effects mediated by TRAILR2 and vice versa. However, further research, particularly in vivo experiments are necessary to state about functionality, half-lives, as well as efficacy and tolerability of the constructs. KW - Apoptosis KW - CD70 KW - Antikörper KW - T-Lymphozyt KW - CD27 KW - scFv KW - TRAIL KW - TRAILR-Mutants KW - Antibodies KW - Antigen KW - Single chain KW - Recombinant protein Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-111592 ER - TY - JOUR A1 - Leicht, Hans Benno A1 - Weinig, Elke A1 - Mayer, Beate A1 - Viebahn, Johannes A1 - Geier, Andreas A1 - Rau, Monika T1 - Ceftriaxone-induced hemolytic anemia with severe renal failure: a case report and review of literature JF - BMC Pharmacology and Toxicology N2 - Background: Drug induced immune hemolytic anemia (DIIHA) is a rare complication and often underdiagnosed. DIIHA is frequently associated with a bad outcome, including organ failure and even death. For the last decades, ceftriaxone has been one of the most common drugs causing DIIHA, and ceftriaxone-induced immune hemolytic anemia (IHA) has especially been reported to cause severe complications and fatal outcomes. Case Presentation: A 76-year-old male patient was treated with ceftriaxone for cholangitis. Short time after antibiotic exposure the patient was referred to intensive care unit due to cardiopulmonary instability. Hemolysis was observed on laboratory testing and the patient developed severe renal failure with a need for hemodialysis for 2 weeks. Medical history revealed that the patient had been previously exposed to ceftriaxone less than 3 weeks before with subsequent hemolytic reaction. Further causes for hemolytic anemia were excluded and drug-induced immune hemolytic (DIIHA) anemia to ceftriaxone could be confirmed. Conclusions: The case demonstrates the severity of ceftriaxone-induced immune hemolytic anemia, a rare, but immediately life-threatening condition of a frequently used antibiotic in clinical practice. Early and correct diagnosis of DIIHA is crucial, as immediate withdrawal of the causative drug is essential for the patient prognosis. Thus, awareness for this complication must be raised among treating physicians. KW - ceftriaxone KW - drug-induced immune hemolytic anemia KW - hemolysis Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-176637 VL - 19 IS - 67 ER - TY - JOUR A1 - Wolter, Patrick A1 - Hanselmann, Steffen A1 - Pattschull, Grit A1 - Schruf, Eva A1 - Gaubatz, Stefan T1 - Central spindle proteins and mitotic kinesins are direct transcriptional targets of MuvB, B-MYB and FOXM1 in breast cancer cell lines and are potential targets for therapy JF - Oncotarget N2 - The MuvB multiprotein complex, together with B-MYB and FOXM1 (MMB-FOXM1), plays an essential role in cell cycle progression by regulating the transcription of genes required for mitosis and cytokinesis. In many tumors, B-MYB and FOXM1 are overexpressed as part of the proliferation signature. However, the transcriptional targets that are important for oncogenesis have not been identified. Given that mitotic kinesins are highly expressed in cancer cells and that selected kinesins have been reported as target genes of MMB-FOXM1, we sought to determine which mitotic kinesins are directly regulated by MMB-FOXM1. We demonstrate that six mitotic kinesins and two microtubule-associated non-motor proteins (MAPs) CEP55 and PRC1 are direct transcriptional targets of MuvB, B-MYB and FOXM1 in breast cancer cells. Suppression of KIF23 and PRC1 strongly suppressed proliferation of MDA-MB-231 cells. The set of MMB-FOXM1 regulated kinesins genes and 4 additional kinesins which we referred to as the mitotic kinesin signature (MKS) is linked to poor outcome in breast cancer patients. Thus, mitotic kinesins could be used as prognostic biomarker and could be potential therapeutic targets for the treatment of breast cancer. KW - breast cancer KW - kinesin KW - cell cycle KW - cytokinesis Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-171851 VL - 8 IS - 7 ER - TY - JOUR A1 - Nickl, Vera A1 - Eck, Juliana A1 - Goedert, Nicolas A1 - Hübner, Julian A1 - Nerreter, Thomas A1 - Hagemann, Carsten A1 - Ernestus, Ralf-Ingo A1 - Schulz, Tim A1 - Nickl, Robert Carl A1 - Keßler, Almuth Friederike A1 - Löhr, Mario A1 - Rosenwald, Andreas A1 - Breun, Maria A1 - Monoranu, Camelia Maria T1 - Characterization and optimization of the tumor microenvironment in patient-derived organotypic slices and organoid models of glioblastoma JF - Cancers N2 - While glioblastoma (GBM) is still challenging to treat, novel immunotherapeutic approaches have shown promising effects in preclinical settings. However, their clinical breakthrough is hampered by complex interactions of GBM with the tumor microenvironment (TME). Here, we present an analysis of TME composition in a patient-derived organoid model (PDO) as well as in organotypic slice cultures (OSC). To obtain a more realistic model for immunotherapeutic testing, we introduce an enhanced PDO model. We manufactured PDOs and OSCs from fresh tissue of GBM patients and analyzed the TME. Enhanced PDOs (ePDOs) were obtained via co-culture with PBMCs (peripheral blood mononuclear cells) and compared to normal PDOs (nPDOs) and PT (primary tissue). At first, we showed that TME was not sustained in PDOs after a short time of culture. In contrast, TME was largely maintained in OSCs. Unfortunately, OSCs can only be cultured for up to 9 days. Thus, we enhanced the TME in PDOs by co-culturing PDOs and PBMCs from healthy donors. These cellular TME patterns could be preserved until day 21. The ePDO approach could mirror the interaction of GBM, TME and immunotherapeutic agents and may consequently represent a realistic model for individual immunotherapeutic drug testing in the future. KW - glioblastoma KW - organoids KW - slice culture KW - tumormicroenvironment Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-319249 SN - 2072-6694 VL - 15 IS - 10 ER - TY - THES A1 - Riedel, Simone Stefanie T1 - Characterization of the fluorescence protein FP635 for in vivo imaging and establishment of a murine multiple myeloma model for non-invasive imaging of disease progression and response to therapy T1 - Charakterisierung des Fluoreszenzproteins FP635 für die in vivo Bildgebung und Etablierung eines Maus Modells für die nicht invasive Bildgebung des Krankheitsverlaufes und Ansprechen auf Therapien imMultiplen Myelom N2 - Optical in vivo imaging methods have advanced the fields of stem cell transplantation, graft-versus–host disease and graft-versus-tumor responses. Two well known optical methods, based on the transmission of light through the test animal are bioluminescence imaging (BLI) and fluorescence imaging (FLI). Both methods allow whole body in vivo imaging of the same animal over an extended time span where the cell distribution and proliferation can be visualized. BLI has the advantages of producing almost no unspecific background signals and no necessity for external excitation light. Hence, BLI is a highly sensitive and reliable detection method. Yet, the BLI reporter luciferase is not applicable with common microscopy techniques, therefore abolishing this method for cellular resolution imaging. FLI in turn, presents the appealing possibility to use one fluorescent reporter for whole body imaging as well as cellular resolution applying microscopy techniques. The absorption of light occurs mainly due to melanin and hemoglobin in wavelengths up to 650 nm. Therefore, the wavelength range beyond 650 nm may allow sensitive optical imaging even in deep tissues. For this reason, significant efforts are undertaken to isolate or develop genetically enhanced fluorescent proteins (FP) in this spectral range. “Katushka” also called FP635 has an emission close to this favorable spectrum and is reported as one of the brightest far-red FPs. Our experiments also clearly showed the superiority of BLI for whole body imaging over FLI. Based on these results we applied the superior BLI technique for the establishment of a pre-clinical multiple myeloma (MM) mouse model. MM is a B-cell disease, where malignant plasma cells clonally expand in the bone marrow (BM) of older people, causing significant morbidity and mortality. Chromosomal abnormalities, considered a hallmark of MM, are present in nearly all patients and may accumulate or change during disease progression. The diagnosis of MM is based on clinical symptoms, including the CRAB criteria: increased serum calcium levels, renal insufficiency, anemia, and bone lesions (osteolytic lesions or osteoporosis with compression fractures). Other clinical symptoms include hyperviscosity, amyloidosis, and recurrent bacterial infections. Additionally, patients commonly exhibit more than 30% clonal BM plasma cells and the presence of monoclonal protein is detected in serum and/or urine. With current standard therapies, MM remains incurable and patients diagnosed with MM between 2001 and 2007 had a 5-year relative survival rate of only 41%. Therefore, the development of new drugs or immune cell-based therapies is desirable and necessary. To this end we developed the MOPC-315 cell line based syngeneic MM mouse model. MOPC-315 cells were labeled with luciferase for in vivo detection by BLI. We validated the non-invasively obtained BLI data with histopathology, measurement of idiotype IgA serum levels and flow cytometry. All methods affirmed the reliability of the in vivo BLI data for this model. We found that this orthotopic MM model reflects several key features of the human disease. MOPC-315 cells homed efficiently to the BM compartment including subsequent proliferation. Additionally, cells disseminated to distant skeletal parts, leading to the typical multifocal MM growth. Osteolytic lesions and bone remodeling was also detected. We found evidence that the cell line had retained plasticity seen by dynamic receptor expression regulation in different compartments such as the BM and the