TY - THES A1 - Stollburges, Elisa T1 - Therapeutisches Potential der IL-1ß-Neutralisierung nach Schädel-Hirn-Trauma - eine präklinische randomisierte Kontrollstudie T1 - The therapeutic potential of interleukin 1 beta neutralisation treating Traumatic Brain injury - A preclinical randomised control study N2 - Durch die Interleukin 1ß Neutralisierung mittels eines Antikörpers soll versucht werden, das Outcome nach einem Schädelhirntrauma zu verbessern und den erlittenen Schaden zu minimieren N2 - With the support of antibodies, interleukin 1 beta neutralisation attempts to improve the outcome after suffering from a traumatic brain injury and to limit the damage suffered KW - Interleukin 1-beta KW - Interleukin 1 beta Neutralisierung KW - Schädel-Hirn-Trauma Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-349346 ER - TY - THES A1 - Zeller, Laura T1 - Auditorisches Hirnstamm-Implantat bei Neurofibromatose Typ 2: Charakteristika der elektrisch evozierten auditorischen Potentiale und deren Bedeutung für den Hörerfolg T1 - Auditory brainstem implants: intraoperative electrophysiology and hearing outcome N2 - Auditorische Hirnstammimplantate (ABI stellen die einzige Option der Hörrehabilitation bei bilateraler retrocochleärer Ertaubung dar. Die Implantate sind insbesondere in ihrer größten Nutzergruppe - Neurofibromatose Typ 2 Patienten - für ihr sehr variables Hörergebnis bekannt. Die Evozierbarkeit und die Qualität der intraoperativ abgeleiteten elektrisch evozierten auditorischen Hirnstammantworten wird als möglicher Einflussfaktor auf das Outcome diskutiert. Bisher gelten weder für die Frage des Einsatzes an sich, noch für die Methodik oder die Analyse und Bewertung der EABR in der ABI-Chirurgie einheitliche Konzepte. Ziel dieser Studie ist die detaillierte Analyse der intraoperativ registrierten EABR während ABI-Implantation bei NF2-Patienten. Zudem stellt Beurteilung der Hörfunktion mit ABI bei NF2-Patienten stellt aufgrund oftmals begleitender Symptomatik der Grunderkrankung eine besondere Herausforderung dar. Sprachtests allein spiegeln die Hörfunktion in dieser Patientengruppe nicht immer umfassend wider. Die in dieser Studie angewendete Würzburger Skala für Implantat-Hören soll dieser Problematik gerecht werden, indem Ergebnisse eines etablierten Sprachtests mit der klinischen Kommunikationsfähigkeit kombiniert werden. Zusammenfassung der Hauptergebnisse: Nach intraoperativer Stimulation mittels ABI zeigten sich EABR-Antworten mit null bis 3 Vertex-positiven Peaks (P1, P2, P3), welche in dieser Kohorte im Mittel nach 0,42 ms (P1), 1,43 ms (P2) bzw. 2,40 ms (P3) auftraten. Eine 2-Peak Wellenform war in dieser Studie die am häufigsten beobachtete Morphologie (78,8%). Bei der Stimulation unterschiedlicher Elektrodenkontakte zeigten sich Unterschiede in der EABR-Wellenmorphologie. Alle Antworten konnten in eine der fünf Kategorien der Würzburger EABR-Klassifikation eingeordnet werden. Für die Latenz von P2 konnte eine statistisch signifikante Korrelation mit der Tumorausdehnung nach Hannover Klassifikation gezeigt werden. Die Einstufung des Hörergebnisses mit ABI in NF2 nach Ergebnis im MTP-Test und nach Kommunikationsfähigkeit im Alltag unterschied sich in 7 von 22 Fällen (31,2%) um eine Kategorie. Bei der Einordnung in die Würzburger Skala für Implantat-Hören zeigte sich nach Diskussion der divergenten Fälle in 2 Fällen die Kategorisierung zugunsten des Ergebnisses im MTP-Test und in 5 Fällen zugunsten des Ergebnisses der Kommunikationsfähigkeit im Alltag. Nützliches Hören mit ABI konnte in 95,5% der Patienten gezeigt werden, davon erzielten 68,2% Sprachverständnis. Die Auslösbarkeit reproduzierbarer intraoperativer EABRs konnte in 95,5% Hörvermögen hervorsagen. N2 - Auditory brainstem implants (ABI) are primarily designed for neurofibromatosis type 2 (NF2) patients with bilateral deafness due to schwannomas. These neuro-prosthetic devices bypass the auditory nerve and produce hearing sensations by direct stimulation of the cochlear nuclei (CN). This study investigates the importance of intraoperative electrically evoked auditory brainstem responses (EABR) with regards to the auditory outcome. Out of a prospectively collected series of ABI implantations from 2005 to 2019, 22 patients (10 male, 12 female) fulfilled inclusion criteria (min. age of 15 y, NF2 diagnosis) and were analysed retrospectively for EABR and hearing outcome. EABR analysis relied on the presence and number of vertex positive peaks P1, P2 and P3 at brainstem stimulation. For post-operative hearing outcome a new Clinical ABI Outcome Classification was developed and applied at 6 to 12 months containing 4 categories: Category 1, Star Performer, with >80% speech understanding in auditory only MTP (mono- to polysyllabic) test and ability for continuous spoken conversation without any lip reading; Category 2, Good Performer, with <40 to 80% in auditory only MTP test and some speech understanding combined with lip reading; Category 3, Useful Performance, communication with some additional measures (hearing, lip-reading and written notes) possible; Category 4 Non-useful Performance, no or only scarce sound reception. In 22 patients, 146 EABR recordings at various sites of the implant were evaluated: A three-peak-formation was present in 7, a two-peek-formation in 115 cases, and one-peak in 13 cases, while 11 remained without any reproducible responses. EABR wave forms showed some variation: Peak P1 mostly developed just out of or after the stimulus artefact while peaks P2 and P3 sometimes showed melting and larger latency differences. Peak P1 appears to correspond to wave III of natural auditory ABR. Overall auditory outcome was useful or better (Categories 1, 2 or 3) in 95.5 % of cases, with Star or Good Performance in about 68 % of the patients. Presence of EABR predicted auditory rehabilitation correctly in 95.5%. False positive EABR are rare and a matter of open discussion such as on lead dislocation or secondary brainstem nuclei degeneration. Overall, intra-operative reproducible EABR are highly predictive of adequate brainstem activation and useful hearing rehabilitation with ABI in deaf NF2 patients and appear indispensable for implant positioning. The most reliable peak P1 of EABR may represent immediate activity of cochlear nuclei. The importance of further peaks P2 and P3 and their anatomic correlation still need further evaluation and possibly correlation with more long-term auditory development. The presented ABI hearing classification uses the internationally accepted MTP test and proves to be a universal tool to elucidate the patient’s capacity for speech communication. KW - Neurofibromatose KW - Audiologie KW - Elektrophysiologie KW - Hörrehabilitation KW - Auditory brainstem implant KW - Neurofibromatose Typ 2 KW - Electric auditory brainstem response KW - Hörprothese Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-303373 ER - TY - THES A1 - Lopez Caperuchipi, Simon T1 - Charakterisierung zellulärer Veränderungen und kognitiver Verhaltensweisen in einem Model vom Schädel-Hirn Trauma in männlichen Mäusen T1 - Characterization of cellular and behavioral changes in a model of traumatic brain injury in male mice N2 - Schädel-Hirn Trauma ist die führende Ursache von Tod und Behinderung unter jungen Erwachsenen in den USA und Europa. Darüber hinaus steigert Schädel-Hirn Trauma das Risiko eine Demenzerkrankung oder andere neurodegenerative Erkrankung zu erleiden. Aus diesem Grund stellt eine bessere Erkenntnis der subakuten und chronischen pathophysiologischen Prozesse eine wichtige Grundlage für eine mögliche zukünftige neuroprotektive Therapie dar. Ziel dieser Arbeit war es daher eine Übersicht von funktionellen Einschränkungen und zellulären Veränderungen in der subakuten Phase innerhalb der ersten drei Monate darzustellen. Dazu wurden Verhaltensexperimente zu kognitiven Leistungen wie räumliches Lernen, kognitive Plastizität, episodisches Gedächtnis, Angstverhalten und allgemeine Lokomotion durchgeführt. Dabei konnten funktionale Einschränkungen der Tiere im Bereich der kognitiven Flexibilität, dem räumlichen Lernen, dem belohnungsmotivierten Verhalten, sowie Hyperaktivität beobachtet werden. Weiterführend erfolgten histologische und immunhistologische Untersuchungen an den Mäusegehirnen. So konnten in unserem Tiermodell sowohl lokale neuroinflammatorische Veränderungen nachgewiesen werden, also auch generalisierte Veränderungen, welche sich auf Isocortex und Hippocampus erstreckten und beide Hemisphären gleichermaßen betrafen. Ebenso konnten demyelinisierende Prozesse im Bereich der Läsion beobachtet werden. Im Bereich des Cortex zeigte sich außerdem eine axonale Schädigung mit begleitender Neuroinflammation, sowie eine Infiltration von B-Zellen. Anschließend wurde eruiert, ob eine Korrelation von funktionalem Outcome und histologischen Veränderungen besteht. Dabei zeigte sich eine signifikante Korrelation neuroinflammatorischer Prozesse mit Einschränkungen im räumlichen Lernen und Umlernen, sowie Auffälligkeiten im Bereich des belohnungsmotivierten Verhaltens. Damit ordnet sich diese Arbeit in die bestehenden Erkenntnisse zur Pathophysiologie des SHTs ein und ergänzt diese weiter. N2 - Traumatic brain injury is the leading cause of death and disability among young adults in the USA and Europe. Traumatic brain injury increases the risk for neurodegenerative diseases and dementia. However, the underlying pathomechanisms that contribute to the increased risk for neurodegeneration remain unclear. The aim of this thesis is to provide an overview of behavioral and cellular changes in the subacute phase of the first three months after injury. Therefore, behavioral experiments were performed with a focus on spatial learning, cognitive plasticity, episodic memory, anxiety, and general locomotion. Deficits in spatial learning, cognitive plasticity, reward-motivated behavior as well as hyperactivity were monitored in mice after traumatic brain injury. Furthermore, histological and immunohistochemical analysis were performed on brain tissue three months after injury. Local neuroinflammatory changes were seen in the lesion area as well as global inflammation in cortex and hippocampus. Both hemispheres showed similar levels of inflammation. Demyelination colocalized with neuroinflammation around the lesion area. In the cortex axonal damage, neuroinflammatory changes, and migration of B-cells were detected. We further investigated the correlation between behavioral and cellular changes. Neuroinflammation correlated significantly with deficits in spatial learning, cognitive plasticity, and reward-motivated behavior. This thesis, therefore, provides an important overview of behavioral changes and cellular pathomechanisms and further knowledge of the subacute phase of traumatic brain injury. KW - Schädel-Hirn-Trauma KW - Neuroinflammation KW - Neurodegeneration Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-302686 ER - TY - THES A1 - Holzmeier, Judith T1 - Effekt einer stufenweisen Hyperkapnie auf den cerebralen Blutfluss bei intubierten, kontrolliert beatmeten Patienten nach aneurysmatischer Subarachnoidalblutung T1 - Effect of a stepwise hypercapnia on cerebral blood flow of intubated, controlled-ventilated patients after aneurysmal subarachnoid hemorrhage N2 - An 12 intubierten, kontrolliert-beatmeten Patienten mit aneurysmatischer Subarachnoidalblutung (aSAB) wurde an Tag 4 bis 14 nach Ereignis eine tägliche, stufenweise Hyperkapnie bis zu einem arteriellen Kohlendioxidpartialdruck (PaCO2) von 60 mmHg erzeugt. Ziel der Studie war zu evaluieren, ob und in welchem Umfang die cerebrovaskuläre PaCO2-Reaktivität nach aSAB erhalten ist. Primärer Studienendpunkt waren die cerebralen Blutflusswerte (CBF) erfasst mit der intraparenchymalen Thermodilutionstechnik. Sekundäre Endpunkte waren die cerebrale Gewebesauerstoffsättigung (StiO2) erfasst mit der Nah-Infrarot-Spektroskopie und die mittleren Flussgeschwindigkeiten (MFV) der basalen Hirngefäße in der transkraniellen Dopplersonographie. Durch die stufenweise Hyperkapnie konnte bei allen 12 Studienpatienten eine dosisabhängige und reproduzierbare Steigerung des CBF, der StiO2 und der MFV in den basalen Hirngefäßen induziert werden. Dies zeigt den Erhalt der cerebrovaskulären PaCO2-Reaktivität auch bei kritisch kranken aSAB-Patienten und auch während der Phase der kritischsten Hirnperfusion an. Es ergaben sich keine Hinweise auf ein Steal-Phänomen oder einen Rebound-Effekt. Die Daten zeigen an, dass die stufenweise Hyperkapnie auch bei kritisch kranken aSAB-Patienten sicher und einfach durchführbar ist, wenn eine externe Ventrikeldrainage zum kontinuierlichen Liquorablass vorhanden ist. N2 - We induced a daily, stepwise hypercapnia up to an arterial partial pressure of carbon dioxide (PaCO2) of 60 mmHg in 12 intubated, controlled-ventilated patients on day 4 to 14 after aneurysmal subarachnoid hemorrhage (aSAH). The aim of the study was to evaluate if and on what scale the cerebrovascular PaCO2-reactivity after aSAH is still intact. The primary endpoint was the cerebral blood flow measured with the intraparenchymal thermodilution technique. Secondary endpoints were the brain tissue oxygen saturation measured with near infrared spectroscopy and the mean flow velocities in the basal cerebral arteries measured with transcranial doppler sonography. The stepwise hypercapnia induced a dose-dependent and reproducible increase in CBF, StiO2 and the MFV in the basal cerebral arteries in all 12 patients. This shows the preservation of the cerebrovascular PaCO2-reactivity in critical-ill patients after aSAH and even in the most critical phase of cerebral perfusion. There were no signs of a steal-phenomenon or a rebound-effect. Our results show that a stepwise hypercapnia is safely and easily feasible if there is an external ventricular drainage to ensure continuous drainage of cerebrospinal fluid. KW - Subarachnoidalblutung KW - Hyperkapnie KW - cerebraler Blutfluss KW - aneurysmatisch Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-316682 ER - TY - THES A1 - Giniunaite, Aiste Marija T1 - Effekte von Tumor Treating Fields (TTFields) auf die Blut-Hirn-Schranke in einem murinen (cerebEND) und humanen (HBMVEC) Zellkulturmodell T1 - Effects of tumour treating fields (TTFields) on the blood-brain barrier in a murine (cerebEND) and human (HBMVEC) cell culture model N2 - TTFields sind eine zugelassene Therapie für die Behandlung von Glioblastom IDH-Wildtyp. Es handelt sich dabei um elektrische Wechselfelder niedriger Intensität und mittlerer Frequenz, die therapeutisch aus zwei Richtungen durch ein tragbares, nicht-invasives Gerät appliziert werden. Sie verhindern die Spindelfaserbildung während der Mitose. Die Wirkung vieler effektiver Chemotherapeutika ist im ZNS durch die Blut-Hirn-Schranke (BHS) eingeschränkt. Die BHS wird nach TTFields Applikation bei 100 kHz in einem murinen cerebEND-Zell-Modell vorübergehend geöffnet. Dieser Effekt wurde in dieser Arbeit zunächst mit Hilfe von Immunfluoreszenzmikroskopie und dann durch einen fraktionierten Western-Blot bestätigt, dass der mutmaßliche Wirkungsmechanismus von TTFields in der Delokalisierung des tight junction Proteins Claudin-5 von der Membran in das Zytoplasma liegt. TEER-Messungen zeigten, dass sich die Integrität der BHS durch 100 kHz TTFields nach 72 h verringerte und 48 h - 72 h nach Ende der Behandlung wieder normalisierte, auch wenn statt eines Behandlungsendes auf 200 kHz TTFields umgeschaltet wurde. Der zweite Teil der Untersuchung bestand darin, ein BHS-Modell aus humanen HBMVEC Zellen zu etablieren, um die Auswirkungen von TTFields im humanen System verifizieren zu können. Zunächst konnten keine Effekte von TTFields unterschiedlicher Frequenz auf eine HBMVEC-Monokultur festgestellt werden. In einer Kokultur mit Perizyten gab es eine erhöhte Expression von Claudin-5, Occludin und PECAM-1. Allerdings zeigten die TEER-Messungen und ein Permeabilitätsassay keine Unterschiede zwischen den Mono- und Kokultur-Modellen der BHS auf. Durch eine transiente Öffnung der BHS könnte eine höhere Dosis von Therapeutika, die normalerweise die BHS nicht überwinden können, im ZNS erreicht werden. Damit könnten TTFields eine innovative Methode zur Behandlung von Hirntumoren und anderen Erkrankungen des ZNS darstellen. Die hier präsentierten Daten geben erste Hinweise in diese Richtung, müssen aber noch optimiert und verifiziert werden. N2 - TTFields are an approved therapy for the treatment of glioblastoma IDH-wildtype. They are low intensity, medium frequency alternating electric fields which are applied therapeutically from two directions by a portable, non-invasive device. TTFields prevent spindle fiber formation during mitosis by aligning the strongly polar tubulin subunits in the electrical fields. The achievement of effective chemotherapy of glioblastoma IDH-wildtype and other central nervous system (CNS) disorders is limited by the blood-brain barrier (BBB). Application of TTFields at 100 kHz at the mouse cell line cerebEND temporarily opens the BBB. This TTFields effect was observed in fluorescence microscopy. Fractionated Western-Blots revealed delocalisation of the TJ-Protein Claudin-5 from the membrane to the cytoplasm due to the application of TTFields. The integrity of the BBB has been shown in TEER measurements to be interrupted by 72 h TTFields application at 100 kHz. This effect was reversible and repeatable. In addition, if TTFields at 200 kHz were applied after BBB-opening at 100 kHz the cells recovered. The second part of this project was to establish a human cell culture BBB model (HBMVEC) to investigate TTFields effects on human cells. There were no effects of TTFields at different frequencies on HBMVEC cells detectable. HBMVEC cells had lower expression of Claudin-5, Occludin and PECAM-1 compared to their co-culture with pericytes. However, TEER measurements and permeability assays revealed no differences between such mono- and co-cultures. By overcoming the BBB a higher dose of the drugs could be achieved in a more controlled manner in the CNS. As a result, TTFields could be an innovative method for the treatment of brain tumours and other diseases of the CNS. The presented experiments provide a first rationale in this direction but require optimisation and verification. KW - Tumortherapiefelder KW - Blut-Hirn-Schranke KW - Glioblastom KW - Zellkultur KW - cerebEND Zellkultur KW - HBMVEC Zellkultur KW - TTFields KW - blood-brain barrier KW - cerebEND KW - HBMVEC