spleen. N2 - Optische in vivo bildgebende Verfahren haben die Felder der Stammzelltransplantation, Graft-versus-Host Krankheit und Graft-versus-Tumor Reaktion vorangebracht. Zwei gut bekannte optische Methoden, die auf der transmission von Licht durch das Versuchtier basieren, sind die Biolumineszenz Bildgebung (BLI) und die Fluoreszenz Bildgebung (FLI). Beide Methoden erlauben die in vivo Ganzkörperbildgebung desselben Tieres über lange Zeit wärenddessen die Zellverteilung und Proliferation sichtbar gemacht werden kann. Vorteil der BLI ist, dass beinahe keine unspezifischen Hintergrundsignale erzeugt werden und keine Notwendigkeit für Anregungslicht besteht. Daher ist BLI eine hochsensitive und verlässliche Detektionsmethode. Jedoch erlaubt der BLI Reporter, die Luziferase, keine Anwendung mit gängigen Mikroskopieanwendungen und verhindert daher, dass diese Methode für die Bildgebung auf zellulärer Ebene genutzt werden kann. FLI wiederum bietet die attraktive Möglichkeit einen fluoreszenten Reporter sowohl für die Bildgebung des gesamten Körpers, als auch auf zellulärer Ebene durch die Anwendung von Mikroskopietechniken zu nutzen. Derzeit bestehen noch größere Einschränkungen bei der Arbeit mit fluoreszent markierten Zellen innerhalb eines Tieres. Die allgemeine Autofluoreszenz des umliegenden Gewebes führt zu hohen Hintergrundsignalen. Zusätzlich werden sowohl das Anregungslicht als auch die emittierte Fluoreszenz durch das umliegende Gewebe abgeschwächt. Die Absorption des Lichtes geschieht hauptsächlich durch Melanin und Hämoglobin in Wellenlängen bis zu 650 nm. Daher könnte der Wellenlängenbereich über 650 nm sensitive optische Bildgebung auch in tief liegendem Gewebe ermöglichen. Aus diesem Grund werden erhebliche Anstrenungen unternommen um Fluoreszenzproteine (FP) in diesem spektralen Bereich zu isolieren oder genetisch verbesserte zu entwickeln. „Katushka“ auch FP635 genannt hat eine Emission, die nahe an diesem günstigen Spektrum liegt und wurde als eines der hellsten dunkelroten FPs beschrieben. Wir untersuchten FP635 für die Anwendung als sensitiver Einzelreporter für die Detektion immunologischer Prozesse von der Ganzkörper- bis zur Einzelzellbildgebung. Unsere Experimente zeigten auch deutlich die Überlegenheit der BLI über die FLI für die Ganzkörperbildgebung. Basierend auf diesen Ergebnissen setzten wir die überlegene BLI für die Etablierung eines präklinischen Mausmodells des Multiplen Myeloms (MM) ein. MM ist eine B-Zell Erkrankung wobei maligne Plasmazellen klonal im Knochenmark (BM) älterer Menschen expandieren und erhebliche Morbidität und Sterblichkeit verursacht. Chromosomale Abnormitäten gelten als Kennzeichen des MM, sind bei beinahe allen Patienten vorhanden und können sich während des Krankheitsverlaufes anhäufen oder verändern. Die Diagnose des MM basiert auf klinischen Syptomen inklusive der folgenden Kriterien: erhöhte Serum Kalzium Konzentration, Niereninsuffizienz, Anämie und Knochenläsionen (osteolytische Läsionen oder Osteoporose mit Kompressionsfrakturen). Weitere klinische Symptome beinhalten Hyperviskosität, Amyloidose und wiederkehrende bakterielle Infektionen. Zusätzlich zeigen Patienten verbreitet mehr als 30% klonale BM Plasmazellen und monoklonales Protein ist in Serum und/oder Urin detektierbar. Mit derzeitigen Standardtherapien bleibt MM unheilbar und Patienten, die zwischen 2001 und 2007 mit MM diagnostiziert wurden hatten eine relative 5-jahres Überlebensrate von nur 41%. Daher ist die Entwicklung neuer Medikamente und immunzellbasierten Therapien wünschenswert und notwendig. Zu diesem Zweck entwickelten wir das auf der Zelllinie MOPC-315 basierende syngene MM Mausmodell. Die MOPC-315 Zellen wurden für die in vivo Detektion mittels BLI mit Luziferase markiert. Wir validierten die nichtinvasiv gewonnenen BLI Daten mit Histopathologie, der Messung des idiotypen IgA Spiegels im Serum und Durchflusszytometrie. Alle Methoden bekräftigten die Zuverlässigkeit in vivo BLI Daten für dieses Modell. Wir stellten fest, dass dieses orthotope MM Modell einige Hauptmerkmale der menschlichen Erkrankung widerspiegelt. Die MOPC-315 Zellen wanderten effizient in das BM Kompartiment inklusive darauffolgender Proliferation. Ausserdem, streuten die Zellen in entfernte Teile des Skeletts aus was zum typischen multifokalen MM Wachstum führte. Wir stellten auch osteolytische Läsionen und Knochenumbau fest. Wir fanden Hinweise darauf, dass sich die Zelllinie Plastizität bewahrte was durch die dynamische Regulation der Rezeptorexpression in verschiedenen Kompartimenten, wie dem BM und der Milz, sichtbar wurde. KW - Fluoreszenzproteine KW - Plasmozytom KW - Biolumineszenzmessung KW - Maus KW - Multiple myeloma KW - bioluminescence imaging KW - fluorescence imaging KW - FP635 KW - mouse model KW - nichtinvasive Bildgebung KW - Multiples Myelom Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-77894 ER - TY - THES A1 - Pauschinger, Christoph Johannes T1 - Charakterisierung bi- und trispezifischer anti-CD40 Antikörper-Fusionsproteine T1 - Characterization of bi- and trispecific antiCD40 antibody fusion proteins N2 - Das Immunsystem zu aktivieren, um eine körpereigene Immunantwort gegen Tumorzellen hervorzurufen, ist ein innovativer Therapieansatz. Eine vielversprechende Zielstruktur hierfür ist CD40, ein Mitglied der TNFRSF- Familie und starker Stimulator Antigen-präsentierender Zellen. Die TNFRSF-Rezeptor Aktivierung ist abhängig von der Bildung oligomerer (TNFSF3-TNFRSF3)2 Komplexe, was insbesondere durch entsprechende räumliche Ausrichtung membranständiger Liganden und deren hohe lokale Konzentration im Zell-Zell-Kontakt gewährleistet wird. Im Rahmen dieser Arbeit wurde die (TNFSF3-TNFRSF3)2 Komplexbildung mittels membranständiger Liganden durch die Generierung von CD40-spezifischen Antikörper-Fusions- proteinen imitiert, die über zusätzliche Bindedomänen, single chain fragment variable (scFvs), für zellständige Zielstrukturen (CD70, BCMA, PDL1) verfügen. Dazu wurden die schweren und/oder leichten anti-CD40 Antikörperketten C-terminal mit einem scFv-Fragment verknüpft und dadurch verschiedene CD40-spezifische Antikörper-Fusionsproteine mit scFv-Fragmenten generiert. Die Funktionalität dieser besonderen Antikörper-Fusionsproteine wurde hinsichtlich ihrer Bindungsfähigkeit mittels Gaussia princeps Luciferaseassay und hinsichtlich ihres Agonismus über den Nachweis der Interleukin-8 Induktion per ELISA analysiert. Dabei zeigte sich, dass die CD40-Aktivierung durch die an den Antikörper-Fusionsproteinen verankerten scFv-Domänen bei einem Großteil potenziert werden konnte, wenn diese die entsprechenden Zielantigene CD70, BCMA, PDL1 binden. Des Weiteren waren hinsichtlich ihres Agonimsus die Antikörper-Fusionsproteine mit einer scFv-Domäne an der schweren oder an der leichten Antikörperkette den Antikörper-Fusionsproteinen überlegen, die scFv-Domänen an beiden Antikörperketten aufwiesen. Dennoch stellen auch letztere eine vielversprechende Therapievariante dar, da sie aufgrund ihrer breiteren Spezifität verschiedene Tumorantigene binden können. Die in dieser Arbeit produzierten und charakterisierten CD40-spezifischen Antikörper-Fusionsproteine aktivieren das Immunsystem gezielter in dem Gewebe, in dem vermehrt spezifische Tumorantigene exprimiert werden. Dadurch eröffnen sie neue Möglichkeiten in der Tumortherapie. N2 - Activating the immune system to induce an endogenous immune response against tumor cells is an innovative therapeutic approach. A promising target structure for this is CD40, a member of the TNFRSF family and potent stimulator of antigen-presenting cells. TNFRSF receptor activation is dependent on the formation of oligomeric (TNFSF3-TNFRSF3)2 complexes, which is particularly ensured by appropriate spatial targeting of membrane-bound ligands and their high local concentration in cell-cell interaction. In this work, (TNFSF3-TNFRSF3)2 complex formation using membrane-bound ligands was mimicked by the generation of CD40-specific antibody fusion proteins possessing additional binding domains, single chain fragment variables (scFvs), for cell-bound targets (CD70, BCMA, PDL1). For this purpose, anti-CD40 antibody heavy and/or light chains were C-terminally linked to a scFv fragment, thereby generating different CD40-specific antibody fusion proteins with scFv fragments. The functionality of these particular antibody fusion proteins was analyzed with respect to their binding ability by Gaussia princeps luciferase assay and to their agonism via detection of interleukin-8 induction by ELISA. This showed that CD40 activation could be potentiated by the scFv domains anchored to the antibody fusion proteins in a large proportion when these bind the corresponding target antigens CD70, BCMA, PDL1. Furthermore, in terms of agonimus, antibody fusion proteins with an scFv domain on the heavy or on the light antibody chain were superior to antibody fusion proteins that had scFv domains on both antibody chains. Nevertheless, the latter also represent a promising therapeutic option, as they can bind various tumor antigens due to their broader specificity. The CD40-specific antibody fusion proteins produced and characterized in this work activate the immune system in a more targeted manner in the tissue where specific tumor antigens are increasingly expressed. Thus, they open up new possibilities in tumor therapy. KW - Fusionsprotein KW - Monoklonaler Antikörper KW - Monoklonaler bispezifischer Antikörper KW - CD 40 KW - Immunotherapie KW - Tumornekrosefaktor Rezeptor Superfamilie KW - Tumornekrosefaktor Liganden Superfamilie KW - CD40-spezifische Antikörperfusionsproteine Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260184 ER - TY - THES A1 - Umrath, Veronika T1 - Charakterisierung der Homing-Rezeptor-Expression nach allogener Stammzelltransplantation - neue Biomarker für eine akute Graft-versus-Host-Disease? T1 - Characterization of the homing receptor expression after allogeneic stem cell transplantation - new biomarkers for acute graft-versus-host-disease? N2 - Homing- und Chemokin-Rezeptoren können wichtige Informationen liefern über Aktivierungsstand und Organspezifität der einzelnen Zelle, aber auch über Homöostase und Gleichgewicht von T-Zellen untereinander. Mittels FACS-Analyse konnte in murinen Transplantationsmodellen durch die Hochregulation einzelner Homing-Rezeptoren auf T-Zellen die Entwicklung einer aGvHD vorhergesagt werden. Ob sich ein solches diagnostisches Fenster auch beim Menschen darstellen könnte, sollte in einer klinischen Pilotstudie untersucht werden. Zu diesem Zweck wurde der Expressionsverlauf von 19 verschiedenen Aktivierungsmarkern, Chemokin- und Homingrezeptoren auf T-Zell-Subpopulationen bei allogen transplantierten Patienten charakterisiert. Anschließend wurde versucht, eine Assoziation zwischen der Höhe der jeweiligen Rezeptorexpression und der späteren Entwicklung einer akuten Graft-versus-Host-Disease herzustellen. Die Expression der meisten untersuchten Rezeptoren nahm im Zeitverlauf ab und war insgesamt nur schwach ausgeprägt. Dabei zeigte sich insbesondere im frühen Verlauf nach SZT eine hohe relative Expression dieser Marker bei Patienten ohne aGvHD verglichen mit Patienten mit aGvHD im Verlauf. Insofern scheint eine hohe relative Expression dieser Rezeptoren kein Hinweis auf eine gesteigerte Alloreaktivität der jeweiligen T-Zellen zu sein. Gleichzeitig schien die absolute Anzahl an rezeptorpositiven Zellen eher positiv mit einer aGvHD korreliert zu sein. Die erhöhte Anzahl rezeptorpositiver Zellen errechnete sich allerdings aus der höheren absoluten Anzahl aller T-Zellen bei Patienten mit aGvHD. Damit war diese nicht rezeptorspezifisch, so dass sich Rezeptoren vom Expressionstyp 1 nicht eignen, um in der klinischen Routine eine aGvHD vorherzusagen. Einige Rezeptoren waren auf T-Helfer-Zellen auf mittlerem Niveau konstant exprimiert. Für manche von diesen zeigten sich unterschiedlich hohe relative Expressionsniveaus vor GvHD-Beginn bei Grad 2-4 verglichen mit Grad 1. Die absolute Anzahl rezeptorpositiver Zellen war bei allen Rezeptoren bei aGvHD Grad 2-4 höher als bei Grad 1. Die Expression einiger Marker war auf T-Zellen ausgeprägt, aber im Zeitverlauf fluktuierend. Für die Expression von beta 7 integrin allein und auch für dessen Koexpression zusammen mit CD 49d alpha 4 deuteten sich bei Patienten mit aGvHD Grad 2-4 höhere relative und absolute Werte an als für Patienten mit aGvHD Grad 1. Die Expression der übrigen hoch exprimierten Rezeptoren schien nicht vom Ausmaß der später einsetzenden aGvHD beeinflusst zu werden. Ob durch FACS-Analyse der Rezeptoren CLA, CCR 4, CD 45RA und/oder alpha 4 beta 7 allein oder in Kombination tatsächlich die alloreaktiven T-Zellen der aGvHD charakterisiert und quantifiziert werden können, muss an einem größeren Patientenkollektiv untersucht werden. Da zum jetzigen Zeitpunkt der prädiktive Wert dieser Marker weder postuliert noch ausgeschlossen werden kann, erscheint eine weitergehende Untersuchung sinnvoll. N2 - Homing and chemokine receptors can provide important information about the activation and organ specifity of the cell itself as well as about homeostasis and equilibrium among t cells in general. In murine transplantion models, FACS analysis of t cells could detect the upregulation of homing receptors on t cells prior to the clinical onset of aGvHD. We tried to invesigate if such a diagnostic window could also be found in a clinical setting. Therefore we characterized the expression of 19 homing and chemokine receptors on t cells subsets in allogeneicly transplantated patients. We then looked for any association between the amount of the very receptor expression and the later development of aGvHD. The expression of most studied receptors was decreasing over the course of time and overall low. Especially in the first weeks after alloHCT, a high percentage of receptor expressing cells could be seen in patients without aGvHD compared to patients who developed aGvHD though. Therefore a relatively high expression of these receptors during lymphopenia did not seem to be associated with alloreactivity of the t cells. At the same time, an increased amount of receptor positive cells seemed to correlate positively with aGvHD. Yet, this was because patients with aGvHD showed overall higher rates of leukocytes and lymphocytes than the controls. The effect did not seem to be receptor specific so that receptors of the expression type 1 do not qualify for predicting aGvHD in clinical routine. Some receptors were constantely expressed on a medium level on helper t cells. A part of those showed higher expression levels when patients developed aGvHD grade 2-4 compared to patients with milder grade 1. The absolute amount of receptor positive cells was higher in severe aGvHD in all markers classified as expression type 2. Type 3 is characterized by an overall high but fluctuating homing receptor expression on t-cells. The receptors beta 7 integrin and CD 49 d alpha 4 were upregulated before patients developed severe aGvHD grade 2-4. The expression of the other type 3 receptors didn't seen to be influenced by later aGvHD. Further investigation in a larger cohort is needed to test the value of CLA, CCR4, CD 45 RA, beta 7 integrin and CD 49 d alpha 4 as predictive aGvHD biomarkers. KW - Graft-versus-host-disease KW - Stammzelltransplantation KW - Homingrezeptor KW - Prädiktiver Biomarker KW - stem cell transplantation KW - homing receptor KW - predictive biomarker Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-102191 ER - TY - THES A1 - Ulrich, Jakob Johannes T1 - Checkpoint inhibierende anti-TNFRSF Rezeptor Antikörper-Fusionsproteine T1 - Checkpoint inhibiting anti-TNFRSF receptor antibody fusion proteins N2 - Es sollten Checkpoint inhibierende anti-TNFRSF Rezeptor Antikörper-Fusionsproteine hergestellt und charakterisiert werden. Die agonistische Aktivität TNFR-spezifischer Antikörper wird maßgeblich durch eine Immobilisation über Fcγ-Rezeptoren beeinflusst. In dieser Arbeit erfolgte die Immobilisation der Antikörper-Fusionsproteine über den PD-L1. In funktionellen Assays konnte eine Aktivitätssteigerung der TNFR-spezifischen Domänen mittels PD-L1 vermittelter Immobilisation gezeigt werden. N2 - Checkpoint inhibiting anti-TNFRSF receptor antibody fusion proteins should be prepared and characterized. The agonistic activity of TNFR-specific antibodies is significantly influenced by immobilization via Fcγ receptors. In this work, immobilization of the antibody fusion proteins was performed via the PD-L1. Functional assays revealed an increase in activity of TNFR-specific domains using PD-L1-mediated immobilization. KW - Monoklonaler Antikörper KW - Monoklonaler bispezifischer Antikörper KW - Antigen CD137 KW - Antigen CD40 KW - CD40 agonist KW - 4-1BB agonist KW - Checkpoint-Inhibitor Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-241568 ER - TY - JOUR A1 - Rydzek, Julian A1 - Nerreter, Thomas A1 - Peng, Haiyong A1 - Jutz, Sabrina A1 - Leitner, Judith A1 - Steinberger, Peter A1 - Einsele, Hermann A1 - Rader, Christoph A1 - Hudecek, Michael T1 - Chimeric Antigen Receptor Library Screening Using a Novel NF-kappa B/NFAT Reporter Cell Platform JF - Molecular Therapy N2 - Chimeric antigen receptor (CAR)-T cell immunotherapy is under intense preclinical and clinical investigation, and it involves a rapidly increasing portfolio of novel target antigens and CAR designs. We established a platform that enables rapid and high-throughput CAR-screening campaigns with reporter cells derived from the T cell lymphoma line Jurkat. Reporter cells were equipped with nuclear factor kappa B (NF kappa B) and nuclear factor of activated T cells (NFAT) reporter genes that generate a duplex output of enhanced CFP (ECFP) and EGFP, respectively. As a proof of concept, we modified reporter cells with CD19-specific and ROR1-specific CARs, and we detected high-level reporter signals that allowed distinguishing functional from non-functional CAR constructs. The reporter data were highly reproducible, and the time required for completing each testing campaign was substantially shorter with reporter cells (6 days) compared to primary CAR-T cells (21 days). We challenged the reporter platform to a large-scale screening campaign on a ROR1-CAR library, and we showed that reporter cells retrieved a functional CAR variant that was present with a frequency of only 6 in 1.05 x 10(6). The data illustrate the potential to implement this reporter platform into the preclinical development path of novel CAR-T cell products and to inform and accelerate the selection of lead CAR candidates for clinical translation. KW - NF-κB/NFAT reporter cells KW - chimeric antigen receptor KW - library screening KW - cancer immunotherapy KW - ROR1 Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227193 VL - 27 IS - 2 ER - TY - JOUR A1 - Banales, Jesus M. A1 - Cardinale, Vincenzo A1 - Carpino, Guido A1 - Marzioni, Marco A1 - Andersen, Jesper B. A1 - Invernizzi, Pietro A1 - Lind, Guro E. A1 - Folseraas, Trine A1 - Forbes, Stuart J. A1 - Fouassier, Laura A1 - Geier, Andreas A1 - Calvisi, Diego F. A1 - Mertens, Joachim C. A1 - Trauner, Michael A1 - Benedetti, Antonio A1 - Maroni, Luca A1 - Vaquero, Javier A1 - Macias, Rocio I. R. A1 - Raggi, Chiara A1 - Perugorria, Maria J. A1 - Gaudio, Eugenio A1 - Boberg, Kirsten M. A1 - Marin, Jose J. G. A1 - Alvaro, Domenico T1 - Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) JF - Nature Reviews Gastroenterology & Hepatology N2 - Cholangiocarcinoma (CCA) is a heterogeneous group of malignancies with features of biliary tract differentiation. CCA is the second most common primary liver tumour and the incidence is increasing worldwide. CCA has high mortality owing to its aggressiveness, late diagnosis and refractory nature. In May 2015, the "European Network for the Study of Cholangiocarcinoma" (ENS-CCA: www.enscca.org or www.cholangiocarcinoma.eu) was created to promote