KW - Tumor Treating Fields Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-310648 ER - TY - THES A1 - Neuhaus, Nikolas T1 - MACC1 - ein prognostischer Blutmarker für das Überleben von Patienten mit Glioblastoma multiforme? T1 - MACC1 – a prognostic tumor marker for the survival of patients with glioblastoma multiforme? N2 - Das GBM ist der aggressivste primäre Hirntumor bei Erwachsenen ohne bekannten Tumormarker. Wir haben im Blutplasma zirkulierende mRNA Transkripte von MACC1, einem prognostischen Biomarker für solide Tumoren, auf ihre Korrelation mit dem klinischem Outcome und der Therapieantwort bei GBM-Patienten getestet. MACC1 mRNA Transkripte waren signifikant erhöht bei GBM-Patienten im Vergleich zur Kontrollgruppe. Eine niedrige MACC1 mRNA Transkript-Konzentration clusterte mit anderen prognostisch wertvollen Faktoren, wie z.B. dem IDH1 Mutationsstatus: Patienten mit der IDH1 R132H Mutation in Kombination mit einer niedrigen MACC1 mRNA Transkript-Konzentration wiesen das längste Gesamtüberleben von über 2 Jahren auf, IDH1 wildtyp und eine hohe MACC1 mRNA Transkript-Konzentration führten zum schlechtesten Outcome (medianes Gesamtüberleben 8,1 Monate). Patienten mit IDH1 wildtyp und einer niedriger MACC1 mRNA Transkript-Konzentration waren intermediär (medianes Gesamtüberleben 9,1 Monate). Kein Patient hatte eine IDH1 R132H Mutation und eine hohe MACC1 mRNA Transkript-Konzentration. Patienten mit niedriger MACC1 mRNA Transkript-Konzentration, die die Standardtherapie nach Stupp erhielten, überlebten länger (medianes Gesamtüberleben 22,6 Monate) als Patienten mit einer hohen MACC1 mRNA Transkript-Konzentration (medianes Gesamtüberleben 8,1 Monate). Patienten, die keine Standardtherapie erhielten, zeigten das schlechteste Outcome, unabhängig von der MACC1 mRNA Transkript-Konzentration (niedrig: 6,8 Monate, hoch: 4,4 Monate). Durch das Hinzufügen der MACC1 mRNA TranskriptKonzentrationen zur präoperativen Diagnostik könnte somit die Prognose und das Outcome von GBM Patienten genauer evaluiert werden und so eine genauere Einteilung in Therapie- und Risikogruppen erfolgen N2 - Glioblastoma multiforme (GBM)is an aggressive primary brain tumor of the adult with unknown tumor markers. We evaluated whether circulating mRNA transcripts of metastasis-associated- in colon-cancer (MACC1), a prognostic tumor marker for other solid tumors, correlats with the prediction of clinical outcome and the therapy response. MACC1-transcripst were significantly higher in GBM patients compared to controls. Low MACC1 transcript levels clustered together with other prognostic markers. MACC1 was associated with the GBM-patient`s prognosis in conjunction with the isocitrate dehydrogenase (IDH) mutation status: IDH1 R132H mutation and low MACC1 transcript levels was most favorable (median OS > 2 years), IDH1 wildtyp and high MACC1 transcript levels was worst (median OS 8,1 months), while IDH1 wildtyp and low MACC1 transcript levels was intermediate (median OS 9,1 months). No patients showed IDH1 R132H mutation and high MACC1 transcript levels. GBM patients with low MACC1 levels receiving standard therapy survived longer (median OS 22.6 months) than patients with high MACC1 levels (median OS 8.1 months). Patients not receiving the standard regimen showed the worst prognosis, independent of MACC1 levels (low: 6.8 months, high: 4.4 months). Addition of circulating MACC1 transcript levels to the existing prognostic workup may improve the accuracy of outcome prediction and help define more precise risk categories of GBM patients. KW - MACC1 KW - Glioblastoma Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-314191 ER - TY - THES A1 - Mangold, Katharina Julia T1 - Einfluss von Rehabilitationsmaßnahmen auf die kognitive Leistungsfähigkeit nach Resektion eines intrakraniellen Meningeoms T1 - Influence of rehabilitation on cognitive functions after resection of an intracranial meningioma N2 - Im Rahmen dieser Dissertation wurde geprüft, welchen Verlauf die kognitiven Leistungen von Patienten nach der operativen Resektion eines intrakraniellen Meningeoms nahmen und ob hierbei Unterschiede zwischen den Personen bestanden, die eine anschließende Rehabilitation absolvierten, sowie jenen, die keine weiteren Maßnahmen erhielten. Mit der ersten Hypothese wurde angenommen, dass Patienten ohne Rehabilitation drei Monate nach der Operation ihre kognitiven Fähigkeiten im Vergleich zu einer Woche nach dem Eingriff verbessern. Dies konnte nicht eindeutig bestätigt werden, da eine Steigerung der Leistungen in dieser Patientengruppe nur in fünf der sechzehn Teilgebiete erreicht wurde. Die zweite Hypothese basierte auf der Annahme, dass Patienten mit einer Rehabilitationsmaßnahme Leistungssteigerungen in den getesteten Gebieten zeigten. Der Vergleich fand eine Woche nach dem operativen Eingriff und drei Monate nach der Operation statt. Diese Hypothese kann durch die vorliegenden Ergebnisse im Rahmen der Konzentrationsleistung zumindest eingeschränkt bejaht werden. Es ließen sich zwei signifikante Unterschiede der Ergebnisse der Patienten mit anschließender Rehabilitation beobachten. Hier konnte im ergänzend zur ANOVA berechneten t-Test ein signifikanter Unterschied bei der Leistungssteigerung der Patienten mit anschließender Rehabilitation nachgewiesen werden. Des Weiteren kam es in dieser Patientengruppe zu gesteigerten Leistungen in vierzehn von sechzehn Teilgebieten. Im Falle der dritten Hypothese sollte exploriert werden, ob die Patientengruppe mit anschließender Rehabilitationsmaßnahme im Vergleich zur Patientengruppe ohne weitere Maßnahmen eine größere Leistungssteigerung erfuhr. Dabei konnte eine leichte Tendenz beobachtet werden. Es wurden Verbesserungen der Patientengruppe mit Rehabilitation gegenüber den Patienten ohne weitere Maßnahmen in neun von sechzehn Kategorien beobachtet. Somit lässt sich die Annahme stützen, dass eine postoperative Rehabilitationsmaßnahme sich positiv auf die kognitiven Leistungen bei Meningeom-Patienten auswirkt. N2 - This dissertation examined the course of the cognitive performance in patients after surgical treatment of an intracranial meningioma. Further should be examined if there are differences between patients with subsequent rehabilitation and the patients without. The first hypothesis assumed that patients without rehabilitation would improve their cognitive abilities three months after surgery compared to one week after surgery. This could not clearly be confirmed, as an increase in performance in this patient group was only achieved in five of sixteen categories. The second hypothesis was based on the assumption that patients who underwent rehabilitation also showed improvements of their cognitive functions. This hypothesis can be confirmed at least to a limited extend by the results of concentration performance. Two significant results were found in the group with further rehabilitation. The ANOVA and the additional calculated t-test demonstrated a significant difference in performance of the patients with subsequent rehabilitation. Furthermore, these patient group showed increased cognitive functions in fourteen of sixteen categories. In the third hypothesis should be explored whether the patient group with rehabilitation reached a higher increase in performance compared to the patient group without further treatment. In this case a slight trend could be observed. The patient group with rehabilitation showed greater improvements in nine of sixteen categories compared to those patients without rehabilitation. This supports the assumption that postoperative rehabilitation has a positive effect on cognitive performance in patients with intracranial meningioma. KW - Meningeom KW - Rehabilitation KW - Kognition KW - Resektion Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-330618 ER - TY - JOUR A1 - Conrads, Nora A1 - Grunz, Jan-Peter A1 - Huflage, Henner A1 - Luetkens, Karsten Sebastian A1 - Feldle, Philipp A1 - Grunz, Katharina A1 - Köhler, Stefan A1 - Westermaier, Thomas T1 - Accuracy of pedicle screw placement using neuronavigation based on intraoperative 3D rotational fluoroscopy in the thoracic and lumbar spine JF - Archives of Orthopaedic and Trauma Surgery N2 - Introduction In spinal surgery, precise instrumentation is essential. This study aims to evaluate the accuracy of navigated, O-arm-controlled screw positioning in thoracic and lumbar spine instabilities. Materials and methods Posterior instrumentation procedures between 2010 and 2015 were retrospectively analyzed. Pedicle screws were placed using 3D rotational fluoroscopy and neuronavigation. Accuracy of screw placement was assessed using a 6-grade scoring system. In addition, screw length was analyzed in relation to the vertebral body diameter. Intra- and postoperative revision rates were recorded. Results Thoracic and lumbar spine surgery was performed in 285 patients. Of 1704 pedicle screws, 1621 (95.1%) showed excellent positioning in 3D rotational fluoroscopy imaging. The lateral rim of either pedicle or vertebral body was protruded in 25 (1.5%) and 28 screws (1.6%), while the midline of the vertebral body was crossed in 8 screws (0.5%). Furthermore, 11 screws each (0.6%) fulfilled the criteria of full lateral and medial displacement. The median relative screw length was 92.6%. Intraoperative revision resulted in excellent positioning in 58 of 71 screws. Follow-up surgery due to missed primary malposition had to be performed for two screws in the same patient. Postsurgical symptom relief was reported in 82.1% of patients, whereas neurological deterioration occurred in 8.9% of cases with neurological follow-up. Conclusions Combination of neuronavigation and 3D rotational fluoroscopy control ensures excellent accuracy in pedicle screw positioning. As misplaced screws can be detected reliably and revised intraoperatively, repeated surgery for screw malposition is rarely required. KW - pedicle screws KW - vertebral pedicles KW - fluoroscopy KW - neuronavigation KW - spine Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324966 VL - 143 IS - 6 ER - TY - THES A1 - Hädrich, Dustin T1 - Schädeldachplastiken: Ein Vergleich zwischen freihand-modellierten- (Palacos®) und computer-assistiert hergestellten (CAD-CAM) - PMMA Implantaten T1 - Cranioplasty: A comparison between intraoperative-moulded (Palacos®) and computer-assisted manufactured (CAD-CAM) PMMA implants N2 - Einführung Die Kranioplastik (KP) nach Kraniektomie dient der Wiederherstellung der Funktionalität und Ästhetik des Schädels. Obwohl es sich um einen Routineeingriff handelt, wurden hohe Komplikationsraten beschrieben, die zum Teil auf die unterschiedlichen Arten des verwendeten Implantatmaterials zurückzuführen sind. Wir haben diese Studie durchgeführt, um intraoperativ-geformte (Palacos®) und CAD-CAM-PMMA-Implantate bei Patienten/-innen nach Kraniektomie hinsichtlich perioperativer Modalitäten, kurz- und langfristiger Komplikationsraten und ästhetischer Ergebnisse zu vergleichen. Methoden Diese retrospektive Single-Center-Analyse wurde an 350 Patienten mit 359 Kranioplastiken durchgeführt, die sich in 133 Palacos®-Fälle (01/2005-12/2012) und 226 CAD-CAM-Fälle (01/2010-12/2018) aufteilten. Postoperative Komplikationen wurden in kurzfristige (≤ 30 Tage) und langfristige (> 30 Tage) unterteilt. Die ästhetischen Ergebnisse wurden per Telefoninterview erhoben und auf einer 5-Punkte-Skala bewertet. Ergebnisse CAD-CAM-Patienten hatten eine kürzere Operationszeit (p < 0.001), einen geringeren intraoperativen Blutverlust (p < 0.001) und einen kürzeren postoperativen Krankenhausaufenthalt (p < 0.005) als Palacos®-Patienten. Operative Revisionen nach CP mussten bei 12,8 % der Patienten durchgeführt werden. Implantatinfektionen traten bei 3,8 % der Palacos®-Fälle und 1,8 % der CAD-CAM-Fälle auf. Wundheilungsstörungen traten bei CAD-CAM-Patienten häufiger auf, was mit einer höheren Anzahl an kraniellen Vor-Operationen und Vorinfektionen einherging. Palacos®-Patienten hatten signifikant mehr Implantatdislokationen (p < 0.05). CAD-CAM-Patienten berichteten von einem besseren ästhetischen Ergebnis im Vergleich zu Palacos®-Patienten. Fazit Diese Studie zeigt eine Überlegenheit der CAD-CAM-PMMA-Implantate im Vergleich zu Palacos®-Implantaten hinsichtlich peri- und postoperativer Faktoren, sowie dem ästhetischen Ergebnis. CAD-CAM-Implantate haben geringere Komplikations- und Infektionsraten als Palacos®-Implantate und zeigten positive Wirkungen, wenn sie in vorinfiziertes Gewebe implantiert wurden. Die langfristigen Komplikationsraten von CAD-CAM-Implantaten müssen weiter evaluiert werden. N2 - Introduction Cranioplasty (CP) after craniectomy restores the functionality and aesthetic of the patient’s cranial vault. Although it is a routine procedure, high complication rates have been described, partly related to the different type of implant material used. We conducted this study to compare intraoperative-moulded (Palacos®) and CAD-CAM-PMMA implants in patients underwent craniectomy regarding perioperative modalities, short- and long-term complication rates and aesthetic results. Methods This retrospective single-center-analysis was conducted on 350 patients with 359 cranioplasties, dividing into 133 Palacos® cases (01/2005-12/2012) and 226 CAD-CAM cases (01/2010-12/2018). Postoperative complications were divided into short-term (> 30 days) and long-term (< 30 days). Aesthetic results were evaluated via telephone interview on a 5-item scale. Results CAD-CAM patients had a shorter surgery time (p < 0.001), a lower intraoperative blood loss (p < 0.001) and shorter postoperative hospitalization (p < 0.005) than Palacos® patients. Operative revisions after CP had to be carried out at 12.8% of patients. Implant infections occurred in 3.8% of Palacos® cases and 1.8% of CAD-CAM cases. Wound healing disorders occurred more frequently in CAD-CAM patients, which was associated with higher cranial pre-operation and pre-infection rates. Palacos® patients had significantly more implant dislocations (p < 0.05). CAD-CAM patients reported a better aesthetic result compared to Palacos® patients. Conclusion This study shows superior peri-, postoperative and aesthetic results for CAD-CAM-implants compared to Palacos®. CAD-CAM implants have lower complication and infection rates than Palacos® implants and showed positive effects when implanted in pre-infected tissue. Long-term complication rates of CAD-CAM implant need to be further evaluated. KW - Schädelchirurgie KW - Trepanation KW - Polymethylmethacrylate KW - Kranioplastik KW - Komplikationen KW - PMMA KW - ästhetische Ergebnisse KW - cranioplasty KW - aesthetic results KW - complications KW - CAD-CAM KW - Komplikation Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-289899 ER - TY - JOUR A1 - Binder, Tobias A1 - Lange, Florian A1 - Pozzi, Nicolò A1 - Musacchio, Thomas A1 - Daniels, Christine A1 - Odorfer, Thorsten A1 - Fricke, Patrick A1 - Matthies, Cordula A1 - Volkmann, Jens A1 - Capetian, Philipp T1 - Feasibility of local field potential-guided programming for deep brain stimulation in Parkinson’s disease: a comparison with clinical and neuro-imaging guided approaches in a randomized, controlled pilot trial JF - Brain Stimulation N2 - Highlights • Beta-Guided programming is an innovative approach that may streamline the programming process for PD patients with STN DBS. • While preliminary findings from our study suggest that Beta Titration may potentially mitigate STN overstimulation and enhance symptom control, • Our results demonstrate that beta-guided programming significantly reduces programming time, suggesting it could be efficiently integrated into routine clinical practice using a commercially available patient programmer. Background Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson's disease (PD). Clinical outcomes after DBS can be limited by poor programming, which remains a clinically driven, lengthy and iterative process. Electrophysiological recordings in PD patients undergoing STN-DBS have shown an association between STN spectral power in the beta frequency band (beta power) and the severity of clinical symptoms. New commercially-available DBS devices now enable the recording of STN beta oscillations in chronically-implanted PD patients, thereby allowing investigation into the use of beta power as a biomarker for DBS programming. Objective To determine the potential advantages of beta-guided DBS programming over clinically and image-guided programming in terms of clinical efficacy and programming time. Methods We conducted a randomized, blinded, three-arm, crossover clinical trial in eight Parkinson's patients with STN-DBS who were evaluated three months after DBS surgery. We compared clinical efficacy and time required for each DBS programming paradigm, as well as DBS parameters and total energy delivered between the three strategies (beta-, clinically- and image-guided). Results All three programming methods showed similar clinical efficacy, but the time needed for programming was significantly shorter for beta- and image-guided programming compared to clinically-guided programming (p < 0.001). Conclusion Beta-guided programming may be a useful and more efficient approach to DBS programming in Parkinson's patients with STN-DBS. It takes significantly less time to program than traditional clinically-based programming, while providing similar symptom control. In addition, it is readily available within the clinical DBS programmer, making it a valuable tool for improving current clinical practice. KW - beta power KW - deep brain stimulation KW - local field potentials KW - Parkinson's disease KW - DBS programming KW - DBS biomarkers Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-350280 VL - 16 IS - 5 ER - TY - JOUR A1 - Lisowski, Dominik A1 - Hartrampf, Philipp E. A1 - Hasenauer, Natalie A1 - Nickl, Vera A1 - Monoranu, Camelia-Maria A1 - Tamihardja, Jörg T1 - Complete loss of E-cadherin expression in a rare case of metastatic malignant meningioma: a case report JF - BMC Neurology N2 - Background Hematogenous tumor spread of malignant meningiomas occurs very rarely but is associated with very poor prognosis. Case presentation We report an unusual case of a patient with a malignant meningioma who developed multiple metastases in bones, lungs and liver after initial complete resection of the primary tumor. After partial hepatic resection, specimens were histologically analyzed, and a complete loss of E-cadherin adhesion molecules was found. No oncogenic