and boost international research collaboration on the study of CCA at basic, translational and clinical level. In this Consensus Statement, we aim to provide valuable information on classifications, pathological features, risk factors, cells of origin, genetic and epigenetic modifications and current therapies available for this cancer. Moreover, future directions on basic and clinical investigations and plans for the ENS-CCA are highlighted. KW - primary sclerosing cholangitis KW - growth-factor-receptor KW - biliary-tract cancer KW - epithelial-mesenchymal transition KW - fine-needle-aspiration KW - human intrahepatic cholangiocarcinoma KW - induce cyclooxygenase-2 expression KW - human cholangiocellular carcinoma KW - nucleoside transporter KW - hepatic stellate cells Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-189077 VL - 13 IS - 5 ER - TY - JOUR A1 - Lauruschkat, Chris D. A1 - Etter, Sonja A1 - Schnack, Elisabeth A1 - Ebel, Frank A1 - Schäuble, Sascha A1 - Page, Lukas A1 - Rümens, Dana A1 - Dragan, Mariola A1 - Schlegel, Nicolas A1 - Panagiotou, Gianni A1 - Kniemeyer, Olaf A1 - Brakhage, Axel A. A1 - Einsele, Hermann A1 - Wurster, Sebastian A1 - Loeffler, Juergen T1 - Chronic occupational mold exposure drives expansion of Aspergillus-reactive type 1 and type 2 T-helper cell responses JF - Journal of Fungi N2 - Occupational mold exposure can lead to Aspergillus-associated allergic diseases including asthma and hypersensitivity pneumonitis. Elevated IL-17 levels or disbalanced T-helper (Th) cell expansion were previously linked to Aspergillus-associated allergic diseases, whereas alterations to the Th cell repertoire in healthy occupationally exposed subjects are scarcely studied. Therefore, we employed functional immunoassays to compare Th cell responses to A. fumigatus antigens in organic farmers, a cohort frequently exposed to environmental molds, and non-occupationally exposed controls. Organic farmers harbored significantly higher A. fumigatus-specific Th-cell frequencies than controls, with comparable expansion of Th1- and Th2-cell frequencies but only slightly elevated Th17-cell frequencies. Accordingly, Aspergillus antigen-induced Th1 and Th2 cytokine levels were strongly elevated, whereas induction of IL-17A was minimal. Additionally, increased levels of some innate immune cell-derived cytokines were found in samples from organic farmers. Antigen-induced cytokine release combined with Aspergillus-specific Th-cell frequencies resulted in high classification accuracy between organic farmers and controls. Aspf22, CatB, and CipC elicited the strongest differences in Th1 and Th2 responses between the two cohorts, suggesting these antigens as potential candidates for future bio-effect monitoring approaches. Overall, we found that occupationally exposed agricultural workers display a largely balanced co-expansion of Th1 and Th2 immunity with only minor changes in Th17 responses. KW - mold exposure KW - immunoassay KW - biomarker KW - Aspergillus KW - cytokines KW - inflammation KW - adaptive immunity KW - hypersensitivity Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-245202 SN - 2309-608X VL - 7 IS - 9 ER - TY - JOUR A1 - Da Vià, Matteo Claudio A1 - Solimando, Antonio Giovanni A1 - Garitano-Trojaola, Andoni A1 - Barrio, Santiago A1 - Munawar, Umair A1 - Strifler, Susanne A1 - Haertle, Larissa A1 - Rhodes, Nadine A1 - Vogt, Cornelia A1 - Lapa, Constantin A1 - Beilhack, Andreas A1 - Rasche, Leo A1 - Einsele, Hermann A1 - Kortüm, K. Martin T1 - CIC Mutation as a Molecular Mechanism of Acquired Resistance to Combined BRAF‐MEK Inhibition in Extramedullary Multiple Myeloma with Central Nervous System Involvement JF - The Oncologist N2 - Combined MEK‐BRAF inhibition is a well‐established treatment strategy in BRAF‐mutated cancer, most prominently in malignant melanoma with durable responses being achieved through this targeted therapy. However, a subset of patients face primary unresponsiveness despite presence of the activating mutation at position V600E, and others acquire resistance under treatment. Underlying resistance mechanisms are largely unknown, and diagnostic tests to predict tumor response to BRAF‐MEK inhibitor treatment are unavailable. Multiple myeloma represents the second most common hematologic malignancy, and point mutations in BRAF are detectable in about 10% of patients. Targeted inhibition has been successfully applied, with mixed responses observed in a substantial subset of patients mirroring the widespread spatial heterogeneity in this genomically complex disease. Central nervous system (CNS) involvement is an extremely rare, extramedullary form of multiple myeloma that can be diagnosed in less than 1% of patients. It is considered an ultimate high‐risk feature, associated with unfavorable cytogenetics, and, even with intense treatment applied, survival is short, reaching less than 12 months in most cases. Here we not only describe the first patient with an extramedullary CNS relapse responding to targeted dabrafenib and trametinib treatment, we furthermore provide evidence that a point mutation within the capicua transcriptional repressor (CIC) gene mediated the acquired resistance in this patient. KW - Multiple myeloma KW - Extramedullary disease KW - Capicua transcriptional repressor KW - Drug resistance KW - BRAF mutation Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219549 VL - 25 IS - 2 ER - TY - JOUR A1 - Janjetovic, Snjezana A1 - Lohneis, Philipp A1 - Nogai, Axel A1 - Balci, Derya A1 - Rasche, Leo A1 - Jähne, Doris A1 - Bokemeyer, Carsten A1 - Schilling, Georgia A1 - Blau, Igor Wolfgang A1 - Schmidt-Hieber, Martin T1 - Clinical and biological characteristics of medullary and extramedullary plasma cell dyscrasias JF - Biology N2 - Background: Extramedullary plasma cell (PC) disorders may occur as extramedullary disease in multiple myeloma (MM-EMD) or as primary extramedullary plasmocytoma (pEMP)/solitary osseous plasmocytoma (SOP). In this study, we aimed to obtain insights into the molecular mechanisms of extramedullary spread of clonal PC. Methods: Clinical and biological characteristics of 87 patients with MM-EMD (n = 49), pEMP/SOP (n = 20) and classical MM (n = 18) were analyzed by using immunohistochemistry (CXCR4, CD31, CD44 and CD81 staining) and cytoplasmic immunoglobulin staining combined with fluorescence in situ hybridization (cIg-FISH). Results: High expression of CD44, a cell-surface glycoprotein involved in cell-cell interactions, was significantly enriched in MM-EMD (90%) vs. pEMP/SOP (27%) or classical MM (33%) (p < 0.001). In addition, 1q21 amplification by clonal PC occurred at a similar frequency of MM-EMD (33%), pEMP/SOP (57%) and classical MM (44%). Conversely, del(17p13), t(4;14) and t(14;16) were completely absent in pEMP/SOP. Besides this, 1q21 amplification was identified in 64% of not paraskeletal samples from MM-EMD or pEMP compared to 9% of SOP or paraskeletal MM-EMD/pEMP and 44% of classical MM samples, respectively (p = 0.02). Conclusion: Expression of molecules involved in homing and cytogenetic aberrations differ between MM with or without EMD and pEMP/SOP. KW - plasma cell disorder KW - multiple myeloma KW - extramedullary KW - immunohistochemistry KW - cytogenetics Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242592 SN - 2079-7737 VL - 10 IS - 7 ER - TY - JOUR A1 - Pilgram, Lisa A1 - Eberwein, Lukas A1 - Wille, Kai A1 - Koehler, Felix C. A1 - Stecher, Melanie A1 - Rieg, Siegbert A1 - Kielstein, Jan T. A1 - Jakob, Carolin E. M. A1 - Rüthrich, Maria A1 - Burst, Volker A1 - Prasser, Fabian A1 - Borgmann, Stefan A1 - Müller, Roman-Ulrich A1 - Lanznaster, Julia A1 - Isberner, Nora A1 - Tometten, Lukas A1 - Dolff, Sebastian T1 - Clinical course and predictive risk factors for fatal outcome of SARS-CoV-2 infection in patients with chronic kidney disease JF - Infection N2 - Purpose The ongoing pandemic caused by the novel severe acute respiratory coronavirus 2 (SARS-CoV-2) has stressed health systems worldwide. Patients with chronic kidney disease (CKD) seem to be more prone to a severe course of coronavirus disease (COVID-19) due to comorbidities and an altered immune system. The study’s aim was to identify factors predicting mortality among SARS-CoV-2-infected patients with CKD. Methods We analyzed 2817 SARS-CoV-2-infected patients enrolled in the Lean European Open Survey on SARS-CoV-2-infected patients and identified 426 patients with pre-existing CKD. Group comparisons were performed via Chi-squared test. Using univariate and multivariable logistic regression, predictive factors for mortality were identified. Results Comparative analyses to patients without CKD revealed a higher mortality (140/426, 32.9% versus 354/2391, 14.8%). Higher age could be confirmed as a demographic predictor for mortality in CKD patients (> 85 years compared to 15–65 years, adjusted odds ratio (aOR) 6.49, 95% CI 1.27–33.20, p = 0.025). We further identified markedly elevated lactate dehydrogenase (> 2 × upper limit of normal, aOR 23.21, 95% CI 3.66–147.11, p < 0.001), thrombocytopenia (< 120,000/µl, aOR 11.66, 95% CI 2.49–54.70, p = 0.002), anemia (Hb < 10 g/dl, aOR 3.21, 95% CI 1.17–8.82, p = 0.024), and C-reactive protein (≥ 30 mg/l, aOR 3.44, 95% CI 1.13–10.45, p = 0.029) as predictors, while renal replacement therapy was not related to mortality (aOR 1.15, 95% CI 0.68–1.93, p = 0.611). Conclusion The identified predictors include routinely measured and universally available parameters. Their assessment might facilitate risk stratification in this highly vulnerable cohort as early as at initial medical evaluation for SARS-CoV-2. KW - chronic kidney disease KW - COVID-19 KW - LEOSS KW - predictive factor KW - SARS-CoV-2 Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-308957 SN - 0300-8126 SN - 1439-0973 VL - 49 IS - 4 ER - TY - THES A1 - Ullmann, Monika Anna T1 - Clostridioides difficile Infektionen im Klinikum Aschaffenburg-Alzenau - Retrospektive Analyse des Zeitraums 01/2013-05/2015 - T1 - Clostridioides difficile infections at the Aschaffenburg-Alzenau Hospital - Retrospective analysis of the period 01/2013-05/2015 - N2 - Die CDI ist weltweit die häufigste Ursache der antibiotikaassoziierten nosokomialen Diarrhoe. Sie geht mit steigender Inzidenz, Hospitalisierung und hohen Behandlungskosten in Milliardenhöhe einher. Auch im ambulanten Sektor werden steigende Infektionszahlen gemeldet, die nicht nur ein Problem für die Krankenhäuser, sondern auch für die Pflegeeinrichtungen darstellen. Ziel dieser Arbeit war es, retrospektiv die CDI-Fälle des Klinikums Aschaffenburg-Alzenau (ausgenommen Kinderklinik) im Zeitraum 01.01.2013 - 25.05.2015 zu erfassen und die antibiotische Initialtherapie zu ermitteln. Für die Diagnose einer CDI wurde ein positiver Toxinnachweis in der Stuhlkultur vorausgesetzt. Im weiteren Fokus standen die Rezidivhäufigkeit, die antibiotische Folgetherapie, die Komplikationen bis hin zu den Todesursachen sowie Präventionsmaßnahmen. Im o.g. Zeitraum waren 299 Patienten und Patientinnen mit einer CDI hospitalisiert. Das mittlere Alter lag bei 73,8 Jahren. Es handelte sich in der Mehrzahl um multimorbide und immunsupprimierte Patienten und Patientinnen. 