target mutations were found. The patient received a combination of conventional radiotherapy and peptide receptor radionuclide therapy (PRRT). Due to aggressive tumor behavior and rapid spread of metastases, the patient deceased after initiation of treatment. Conclusions E-cadherin downregulation is associated with a higher probability of tumor invasion and distant metastasis formation in malignant meningioma. Up to now, the efficacy of systemic therapy, including PRRT, is very limited in malignant meningioma patients. KW - beta-catenin KW - E-cadherin KW - meningioma KW - peptide receptor radionuclide therapy (PRRT) KW - radiotherapy Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357996 VL - 23 ER - TY - JOUR A1 - Breun, Maria A1 - Flock, Katharina A1 - Feldheim, Jonas A1 - Nattmann, Anja A1 - Monoranu, Camelia M. A1 - Herrmann, Pia A1 - Ernestus, Ralf-Ingo A1 - Löhr, Mario A1 - Hagemann, Carsten A1 - Stein, Ulrike T1 - Metastasis associated in colorectal cancer 1 (MACC1) mRNA expression is enhanced in sporadic vestibular schwannoma and correlates to deafness JF - Cancers N2 - Vestibular schwannoma (VS) are benign cranial nerve sheath tumors of the vestibulocochlear nerve. Their incidence is mostly sporadic, but they can also be associated with NF2-related schwannomatosis (NF2), a hereditary tumor syndrome. Metastasis associated in colon cancer 1 (MACC1) is known to contribute to angiogenesis, cell growth, invasiveness, cell motility and metastasis of solid malignant cancers. In addition, MACC1 may be associated with nonsyndromic hearing impairment. Therefore, we evaluated whether MACC1 may be involved in the pathogenesis of VS. Sporadic VS, recurrent sporadic VS, NF2-associated VS, recurrent NF2-associated VS and healthy vestibular nerves were analyzed for MACC1 mRNA and protein expression by quantitative polymerase chain reaction and immunohistochemistry. MACC1 expression levels were correlated with the patients’ clinical course and symptoms. MACC1 mRNA expression was significantly higher in sporadic VS compared to NF2-associated VS (p < 0.001). The latter expressed similar MACC1 concentrations as healthy vestibular nerves. Recurrent tumors resembled the MACC1 expression of the primary tumors. MACC1 mRNA expression was significantly correlated with deafness in sporadic VS patients (p = 0.034). Therefore, MACC1 might be a new molecular marker involved in VS pathogenesis. KW - vestibular schwannoma KW - metastasis associated in colorectal cancer 1 (MACC1) KW - pathogenesis KW - deafness KW - NF2-related schwannomatosis (NF2) KW - mRNA expression Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-362543 SN - 2072-6694 VL - 15 IS - 16 ER - TY - THES A1 - Schulz, Ellina T1 - Lokale Ultraschall-vermittelte Zytostatika-Applikation zur Behandlung von Hirntumoren T1 - Local ultrasound mediated cytostatic drug application for the treatment of brain tumors N2 - Glioblastoma (GBM) sind bösartige hirneigene Tumore, deren schlechte Prognose einer innovativen Therapie bedarf. Aus diesem Grund wurde ein neuer Therapieansatz entwickelt, der auf einer lokalen Ultraschall-vermittelten Zytostatika Applikation beruht. Hierfür wurden stabile Microbubbles (MB) bestehend aus Phospholipiden synthetisiert. Es konnte gezeigt werden, dass MB als auch fokussierter Ultraschall niedriger Intensität (LIFU) keinen negativen Einfluss auf GBM-Zellen hat. MB hingegen konnten mittels LIFU destruiert werden, wodurch das in den MB eingeschlossene Chemotherapeutikum freigesetzt werden kann. Es wurden verschiedene Platin(II)- und Palladium(II)-Komplexe auf GBM Zellen getestet. Zur Beladung der MB wurde Doxorubicin (Dox) verwendet. Es konnte eine Beladungseffizienz der MB mit Dox von 52 % erreicht werden, auch eine Aufreinigung dieser mittel Ionenaustausch-Chromatographie und Dialyse war erfolgreich. Die Austestung der mit Dox beladenen MB (MBDox) erfolgte auf GBM-Zellen in 2D- und 3D-Zelkulturmodellen. Dabei zeigte sich, dass die Behandlung mit MBDox und LIFU für 48 h eine zytotoxische Wirkung hatte, die sich signifikant von der Behandlung mit MBDox ohne LIFU unterschied. Zur Austestung der MBDox in 3D-Zellkulturmodellen wurden zwei Scaffold-Systeme eingesetzt. Es zeigte sich in den Versuchen, dass MBDox mit LIFU im Vergleich zu MBDox ohne LIFU Applikation einen zytotoxischen Effekt auf GBM-Zellen haben. Somit konnte die Wirksamkeit der Zytostatika Applikation mittels MB und LIFU in 2D- und 3D-Zellkulturmodellen erfolgreich etabliert werden. Als weiterer Schritt wurden zwei 3D in vitro Modelle erarbeitet. Dabei wurden zunächst organotypische hippocampale Slice Kulturen (organotypic hippocampal brain slice cultures, OHSC) aus der Maus hergestellt und anschließend mit fluoreszent-markierten Mikrotumoren aus GBM-Zelllinien, Primärzellen (PZ) und aus Patienten generierten GBM-Organoiden hergestellt. Diese GBM-Modelle wurden mit Tumor Treating Fields (TTFields) behandelt. Dabei war eine Abnahme der Tumorgröße von Mikrotumoren aus GBM-Zellen und PZ unter TTFields-Behandlung für 72 h messbar. Als weiteres in vitro Modell wurden humane Tumorschnitte aus intraoperativ entferntem GBM-Patientenmaterial hergestellt. Die Schnitte wiesen ein heterogenes Ansprechen nach 72 h TTFields-Applikation auf. Dies spiegelt die Heterogenität des GBM sehr gut wider und bestärkt die Eignung des Modelles zur Untersuchung von neuen Therapieansätzen zur Behandlung von GBM. N2 - Glioblastoma (GBM) are malignant brain tumor with a poor prognosis requiring innovative therapy. For this reason, a new therapeutic approach based on local ultrasound-mediated cytostatic application is now being established. For this purpose, stable microbubbles (MB) consisting of phospholipids were synthesized. It could be shown that MB as well as focused low intensity ultrasound (LIFU) had no negative effect on GBM cells. MB, on the other hand, could be destroyed by LIFU, allowing the release of the chemotherapeutic agent entrapped in MB. Different platinum(II) and palladium(II) complexes were tested on GBM cells. Doxorubicin (Dox) was used to load the MB. Loading efficiency of MB with Dox of 52% was achieved, and purification of these by ion-exchange chromatography and dialysis was also successful. Dox-loaded MB (MBDox) was tested on GBM cells in 2D and 3D cell culture models. This showed that treatment with MBDox and LIFU for 48 h had a cytotoxic effect that was significantly different from treatment with MBDox without LIFU. Two scaffold systems were used to test MBDox in 3D cell culture models. It was shown in the experiments that MBDox with LIFU had a cytotoxic effect on GBM cells compared with MBDox without LIFU application. Thus, the efficacy of cytostatic drug application using MB and LIFU was successfully established in 2D and 3D cell culture models. As a further step, two 3D in vitro models were developed. Here, organotypic hippocampal brain slice cultures (OHSC) were first prepared from mice and then with fluorescent-labeled microtumors from GBM cell lines, primary cells (PZ), and GBM organoids generated from patients. These GBM models were treated with tumor treating fields (TTFields). Thereby, a decrease in tumor size of microtumors derived from GBM cells and PZ was measurable under TTFields treatment for 72 h. As another in vitro model, human tumor sections were prepared from intraoperatively removed GBM patient material. The sections showed heterogeneous responses after 72 h of TTFields application. This reflects the heterogeneity of GBM very well and reinforces the suitability of the model to investigate new therapeutic approaches for the treatment of GBM. KW - Glioblastom KW - Hirntumor KW - Ultraschall KW - Microbubbles KW - Glioblastoma KW - Slice Culture KW - 3D cell culture Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-320168 ER - TY - JOUR A1 - Mrestani, Achmed A1 - Lichter, Katharina A1 - Sirén, Anna-Leena A1 - Heckmann, Manfred A1 - Paul, Mila M. A1 - Pauli, Martin T1 - Single-molecule localization microscopy of presynaptic active zones in Drosophila melanogaster after rapid cryofixation JF - International Journal of Molecular Sciences N2 - Single-molecule localization microscopy (SMLM) greatly advances structural studies of diverse biological tissues. For example, presynaptic active zone (AZ) nanotopology is resolved in increasing detail. Immunofluorescence imaging of AZ proteins usually relies on epitope preservation using aldehyde-based immunocompetent fixation. Cryofixation techniques, such as high-pressure freezing (HPF) and freeze substitution (FS), are widely used for ultrastructural studies of presynaptic architecture in electron microscopy (EM). HPF/FS demonstrated nearer-to-native preservation of AZ ultrastructure, e.g., by facilitating single filamentous structures. Here, we present a protocol combining the advantages of HPF/FS and direct stochastic optical reconstruction microscopy (dSTORM) to quantify nanotopology of the AZ scaffold protein Bruchpilot (Brp) at neuromuscular junctions (NMJs) of Drosophila melanogaster. Using this standardized model, we tested for preservation of Brp clusters in different FS protocols compared to classical aldehyde fixation. In HPF/FS samples, presynaptic boutons were structurally well preserved with ~22% smaller Brp clusters that allowed quantification of subcluster topology. In summary, we established a standardized near-to-native preparation and immunohistochemistry protocol for SMLM analyses of AZ protein clusters in a defined model synapse. Our protocol could be adapted to study protein arrangements at single-molecule resolution in other intact tissue preparations. KW - active zone KW - nanotopology KW - neuromuscular junction KW - high-pressure freezing/freeze substitution KW - PFA in ethanol KW - dSTORM KW - Drosophila melanogaster Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304904 SN - 1422-0067 VL - 24 IS - 3 ER - TY - JOUR A1 - Vergote, Ignace A1 - Macarulla, Teresa A1 - Hirsch, Fred R. A1 - Hagemann, Carsten A1 - Miller, David Scott T1 - Tumor Treating Fields (TTFields) therapy concomitant with taxanes for cancer treatment JF - Cancers N2 - Non-small cell lung cancer, ovarian cancer, and pancreatic cancer all present with high morbidity and mortality. Systemic chemotherapies have historically been the cornerstone of standard of care (SOC) regimens for many cancers, but are associated with systemic toxicity. Multimodal treatment combinations can help improve patient outcomes; however, implementation is limited by additive toxicities and potential drug–drug interactions. As such, there is a high unmet need to develop additional therapies to enhance the efficacy of SOC treatments without increasing toxicity. Tumor Treating Fields (TTFields) are electric fields that exert physical forces to disrupt cellular processes critical for cancer cell viability and tumor progression. The therapy is locoregional and is delivered noninvasively to the tumor site via a portable medical device that consists of field generator and arrays that are placed on the patient’s skin. As a noninvasive treatment modality, TTFields therapy-related adverse events mainly consist of localized skin reactions, which are manageable with effective acute and prophylactic treatments. TTFields selectively target cancer cells through a multi-mechanistic approach without affecting healthy cells and tissues. Therefore, the application of TTFields therapy concomitant with other cancer treatments may lead to enhanced efficacy, with low risk of further systemic toxicity. In this review, we explore TTFields therapy concomitant with taxanes in both preclinical and clinical settings. The summarized data suggest that TTFields therapy concomitant with taxanes may be beneficial in the treatment of certain cancers. KW - Tumor Treating Fields (TTFields) KW - taxanes KW - non-small cell lung cancer (NSCLC) KW - ovarian cancer KW - pancreatic cancer KW - mechanism of action Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-305007 SN - 2072-6694 VL - 15 IS - 3 ER - TY - JOUR A1 - Salvador, Ellaine A1 - Köppl, Theresa A1 - Hörmann, Julia A1 - Schönhärl, Sebastian A1 - Bugaeva, Polina A1 - Kessler, Almuth F. A1 - Burek, Malgorzata A1 - Ernestus, Ralf-Ingo A1 - Löhr, Mario A1 - Hagemann, Carsten T1 - Tumor Treating Fields (TTFields) induce cell junction alterations in a human 3D in vitro model of the blood-brain barrier JF - Pharmaceutics N2 - In a recent study, we showed in an in vitro murine cerebellar microvascular endothelial cell (cerebEND) model as well as in vivo in rats that Tumor-Treating Fields (TTFields) reversibly open the blood–brain barrier (BBB). This process is facilitated by delocalizing tight junction proteins such as claudin-5 from the membrane to the cytoplasm. In investigating the possibility that the same effects could be observed in human-derived cells, a 3D co-culture model of the BBB was established consisting of primary microvascular brain endothelial cells (HBMVEC) and immortalized pericytes, both of human origin. The TTFields at a frequency of 100 kHz administered for 72 h increased the permeability of our human-derived BBB model. The integrity of the BBB had already recovered 48 h post-TTFields, which is earlier than that observed in cerebEND. The data presented herein validate the previously observed effects of TTFields in murine models. Moreover, due to the fact that human cell-based in vitro models more closely resemble patient-derived entities, our findings are highly relevant for pre-clinical studies. KW - blood-brain barrier KW - Tumor-Treating Fields (TTFields) KW - CNS disorders KW - human brain microvascular endothelial cells (HBMVEC) KW - human cells KW - 3D in vitro model Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304830 SN - 1999-4923 VL - 15 IS - 1 ER - TY - THES A1 - Herbinger, Anna Maria T1 - Wirkungsverstärkung von Vincristin und Paclitaxel auf Glioblastomzellen durch TTFields T1 - Enhancement of effect of vincristine and paclitaxel on glioblastoma cells by TTFields N2 - Das Glioblastom (GBM) ist der häufigste maligne primäre Hirntumor im Erwachsenenalter und geht mit einer infausten Prognose einher. Die Standardtherapie bei Erstdiagnose besteht aus Tumorresektion gefolgt von kombinierter Radiochemotherapie mit Temozolomid nach Stupp-Schema. Eine neue Therapieoption stellen die Tumor Treating Fields (TTFields) in Form lokal applizierter elektrischer Wechselfelder dar. Mit dem Einsatz der TTFields kann durch Störung der mitotischen Abläufe die Zellproliferation von Tumorzellen gehemmt und dadurch das Gesamtüberleben im Vergleich zur alleinigen Radiochemotherapie nachweislich deutlich verlängert werden. Auch verschiedene Chemotherapeutika, die bereits klinisch eingesetzt werden, greifen in den Ablauf der Mitose ein. So auch die Zytostatika Vincristin (VIN) und Paclitaxel (PTX), die durch einen gegensätzlichen Mechanismus durch Destabilisierung bzw. Stabilisierung von Mikrotubulistrukturen ihre Wirkung entfalten. Die Frage, ob eine Verstärkung dieser Wirkung durch den kombinierten Einsatz mit TTFields erreicht werden kann, wurde in dieser Arbeit an den beiden GBM-Zelllinien U87 und GaMG untersucht. Zunächst wurde mit dem xCELLigence-Systems über eine Real-Time-Impedanzmessung für diese beiden Chemotherapeutika jeweils die mittlere effektive Dosis (EC50-Wert), bei der ein halbmaximaler Effekt auftritt, spezifisch für jede Zelllinie bestimmt. Diese betrug bei VIN durchschnittlich 200nM für die Zelllinie U87 bzw. 20nM für die Zelllinie GaMG und lag für PTX bei 60nM für beide Zelllinien. Mit diesen Dosierungen wurden die beiden Zelllinien allein und in Kombination mit TTFields über 72h behandelt. Anschließend wurde die Zellproliferation analysiert und mit unbehandelten Tumorzellen verglichen. Während jeder Behandlungsarm einzeln eine signifikante Wirkung gegenüber der unbehandelten Vergleichsgruppe zeigte, hatte weder die Kombination von TTFields mit VIN noch mit PTX in den untersuchten Dosierungen einen zusätzlichen signifikanten Nutzen. Es besteht weiterer Forschungsbedarf zum kombinierten Einsatz von TTFields mit anderen Therapieformen. N2 - Glioblastoma (GBM) is the most common malignant primary brain tumor in adults and is associated with an infavorable prognosis. Standard therapy at initial diagnosis consists of tumor resection followed by combined radiochemotherapy with temozolomide according to the Stupp regimen. Tumor Treating Fields (TTFields) in the form of locally applied alternating electric fields represent a new therapeutic option. With the use of TTFields, cell proliferation of tumor cells can be inhibited by interfering with mitotic processes, which has been shown to significantly prolong overall survival compared to radiochemotherapy alone. Various chemotherapeutic treatments already in clinical use also interfere with mitotic processes. This is also the case with the cytostatic drugs vincristine (VIN) and paclitaxel (PTX), which exert their effects by an opposing mechanism through destabilization and stabilization of microtubule structures. The question whether an enhancement of this effect can be achieved by combined use with TTFields was investigated in this work using the two GBM cell lines U87 and GaMG. First, using the xCELLigence system via real-time impedance measurement, the mean effective dose (EC50-value) at which a half-maximal effect occurs was determined for each of these two chemotherapeutic agents specifically for each cell line. This was averaged 200nM for VIN for the U87 cell line and 20nM for the GaMG cell line, and was 60nM for PTX for both cell lines. The two cell lines were treated with these doses alone and in combination with TTFields for 72h. Cell proliferation was then analyzed and compared to untreated tumor cells. While each treatment individually showed a significant effect compared with the untreated control group, neither the combination of TTFields with VIN nor with PTX had any additional significant benefit at the doses studied. Further research is needed on the combined use of TTFields with other therapies. KW - Tumortherapiefelder KW - Vincristin KW - Taxol KW - TTFields KW - Paclitaxel KW - glioblastoma KW - tumor treating fields KW - vincristine KW - paclitaxel KW - Glioblastom Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-329836 ER - TY - JOUR A1 - Feldheim, Jonas A1 - Kessler, Almuth F. A1 - Feldheim, Julia J. A1 - Schmitt, Dominik A1 - Oster, Christoph A1 - Lazaridis, Lazaros A1 - Glas, Martin A1 - Ernestus, Ralf-Ingo A1 - Monoranu, Camelia M. A1 - Löhr, Mario A1 - Hagemann, Carsten T1 - BRMS1 in gliomas — an expression analysis JF - Cancers N2 - The metastatic suppressor BRMS1 interacts with critical steps of the metastatic cascade in many cancer entities. As gliomas rarely metastasize, BRMS1 has mainly been neglected in glioma research. However, its interaction partners, such as NFκB, VEGF, or MMPs, are old acquaintances in neurooncology. The steps regulated by BRMS1, such as invasion, migration, and apoptosis, are commonly dysregulated in gliomas. Therefore, BRMS1 shows potential as a regulator of glioma behavior. By bioinformatic analysis, in addition to our cohort of 118 specimens, we determined BRMS1 mRNA and protein expression as well as its correlation with the clinical course in astrocytomas IDH mutant, CNS WHO grade 2/3, and glioblastoma IDH wild-type, CNS WHO grade 4. Interestingly, we found BRMS1 protein expression to be significantly decreased in the aforementioned gliomas, while BRMS1 mRNA appeared to be overexpressed throughout. This dysregulation was independent of patients’ characteristics or survival. The protein and mRNA expression differences cannot be finally explained at this stage. However, they suggest a post-transcriptional dysregulation that has been previously described in other cancer entities. Our analyses present the first data on BRMS1 expression in gliomas that can provide a starting point for further investigations. KW - glioblastoma KW - metastasis KW - suppressor KW - behavior KW - mRNA KW - protein Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-319225 SN - 2072-6694 VL - 15 IS - 11 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 - JOUR A1 - Paul, Mila M. A1 - Mieden, Hannah J. A1 - Lefering, Rolf A1 - Kupczyk, Eva K. A1 - Jordan, Martin C. A1 - Gilbert, Fabian A1 - Meffert, Rainer H. A1 - Sirén, Anna-Leena A1 - Hoelscher-Doht, Stefanie T1 - Impact of a femoral fracture on outcome after traumatic brain injury — a matched-pair analysis of the TraumaRegister DGU\(^®\) JF - Journal of Clinical Medicine N2 - Traumatic brain injury (TBI) is the leading cause of death and disability in polytrauma and is often accompanied by concomitant injuries. We conducted a retrospective matched-pair analysis of data from a 10-year period from the multicenter database TraumaRegister DGU\(^®\) to analyze the impact of a concomitant femoral fracture on the outcome of TBI patients. A total of 4508 patients with moderate to critical TBI were included and matched by severity of TBI, American Society of Anesthesiologists (ASA) risk classification, initial Glasgow Coma Scale (GCS), age, and sex. Patients who suffered combined TBI and femoral fracture showed increased mortality and worse outcome at the time of discharge, a higher chance of multi-organ failure, and a rate of neurosurgical intervention. Especially those with moderate TBI showed enhanced in-hospital mortality when presenting with a concomitant femoral fracture (p = 0.037). The choice of fracture treatment (damage control orthopedics vs. early total care) did not impact mortality. In summary, patients with combined TBI and femoral fracture have higher mortality, more in-hospital complications, an increased need for neurosurgical intervention, and inferior outcome compared to patients with TBI solely. More investigations are needed to decipher the pathophysiological consequences of a long-bone fracture on the outcome after TBI. KW - traumatic brain injury KW - femoral fracture KW - damage control orthopedics KW - mortality Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-319363 SN - 2077-0383 VL - 12 IS - 11 ER - TY - JOUR A1 - Schadt, Fabian A1 - Israel, Ina A1 - Beez, Alexandra A1 - Alushi, Kastriot A1 - Weiland, Judith A1 - Ernestus, Ralf-Ingo A1 - Westermaier, Thomas A1 - Samnick, Samuel A1 - Lilla, Nadine T1 - Analysis of cerebral glucose metabolism following experimental subarachnoid hemorrhage over 7 days JF - Scientific Reports N2 - Little is known about changes in brain metabolism following SAH, possibly leading towards secondary brain damage. Despite sustained progress in the last decade, analysis of in vivo acquired data still remains challenging. The present interdisciplinary study uses a semi-automated data analysis tool analyzing imaging data independently from the administrated radiotracer. The uptake of 2-[18F]Fluoro-2-deoxy-glucose ([\(^{18}\)F]FDG) was evaluated in different brain regions in 14 male Sprague–Dawley rats, randomized into two groups: (1) SAH induced by the endovascular filament model and (2) sham operated controls. Serial [\(^{18}\)F]FDG-PET measurements were carried out. Quantitative image analysis was performed by uptake ratio using a self-developed MRI-template based data analysis tool. SAH animals showed significantly higher [\(^{18}\)F]FDG accumulation in gray matter, neocortex and olfactory system as compared to animals of the sham group, while white matter and basal forebrain region showed significant reduced tracer accumulation in SAH animals. All significant metabolic changes were visualized from 3 h, over 24 h (day 1), day 4 and day 7 following SAH/sham operation. This [\(^{18}\)F]FDG-PET study provides important insights into glucose metabolism alterations following SAH—for the first time in different brain regions and up to day 7 during course of disease. KW - SAH KW - metabolism KW - brain Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300725 VL - 13 IS - 1 ER - TY - THES A1 - Lichter, Katharina T1 - Die Ultrastruktur von Aktiven Zonen in hippocampalen Moosfaserboutons T1 - The ultrastructure of active zones in hippocampal mossy fiber boutons N2 - In nervous systems, synapses precisely orchestrate information transfer and memory formation. Active zones (AZ) are specialized subcellular compartments at the presynaptic mesoscale which process synaptic transmission on an ultrastructural level. The AZ cytomatrix including the essential scaffold protein Rab3 interacting molecule (RIM) enables exocytosis of synaptic vesicles. A deficiency of the locally most abundant protein isoform RIM1α diminishes long-term potentiation in a complex central mammalian synapse – the connection of hippocampal mossy fiber boutons (MFB) to cornu ammonis (CA)3 pyramidal neurons. Behaviourally, these mice present with learning impairment. The present MD thesis addresses the so far unknown three-dimensional (3D) AZ ultrastructure of MFBs in acute hippocampal slices of wild-type and RIM1α-/- mice. In a first set of experiments, a standardized protocol for near-to-native synaptic tissue preparation at MFBs using high-pressure freezing and freeze substitution and 3D modelling using electron tomography was developed and established. Based on the excellent preservation of synaptic tissue using this protocol, the AZ ultrastructure in both genotypes was quantified in detail up to an individual docked synaptic vesicle using custom-written programming scripts. The experiments demonstrate that deficiency of RIM1α leads to multidimensional alter-ation of AZ 3D ultrastructure and synaptic vesicle pools in MFBs. (Tightly) docked synaptic vesicles – ultrastructural correlates of the readily releasable pool – are reduced, decentralized, and structurally modified, whereas the more distant vesicle pool clusters more densely above larger and more heterogenous AZ surfaces with higher synaptic clefts. The present thesis contributes to a more comprehensive understanding regarding the role of RIM1α for (tight) vesicle docking and organization at MFBs. Furthermore, the precise 3D ultrastructural analysis of MFB AZs in this thesis provides the necessary mor-phological basis for further studies to correlate synaptic ultrastructure with presynaptic plasticity and memory dysfunction in RIM1α-/- mice using advanced electrophysiological and behavioral techniques. N2 - In Nervensystemen bedürfen Informationsweitergabe und Gedächtnisformation eines präzisen Zusammenspiels von Synapsen in Zeit und Raum. Synaptische Transmission basiert strukturell auf mesoskopischen cytosolischen Kompartimenten an der präsynaptischen Membran, sogenannten Aktiven Zonen (AZ). Ihre Cytomatrix, bestehend aus zentralen Gerüstproteinen wie Rab3 interacting molecule (RIM), ermöglicht eine schnelle Freisetzung synaptischer Vesikel. Die Defizienz der lokal häufigsten Isoform RIM1α resultiert an einer komplexen zentralen Säugersynapse, die des hippocampalen Moosfaserboutons (MFB) zu im Cornu ammonis (CA)3 befindlichen Pyramidalzellen, in einer dezimierten Langzeitplastizität. Auf Verhaltensebene zeigen diese Mäuse eine reduzierte Lernfähigkeit. Die vorliegende Dissertation widmet sich grundlegend der bisher unbekannten dreidimensionalen (3D) AZ-Ultrastruktur des MFB in akuten Hippocampusschnitten der adulten Wildtyp- und RIM1α-Knock-Out-Maus (RIM1α\(^{-/-}\)). In einer methodischen Entwicklungsphase wurde ein neuartiges, anspruchsvolles Protokoll der nahezu artefaktfreien (near to native) Synapsenpräparation am MFB mittels Hochdruckgefrierung und Gefriersubstitution sowie der 3D-Modellierung mittels Elektronentomographie etabliert. In einer zweiten Experimentier- und Analysephase ermöglichte die hochwertige synaptische Gewebeerhaltung in beiden Genotypen eine standardisierte, auf Programmierskripten basierte Quantifizierung der AZ-Ultrastruktur bis auf die Ebene eines individuell gedockten synaptischen Vesikels. Dieser Dissertation gelingt der Nachweis, dass eine Defizienz von RIM1α zu einer multidimensionalen ultrastrukturellen Veränderung der AZ und ihres Vesikelpools am MFB führt. Neben einer Reduktion, Dezentralisierung und strukturellen Veränderung (eng) gedockter Vesikel – der ultrastrukturellen Messgrößen von unmittelbar freisetzungsfähigen Vesikeln – verdichtet sich der distaler lokalisierte Vesikelpool auf zugleich größeren, heterogenen AZ-Flächen mit erweitertem synaptischem Spalt. Vorliegende Untersuchungen tragen zum Verständnisgewinn über eine zentrale Rolle von RIM1α für das Docking und die Organisation von Vesikeln der AZ im MFB bei. Darüber hinaus stellen die präzisen ultrastrukturellen Analysen eine morphologische Grundlage für weiterführende Studien mit Hilfe modernster Techniken dar, beispielsweise über die Auswirkungen der geänderten RIM1α\(^{-/-}\) AZ-Ultrastruktur auf die präsynaptische Plastizität sowie in Korrelation zum Gedächtnis und Lernen der Tiere. KW - Hippocampus KW - Neurowissenschaften KW - Exzitatorische Synapse KW - Synaptische Transmission KW - Synaptische Vesikel KW - active zone KW - presynaptic KW - mossy fiber synapse KW - RIM1α KW - CA3 KW - high-pressure freezing/freeze substitution KW - electron tomography KW - acute brain slices Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-303126 ER - TY - THES A1 - Pies, Jennifer T1 - Die Funktion des Nervus facialis – Bedeutung für die Lebensqualität nach Operationen von Vestibularisschwannomen T1 - Impact of facial nerve function on quality of life after vestibular schwannoma surgery N2 - Im Rahmen der vorliegenden Arbeit wurden Daten von Patienten ausgewertet, die an einem Vestibularisschwannom erkrankt sind. Dabei wurde der Einfluss einer Facialisparese auf die Lebensqualität untersucht. Die Auswertung der Daten zeigte statistisch signifikante Zusammenhänge zwischen verschiedenen Domänen der Lebensqualität und einer postoperativen Facialisparese. N2 - In context of the present work, data from patients were evaluated, who suffered from a vestibular schwannoma. The influence of facial nerve dysfunction on quality of life was examined. The evaluation of the data showed statistically significant relationships between different domains of quality of life and postoperative facial nerve dysfunction. KW - Vestibularisschwannom KW - Facialisparese KW - Lebensqualität Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235481 ER - TY - JOUR A1 - Dufner, Vera A1 - Kessler, Almuth Friederike A1 - Just, Larissa A1 - Hau, Peter A1 - Bumes, Elisabeth A1 - Pels, Hendrik Johannes A1 - Grauer, Oliver Martin A1 - Wiese, Bettina A1 - Löhr, Mario A1 - Jordan, Karin A1 - Strik, Herwig T1 - The emesis trial: depressive glioma patients are more affected by chemotherapy-induced nausea and vomiting JF - Frontiers in Neurology N2 - Purpose Glioma patients face a limited life expectancy and at the same time, they suffer from afflicting symptoms and undesired effects of tumor treatment. Apart from bone marrow suppression, standard chemotherapy with temozolomide causes nausea, emesis and loss of appetite. In this pilot study, we investigated how chemotherapy-induced nausea and vomiting (CINV) affects the patients' levels of depression and their quality of life. Methods In this prospective observational multicentre study (n = 87), nausea, emesis and loss of appetite were evaluated with an expanded MASCC questionnaire, covering 10 days during the first and the second cycle of chemotherapy. Quality of life was assessed with the EORTC QLQ-C30 and BN 20 questionnaire and levels of depression with the PHQ-9 inventory before and after the first and second cycle of chemotherapy. Results CINV affected a minor part of patients. If present, it reached its maximum at day 3 and decreased to baseline level not before day 8. Levels of depression increased significantly after the first cycle of chemotherapy, but decreased during the further course of treatment. Patients with higher levels of depression were more severely affected by CINV and showed a lower quality of life through all time-points. Conclusion We conclude that symptoms of depression should be perceived in advance and treated in order to avoid more severe side effects of tumor treatment. Additionally, in affected patients, delayed nausea was most prominent, pointing toward an activation of the NK1 receptor. We conclude that long acting antiemetics are necessary totreat temozolomide-induced nausea. KW - glioblastoma KW - chemotherapy KW - depression KW - nausea and emesis KW - quality of life Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262859 SN - 1664-2295 VL - 13 ER - TY - JOUR A1 - Lichter, Katharina A1 - Paul, Mila Marie A1 - Pauli, Martin A1 - Schoch, Susanne A1 - Kollmannsberger, Philip A1 - Stigloher, Christian A1 - Heckmann, Manfred A1 - Sirén, Anna-Leena T1 - Ultrastructural analysis of wild-type and RIM1α knockout active zones in a large cortical synapse JF - Cell Reports N2 - Rab3A-interacting molecule (RIM) is crucial for fast Ca\(^{2+}\)-triggered synaptic vesicle (SV) release in presynaptic active zones (AZs). We investigated hippocampal giant mossy fiber bouton (MFB) AZ architecture in 3D using electron tomography of rapid cryo-immobilized acute brain slices in RIM1α\(^{−/−}\) and wild-type mice. In RIM1α\(^{−/−}\), AZs are larger with increased synaptic cleft widths and a 3-fold reduced number of tightly docked SVs (0–2 nm). The distance of tightly docked SVs to the AZ center is increased from 110 to 195 nm, and the width of their electron-dense material between outer SV membrane and AZ membrane is reduced. Furthermore, the SV pool in RIM1α\(^{−/−}\) is more heterogeneous. Thus, RIM1α, besides its role in tight SV docking, is crucial for synaptic architecture and vesicle pool organization in MFBs. KW - active zone KW - acute brain slices KW - CA3 KW - electron tomography KW - high-pressure freezing KW - hippocampal mossy fiber bouton KW - RIM1α KW - SV pool KW - synaptic ultrastructure KW - presynaptic Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300913 VL - 40 IS - 12 ER - TY - JOUR A1 - Linz, Christian A1 - Faber, Julian A1 - Schmid, Reiner A1 - Kunz, Felix A1 - Böhm, Hartmut A1 - Hartmann, Stefan A1 - Schweitzer, Tilmann T1 - Using a 3D asymmetry index as a novel form for capturing complex three-dimensionality in positional plagiocephaly JF - Scientific Reports N2 - Positional plagiocephaly (PP) is the most common skull deformity in infants. Different classification systems exist for graduating the degree of PP, but all of these systems are based on two-dimensional (2D) parameters. This limitation leads to several problems stemming from the fact that 2D parameters are used to classify the three-dimensional (3D) shape of the head. We therefore evaluate existing measurement parameters and validate a newly developed 3D parameter for quantifying PP. Additionally, we present a new classification of PP based on a 3D parameter. 