61% waren antibiotisch vorbehandelt. Am häufigsten verwendet wurden Breitbandpenicilline (36%), Cephalosporine der 3. Generation (12%) und Fluorchinolone (10%). Über 1/3 der Patienten und Patientinnen wurde mit Mehrfachkombinationen behandelt und bei 2% war eine zytostatische Behandlung vorausgegangen. In der Initialtherapie der CDI kam bei fast der Hälfte Erkrankten (47%) Metronidazol zur Anwendung. Die Rezidivrate lag bei 20%, Mehrfachrezidive traten bei 5,7% auf. Die antibiotische Folgetherapie der CDI erfolgte bei 39% der Patienten und Patientinnen mit Vancomycin oder Fidaxomicin entsprechend den damals geltenden Empfehlungen leitlinienkonform. Rund ¼ aller Erkrankten verstarben, davon 17% CDI-assoziiert. Der fäkale Stuhltransfer, der ab dem 2. Rezidiv empfohlen wird, und die Genotypisierung bei Mehrfachrezidiven wurde in keinem Fall durchgeführt. 2021 wurde die CDI-Behandlungsleitlinie der ESCMID aktualisiert. Statt dem Einsatz von Metronidazol werden nun Fidaxomicin oder Vancomycin, in Rezidivsituationen die Standardantibiose um den Antikörper Bezlotoxumab ergänzt. 06/2023 erschien die Konsultationsfassung der S2k-Leitlinie “Gastrointestinale Infektionen und Morbus Whipple” der DGVS. Die Empfehlungen gleichen sich. Es kann festgehalten werden, dass die CDI auch im Klinikum Aschaffenburg-Alzenau ein ernstes Problem darstellt, das Präventionsmaßnahmen bedarf. Die Rezidiv- und Todesraten sind hoch. In dieser Arbeit konnte bestätigt werden, dass der unbedachte Einsatz von Antibiotika ein wichtiger Hauptrisikofaktor für die Entstehung einer CDI ist. Daher sollte die Indikation für eine antibiotische Therapie streng gestellt werden. Die Daten zeigen ferner, dass die Umsetzung aktueller Leitlinienempfehlungen nicht oder zeitlich verzögert erfolgte. Seit der Etablierung und Umsetzung des ABS 2017 am Klinikum Aschaffenburg-Alzenau konnte ein Rückgang der CDI um 21% verzeichnet werden. Ein ABS ist eine Möglichkeit die konsequente Anwendung aktueller Empfehlungen im klinischen Alltag umzusetzen und so zu einer höheren Erfolgsrate der Behandlung und einer niedrigeren Rezidivrate beizutragen. Die Umsetzung einer gezielten frühen Diagnostik, Schutz- und Isoliermaßnahmen, Surveillance und regelmäßige Fort- und Weiterbildung der Mitarbeiter*innen sind weitere wichtige Bausteine, die zur Prävention der CDI beitragen. N2 - CDI is the most common cause of antibiotic-associated nosocomial diarrhea worldwide. It is accompanied by rising incidence, hospitalization and high treatment costs in the billions. Rising numbers of infections are also reported in the outpatient sector, posing a problem not only for hospitals, but also for care facilities. The aim of this study was to retrospectively record the CDI cases of the Aschaffenburg-Alzenau Hospital (except for the Children's Hospital) in the period 01.01.2013 - 25.05.2015 and to determine the initial antibiotic therapy. For the diagnosis of CDI, a positive toxin detection in the stool culture was required. The focus was also on the frequency of recurrence, antibiotic follow-up therapy, complications and causes of death, and preventive measures. In the above-mentioned period, 299 patients with CDI were hospitalized. The median age was 73.8 years. The majority of them were multimorbid and immunosuppressed patients. 61% were pre-treated with antibiotics. The most commonly used antibiotics were broad-spectrum penicillins (36%), 3rd generation cephalosporins (12%) and fluoroquinolones (10%). In the initial therapy of CDI, metronidazole was used in almost half of the patients (47%). The recurrence rate was 20%, multiple recurrences occurred at 5.7%. Follow-up antibiotic therapy of CDI was carried out in 39% of patients with vancomycin or fidaxomicin in accordance with the guidelines in force at the time. About 1/4 of all patients died, 17% of them CDI-associated. Fecal microbiota transplantation, which is recommended from the 2nd recurrence, and genotyping in case of multiple recurrences was not performed in any case. In 2021, ESCMID's CDI treatment guideline, was updated. Instead of the use of metronidazole, fidaxomicin or vancomycin are now supplemented, and in relapse situations, the standard antibiosis is supplemented by the antibody bezlotoxumab. 06/2023, the consultation version of the S2k guideline "Gastrointestinal Infections and Whipple's Disease" of the DGVS was published. The recommendations are similar. It can be stated that CDI is also a serious problem at the Aschaffenburg-Alzenau Hospital, which requires preventive measures. The recurrence and Death rates are high. This study confirmed that the careless use of antibiotics is an important main risk factor for the development of CDI. Therefore, the indication for antibiotic therapy should be set strictly. The data also show that the implementation of current guideline recommendations did not take place or was delayed. Since the establishment and implementation of the ABS in 2017 at the Aschaffenburg-Alzenau Hospital, a 21% decline in CDI has been recorded. An ABS is a way to implement the consistent application of current recommendations in everyday clinical practice and thus contribute to a higher success rate of treatment and a lower recurrence rate. The implementation of targeted early diagnostics, protective and isolation measures, surveillance and regular further education and training of employees are further important building blocks that contribute to the prevention of CDI. KW - Clostridium-difficile-Infektion KW - CDI KW - Rezidiv KW - Antibiotic stewardship Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-328085 ER - TY - JOUR A1 - Reiter, Theresa A1 - Demirbas, Senem A1 - Schmalzing, Marc A1 - Voelker, Wolfram A1 - Bauer, Wolfgang R. A1 - Güder, Gülmisal T1 - CMR detects extensive intracavitary thrombi as solitary clinical presentation of Antiphospholipid Syndrome: A case report JF - Clinical Case Reports N2 - Intracavitary thrombi are an important differential diagnosis of cardiac masses. Cardiac magnetic resonance imaging (CMR) allows their non-invasive characterization. This case highlights extensive cardiac thrombi detected by CMR as solitary presentation of antiphospholipid syndrome. KW - antiphospholipid syndrome KW - cardiac thrombi KW - CMR Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312766 SN - 2050-0904 VL - 10 IS - 11 ER - TY - JOUR A1 - Schmidt-Hieber, M. A1 - Silling, G. A1 - Schalk, E. A1 - Heinz, W. A1 - Panse, J. A1 - Penack, O. A1 - Christopeit, M. A1 - Buchheidt, D. A1 - Meyding-Lamadé, U. A1 - Hähnel, S. A1 - Wolf, H. H. A1 - Ruhnke, M. A1 - Schwartz, S. A1 - Maschmeyer, G. T1 - CNS infections in patients with hematological disorders (including allogeneic stem-cell transplantation)-Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) JF - Annals of Oncology N2 - Infections of the central nervous system (CNS) are infrequently diagnosed in immunocompetent patients, but they do occur in a significant proportion of patients with hematological disorders. In particular, patients undergoing allogeneic hematopoietic stem-cell transplantation carry a high risk for CNS infections of up to 15%. Fungi and Toxoplasma gondii are the predominant causative agents. The diagnosis of CNS infections is based on neuroimaging, cerebrospinal fluid examination and biopsy of suspicious lesions in selected patients. However, identification of CNS infections in immunocompromised patients could represent a major challenge since metabolic disturbances, side-effects of antineoplastic or immunosuppressive drugs and CNS involvement of the underlying hematological disorder may mimic symptoms of a CNS infection. The prognosis of CNS infections is generally poor in these patients, albeit the introduction of novel substances (e.g. voriconazole) has improved the outcome in distinct patient subgroups. This guideline has been developed by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) with the contribution of a panel of 14 experts certified in internal medicine, hematology/oncology, infectious diseases, intensive care, neurology and neuroradiology. Grades of recommendation and levels of evidence were categorized by using novel criteria, as recently published by the European Society of Clinical Microbiology and Infectious Diseases. KW - Central nervous system KW - Polymerase chain raction KW - Herpes simplex encephalitis KW - Invasive fungal-infections KW - Clinical practice guidelines KW - Liposomal amphotericin-B KW - Immunocompromised patient KW - Progressive multifocal leukoencephalopathy KW - Varicella-zoster-virus KW - Diagnosis KW - Treatment KW - Bone-marrow-transplantation KW - Real-time PCR KW - Guideline KW - Central nervous system infection Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-188210 