210 patients with PP and 50 patients without PP were included in this study. Existing parameters (2D and 3D) and newly developed volume parameters based on a 3D stereophotogrammetry scan were validated using ROC curves. Additionally, thresholds for the new 3D parameter of a 3D asymmetry index were assessed. The volume parameter 3D asymmetry index quantifies PP equally as well as the gold standard of 30° diagonal difference. Moreover, a 3D asymmetry index allows for a 3D-based classification of PP. The 3D asymmetry index can be used to define the degree of PP. It is easily applicable in stereophotogrammetric datasets and allows for comparability both intra- and inter-individually as well as for scientific analysis. KW - craniofacial orthodontics KW - physical examination KW - three-dimensional imaging Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300427 VL - 12 ER - TY - JOUR A1 - Feldheim, Jonas A1 - Kessler, Almuth F. A1 - Feldheim, Julia J. A1 - Schulz, Ellina A1 - Wend, David A1 - Lazaridis, Lazaros A1 - Kleinschnitz, Christoph A1 - Glas, Martin A1 - Ernestus, Ralf-Ingo A1 - Brandner, Sebastian A1 - Monoranu, Camelia M. A1 - Löhr, Mario A1 - Hagemann, Carsten T1 - Effects of long-term temozolomide treatment on glioblastoma and astrocytoma WHO grade 4 stem-like cells JF - International Journal of Molecular Sciences N2 - Glioblastoma leads to a fatal course within two years in more than two thirds of patients. An essential cornerstone of therapy is chemotherapy with temozolomide (TMZ). The effect of TMZ is counteracted by the cellular repair enzyme O\(^6\)-methylguanine-DNA methyltransferase (MGMT). The MGMT promoter methylation, the main regulator of MGMT expression, can change from primary tumor to recurrence, and TMZ may play a significant role in this process. To identify the potential mechanisms involved, three primary stem-like cell lines (one astrocytoma with the mutation of the isocitrate dehydrogenase (IDH), CNS WHO grade 4 (HGA)), and two glioblastoma (IDH-wildtype, CNS WHO grade 4) were treated with TMZ. The MGMT promoter methylation, migration, proliferation, and TMZ-response of the tumor cells were examined at different time points. The strong effects of TMZ treatment on the MGMT methylated cells were observed. Furthermore, TMZ led to a loss of the MGMT promoter hypermethylation and induced migratory rather than proliferative behavior. Cells with the unmethylated MGMT promoter showed more aggressive behavior after treatment, while HGA cells reacted heterogenously. Our study provides further evidence to consider the potential adverse effects of TMZ chemotherapy and a rationale for investigating potential relationships between TMZ treatment and change in the MGMT promoter methylation during relapse. KW - glioblastoma KW - astrocytoma KW - IDH KW - MGMT KW - therapy KW - temozolomide KW - cancer stem cells Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-284417 SN - 1422-0067 VL - 23 IS - 9 ER - TY - JOUR A1 - Schulz, Ellina A1 - Mawamba, Viviane A1 - Löhr, Mario A1 - Hagemann, Carsten A1 - Friedrich, Alexandra A1 - Schatzschneider, Ulrich T1 - Structure–activity relations of Pd(II) and Pt(II) thiosemicarbazone complexes on different human glioblastoma cell lines JF - Zeitschrift für Anorganische und Allgemeine Chemie N2 - Ten thiosemicarbazone ligands obtained by condensation of pyridine-2-carbaldehyde, quinoline-2-carbaldehyde, 2-acetylpyridine, 2-acetylquinoline, or corresponding 2-pyridyl ketones with thiosemicarbazides RNHC(S)NHNH\(_{2}\) and R=CH\(_{3}\), C\(_{6}\)H\(_{5}\) were prepared in good yield. The reaction of [PdCl\(_{2}\)(cod)] with cod=1,5-cyclooctadiene or K\(_{2}\)[PtCl\(_{4}\)] resulted in a total of 17 Pd(II) and Pt(II) complexes isolated in excellent purity, as demonstrated by \(^{1}\)H, \(^{13}\)C, and, where applicable, \(^{195\)Pt NMR spectroscopy combined with CHNS analysis. The cytotoxicity of the title compounds was studied on four human glioblastoma cell lines (GaMG, U87, U138, and U343). The most active compound, with a Pd(II) metal centre, a 2-quinolinyl ring, and methyl groups on both the proximal C and distal N atoms exhibited an EC\(_{50}\) value of 2.1 μM on the GaMG cell lines, thus being slightly more active than cisplatin (EC\(_{50}\) 3.4 μM) and significantly more potent than temozolomide (EC\(_{50}\) 67.1 μM). Surprisingly, the EC\(_{50}\) values were inversely correlated with the lipophilicity, as determined with the “shake-flask method”, and decreased with the length of the alkyl substituents (C\(_{1}\)>C\(_{8}\)>C\(_{10}\)). Correlation with the different structural motifs showed that for the most promising anticancer activity, a maximum of two aromatic rings (either quinolinyl or pyridyl plus phenyl) combined with one methyl group are favoured and the Pd(II) complexes are slightly more potent than their Pt(II) analogues. KW - glioblastoma KW - platinum KW - palladium KW - thiosemicarbazone KW - anticancer activity Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318281 SN - 0044-2313 VL - 648 IS - 12 ER - TY - THES A1 - Jawork, Anna T1 - Die Rolle von durch rhGM-CSF aktivierten Makrophagen bei der Immunabwehr von Glioblastomen im orthotopen C6-Tumormodell der Ratte T1 - The role of macrophages activated by rhGM-CSF in the immune defense of glioblastoma in the rodent orthotopic C6 tumor model N2 - Die Immunabwehr des Patienten stellt eine Schlüsselrolle bei der spontanen Tumorregression dar. Bisher zählten zytotoxische CD8-positive T Zellen und natürliche Killerzellen zu den wichtigsten zellulären Vertretern der Tumorkontrolle. Im Tierversuch konnte jedoch kein signifikanter Einfluss dieser Zellen auf die spontane Regression nachgewiesen werden. Allerdings fand sich eine hohe Anzahl an Makrophagen im Tumorgewebe. In vorangegangenen Untersuchungen zeigte sich bei der Depletion der Makrophagen mittels Clodronate im Tiermodell der Ratte ein deutlich gesteigertes Tumorwachstum. In der hier durchgeführten Versuchsreihe wurde nun der Einfluss von Makrophagen auf das Tumorwachstum orthotop implantierter C6-Glioblastomsphäroide betrachtet. Dabei wurden die Makrophagen durch den Granulozyten-Makrophagen Kolonie-stimulierenden Faktor (rhGM-CSF, Leukine) aktiviert. 29 SD-Ratten wurden C6-Gliom-Sphäroide orthotop implantiert. 20 der Tiere wurden jeden zweiten Tag mit 1µg/100g Körpergewicht rhGSM-CSF s. c. behandelt. Neun Tiere dienten als Kontrollgruppe. Zur Verlaufsbeurteilung wurden an den Tagen 7, 14, 21, 28, 32 und 42 nach Implantation MRT-Untersuchungen (T1, T2 und 3D CISS-Sequenzen) durchgeführt. Die Tumorvolumina wurden mit Hilfe dieser MRT-Untersuchungen ermittelt. Die histologische Aufarbeitung beinhaltete HE-, CD68-Makrophagen-, CD8-positive T Zellen- sowie Ki-67 Proliferations- Färbungen in Paraffinschnitten von Gehirn, Tumor und Milz. In 15 der 20 behandelten Tiere entwickelten sich solide Tumoren. Am Tag 7 konnte lediglich bei zwei Tieren mittels MRT ein minimales Tumorwachstum nachgewiesen werden. In der Kontrollgruppe war bereits bei drei von neun Tieren minimales Tumorwachstum zu verzeichnen. Am Tag 14 zeigten sich bei 11 von 17 (65%) Tieren der Versuchsgruppe solide Tumoren. Drei der verbleibenden 15 Tiere zeigten am Tag 21 erstmalig Tumorwachstum. Im Gegensatz dazu konnte in der Kontrollgruppe bereits an Tag 14 bei allen Tieren ein Tumorwachstum nachgewiesen werden. In der GM-CSF Gruppe entwickelten sich die Tumoren später und erreichten mit einem Median von 134mm³ ein geringeres Volumen als in der Kontrollgruppe (262mm³). Das mediane Überleben war mit 35 Tagen in der Gruppe der behandelten Tiere signifikant länger als in der Kontrollgruppe mit 24 Tagen. Zudem wurden in der histologischen Aufarbeitung der Tumoren signifikant mehr Makrophagen im Tumorgewebe nachgewiesen. Die Stimulation der Makrophagen durch GM CSF im orthotopen C6 Glioblastommodell der Ratte führte zu einem beachtlich reduzierten und verzögerten Tumorwachstum. Die behandelten Tiere überlebten signifikant länger als die Tiere der Kontrollgruppe. Die aktuelle Datenlage bestätigt die bedeutende Rolle der angeborenen Immunabwehr durch Makrophagen in der Kontrolle des Tumorwachstums bei experimentellen Glioblastomen. Die Aktivierung der Makrophagen hatte einen deutlichen Einfluss auf das Tumorwachstum, wohingegen eine T Zell-Depletion nur einen geringen Einfluss darauf hatte. Makrophagen als Vertreter des angeborenen Immunsystems wurden bisher in ihrer Rolle der Tumorkontrolle unterschätzt. Es bedarf noch weiterer Untersuchungen, ob die Makrophagen in Zukunft, ohne die körpereigenen Zellen anzugreifen, zur wirkungsvollen Tumorbekämpfung herangezogen werden könnten. N2 - The patient's immune defense represents a key role in spontaneous tumor regression. Until now, cytotoxic CD8-positive T cells and natural killer cells were considered to be one of the most important cellular representatives of tumor control. The aim of the present study was to investigate the influence of macrophages on tumor growth of orthotopically implanted C6 glioma spheroids. Macrophages were activated by granulocyte-macrophage colony-stimulating factor (rhGM-CSF, Leukine). 29 Sprague-Dawley rats were implanted C6 glioma spheroids orthotopically. 20 of the animals were treated with 1μg/100g rhGSM-CSF s. c. every other day. Nine animals served as the control group. MRI examinations (T1, T2, and 3D CISS sequences) were performed on days 7, 14, 21, 28, 32, and 42 after implantation. Tumor volumes were determined using these MRI examinations. Histologic workup included HE, CD68, CD8, and Ki-67 staining in sections of brain and spleen. Tumors developed later and reached with a median of 126 mm³ a smaller size in the GM-CSF series compared to the controls with 150 mm³. Median survival was significantly longer in the treated group (35 days) compared with the control group (24 days). In addition, histological workup of the tumors showed significantly more macrophages in the tumor tissue. Stimulation of macrophages by GM-CSF in the rodent C6 glioma model resulted in reduced and delayed tumor growth. Treated animals survived significantly longer than in the control group. The current data confirm the important role of innate immune defense by macrophages in the control of tumor growth in experimental gliomas. Macrophage activation had a marked effect on tumor growth. Macrophages as representatives of the innate immune system have been underestimated in their role of tumor control. KW - Glioblastoma multiforme KW - Makrophagen KW - Granulozyten-Makrophagen-koloniestimulierender Faktor Leukomax (rekombinant hergestelltes Präparat) KW - Tumorwachstum KW - Tiermodell KW - Regression Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-278550 ER - TY - JOUR A1 - Löhr, Mario A1 - Härtig, Wolfgang A1 - Schulze, Almut A1 - Kroiß, Matthias A1 - Sbiera, Silviu A1 - Lapa, Constantin A1 - Mages, Bianca A1 - Strobel, Sabrina A1 - Hundt, Jennifer Elisabeth A1 - Bohnert, Simone A1 - Kircher, Stefan A1 - Janaki-Raman, Sudha A1 - Monoranu, Camelia-Maria T1 - SOAT1: A suitable target for therapy in high-grade astrocytic glioma? JF - International Journal of Molecular Sciences N2 - Targeting molecular alterations as an effective treatment for isocitrate dehydrogenase-wildtype glioblastoma (GBM) patients has not yet been established. Sterol-O-Acyl Transferase 1 (SOAT1), a key enzyme in the conversion of endoplasmic reticulum cholesterol to esters for storage in lipid droplets (LD), serves as a target for the orphan drug mitotane to treat adrenocortical carcinoma. Inhibition of SOAT1 also suppresses GBM growth. Here, we refined SOAT1-expression in GBM and IDH-mutant astrocytoma, CNS WHO grade 4 (HGA), and assessed the distribution of LD in these tumors. Twenty-seven GBM and three HGA specimens were evaluated by multiple GFAP, Iba1, IDH1 R132H, and SOAT1 immunofluorescence labeling as well as Oil Red O staining. To a small extent SOAT1 was expressed by tumor cells in both tumor entities. In contrast, strong expression was observed in glioma-associated macrophages. Triple immunofluorescence labeling revealed, for the first time, evidence for SOAT1 colocalization with Iba1 and IDH1 R132H, respectively. Furthermore, a notable difference in the amount of LD between GBM and HGA was observed. Therefore, SOAT1 suppression might be a therapeutic option to target GBM and HGA growth and invasiveness. In addition, the high expression in cells related to neuroinflammation could be beneficial for a concomitant suppression of protumoral microglia/macrophages. KW - SOAT1 KW - glioblastoma KW - astrocytoma KW - IDH1/2 KW - lipid droplets KW - mitotane KW - targeted therapy Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-284178 SN - 1422-0067 VL - 23 IS - 7 ER - TY - JOUR A1 - Nickl, Vera A1 - Schulz, Ellina A1 - Salvador, Ellaine A1 - Trautmann, Laureen A1 - Diener, Leopold A1 - Kessler, Almuth F. A1 - Monoranu, Camelia M. A1 - Dehghani, Faramarz A1 - Ernestus, Ralf-Ingo A1 - Löhr, Mario A1 - Hagemann, Carsten T1 - Glioblastoma-derived three-dimensional ex vivo models to evaluate effects and efficacy of Tumor Treating Fields (TTFields) JF - Cancers N2 - Simple Summary In glioblastoma, tumor recurrence is inevitable and the prognosis of patients is poor, despite multidisciplinary treatment approaches involving surgical resection, radiotherapy and chemotherapy. Recently, Tumor Treating Fields (TTFields) have been added to the therapeutic set-up. These alternating electric fields are applied to glioblastoma at 200 kHz frequency via arrays placed on the shaved scalp of patients. Patients show varying response to this therapy. Molecular effects of TTFields have been investigated largely in cell cultures and animal models, but not in patient tissue samples. Acquisition of matched treatment-naïve and recurrent patient tissues is a challenge. Therefore, we suggest three reliable patient-derived three-dimensional ex vivo models (primary cells grown as microtumors on murine organotypic hippocampal slices, organoids and tumor slice cultures) which may facilitate prediction of patients’ treatment responses and provide important insights into clinically relevant cellular and molecular alterations under TTFields. Abstract Glioblastoma (GBM) displays a wide range of inter- and intra-tumoral heterogeneity contributing to therapeutic resistance and relapse. Although Tumor Treating Fields (TTFields) are effective for the treatment of GBM, there is a lack of ex vivo models to evaluate effects on patients’ tumor biology or to screen patients for treatment efficacy. Thus, we adapted patient-derived three-dimensional tissue culture models to be compatible with TTFields application to tissue culture. Patient-derived primary cells (PDPC) were seeded onto murine organotypic hippocampal slice cultures (OHSC), and microtumor development with and without TTFields at 200 kHz was observed. In addition, organoids were generated from acute material cultured on OHSC and treated with TTFields. Lastly, the effect of TTFields on expression of the Ki67 proliferation marker was evaluated on cultured GBM slices. Microtumors exhibited increased sensitivity towards TTFields compared to monolayer cell cultures. TTFields affected tumor growth and viability, as the size of microtumors and the percentage of Ki67-positive cells decreased after treatment. Nevertheless, variability in the extent of the response was preserved between different patient samples. Therefore, these pre-clinical GBM models could provide snapshots of the tumor to simulate patient treatment response and to investigate molecular mechanisms of response and resistance. KW - glioblastoma KW - Tumor Treating Fields (TTFields) KW - organotypic hippocampal slice cultures (OHSC) KW - organoids KW - tumor slice cultures KW - 3D ex vivo models Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-290340 SN - 2072-6694 VL - 14 IS - 21 ER - TY - JOUR A1 - Fröhlich, Ellen A1 - Sassenrath, Claudia A1 - Nadji-Ohl, Minou A1 - Unteroberdörster, Meike A1 - Rückriegel, Stefan A1 - Brelie, Christian von der A1 - Roder, Constantin A1 - Forster, Marie-Therese A1 - Schommer, Stephan A1 - Löhr, Mario A1 - Pala, Andrej A1 - Goebel, Simone A1 - Mielke, Dorothee A1 - Gerlach, Rüdiger A1 - Renovanz, Mirjam A1 - Wirtz, Christian Rainer A1 - Onken, Julia A1 - Czabanka, Marcus A1 - Tatagiba, Marcos Soares A1 - Rohde, Veit A1 - Ernestus, Ralf-Ingo A1 - Vajkoczy, Peter A1 - Gansland, Oliver A1 - Coburger, Jan T1 - Resilience in lower grade glioma patients JF - Cancers N2 - Current data show that resilience is an important factor in cancer patients’ well-being. We aim to explore the resilience of patients with lower grade glioma (LGG) and the potentially influencing factors. We performed a cross-sectional assessment of adult patients with LGG who were enrolled in the LoG-Glio registry. By phone interview, we administered the following measures: Resilience Scale (RS-13), distress thermometer, Montreal Cognitive Assessment Test for visually impaired patients (MoCA-Blind), internalized stigmatization by brain tumor (ISBI), Eastern Cooperative Oncological Group performance status (ECOG), patients’ perspective questionnaire (PPQ) and typical clinical parameters. We calculated correlations and multivariate regression models. Of 74 patients who were assessed, 38% of those showed a low level of resilience. Our results revealed significant correlations of resilience with distress (p < 0.001, −0.49), MOCA (p = 0.003, 0.342), ECOG (p < 0.001, −0.602), stigmatization (p < 0.001, −0.558), pain (p < 0.001, −0.524), and occupation (p = 0.007, 0.329). In multivariate analyses, resilience was negatively associated with elevated ECOG (p = 0.020, β = −0.383) and stigmatization levels (p = 0.008, β = −0.350). Occupation showed a tendency towards a significant association with resilience (p = 0.088, β = −0.254). Overall, low resilience affected more than one third of our cohort. Low functional status is a specific risk factor for low resilience. The relevant influence of stigmatization on resilience is a novel finding for patients suffering from a glioma and should be routinely identified and targeted in clinical routine. KW - resilience KW - lower grade glioma KW - diffuse astrocytoma KW - oligodendroglioma KW - RS-13 KW - distress KW - internalized stigmatization KW - ISBI KW - occupation KW - pain Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-297518 SN - 2072-6694 VL - 14 IS - 21 ER - TY - JOUR A1 - Polat, Bülent A1 - Wohlleben, Gisela A1 - Kosmala, Rebekka A1 - Lisowski, Dominik A1 - Mantel, Frederick A1 - Lewitzki, Victor A1 - Löhr, Mario A1 - Blum, Robert A1 - Herud, Petra A1 - Flentje, Michael A1 - Monoranu, Camelia-Maria T1 - Differences in stem cell marker and osteopontin expression in primary and recurrent glioblastoma JF - Cancer Cell International N2 - Background Despite of a multimodal approach, recurrences can hardly be prevented in glioblastoma. This may be in part due to so called glioma stem cells. However, there is no established marker to identify these stem cells. Methods Paired samples from glioma patients were analyzed by immunohistochemistry for expression of the following stem cell markers: CD133, Musashi, Nanog, Nestin, octamer-binding transcription factor 4 (Oct4), and sex determining region Y-box 2 (Sox2). In addition, the expression of osteopontin (OPN) was investigated. The relative number of positively stained cells was determined. By means of Kaplan–Meier analysis, a possible association with overall survival by marker expression was investigated. Results Sixty tissue samples from 30 patients (17 male, 13 female) were available for analysis. For Nestin, Musashi and OPN a significant increase was seen. There was also an increase (not significant) for CD133 and Oct4. Patients with mutated Isocitrate Dehydrogenase-1/2 (IDH-1/2) status had a reduced expression for CD133 and Nestin in their recurrent tumors. Significant correlations were seen for CD133 and Nanog between OPN in the primary and recurrent tumor and between CD133 and Nestin in recurrent tumors. By confocal imaging we could demonstrate a co-expression of CD133 and Nestin within recurrent glioma cells. Patients with high CD133 expression had a worse prognosis (22.6 vs 41.1 months, p = 0.013). A similar trend was seen for elevated Nestin levels (24.9 vs 41.1 months, p = 0.08). Conclusions Most of the evaluated markers showed an increased expression in their recurrent tumor. CD133 and Nestin were associated with survival and are candidate markers for further clinical investigation. KW - Glioblastoma KW - Glioma stem cells KW - Osteopontin KW - CD133 KW - Nestin Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-301240 SN - 1475-2867 VL - 22 ER - TY - JOUR A1 - Salvador, Ellaine A1 - Kessler, Almuth F. A1 - Domröse, Dominik A1 - Hörmann, Julia A1 - Schaeffer, Clara A1 - Giniunaite, Aiste A1 - Burek, Malgorzata A1 - Tempel-Brami, Catherine A1 - Voloshin, Tali A1 - Volodin, Alexandra A1 - Zeidan, Adel A1 - Giladi, Moshe A1 - Ernestus, Ralf-Ingo A1 - Löhr, Mario A1 - Förster, Carola Y. A1 - Hagemann, Carsten T1 - Tumor Treating Fields (TTFields) reversibly permeabilize the blood–brain barrier in vitro and in vivo JF - Biomolecules N2 - Despite the availability of numerous therapeutic substances that could potentially target CNS disorders, an inability of these agents to cross the restrictive blood–brain barrier (BBB) limits their clinical utility. Novel strategies to overcome the BBB are therefore needed to improve drug delivery. We report, for the first time, how Tumor Treating Fields (TTFields), approved for glioblastoma (GBM), affect the BBB’s integrity and permeability. Here, we treated murine microvascular cerebellar endothelial cells (cerebEND) with 100–300 kHz TTFields for up to 72 h and analyzed the expression of barrier proteins by immunofluorescence staining and Western blot. In vivo, compounds normally unable to cross the BBB were traced in healthy rat brain following TTFields administration at 100 kHz. The effects were analyzed via MRI and immunohistochemical staining of tight-junction proteins. Furthermore, GBM tumor-bearing rats were treated with paclitaxel (PTX), a chemotherapeutic normally restricted by the BBB combined with TTFields at 100 kHz. The tumor volume was reduced with TTFields plus PTX, relative to either treatment alone. In vitro, we demonstrate that TTFields transiently disrupted BBB function at 100 kHz through a Rho kinase-mediated tight junction claudin-5 phosphorylation pathway. Altogether, if translated into clinical use, TTFields could represent a novel CNS drug delivery strategy. KW - blood–brain barrier KW - TTFields KW - CNS disorders Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288057 SN - 2218-273X VL - 12 IS - 10 ER - TY - JOUR A1 - Feldheim, Jonas A1 - Wend, David A1 - Lauer, Mara J. A1 - Monoranu, Camelia M. A1 - Glas, Martin A1 - Kleinschnitz, Christoph A1 - Ernestus, Ralf-Ingo A1 - Braunger, Barbara M. A1 - Meybohm, Patrick A1 - Hagemann, Carsten A1 - Burek, Malgorzata T1 - Protocadherin Gamma C3 (PCDHGC3) is strongly expressed in glioblastoma and its high expression is associated with longer progression-free survival of patients JF - International Journal of Molecular Sciences N2 - Protocadherins (PCDHs) belong to the cadherin superfamily and represent the largest subgroup of calcium-dependent adhesion molecules. In the genome, most PCDHs are arranged in three clusters, α, β, and γ on chromosome 5q31. PCDHs are highly expressed in the central nervous system (CNS). Several PCDHs have tumor suppressor functions, but their individual role in primary brain tumors has not yet been elucidated. Here, we examined the mRNA expression of PCDHGC3, a member of the PCDHγ cluster, in non-cancerous brain tissue and in gliomas of different World Health Organization (WHO) grades and correlated it with the clinical data of the patients. We generated a PCDHGC3 knockout U343 cell line and examined its growth rate and migration in a wound healing assay. We showed that PCDHGC3 mRNA and protein were significantly overexpressed in glioma tissue compared to a non-cancerous brain specimen. This could be confirmed in glioma cell lines. High PCDHGC3 mRNA expression correlated with longer progression-free survival (PFS) in glioma patients. PCDHGC3 knockout in U343 resulted in a slower growth rate but a significantly faster migration rate in the wound healing assay and decreased the expression of several genes involved in WNT signaling. PCDHGC3 expression should therefore be further investigated as a PFS-marker in gliomas. However, more studies are needed to elucidate the molecular mechanisms underlying the PCDHGC3 effects. KW - glioblastoma multiforme KW - glioma KW - astrocytoma KW - recurrence KW - relapse KW - mRNA KW - protein KW - brain KW - expression KW - PCDHGC3 KW - WNT signaling Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-284433 SN - 1422-0067 VL - 23 IS - 15 ER - TY - THES A1 - Nattmann, Anja Maria T1 - ADAM9 und CXCR4 – neue Angriffspunkte in der Pathogenese des Vestibularisschwannoms T1 - ADAM9 and CXCR4 – new targets in vestibular schwannoma pathogenesis N2 - Obwohl es sich bei Vestibularisschwannomen (VS) um benigne Tumoren handelt, können sie die Lebensqualität der betroffenen Patienten deutlich beeinträchtigen. Gerade bei Patienten, die an einer NF 2 leiden und sich daher wiederholt operativen Eingriffen unterziehen müssen, ist es notwendig, eine medikamentöse Therapiealternative anbieten zu können, die ohne die Notwendigkeit einer operativen Intervention auskommt und gleichzeitig schwerwiegenden Folgen der Tumorerkrankung – wie dem drohenden Hörverlust – Einhalt gebietet. Die vorliegende Arbeit hatte zum Ziel, sich dieser medikamentösen Therapiealternative einen Schritt anzunähern, indem molekulare Pathomechanismen, die dem VS zugrunde liegen könnten, untersucht wurden. Im Mittelpunkt standen der Chemokinrezeptor CXCR4, das Tumorsuppressorprotein Merlin und die Metalloprotease ADAM9. Für CXCR4 ließen sich keine Effekte in Bezug auf die Aktivierung der ERK- und AKT-Signalwege erkennen. Auch beeinflusste eine Merlinüberexpression in VS-Zellen die CXCR4- und ADAM9-Proteinexpression nicht. Für ADAM9 zeigte sich eine potenzielle Relevanz für die Pathogenese des VS: Wurde die ADAM9-Konzentration durch einen knock-down reduziert, hatte dies eine verminderte VS-Zellzahl zur Folge. Des Weiteren scheint Integrin α6 ein Substrat von ADAM9 zu sein, das möglicherweise in die Zytoskelettmodifikation durch ADAM9 involviert ist. Somit stellt die ADAM9-Inhibition einen interessanten Angriffspunkt für eine mögliche medikamentöse Behandlung von VS dar. Ferner wurden Cytokine gefunden, die bisher nicht in einen Zusammenhang mit dem VS gebracht worden waren. Vor allem die Bedeutung der Cytokine TIMP-2 und CXCL7 sollte für das VS näher untersucht werden. Somit konnte diese Arbeit weitere Aspekte aufdecken, die für die Pathogenese des VS relevant sein könnten und an die zukünftige Forschung anknüpfen sollte. N2 - Although they are benign tumors, vestibular schwannomas have the potential to noticeably impair the patients’ quality of life. Especially patients suffering from neurofibromatosis type 2 develop multiple schwannomas and therefore often require repeated surgery. Thus, a non-invasive and effective pharmacotherapy is urgently needed to prevent severe consequences of vestibular schwannoma such as hearing loss. The aim of this thesis was to investigate pathological mechanisms of vestibular schwannoma to identify potential druggable targets. Especially the chemokine receptor CXCR4, the tumor suppressor protein Merlin and the metalloproteinase ADAM9 were in the focus of interest. Neither inhibition, nor stimulation of CXCR4 affected the activity of ERK and AKT signaling pathways, respectively. Similarly, Merlin overexpression did not change CXCR4 or ADAM9 protein expression in vestibular schwannoma. However, ADAM9 appeared to be potentially important for the pathogenesis of vestibular schwannoma: An ADAM9 knock-down led to reduced vestibular schwannoma cell numbers. Moreover, integrin α6 appeared to be a substrate of ADAM9 and might be involved in its mediation of cytoskeleton alterations. Thus, pharmacological inhibition of ADAM9 could be a promising therapeutic strategy to target vestibular schwannoma. In addition, a cytokine screen revealed the tissue inhibitor of metalloproteinases 2 (TIMP-2) and the chemokine ligand CXCL7 as hitherto unknown factors with putative relevance for the vestibular schwannoma pathogenesis. To conclude, this thesis revealed new perspectives on pathological mechanisms of vestibular schwannoma which deserve further investigation. KW - Akustikustumor KW - Vestibularisschwannom KW - ADAM9 KW - CXCR4 KW - Merlin KW - vestibular schwannoma Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-278086 ER - TY - JOUR A1 - Reschke, Moritz A1 - Salvador, Ellaine A1 - Schlegel, Nicolas A1 - Burek, Malgorzata A1 - Karnati, Srikanth A1 - Wunder, Christian A1 - Förster, Carola Y. T1 - Isosteviol sodium (STVNA) reduces pro-inflammatory cytokine IL-6 and GM-CSF in an in vitro murine stroke model of the blood–brain barrier (BBB) JF - Pharmaceutics N2 - Early treatment with glucocorticoids could help reduce both cytotoxic and vasogenic edema, leading to improved clinical outcome after stroke. In our previous study, isosteviol sodium (STVNA) demonstrated neuroprotective effects in an in vitro stroke model, which utilizes oxygen-glucose deprivation (OGD). Herein, we tested the hypothesis that STVNA can activate glucocorticoid receptor (GR) transcriptional activity in brain microvascular endothelial cells (BMECs) as previously published for T cells. STVNA exhibited no effects on transcriptional activation of the glucocorticoid receptor, contrary to previous reports in Jurkat cells. However, similar to dexamethasone, STVNA inhibited inflammatory marker IL-6 as well as granulocyte-macrophage colony-stimulating factor (GM-CSF) secretion. Based on these results, STVNA proves to be beneficial as a possible prevention and treatment modality for brain ischemia-reperfusion injury-induced blood–brain barrier (BBB) dysfunction. KW - IL-6 KW - ischemia KW - isosteviol sodium (STVNA) KW - dexamethasone KW - glucocorticoid receptor KW - cerebEND Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-286275 SN - 1999-4923 VL - 14 IS - 9 ER - TY - JOUR A1 - Reinhold, Ann Kristin A1 - Krug, Susanne M. A1 - Salvador, Ellaine A1 - Sauer, Reine S. A1 - Karl-Schöller, Franziska A1 - Malcangio, Marzia A1 - Sommer, Claudia A1 - Rittner, Heike L. T1 - MicroRNA-21-5p functions via RECK/MMP9 as a proalgesic regulator of the blood nerve barrier in nerve injury JF - Annals of the New York Academy of Sciences N2 - Both nerve injury and complex regional pain syndrome (CRPS) can result in chronic pain. In traumatic neuropathy, the blood nerve barrier (BNB) shielding the nerve is impaired—partly due to dysregulated microRNAs (miRNAs). Upregulation of microRNA-21-5p (miR-21) has previously been documented in neuropathic pain, predominantly due to its proinflammatory features. However, little is known about other functions. Here, we characterized miR-21 in neuropathic pain and its impact on the BNB in a human-murine back translational approach. MiR-21 expression was elevated in plasma of patients with CRPS as well as in nerves of mice after transient and persistent nerve injury. Mice presented with BNB leakage, as well as loss of claudin-1 in both injured and spared nerves. Moreover, the putative miR-21 target RECK was decreased and downstream Mmp9 upregulated, as was Tgfb. In vitro experiments in human epithelial cells confirmed a downregulation of CLDN1 by miR-21 mimics via inhibition of the RECK/MMP9 pathway but not TGFB. Perineurial miR-21 mimic application in mice elicited mechanical hypersensitivity, while local inhibition of miR-21 after nerve injury reversed it. In summary, the data support a novel role for miR-21, independent of prior inflammation, in elicitation of pain and impairment of the BNB via RECK/MMP9. KW - claudin-1 KW - RECK KW - MMP9 KW - CRPS KW - microRNA KW - neuropathic pain KW - blood nerve barrier Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318226 VL - 1515 IS - 1 SP - 184 EP - 195 ER - TY - THES A1 - Martellotta, Donato Daniel T1 - Stellenwert von CXCL12 und CXCR4 in der Pathogenese des Vestibularisschwannomes T1 - Significance of CXCL12 and CXCR4 in the pathogenesis of vestibular schwannoma N2 - CXCR4 ist der spezifische Rezeptor für das Chemokin CXCL12 und ist überexprimiert in Vestibularisschwannomzellen. Das Ziel dieser Arbeit war es den Effekt des spezifischen Inhibitors AMD3100 auf die CXCR4 vermittelte Proliferation und Migration der Vestibularisschwannomzellen in verschiedenen Zellkuturmodellen zu analysieren. Die nachgewiesene Inhibition von CXCR4 deutet auf einen möglichen Einsatz von AMD3100 in der systemischen Therapie von NF-2 Patienten hin. N2 - CXCR4 is the specific receptor for the chemokine CXCL12 and is hyperexpressed in vestibular schwannoma cells. The aim was to analyse the influence of the specific inhibitor AMD 3100 on the CXCR4 stimulated proliferation and migration of vestibular schwannoma cells in different cell culture models. The demonstrated inhibition of CXCR4 suggests the use of AMD3100 in the systemic therapy of NF-2 patients. KW - CXCL12 KW - Vestibularisschwannom KW - CXCR4 KW - NF-2 KW - 3D-Modell Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-241454 ER - TY - JOUR A1 - Lilla, Nadine A1 - Kessler, Almuth F. A1 - Weiland, Judith A1 - Ernestus, Ralf-Ingo A1 - Westermaier, Thomas T1 - Case Report: A Case Series Using Natural Anatomical Gaps — Posterior Cervical Approach to Skull Base and Upper Craniocervical Meningiomas Without Bone Removal JF - Frontiers in Surgery N2 - Background: Removal of anteriorly located tumors of the upper cervical spine and craniovertebral junction (CVJ) is a particular surgical challenge. Extensive approaches are associated with pain, restricted mobility of neck and head and, in case of foramen magnum and clivus tumors, with retraction of brainstem and cerebellum. Methods: Four symptomatic patients underwent resection of anteriorly located upper cervical and lower clivus meningiomas without laminotomy or craniotomy using a minimally invasive posterior approach. Distances of natural gaps between C0/C1, C1/C2, and C2/C3 were measured using preoperative CT scans and intraoperative lateral x-rays. Results: In all patients, safe and complete resection was conducted by the opening of the dura between C0/C1, C1/C2, and C2/C3, respectively. There were no surgical complications. Local pain was reported as very moderate by all patients and postoperative recovery was extremely fast. All tumors had a rather soft consistency, allowing mass reduction prior to removal of the tumor capsule and were well separable from lower cranial nerves and vascular structures. Conclusion: If tumor consistency is appropriate for careful mass reduction before removal of the tumor capsule and if tumor margins are not firmly attached to crucial structures, then upper cervical, foramen magnum, and lower clivus meningiomas can be safely and completely removed through natural gaps in the CVJ region. Both prerequisites usually become clear early during surgery. Thus, this tumor entity may be planned using this minimally invasive approach and may be extended if tumor consistency turns out to be less unfavorable for resection or if crucial structures cannot be easily separated from the tumor. KW - minimally invasive KW - meningioma KW - cervical spine KW - spinal tumor operation KW - craniovertebral junction Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-244613 SN - 2296-875X VL - 8 ER - TY - THES A1 - Chatzidimitriou, Nikolaos T1 - Wird die Behandlung des kindlichen Hydrocephalus durch neue Ventilsysteme verbessert? Ein Vergleich zweier Shuntsysteme T1 - Do new shunt systems improve the treatment of pediatrich hydrocephalus. A comparison between two shunt systems N2 - Der Unishunt der Firma Codman gilt als Niederdruck-System und führt in aufrechter Körperposition zur erheblichen Überdrainage. Das Delta-System der Firma Medtronic hingegen soll durch seinen Ventilmechanismus eine Überdrainage verhindern und den Liquordruck in einem physiologischen Rahmen halten. Die vorliegende Studie untersucht die Frage, ob das Delta-System gegenüber dem Unishunt einen Vorteil hinsichtlich der Überdrainage aufweist, der sich an der revisionsfreien Funktionsdauer zeigt. Unter Berücksichtigung der Ventrikelweite prüften wir insbesondere, ob die Überdrainage und die damit verbundenen Komplikationen verringert werden können. In einer retrospektiven Fall-Sammel-Studie wurden die Patientendaten von 199 Kindern im Alter zwischen einem Tag und 10.4 Jahren ausgewertet, die im Zeitraum vom 01.01.1985 bis 01.03.2002 in der Abteilung für pädiatrische Neurochirurgie der Universitätsklinik Würzburg eine Erstimplantation eines ventrikuloperitonealen oder -atrialen Shunts mit Verwendung eines Unishunts (n= 138) oder eines Delta-Systems (n=61) erhielten. Gewertet wurden alle mechanischen oder infektiösen Komplikationen, die zu einer operativen Shuntrevision führten. Bei den mechanischen Komplikationen unterschieden wir zwischen proximaler Obstruktion, distaler Obstruktion, Migration, Diskonnektion oder Katheterriss, Ventilunterfunktion und Überdrainage. Als Überdrainage wurden operationspflichtige Subduralergüsse, eindeutige Unterdruck-beschwerden und das Slit-Ventricle-Syndrom gewertet. Asymptomatische Subdural-ergüsse und andere nicht operationspflichtige Funktionsanomalien werteten wir nicht als Komplikation. Als Shuntinfektion bezeichneten wir klinische und laborchemische Zeichen einer bakteriellen Infektion, die nach Shuntexplantation abklangen. Die durchschnittliche Funktionsdauer der Shunts wurde in vorliegender Studie durch das Delta-System nicht verlängert. Die kumulative Revisionswahrscheinlichkeit nach einem Jahr betrug beim Unishunt 30.6 %, beim Delta-System 24.9 %, lag aber nach fünf Jahren mit 58.0 % beim Delta-System höher als beim Unishunt (40.9 %). Bei den mechanischen Komplikationen ergab sich als wesentlicher Unterschied zwischen beiden getesteten Systemen eine häufigere distale Blockade des Peritonealkatheters beim Unishunt, die aber durch häufigere Ventilfehlfunktion des Delta-Systems weitgehend ausgeglichen wurde. Die niedrigste Druckstufe führte beim Delta-System signifikant häufiger zu einer proximalen Obstruktion als die höchste. Die eigenen Untersuchungsergebnisse sprechen dafür, dass Delta-Ventile tatsächlich der Neigung zur Überdrainage entgegenwirken, ohne dass sich dieser Vorteil in der Revisionsrate bemerkbar macht. Das Delta-System führt zu einer niedrigeren Überdrainagerate und weniger Überdrainage-assoziierten Erscheinungen wie Subduralergüssen. Dieser Unterschied war am ehesten morphologisch zu erfassen, jedoch im Vergleich zum Unishunt nicht signifikant. Der Unishunt war mit einer höheren Infektionsrate von 11.6 % im Vergleich zum Delta-System (3.3 %) belastet. Der Unterschied lässt sich weder mit konstruktiven Ventilmerkmalen noch mit besonderen Maßnahmen der Infektionsprophylaxe erklären. Der im Vergleich zum Unishunt höhere Preis des Delta-Systems findet keinen Niederschlag