VL - 27 IS - 7 ER - TY - JOUR A1 - Paholcsek, Melinda A1 - Fidler, Gabor A1 - Konya, Jozsef A1 - Rejto, Laszlo A1 - Mehes, Gabor A1 - Bukta, Evelin A1 - Loeffler, Juergen A1 - Biro, Sandor T1 - Combining standard clinical methods with PCR showed improved diagnosis of invasive pulmonary aspergillosis in patients with hematological malignancies and prolonged neutropenia JF - BMC Infectious Diseases N2 - Background: We assessed the diagnostic value of standard clinical methods and combined biomarker testing (galactomannan assay and polymerase chain reaction screening) in a prospective case-control study to detect invasive pulmonary aspergillosis in patients with hematological malignancies and prolonged neutropenia. Methods: In this observational study 162 biomarker analyses were performed on samples from 27 febrile neutropenic episodes. Sera were successively screened for galactomannan antigen and for Aspergillus fumigatus specific nucleic acid targets. Furthermore thoracic computed tomography scanning was performed along with bronchoscopy with lavage when clinically indicated. Patients were retrospectively stratified to define a case-group with "proven" or "probable" invasive pulmonary aspergillosis (25.93 %) and a control-group of patients with no evidence for of invasive pulmonary aspergillosis (74.07 %). In 44.44 % of episodes fever ceased in response to antibiotic treatment (group II). Empirical antifungal therapy was administered for episodes with persistent or relapsing fever (group I). 48.15 % of patients died during the study period. Postmortem histology was pursued in 53.85 % of fatalities. Results: Concordant negative galactomannan and computed tomography supported by a polymerase chain reaction assay were shown to have the highest discriminatory power to exclude invasive pulmonary aspergillosis. Bronchoalveolar lavage was performed in 6 cases of invasive pulmonary aspergillosis and in 15 controls. Although bronchoalveolar lavage proved negative in 93 % of controls it did not detect IPA in 86 % of the cases. Remarkably post mortem histology convincingly supported the presence of Aspergillus hyphae in lung tissue from a single case which had consecutive positive polymerase chain reaction assay results but was misdiagnosed by both computed tomography and consistently negative galactomannan assay results. For the galactomannan enzyme-immunoassay the diagnostic odds ratio was 15.33 and for the polymerase chain reaction assay it was 28.67. According to Cohen's kappa our in-house polymerase chain reaction method showed a fair agreement with the galactomannan immunoassay. Combined analysis of the results from the Aspergillus galactomannan enzyme immunoassay together with those generated by our polymerase chain reaction assay led to no misdiagnoses in the control group. Conclusion: The data from this pilot-study demonstrate that the consideration of standard clinical methods combined with biomarker testing improves the capacity to make early and more accurate diagnostic decisions. KW - whole blood specimens KW - high risk KW - mold disease KW - therapy KW - combination testing KW - real time PCR KW - fungal infections KW - immunocompromised patients KW - prospective feasibility KW - galactomannan KW - epidemiology KW - invasive pulmonary aspergillosis KW - biomarkers KW - acute leukemia KW - neutropenic fever Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-151607 VL - 15 IS - 251 ER - TY - JOUR A1 - Lupiañez, Carmen B. A1 - Villaescusa, Maria T. A1 - Carvalho, Agostinho A1 - Springer, Jan A1 - Lackner, Michaela A1 - Sánchez-Maldonado, José M. A1 - Canet, Luz M. A1 - Cunha, Cristina A1 - Segura-Catena, Joana A1 - Alcazar-Fuoli, Laura A1 - Solano, Carlos A1 - Fianchi, Luana A1 - Pagano, Livio A1 - Potenza, Leonardo A1 - Aguado, José M. A1 - Luppi, Mario A1 - Cuenca-Estrella, Manuel A1 - Lass-Flörl, Cornelia A1 - Einsele, Hermann A1 - Vázquez, Lourdes A1 - Ríos-Tamayo, Rafael A1 - Loeffler, Jürgen A1 - Jurado, Manuel A1 - Sainz, Juan T1 - Common Genetic Polymorphisms within NF kappa B-Related Genes and the Risk of Developing Invasive Aspergillosis JF - Frontiers in Microbiology N2 - Invasive Aspergillosis (IA) is an opportunistic infection caused by Aspergillus, a ubiquitously present airborne pathogenic mold. A growing number of studies suggest a major host genetic component in disease susceptibility. Here, we evaluated whether 14 single-nucleotide polymorphisms within NFκB1, NFκB2, RelA, RelB, Rel, and IRF4 genes influence the risk of IA in a population of 834 high-risk patients (157 IA and 677 non-IA) recruited through a collaborative effort involving the aspBIOmics consortium and four European clinical institutions. No significant overall associations between selected SNPs and the risk of IA were found in this large cohort. Although a hematopoietic stem cell transplantation (HSCT)-stratified analysis revealed that carriers of the IRF4rs12203592T/T genotype had a six-fold increased risk of developing the infection when compared with those carrying the C allele (ORREC = 6.24, 95%CI 1.25–31.2, P = 0.026), the association of this variant with IA risk did not reach significance at experiment-wide significant threshold. In addition, we found an association of the IRF4AATC and IRF4GGTC haplotypes (not including the IRF4rs12203592T risk allele) with a decreased risk of IA but the magnitude of the association was similar to the one observed in the single-SNP analysis, which indicated that the haplotypic effect on IA risk was likely due to the IRF4rs12203592 SNP. Finally, no evidence of significant interactions among the genetic markers tested and the risk of IA was found. These results suggest that the SNPs on the studied genes do not have a clinically relevant impact on the risk of developing IA. KW - Invasive Aspergillosis KW - genetic polymorphisms KW - susceptibility KW - NFkB-relatedgenes KW - interaction Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-165209 VL - 7 IS - 1243 ER - TY - JOUR A1 - Belic, Stanislav A1 - Page, Lukas A1 - Lazariotou, Maria A1 - Waaga-Gasser, Ana Maria A1 - Dragan, Mariola A1 - Springer, Jan A1 - Loeffler, Juergen A1 - Morton, Charles Oliver A1 - Einsele, Hermann A1 - Ullmann, Andrew J. A1 - Wurster, Sebastian T1 - Comparative Analysis of Inflammatory Cytokine Release and Alveolar Epithelial Barrier Invasion in a Transwell® Bilayer Model of Mucormycosis JF - Frontiers in Microbiology N2 - Understanding the mechanisms of early invasion and epithelial defense in opportunistic mold infections is crucial for the evaluation of diagnostic biomarkers and novel treatment strategies. Recent studies revealed unique characteristics of the immunopathology of mucormycoses. We therefore adapted an alveolar Transwell® A549/HPAEC bilayer model for the assessment of epithelial barrier integrity and cytokine response to Rhizopus arrhizus, Rhizomucor pusillus, and Cunninghamella bertholletiae. Hyphal penetration of the alveolar barrier was validated by 18S ribosomal DNA detection in the endothelial compartment. Addition of dendritic cells (moDCs) to the alveolar compartment led to reduced fungal invasion and strongly enhanced pro-inflammatory cytokine response, whereas epithelial CCL2 and CCL5 release was reduced. Despite their phenotypic heterogeneity, the studied Mucorales species elicited the release of similar cytokine patterns by epithelial and dendritic cells. There were significantly elevated lactate dehydrogenase concentrations in the alveolar compartment and epithelial barrier permeability for dextran blue of different molecular weights in Mucorales-infected samples compared to Aspergillus fumigatus infection. Addition of monocyte-derived dendritic cells further aggravated LDH release and epithelial barrier permeability, highlighting the influence of the inflammatory response in mucormycosis-associated tissue damage. An important focus of this study was the evaluation of the reproducibility of readout parameters in independent experimental runs. Our results revealed consistently low coefficients of variation for cytokine concentrations and transcriptional levels of cytokine genes and cell integrity markers. As additional means of model validation, we confirmed that our bilayer model captures key principles of Mucorales biology such as accelerated growth in a hyperglycemic or ketoacidotic environment or reduced epithelial barrier invasion upon epithelial growth factor receptor blockade by gefitinib. Our findings indicate that the Transwell® bilayer model provides a reliable and reproducible tool for assessing host response in mucormycosis. KW - mucormycosis KW - alveolar epithelium KW - in vitro model KW - cytokines KW - dendritic cells Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-252477 VL - 9 ER - TY - JOUR A1 - Wagner-Drouet, Eva A1 - Teschner, Daniel A1 - Wolschke, Christine A1 - Schäfer-Eckart, Kerstin A1 - Gärtner, Johannes A1 - Mielke, Stephan A1 - Schreder, Martin A1 - Kobbe, Guido A1 - Hilgendorf, Inken A1 - Klein, Stefan A1 - Verbeek, Mareike A1 - Ditschkowski, Markus A1 - Koch, Martina A1 - Lindemann, Monika A1 - Schmidt, Traudel A1 - Rascle, Anne A1 - Barabas, Sascha A1 - Deml, Ludwig A1 - Wagner, Ralf A1 - Wolff, Daniel T1 - Comparison of cytomegalovirus-specific immune cell response to proteins versus peptides using an IFN-γ ELISpot assay after hematopoietic stem cell transplantation JF - Diagnostics N2 - Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality following hematopoietic stem cell transplantation (HSCT). Measuring CMV-specific cellular immunity may improve the risk stratification and management of patients. IFN-γ ELISpot assays, based on the stimulation of peripheral blood mononuclear cells with CMV pp65 and IE-1 proteins or peptides, have been validated in clinical settings. However, it remains unclear to which extend the T-cell response to synthetic peptides reflect that mediated by full-length proteins processed by antigen-presenting cells. We compared the stimulating ability of pp65 and IE-1 proteins and corresponding overlapping peptides in 16 HSCT recipients using a standardized IFN-γ ELISpot assay. Paired qualitative test results showed an overall 74.4% concordance. Discordant results were mainly due to low-response tests, with one exception. One patient with early CMV reactivation and graft-versus-host disease, sustained CMV DNAemia and high CD8\(^+\) counts showed successive negative protein-based ELISpot results but a high and sustained response to IE-1 peptides. Our results suggest that the response to exogenous proteins, which involves their uptake and processing by antigen-presenting cells, more closely reflects the physiological response to CMV infection, while the response to exogenous peptides may lead to artificial in vitro T-cell responses, especially in strongly immunosuppressed patients. KW - CMV KW - CMV-specific cellular immunity KW - hematopoietic stem cell transplantation KW - recall antigen KW - peptide KW - immune monitoring KW - IFN-γ ELISpot KW - T cells KW - antigen processing and presentation KW - immunosuppression Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228843 SN - 2075-4418 VL - 11 IS - 2 ER - TY - JOUR A1 - White, P. Lewis A1 - Wiederhold, Nathan P. A1 - Loeffler, Juergen A1 - Najvar, Laura K. A1 - Melchers, Willem A1 - Herrera, Monica A1 - Bretagne, Stephane A1 - Wickes, Brian A1 - Kirkpatrick, William R. A1 - Barnes, Rosemary A. A1 - Donnelly, J. Peter A1 - Patterson, Thomas F. T1 - Comparison of nonculture blood-based tests for diagnosing invasive aspergillosis in an animal model JF - Journal of Clinical Microbiology N2 - The European Aspergillus PCR Initiative (EAPCRI) has provided recommendations for the PCR testing of whole blood (WB) and serum/plasma. It is important to test these recommended protocols on nonsimulated "in vivo" specimens before full clinical evaluation. The testing of an animal model of invasive aspergillosis (IA) overcomes the low incidence of disease and provides experimental design and control that is not possible in the clinical setting. Inadequate performance of the recommended protocols at this stage would require reassessment of methods before clinical trials are performed and utility assessed. The manuscript describes the performance of EAPCRI protocols in an animal model of invasive aspergillosis. Blood samples taken from a guinea pig model of IA were used for WB and serum PCR. Galactomannan and beta-D-glucan detection were evaluated, with particular focus on the timing of positivity and on the interpretation of combination testing. The overall sensitivities for WB PCR, serum PCR, galactomannan, and beta-D-glucan were 73%, 65%, 68%, and 46%, respectively. The corresponding specificities were 92%, 79%, 80%, and 100%, respectively. PCR provided the earliest indicator of IA, and increasing galactomannan and beta-D-glucan values were indicators of disease progression. The combination of WB PCR with galactomannan and beta-D-glucan proved optimal (area under the curve AUC], 0.95), and IA was confidently diagnosed or excluded. The EAPRCI-recommended PCR protocols provide performance comparable to commercial antigen tests, and clinical trials are warranted. By combining multiple tests, IA can be excluded or confirmed, highlighting the need for a combined diagnostic strategy. However, this approach must be balanced against the practicality and cost of using multiple tests. KW - high-risk hematology KW - Guinea pig model KW - real-time PCR KW - fungal disease KW - galactomannan KW - pulmonary aspergillosis KW - amphotericin B KW - Aspergillus fumigatus KW - beta-D-glucan Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-189674 VL - 54 IS - 4 ER - TY - JOUR A1 - Schanbacher, Constanze A1 - Hermanns, Heike M. A1 - Lorenz, Kristina A1 - Wajant, Harald A1 - Lang, Isabell T1 - Complement 1q/tumor necrosis factor-related proteins (CTRPs): structure, receptors and signaling JF - Biomedicines N2 - Adiponectin and the other 15 members of the complement 1q (C1q)/tumor necrosis factor (TNF)-related protein (CTRP) family are secreted proteins composed of an N-terminal variable domain followed by a stalk region and a characteristic C-terminal trimerizing globular C1q (gC1q) domain originally identified in the subunits of the complement protein C1q. We performed a basic PubMed literature search for articles mentioning the various CTRPs or their receptors in the abstract or title. In this narrative review, we briefly summarize the biology of CTRPs and focus then on the structure, receptors and major signaling pathways of CTRPs. Analyses of CTRP knockout mice and CTRP transgenic mice gave overwhelming evidence for the relevance of the anti-inflammatory and insulin-sensitizing effects of CTRPs in autoimmune diseases, obesity, atherosclerosis and cardiac dysfunction. CTRPs form homo- and heterotypic trimers and oligomers which can have different activities. The receptors of some CTRPs are unknown and some receptors are redundantly targeted by several CTRPs. The way in which CTRPs activate their receptors to trigger downstream signaling pathways is largely unknown. CTRPs and their receptors are considered as promising therapeutic targets but their translational usage is still hampered by the limited knowledge of CTRP redundancy and CTRP signal transduction. KW - adiponectin KW - AMPK KW - C1q/TNF related protein (CTRP) KW - inflammation KW - metabolism Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304136 SN - 2227-9059 VL - 11 IS - 2 ER - TY - JOUR A1 - Zhou, Xiang A1 - Bai, Tao A1 - Meckel, Katharina A1 - Song, Jun A1 - Jin, Yu A1 - Kortüm, Martin K. A1 - Eisele, Hermann A1 - Hou, Xiaohua A1 - Rasche, Leo T1 - COVID-19 infection in patients with multiple myeloma: a German-Chinese experience from Würzburg and Wuhan JF - Annals of Hematology N2 - No abstract available. KW - COVID-19 KW - patients with multiple myeloma Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235108 SN - 0939-5555 VL - 100 ER - TY - JOUR A1 - Tappe, Beeke A1 - Lauruschkat, Chris D. A1 - Strobel, Lea A1 - Pantaleón García, Jezreel A1 - Kurzai, Oliver A1 - Rebhan, Silke A1 - Kraus, Sabrina A1 - Pfeuffer-Jovic, Elena A1 - Bussemer, Lydia A1 - Possler, Lotte A1 - Held, Matthias A1 - Hünniger, Kerstin A1 - Kniemeyer, Olaf A1 - Schäuble, Sascha A1 - Brakhage, Axel A. A1 - Panagiotou, Gianni A1 - White, P. Lewis A1 - Einsele, Hermann A1 - Löffler, Jürgen A1 - Wurster, Sebastian T1 - COVID-19 patients share common, corticosteroid-independent features of impaired host immunity to pathogenic molds JF - Frontiers in Immunology N2 - Patients suffering from coronavirus disease-2019 (COVID-19) are susceptible to deadly secondary fungal infections such as COVID-19-associated pulmonary aspergillosis and COVID-19-associated mucormycosis. Despite this clinical observation, direct experimental evidence for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)-driven alterations of antifungal immunity is scarce. Using an ex-vivo whole blood stimulation assay, we challenged blood from twelve COVID-19 patients with Aspergillus fumigatus and Rhizopus arrhizus antigens and studied the expression of activation, maturation, and exhaustion markers, as well as cytokine secretion. Compared to healthy controls, T-helper cells from COVID-19 patients displayed increased expression levels of the exhaustion marker PD-1 and weakened A. fumigatus- and R. arrhizus-induced activation. While baseline secretion of proinflammatory cytokines was massively elevated, whole blood from COVID-19 patients elicited diminished release of T-cellular (e.g., IFN-γ, IL-2) and innate immune cell-derived (e.g., CXCL9, CXCL10) cytokines in response to A. fumigatus and R. arrhizus antigens. Additionally, samples from COVID-19 patients showed deficient granulocyte activation by mold antigens and reduced fungal killing capacity of neutrophils. These features of weakened anti-mold immune responses were largely decoupled from COVID-19 severity, the time elapsed since diagnosis of COVID-19, and recent corticosteroid uptake, suggesting that impaired anti-mold defense is a common denominator of the underlying SARS-CoV-2 infection. Taken together, these results expand our understanding of the immune predisposition to post-viral mold infections and could inform future studies of immunotherapeutic strategies to prevent and treat fungal superinfections in COVID-19 patients. KW - COVID-19 KW - immune impairment KW - T cells KW - granulocytes KW - Aspergillus KW - Rhizopus Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-283558 SN - 1664-3224 VL - 13 ER - TY - JOUR A1 - Maucher, Marius A1 - Srour, Micha A1 - Danhof, Sophia A1 - Einsele, Hermann A1 - Hudecek, Michael A1 - Yakoub-Agha, Ibrahim T1 - Current limitations and perspectives of chimeric antigen receptor-T-cells in acute myeloid leukemia JF - Cancers N2 - Adoptive transfer of gene-engineered chimeric antigen receptor (CAR)-T-cells has emerged as a powerful immunotherapy for combating hematologic cancers. Several target antigens that are prevalently expressed on AML cells have undergone evaluation in preclinical CAR-T-cell testing. Attributes of an ‘ideal’ target antigen for CAR-T-cell therapy in AML include high-level expression on leukemic blasts and leukemic stem cells (LSCs), and absence on healthy tissues, normal hematopoietic stem and progenitor cells (HSPCs). In contrast to other blood cancer types, where CAR-T therapies are being similarly studied, only a rather small number of AML patients has received CAR-T-cell treatment in clinical trials, resulting in limited clinical experience for this therapeutic approach in AML. For curative AML treatment, abrogation of bulk blasts and LSCs is mandatory with the need for hematopoietic recovery after CAR-T administration. Herein, we provide a critical review of the current pipeline of candidate target antigens and corresponding CAR-T-cell products in AML, assess challenges for clinical translation