in einer niedrigeren Komplikationsrate des Systems. N2 - The Unishunt (Codman) is a low-pressure-system and tends to excessive overdrainage in the erect position. The delta-valve is supposed to prevent overdrainage and to keep CSF in his physiologic limits.This study compares the unishunt-system with the delta-system and examines if there is any advantage regarding overdrainage and if this advantage displays in the revision-free survival of an shunt. We also considered the effect of the different shunt technologies on the ventricle width. In a retrospective analysis we reviewed the medical and surgical charts of 138 children with unishunt system and 61 childeren with delta-system who were treated with a first-time shunt implantation at the department of pediatric neurosurgery,University of Würzburg between 1.1.1985 and 1.3.2002 We considered all mechanical and infectious complications that led to a operative shunt revision. We distinguished between proximal obstruction, distal obstruction, valve obstuction, migration, disconnection or fracture of the catheter and overdrainage. Overdrainage was said to be occured in the presence of symptomatic subdural effusions that needed operative revision and the Slit-ventricle-syndrom. Asymptomatic subdural effusions and other functional anomalies that could be treated consevativly were not considered as overdrainage. Shunt infection was defined as clinical and laboratory signs of a infection that ease off with shunt explantation and antibiotic treatment. Positive Gram stains or cultures were not necessary for the diagnosis of a shunt infection. Results: the overall shunt survival was not influenced by the delta-system. The overall- complication rate in the first year after implantation was 30.6 % for the unishunt and 24.9 % for the delta-valve and 40.9 % and 58 % respectively after 5 years. Overdrainage rate was 1.4 % for the unishunt-system, no shunt revision was necessary for the delta-system, the between the two systems was not signifikant. The advantage of the delta-system concerning overdrainage was seen more morphologically, the normalization or collaps of the ventricles was seen slowlier in the delta-system, the difference to the unishunt-system was not significant. The infection rate was 11.6 % for the unishunt-system and 3.3 % for the delta-system. This difference also was not significant and cannot be explained with the parameters studied. KW - Hydrocephalus KW - Unishunt KW - Delta-Valve KW - Overdrainage Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234729 N1 - Dieses Dokument wurde aus Datenschutzgründen - ohne inhaltliche Änderungen - erneut veröffentlicht. Die ursprüngliche Veröffentlichung war am: 09.07.2005 ER - TY - JOUR A1 - Kunz, Felix A1 - Hirth, Matthias A1 - Schweitzer, Tilmann A1 - Linz, Christian A1 - Goetz, Bernhard A1 - Stellzig-Eisenhauer, Angelika A1 - Borchert, Kathrin A1 - Böhm, Hartmut T1 - Subjective perception of craniofacial growth asymmetries in patients with deformational plagiocephaly JF - Clinical Oral Investigations N2 - Objectives The present investigation aimed to evaluate the subjective perception of deformational cranial asymmetries by different observer groups and to compare these subjective perceptions with objective parameters. Materials and methods The 3D datasets of ten infants with different severities of deformational plagiocephaly (DP) were presented to 203 observers, who had been subdivided into five different groups (specialists, pediatricians, medical doctors (not pediatricians), parents of infants with DP, and laypersons). The observers rated their subjective perception of the infants’ cranial asymmetries using a 4-point Likert-type scale. The ratings from the observer groups were compared with one another using a multilevel modelling linear regression analysis and were correlated with four commonly used parameters to objectively quantify the cranial asymmetries. Results No significant differences were found between the ratings of the specialists and those of the parents of infants with DP, but both groups provided significantly more asymmetric ratings than did pediatricians, medical doctors, or laypersons. Moreover, the subjective perception of cranial asymmetries correlated significantly with commonly used parameters for objectively quantifying cranial asymmetries. Conclusions Our results demonstrate that different observer groups perceive the severity of cranial asymmetries differently. Pediatricians’ more moderate perception of cranial asymmetries may reduce the likelihood of parents to seek therapeutic interventions for their infants. Moreover, we identified some objective symmetry-related parameters that correlated strongly with the observers’ subjective perceptions. Clinical relevance Knowledge about these findings is important for clinicians when educating parents of infants with DP about the deformity. KW - infants with deformational plagiocephaly (DP) KW - deformational cranial asymmetry KW - subjective perception KW - positionalskull deformities KW - three-dimensional Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232803 SN - 1432-6981 VL - 25 ER - TY - THES A1 - Schmitt, Dominik T1 - Genexpressionsanalysen der tumor-/metastasierungsassoziierten Proteine ATF5, KiSS1, RPS27, BRMS1 und TTK in neuroglialen Hirntumoren T1 - Gene expression analyses of tumor and metastasis associated proteins ATF5, KiSS1, RPS27, BRMS1 and TTK in neuroglial brain tumors N2 - Hirntumoren werden nach histologischen und molekulargenetischen Gesichtspunkten unterteilt. Neben dem Krankheitsverlauf unterscheiden sich LGA auch genetisch von GBM. Wie die mRNA der Proteine ATF5, KiSS1, RPS27, BRMS1 und TTK in LGA exprimiert ist bzw. sich im Verlauf verändert, war in dieser Form noch nicht in einem Patientenpanel untersucht worden. Ziel dieser Arbeit war es, die mRNA-Expressionsraten zu bestimmen sowie Korrelationen und Kointegrationen mit klinischen Daten zu analysieren. Außerdem wurden Besonderheiten der Verteilung innerhalb des Patientenpanels beschrieben. Quantitative-PCR-Analysen wurden durchgeführt. Die Expressionswerte wurden auf die Expression des Haushaltsgens GAPDH normalisiert. Die resultierenden ∆CTm - bzw. ∆∆CT-Werte sowie die klinischen Patientendaten waren Basis für Kointegrations-, Korrelations-, Expressions-, Ähnlichkeits- und Verlaufsanalysen. KiSS1 schien generell kaum oder nicht in der Vielzahl der Tumoren exprimiert zu sein, Aussagen zur klinischen Korrelation erwiesen sich als schwierig. Für RPS27 konnten tendenziell niedrigere Werte in den Verlaufstumoren im Vergleich zu den LGA gefunden werden. Auch für BRMS1 war in der Mehrzahl der Fälle die mRNA der Vorläufertumoren in Relation zu den Rezidiven stärker exprimiert. ATF5 korrelierte nach Kendall RE und PFS (-0,324; p=0,077) in der Gruppe der IDH1-mutierten LGA, für TTK nach Kendall OS und RE (-0,444; p=0,097) im Gesamtpanel und nach Pearson auch RE und PFS (-0,43; p=0,096) in der Gruppe der IDH1-mutierten LGA. N2 - Brain tumors can be classified histologically and by their molecular characteristics. Besides progression of disease low grade astrocytoma (LGA) differ from Glioblastoma (GBM) patients in their genetic characteristics. In a brain tumor patient panel we analyzed mRNA-expressions of the proteins ATF5, KiSS1, RPS27, BRMS1 and TTK in LGA as well as in relapses by showing expression rates and using correlation, similarity, progression and cointegration analyses. Besides clinical information (progression free survival (PFS) overall survival (OS) and age at first diagnose (AED)) we used real time PCR data (normalized relative Expression (RE) compared to the household gene GAPDH; ∆CTm – and ∆∆CT-value). Conclusions: KiSS1-mRNA generally was hardly or not expressed in the majority of samples. RPS27 and BRMS1 showed lower mRNA expression rates in relapse tumors than in LGA. In the subgroup of IDH1-mutated LGA a negative correlation could be found for ATF5 between RE and PFS (Kendall: -0,324; p=0,077). TTK showed a negative correlation between OS and RE in the entire group (-0,444; p=0,097) and a negative correlation between RE and PFS in a subgroup of IDH1-mutated LGA (-0,43; p=0,096). KW - Genexpression KW - ATF5 KW - KiSS1 KW - RPS27 KW - BRMS1 KW - TTK KW - Low grade Astrocytoma KW - LGA Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-222873 ER - TY - JOUR A1 - Linsenmann, Thomas A1 - Cattaneo, Andrea A1 - März, Alexander A1 - Weiland, Judith A1 - Stetter, Christian A1 - Nickl, Robert A1 - Westermaier, Thomas T1 - Combined frameless stereotactical biopsy and intraoperative cerebral angiography by 3D-rotational fluoroscopy with intravenous contrast administration: a feasibility study JF - BMC Medical Imaging N2 - Background Mobile 3-dimensional fluoroscopes are an integral part of modern neurosurgical operating theatres and can also be used in combination with free available image post processing to depict cerebral vessels. In preparation of stereotactic surgery, preoperative Computed Tomography (CT) may be required for image fusion. Contrast CT may be of further advantage for image fusion as it regards the vessel anatomy in trajectory planning. Time-consuming in-hospital transports are necessary for this purpose. Mobile 3D-fluoroscopes may be used to generate a CT equal preoperative data set without an in-hospital transport. This study was performed to determine the feasibility and image quality of intraoperative 3-dimensional fluoroscopy with intravenous contrast administration in combination with stereotactical procedures. Methods 6 patients were included in this feasibility study. After fixation in a radiolucent Mayfield clamp a rotational fluoroscopy scan was performed with 50 mL iodine contrast agent. The image data sets were merged with the existing MRI images at a planning station and visually evaluated by two observer. The operation times were compared between the frame-based and frameless systems (“skin-to-skin” and “OR entry to exit”). Results The procedure proves to be safe. The entire procedure from fluoroscope positioning to the transfer to the planning station took 5–6 min with an image acquisition time of 24 s. In 5 of 6 cases, the fused imaging was able to reproduce the vascular anatomy accurately and in good quality. Both time end-points were significantly shorter compared to frame-based interventions. Conclusion The images could easily be transferred to the planning and navigation system and were successfully merged with the MRI data set. The procedure can be completely integrated into the surgical workflow. Preoperative CT imaging or transport under anaesthesia may even be replaced by this technique in the future. Furthermore, hemorrhages can be successfully visualized intraoperatively and might prevent time delays in emergencies. KW - 3 D rotational fluoroscopy KW - neurosurgery KW - stereotaxy KW - frameless systems KW - intraoperative imaging Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-270370 VL - 21 ER - TY - THES A1 - Feldheim, Jonas Alexander T1 - ATF5-Expression und MGMT-Promotormethylierungsänderungen in glialen Tumoren T1 - ATF5-expression and alterations of the MGMT promoter methylation status in glial tumors N2 - Die WHO-Klassifikation der Hirntumoren von 2016 ebnete den Weg für molekulare Marker und Therapie-Angriffspunkte. Der Transkriptionsfaktor ATF5 könnte ein solcher sein. Er unterdrückt die Differenzierung von neuronalen Vorläuferzellen und wird in Glioblastomen (GBM) überexprimiert. Daten zur ATF5-Expression in WHO Grad II Gliomen (LGG) und GBM-Rezidiven sind nur spärlich vorhanden. Daher untersuchten wir 79 GBM, 40 LGG und 10 Normalhirnproben auf ihre ATF5-mRNA- und Proteinexpression mit quantitativer Echtzeit-PCR bzw. Immunhistochemie und verglichen sie mit multiplen, retrospektiv erhobenen klinischen Charakteristika der Patienten. ATF5 war in LGG und GBM verglichen zum Normalhirn sowohl auf mRNA-, als auch Proteinebene überexprimiert. Obwohl die ATF5-mRNA-Expression im GBM eine erhebliche Fluktuationsrate zeigte, gab es keine signifikanten Expressionsunterschiede zwischen GBM-Gruppen unterschiedlicher biologischer Wachstumsmuster. ATF5-mRNA korrelierte mit dem Alter der Patienten und invers mit der Ki67-Färbung. Kaplan Meier- und Cox-Regressionsanalysen zeigten eine signifikante Korrelation der ATF5-mRNA-Expression mit dem Überleben nach 12 Monaten sowie dem progressionsfreien Überleben. Die Methylierung des Promotors der O6-Methylguanin-DNA-Methyltransferase (MGMT) ist ein etablierter Marker in der Therapie des GBMs. Sie ist mit dem therapeutischen Ansprechen auf Temozolomid und dem Überleben assoziiert. Uns fielen inzidentell Veränderungen der MGMT-Promotormethylierung auf, woraufhin wir den aktuellen Wissensstand mittels einer ausführlichen Literatur-Metaanalyse zusammenfassten. Dabei fanden wir Veränderungen der MGMT-Promotormethylierung bei 115 der 476 Patienten. Wir schlussfolgern, dass die ATF5-mRNA-Expression als prognostischer Faktor für das Überleben der Patienten dienen könnte. Da seine in vitro-Inhibition zu einem selektiven Zelltod von Gliomzellen führte und wir eine Überexpression in glialen Tumoren nachweisen konnten, zeigt ATF5 Potential als ubiquitäres Therapieziel in Gliomen. Zum aktuellen Zeitpunkt ergibt sich keine klare Indikation, den klinischen Standard der MGMT-Teststrategie zu verändern. Trotzdem könnte eine erneute Testung der MGMT-Promotormethylierung für zukünftige Therapieentscheidungen sinnvoll sein und wir regen an, dass dieses Thema in klinischen Studien weiter untersucht wird. N2 - The 2016 WHO classification for brain tumors signaled a major paradigm shift and paves the way for molecular markers and molecular targets. One such target could be the transcription factor ATF5. It suppresses differentiation of neuroprogenitor cells and is overexpressed in glioblastoma (GBM). Data on ATF5 expression in glioma of WHO grade II (LGG) are scarce and lacking on recurrent GBM. Therefore, we examined 79 GBM, 40 LGG and 10 normal brain (NB) specimens for their ATF5-mRNA and protein expression by quantitative real-time PCR and immunohistochemistry, respectively, and compared it to multiple retrospectively obtained clinical characteristics of the patients. ATF5-mRNA was overexpressed in LGG and GBM compared to NB on mRNA and protein level. Although ATF5-mRNA expression in GBM showed a considerable fluctuation range, GBM groups of varying biological behavior were not significantly different. ATF5-mRNA correlated with the patients' age and inversely with Ki67-staining. Kaplan-Meier analysis and Cox regression indicated that ATF5-mRNA expression was significantly associated with survival after 12 months and progression-free survival. Methylation of the O6-Methylguanin DNA methyltransferase (MGMT) promoter is a well-established strong prognostic factor in the therapy of GBM. It is associated with an improved response to chemotherapy with temozolomide and longer overall survival. We made the incidental finding of patients with changing MGMT promoter methylation during the clinical course, which prompted us to further investigate this topic. Indeed, a meta-analysis of the literature revealed changes in MGMT promoter methylation in 115 of 476 patients. To conclude, ATF5-mRNA expression could be identified as an additional, though not independent factor correlating with patients‘ survival. Since its inhibition might lead to the selective death of glioma cells, it might serve as a potential ubiquitous therapeutic target in astrocytic tumors. Clinical implications of the observed changes in MGMT promoter methylation are still ambiguous and do not yet support a change in clinical practice. However, retesting MGMT methylation might be useful for future treatment decisions and we encourage clinical studies to address this topic.  