and implementation in routine clinical practice, as well as perspectives for overcoming them. KW - AML KW - CAR-T-cell KW - hematology KW - gene therapy KW - adoptive cell therapy Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-252180 SN - 2072-6694 VL - 13 IS - 24 ER - TY - JOUR A1 - Lapa, Constantin A1 - Herrmann, Ken A1 - Schirbel, Andreas A1 - Hänscheid, Heribert A1 - Lückerath, Katharina A1 - Schottelius, Margret A1 - Kircher, Malte A1 - Werner, Rudolf A. A1 - Schreder, Martin A1 - Samnick, Samuel A1 - Kropf, Saskia A1 - Knop, Stefan A1 - Buck, Andreas K. A1 - Einsele, Hermann A1 - Wester, Hans-Juergen A1 - Kortüm, K. Martin T1 - CXCR4-directed endoradiotherapy induces high response rates in extramedullary relapsed multiple myeloma JF - Theranostics N2 - C-X-C-motif chemokine receptor 4 (CXCR4) is a key factor for tumor growth and metastasis in several types of human cancer. We have recently reported promising first-in-man experience with CXCR4-directed endoradiotherapy (ERT) in multiple myeloma (MM). Eight heavily pretreated MM patients underwent a total of 10 ERT cycles (7 patients with 1 cycle and a single patient with 3 cycles). ERT was administered in combination with chemotherapy and autologous stem cell support. End points were occurrence and timing of adverse events, progression-free and overall survival. ERT was overall well tolerated without any unexpected acute adverse events or changes in vital signs. With absorbed tumor doses >30-70 Gy in intra- or extramedullary lesions, significant anti-myeloma activity was observed with 1 patient achieving complete remission and 5/8 partial remission. Directly after ERT major infectious complications were seen in one patient who died from sepsis 22 days after ERT, another patient with high tumor burden experienced lethal tumor lysis syndrome. Median progression-free survival was 54 days (range, 13-175), median overall survival was 223 days (range, 13-313). During follow-up (6 patients available), one patient died from infectious complications, 2/8 from disease progression, the remaining 3/8 patients are still alive. CXCR4-directed ERT was well-tolerated and exerted anti-myeloma activity even at very advanced stage MM with presence of extramedullary disease. Further assessment of this novel treatment option is highly warranted. KW - medicine KW - multiple myeloma KW - PET KW - CXCR4 KW - theranostics Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-172095 VL - 7 IS - 6 ER - TY - JOUR A1 - Buck, Andreas K. A1 - Serfling, Sebastian E. A1 - Lindner, Thomas A1 - Hänscheid, Heribert A1 - Schirbel, Andreas A1 - Hahner, Stefanie A1 - Fassnacht, Martin A1 - Einsele, Hermann A1 - Werner, Rudolf A. T1 - CXCR4-targeted theranostics in oncology JF - European Journal of Nuclear Medicine and Molecular Imaging N2 - A growing body of literature reports on the upregulation of C-X-C motif chemokine receptor 4 (CXCR4) in a variety of cancer entities, rendering this receptor as suitable target for molecular imaging and endoradiotherapy in a theranostic setting. For instance, the CXCR4-targeting positron emission tomography (PET) agent [\(^{68}\)Ga]PentixaFor has been proven useful for a comprehensive assessment of the current status quo of solid tumors, including adrenocortical carcinoma or small-cell lung cancer. In addition, [\(^{68}\)Ga]PentixaFor has also provided an excellent readout for hematological malignancies, such as multiple myeloma, marginal zone lymphoma, or mantle cell lymphoma. PET-based quantification of the CXCR4 capacities in vivo allows for selecting candidates that would be suitable for treatment using the theranostic equivalent [\(^{177}\)Lu]/[\(^{90}\)Y]PentixaTher. This CXCR4-directed theranostic concept has been used as a conditioning regimen prior to hematopoietic stem cell transplantation and to achieve sufficient anti-lymphoma/-tumor activity in particular for malignant tissues that are highly sensitive to radiation, such as the hematological system. Increasing the safety margin, pretherapeutic dosimetry is routinely performed to determine the optimal activity to enhance therapeutic efficacy and to reduce off-target adverse events. The present review will provide an overview of current applications for CXCR4-directed molecular imaging and will introduce the CXCR4-targeted theranostic concept for advanced hematological malignancies. KW - CXCR4 KW - theranostics KW - C-X-C motif chemokine receptor 4 KW - [68Ga]PentixaFor KW - [177Lu]PentixaTher KW - [90Y]PentixaTher KW - endoradiotherapy KW - adrenocortical carcinoma KW - multiple myeloma Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324545 VL - 49 IS - 12 ER - TY - JOUR A1 - Dimopoulos, Meletios A. A1 - Weisel, Katja C. A1 - Song, Kevin W. A1 - Delforge, Michel A1 - Karlin, Lionel A1 - Goldschmidt, Hartmut A1 - Moreau, Philippe A1 - Banos, Anne A1 - Oriol, Albert A1 - Garderet, Laurent A1 - Cavo, Michele A1 - Ivanova, Valentina A1 - Alegre, Adrian A1 - Martinez-Lopez, Joaquin A1 - Chen, Christine A1 - Spencer, Andrew A1 - Knop, Stefan A1 - Bahlis, Nizar J. A1 - Renner, Christoph A1 - Yu, Xin A1 - Hong, Kevin A1 - Sternas, Lars A1 - Jacques, Christian A1 - Zaki, Mohamed H. A1 - San Miguel, Jesus F. T1 - Cytogenetics and long-term survival of patients with refractory or relapsed and refractory multiple myeloma treated with pomalidomide and low-dose dexamethasone JF - Haematologica N2 - Patients with refractory or relapsed and refractory multiple myeloma who no longer receive benefit from novel agents have limited treatment options and short expected survival. del(17p) and t(4;14) are correlated with shortened survival. The phase 3 MM-003 trial demonstrated significant progression-free and overall survival benefits from treatment with pomalidomide plus low-dose dexamethasone compared to high-dose dexamethasone among patients in whom bortezomib and lenalidomide treatment had failed. At an updated median follow-up of 15.4 months, the progression-free survival was 4.0 versus 1.9 months (HR, 0.50; P<0.001), and median overall survival was 13.1 versus 8.1 months (HR, 0.72; P=0.009). Pomalidomide plus low-dose dexamethasone, compared with high-dose dexamethasone, improved progression-free survival in patients with del(17p) (4.6 versus 1.1 months; HR, 0.34; P < 0.001), t(4;14) (2.8 versus 1.9 months; HR, 0.49; P=0.028), and in standard-risk patients (4.2 versus 2.3 months; HR, 0.55; P<0.001). Although the majority of patients treated with high-dose dexamethasone took pomalidomide after discontinuation, the overall survival of patients treated with pomalidomide plus low-dose dexamethasone or highdose dexamethasone was 12.6 versus 7.7 months (HR, 0.45; P=0.008) in patients with del(17p), 7.5 versus 4.9 months (HR, 1.12; P=0.761) in those with t(4;14), and 14.0 versus 9.0 months (HR, 0.85; P=0.380) in standard-risk subjects. The overall response rate was higher in patients treated with pomalidomide plus low-dose dexamethasone than in those treated with high-dose dexamethasone both among standard-risk patients (35.2% versus 9.7%) and those with del(17p) (31.8% versus 4.3%), whereas it was similar in patients with t(4; 14) (15.9% versus 13.3%). The safety of pomalidomide plus low-dose dexamethasone was consistent with initial reports. In conclusion, pomalidomide plus low-dose dexamethasone is efficacious in patients with relapsed/refractory multiple myeloma and del(17p) and/or t(4;14). KW - translocation KW - plus dexamethasone KW - deletion 17P KW - bortezomib KW - therapy KW - abnormalities KW - stem-cell transplantation KW - growth-factor receptor 3 KW - high-risk cytogenetics KW - intergroupe francophone Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-140349 VL - 100 IS - 10 SP - 1327 EP - 1333 ER - TY - JOUR A1 - Schwinn, Stefanie A1 - Mokhtari, Zeinab A1 - Thusek, Sina A1 - Schneider, Theresa A1 - Sirén, Anna-Leena A1 - Tiemeyer, Nicola A1 - Caruana, Ignazio A1 - Miele, Evelina A1 - Schlegel, Paul G. A1 - Beilhack, Andreas A1 - Wölfl, Matthias T1 - Cytotoxic effects and tolerability of gemcitabine and axitinib in a xenograft model for c-myc amplified medulloblastoma JF - Scientific Reports N2 - Medulloblastoma is the most common high-grade brain tumor in childhood. Medulloblastomas with c-myc amplification, classified as group 3, are the most aggressive among the four disease subtypes resulting in a 5-year overall survival of just above 50%. Despite current intensive therapy regimens, patients suffering from group 3 medulloblastoma urgently require new therapeutic options. Using a recently established c-myc amplified human medulloblastoma cell line, we performed an in-vitro-drug screen with single and combinatorial drugs that are either already clinically approved or agents in the advanced stage of clinical development. Candidate drugs were identified in vitro and then evaluated in vivo. Tumor growth was closely monitored by BLI. Vessel development was assessed by 3D light-sheet-fluorescence-microscopy. We identified the combination of gemcitabine and axitinib to be highly cytotoxic, requiring only low picomolar concentrations when used in combination. In the orthotopic model, gemcitabine and axitinib showed efficacy in terms of tumor control and survival. In both models, gemcitabine and axitinib were better tolerated than the standard regimen comprising of cisplatin and etoposide phosphate. 3D light-sheet-fluorescence-microscopy of intact tumors revealed thinning and rarefication of tumor vessels, providing one explanation for reduced tumor growth. Thus, the combination of the two drugs gemcitabine and axitinib has favorable effects on preventing tumor progression in an orthotopic group 3 medulloblastoma xenograft model while exhibiting a favorable toxicity profile. The combination merits further exploration as a new approach to treat high-risk group 3 medulloblastoma. KW - cancer KW - CNS cancer KW - paediatric cancer Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-261476 VL - 11 IS - 1 ER -