KW - Glioblastom KW - Gliom KW - Biomarker KW - Methylierung KW - O(6)-Methylguanine-DNA Methyltransferase KW - MGMT KW - ATF5 KW - Therapie Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-243208 ER - TY - JOUR A1 - Stetter, Christian A1 - Weidner, Franziska A1 - Lilla, Nadine A1 - Weiland, Judith A1 - Kunze, Ekkehard A1 - Ernestus, Ralf-Ingo A1 - Muellenbach, Ralf Michael A1 - Westermaier, Thomas T1 - Therapeutic hypercapnia for prevention of secondary ischemia after severe subarachnoid hemorrhage: physiological responses to continuous hypercapnia JF - Scientific Reports N2 - Temporary hypercapnia has been shown to increase cerebral blood flow (CBF) and might be used as a therapeutical tool in patients with severe subarachnoid hemorrhage (SAH). It was the aim of this study was to investigate the optimum duration of hypercapnia. This point is assumed to be the time at which buffer systems become active, cause an adaptation to changes of the arterial partial pressure of carbon dioxide (PaCO2) and annihilate a possible therapeutic effect. In this prospective interventional study in a neurosurgical ICU the arterial partial pressure of carbon dioxide (PaCO\(_2\)) was increased to a target range of 55 mmHg for 120 min by modification of the respiratory minute volume (RMV) one time a day between day 4 and 14 in 12 mechanically ventilated poor-grade SAH-patients. Arterial blood gases were measured every 15 min. CBF and brain tissue oxygen saturation (StiO\(_2\)) were the primary and secondary end points. Intracranial pressure (ICP) was controlled by an external ventricular drainage. Under continuous hypercapnia (PaCO\(_2\) of 53.17 ± 5.07), CBF was significantly elevated between 15 and 120 min after the start of hypercapnia. During the course of the trial intervention, cardiac output also increased significantly. To assess the direct effect of hypercapnia on brain perfusion, the increase of CBF was corrected by the parallel increase of cardiac output. The maximum direct CBF enhancing effect of hypercapnia of 32% was noted at 45 min after the start of hypercapnia. Thereafter, the CBF enhancing slowly declined. No relevant adverse effects were observed. CBF and StiO\(_2\) reproducibly increased by controlled hypercapnia in all patients. After 45 min, the curve of CBF enhancement showed an inflection point when corrected by cardiac output. It is concluded that 45 min might be the optimum duration for a therapeutic use and may provide an optimal balance between the benefits of hypercapnia and risks of a negative rebound effect after return to normal ventilation parameters. KW - cerebrovascular disorders KW - clinical trials KW - neurology KW - neurovascular disorders KW - Phase II trials Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260779 VL - 11 IS - 1 ER - TY - JOUR A1 - Stetter, Christian A1 - Lopez-Caperuchipi, Simon A1 - Hopp-Krämer, Sarah A1 - Bieber, Michael A1 - Kleinschnitz, Christoph A1 - Sirén, Anna-Leena A1 - Albert-Weißenberger, Christiane T1 - Amelioration of cognitive and behavioral deficits after traumatic brain injury in coagulation factor XII deficient mice JF - International Journal of Molecular Sciences N2 - Based on recent findings that show that depletion of factor XII (FXII) leads to better posttraumatic neurological recovery, we studied the effect of FXII-deficiency on post-traumatic cognitive and behavioral outcomes in female and male mice. In agreement with our previous findings, neurological deficits on day 7 after weight-drop traumatic brain injury (TBI) were significantly reduced in FXII\(^{−/−}\) mice compared to wild type (WT) mice. Also, glycoprotein Ib (GPIb)-positive platelet aggregates were more frequent in brain microvasculature of WT than FXII\(^{−/−}\) mice 3 months after TBI. Six weeks after TBI, memory for novel object was significantly reduced in both female and male WT but not in FXII\(^{−/−}\) mice compared to sham-operated mice. In the setting of automated home-cage monitoring of socially housed mice in IntelliCages, female WT mice but not FXII\(^{−/−}\) mice showed decreased exploration and reacted negatively to reward extinction one month after TBI. Since neuroendocrine stress after TBI might contribute to trauma-induced cognitive dysfunction and negative emotional contrast reactions, we measured peripheral corticosterone levels and the ration of heart, lung, and spleen weight to bodyweight. Three months after TBI, plasma corticosterone levels were significantly suppressed in both female and male WT but not in FXII\(^{−/−}\) mice, while the relative heart weight increased in males but not in females of both phenotypes when compared to sham-operated mice. Our results indicate that FXII deficiency is associated with efficient post-traumatic behavioral and neuroendocrine recovery. KW - closed head injury KW - contact-kinin system KW - object recognition memory KW - IntelliCage KW - Crespi effect KW - stress Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-284959 SN - 1422-0067 VL - 22 IS - 9 ER - TY - JOUR A1 - Abboud, Tammam A1 - Asendorf, Thomas A1 - Heinrich, Jutta A1 - Faust, Katharina A1 - Krieg, Sandro M. A1 - Seidel, Kathleen A1 - Mielke, Dorothee A1 - Matthies, Cordola A1 - Ringel, Florian A1 - Rohde, Veit A1 - Szelényi, Andrea T1 - Transcranial versus direct cortical stimulation for motor-evoked potentials during resection of supratentorial tumors under general anesthesia (the TRANSEKT-trial): study protocol for a randomized controlled trial JF - Biomedicines N2 - Background: Monitoring of motor function during surgery for supratentorial tumors under general anesthesia applies either transcranial electrical stimulation (TES) or direct cortical stimulation (DCS) to elicit motor-evoked potentials. To date, there is no guideline that favor one method over the other. Therefore, we designed this randomized study to compare between both methods regarding the prediction of postoperative motor deficits and extent of tumor resection. Methods: This is a multicenter (six centers in Germany and one in Switzerland), double blind, parallel group, exploratory, randomized controlled clinical trial. Patients without or with mild paresis, who are scheduled for surgical resection of motor-eloquent brain tumors under general anesthesia will be randomized to surgical resection under TES or surgical resection under DCS. The primary endpoint is sensitivity and specificity in prognosis of motor function 7 days after surgery. The main secondary endpoint is the extent of tumor resection. The study is planned to include 120 patients within 2 years. Discussion: The present exploratory study should compare TES and DCS regarding sensitivity and specificity in predicting postoperative motor deficit and extent of tumor resection to calculate the required number of patients in a confirmatory trial to test the superiority of one method over the other. KW - threshold criterion KW - amplitude criterion KW - intraoperative monitoring KW - transcranial motor-evoked potentials KW - direct cortical stimulation KW - threshold level Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-248513 SN - 2227-9059 VL - 9 IS - 10 ER - TY - JOUR A1 - Notz, Quirin A1 - Lotz, Christopher A1 - Herrmann, Johannes A1 - Vogt, Marius A1 - Schlesinger, Tobias A1 - Kredel, Markus A1 - Muellges, Wolfgang A1 - Weismann, Dirk A1 - Westermaier, Thomas A1 - Meybohm, Patrick A1 - Kranke, Peter T1 - Severe neurological complications in critically ill COVID‑19 patients JF - Journal of Neurology N2 - No abstract available. KW - COVID-19 KW - neurological complications Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232429 SN - 0340-5354 ER - TY - JOUR A1 - Grosse, Frederik A1 - Rueckriegel, Stefan Mark A1 - Thomale, Ulrich-Wilhelm A1 - Hernáiz Driever, Pablo T1 - Mapping of long-term cognitive and motor deficits in pediatric cerebellar brain tumor survivors into a cerebellar white matter atlas JF - Child's Nervous System N2 - Purpose Diaschisis of cerebrocerebellar loops contributes to cognitive and motor deficits in pediatric cerebellar brain tumor survivors. We used a cerebellar white matter atlas and hypothesized that lesion symptom mapping may reveal the critical lesions of cerebellar tracts. Methods We examined 31 long-term survivors of pediatric posterior fossa tumors (13 pilocytic astrocytoma, 18 medulloblastoma). Patients underwent neuronal imaging, examination for ataxia, fine motor and cognitive function, planning abilities, and executive function. Individual consolidated cerebellar lesions were drawn manually onto patients’ individual MRI and normalized into Montreal Neurologic Institute (MNI) space for further analysis with voxel-based lesion symptom mapping. Results Lesion symptom mapping linked deficits of motor function to the superior cerebellar peduncle (SCP), deep cerebellar nuclei (interposed nucleus (IN), fastigial nucleus (FN), ventromedial dentate nucleus (DN)), and inferior vermis (VIIIa, VIIIb, IX, X). Statistical maps of deficits of intelligence and executive function mapped with minor variations to the same cerebellar structures. Conclusion We identified lesions to the SCP next to deep cerebellar nuclei as critical for limiting both motor and cognitive function in pediatric cerebellar tumor survivors. Future strategies safeguarding motor and cognitive function will have to identify patients preoperatively at risk for damage to these critical structures and adapt multimodal therapeutic options accordingly. KW - VLSM KW - lesion symptom mapping KW - brain tumor KW - childhood KW - adolescence KW - cognitive function KW - executive function Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-307416 SN - 0256-7040 SN - 1433-0350 VL - 37 IS - 9 ER - TY - JOUR A1 - Lange, Florian A1 - Steigerwald, Frank A1 - Malzacher, Tobias A1 - Brandt, Gregor Alexander A1 - Odorfer, Thorsten Michael A1 - Roothans, Jonas A1 - Reich, Martin M. A1 - Fricke, Patrick A1 - Volkmann, Jens A1 - Matthies, Cordula A1 - Capetian, Philipp D. T1 - Reduced Programming Time and Strong Symptom Control Even in Chronic Course Through Imaging-Based DBS Programming JF - Frontiers in Neurology N2 - Objectives: Deep brain stimulation (DBS) programming is based on clinical response testing. Our clinical pilot trial assessed the feasibility of image-guided programing using software depicting the lead location in a patient-specific anatomical model. Methods: Parkinson's disease patients with subthalamic nucleus-DBS were randomly assigned to standard clinical-based programming (CBP) or anatomical-based (imaging-guided) programming (ABP) in an 8-week crossover trial. Programming characteristics and clinical outcomes were evaluated. Results: In 10 patients, both programs led to similar motor symptom control (MDS-UPDRS III) after 4 weeks (medicationOFF/stimulationON; CPB: 18.27 ± 9.23; ABP: 18.37 ± 6.66). Stimulation settings were not significantly different, apart from higher frequency in the baseline program than CBP (p = 0.01) or ABP (p = 0.003). Time spent in a program was not significantly different (CBP: 86.1 ± 29.82%, ABP: 88.6 ± 29.0%). Programing time was significantly shorter (p = 0.039) with ABP (19.78 ± 5.86 min) than CBP (45.22 ± 18.32). Conclusion: Image-guided DBS programming in PD patients drastically reduces programming time without compromising symptom control and patient satisfaction in this small feasibility trial. KW - directional deep brain stimulation KW - image-guided programming KW - subthalamic nucleus KW - chronic stimulation KW - randomized controlled double-blind study KW - Parkinson's disease Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-249634 SN - 1664-2295 VL - 12 ER - TY - JOUR A1 - Weiland, Judith A1 - Beez, Alexandra A1 - Westermaier, Thomas A1 - Kunze, Ekkehard A1 - Sirén, Anna-Leena A1 - Lilla, Nadine T1 - Neuroprotective strategies in aneurysmal subarachnoid hemorrhage (aSAH) JF - International Journal of Molecular Sciences N2 - Aneurysmal subarachnoid hemorrhage (aSAH) remains a disease with high mortality and morbidity. Since treating vasospasm has not inevitably led to an improvement in outcome, the actual emphasis is on finding neuroprotective therapies in the early phase following aSAH to prevent secondary brain injury in the later phase of disease. Within the early phase, neuroinflammation, thromboinflammation, disturbances in brain metabolism and early neuroprotective therapies directed against delayed cerebral ischemia (DCI) came into focus. Herein, the role of neuroinflammation, thromboinflammation and metabolism in aSAH is depicted. Potential neuroprotective strategies regarding neuroinflammation target microglia activation, metalloproteases, autophagy and the pathway via Toll-like receptor 4 (TLR4), high mobility group box 1 (HMGB1), NF-κB and finally the release of cytokines like TNFα or IL-1. Following the link to thromboinflammation, potential neuroprotective therapies try to target microthrombus formation, platelets and platelet receptors as well as clot clearance and immune cell infiltration. Potential neuroprotective strategies regarding metabolism try to re-balance the mismatch of energy need and supply following aSAH, for example, in restoring fuel to the TCA cycle or bypassing distinct energy pathways. Overall, this review addresses current neuroprotective strategies in aSAH, hopefully leading to future translational therapy options to prevent secondary brain injury. KW - subarachnoid hemorrhage (SAH) KW - inflammation KW - thromboinflammation KW - metabolism KW - neuroprotection KW - therapy Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260755 SN - 1422-0067 VL - 22 IS - 11 ER - TY - JOUR A1 - Gugel, Isabel A1 - Grimm, Florian A1 - Hartjen, Philip A1 - Breun, Maria A1 - Zipfel, Julian A1 - Liebsch, Marina A1 - Löwenheim, Hubert A1 - Ernemann, Ulrike A1 - Kluwe, Lan A1 - Mautner, Victor-Felix A1 - Tatagiba, Marcos A1 - Schuhmann, Martin Ulrich T1 - Risk stratification for immediate postoperative hearing loss by preoperative BAER (brainstem auditory evoked response) and audiometry in NF2-associated vestibular schwannomas JF - Cancers N2 - Both brainstem auditory evoked potentials (BAEP) and audiometry play a crucial role in neuro-oncological treatment decisions in Neurofibromatosis Type 2 associated (NF2) vestibular schwannoma (VS) as hearing preservation is the major goal. In this study, we investigated the risk of immediate postoperative hearing deterioration (>15 dB and/or 15% loss in pure-tone average [PTA]/ speech discrimination score [SDS] in a cohort of 100 operated VS (ears) in 72 NF2 patients by retrospective analysis of pre- and postoperative hearing data (PTA, SDS, American Association of Otolaryngology–Head and Neck Surgery [AAO-HNS], and brainstem auditory evoked potential [BAEP] class) taking into account relevant influencing factors, particularly preoperative audiometry and BAEP status and the extent of resection. Immediately after surgery, the hearing was preserved in 73% of ears and approximately ~60% of ears kept their hearing classes. Preoperative BAEP (p = 0.015) and resection amount (p = 0.048) significantly influenced postoperative hearing outcome. The prediction model for postoperative hearing deterioration/loss between preoperative BAEP and AAO-HNS class showed increased risk by increasing BAEP class. Twenty-one tumors/ears were identified with large BAEP and AAO-HNS class discrepancies (≥2 points) and were associated with a high (48–100%) risk of deafness after surgery in ears with preoperative available hearing. Overall, the results were heterogeneous but the better both BAEP and audiometry class before surgery, the higher the chance of hearing maintenance afterwards. Large resection amounts (e.g., 100% risk in near-total resections) exhibit a significant (p < 0.05) higher risk compared to smaller amounts (e.g., 10/20% in laser-coagulated/partially resected tumors). Our results emphasized the indispensable role of both hearing monitoring in form of audiometry and neurophysiology (BAEP) in the pre-and perioperative monitoring of NF2-associated VS. Both BAEP and audiometry are good prognostic markers for the postoperative hearing outcome. The extent of resection should be strictly guided by and adjusted to the intraoperative neurophysiological monitoring. KW - hearing preservation KW - neurofibromatosis type 2 KW - vestibular schwannoma KW - audiometry KW - brainstem auditory evoked potentials Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234165 SN - 2072-6694 VL - 13 IS - 6 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 - TY - JOUR A1 - Linsenmann, Thomas A1 - März, Alexander A1 - Dufner, Vera A1 - Stetter, Christian A1 - Weiland, Judith A1 - Westermaier, Thomas T1 - Optimization of radiation settings for angiography using 3D fluoroscopy for imaging of intracranial aneurysms JF - Computer Assisted Surgery N2 - Mobile 3D fluoroscopes have become increasingly available in neurosurgical operating rooms. We recently reported its use for imaging cerebral vascular malformations and aneurysms. This study was conducted to evaluate various radiation settings for the imaging of cerebral aneurysms before and after surgical occlusion. Eighteen patients with cerebral aneurysms with the indication for surgical clipping were included in this prospective analysis. Before surgery the patients were randomized into one of three different scan protocols according (default settings of the 3D fluoroscope): Group 1: 110 kV, 80 mA (enhanced cranial mode), group 2: 120 kV, 64 mA (lumbar spine mode), group 3: 120 kV, 25 mA (head/neck settings). Prior to surgery, a rotational fluoroscopy scan (duration 24 s) was performed without contrast agent followed by another scan with 50 ml of intravenous iodine contrast agent. The image files of both scans were transferred to an Apple PowerMac(R) workstation, subtracted and reconstructed using OsiriX(R) MD 10.0 software. The procedure was repeated after clip placement. The image quality regarding preoperative aneurysm configuration and postoperative assessment of aneurysm occlusion and vessel patency was analyzed by 2 independent reviewers using a 6-grade scale. This technique quickly supplies images of adequate quality to depict intracranial aneurysms and distal vessel patency after aneurysm clipping. Regarding these features, a further optimization to our previous protocol seems possible lowering the voltage and increasing tube current. For quick intraoperative assessment, image subtraction seems not necessary. Thus, a native scan without a contrast agent is not necessary. Further optimization may be possible using a different contrast injection protocol. KW - 3D fluoroscopy KW - aneurysm KW - fluoroscopy KW - intraoperative imaging Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259251 VL - 26 IS - 1 ER - TY - JOUR A1 - Mrestani, Achmed A1 - Pauli, Martin A1 - Kollmannsberger, Philip A1 - Repp, Felix A1 - Kittel, Robert J. A1 - Eilers, Jens A1 - Doose, Sören A1 - Sauer, Markus A1 - Sirén, Anna-Leena A1 - Heckmann, Manfred A1 - Paul, Mila M. T1 - Active zone compaction correlates with presynaptic homeostatic potentiation JF - Cell Reports N2 - Neurotransmitter release is stabilized by homeostatic plasticity. Presynaptic homeostatic potentiation (PHP) operates on timescales ranging from minute- to life-long adaptations and likely involves reorganization of presynaptic active zones (AZs). At Drosophila melanogaster neuromuscular junctions, earlier work ascribed AZ enlargement by incorporating more Bruchpilot (Brp) scaffold protein a role in PHP. We use localization microscopy (direct stochastic optical reconstruction microscopy [dSTORM]) and hierarchical density-based spatial clustering of applications with noise (HDBSCAN) to study AZ plasticity during PHP at the synaptic mesoscale. We find compaction of individual AZs in acute philanthotoxin-induced and chronic genetically induced PHP but unchanged copy numbers of AZ proteins. Compaction even occurs at the level of Brp subclusters, which move toward AZ centers, and in Rab3 interacting molecule (RIM)-binding protein (RBP) subclusters. Furthermore, correlative confocal and dSTORM imaging reveals how AZ compaction in PHP translates into apparent increases in AZ area and Brp protein content, as implied earlier. KW - active zone KW - Bruchpilot KW - RIM-binding protein KW - compaction KW - homeostasis KW - presynaptic plasticity KW - super-resolution microscopy Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265497 VL - 37 IS - 1 ER - TY - JOUR A1 - Salvador, Ellaine A1 - Burek, Malgorzata A1 - Löhr, Mario A1 - Nagai, Michiaki A1 - Hagemann, Carsten A1 - Förster, Carola Y. T1 - Senescence and associated blood-brain barrier alterations in vitro JF - Histochemistry and Cell Biology N2 - Progressive deterioration of the central nervous system (CNS) is commonly associated with aging. An important component of the neurovasculature is the blood-brain barrier (BBB), majorly made up of endothelial cells joined together by intercellular junctions. The relationship between senescence and changes in the BBB has not yet been thoroughly explored. Moreover, the lack of in vitro models for the study of the mechanisms involved in those changes impede further and more in-depth investigations in the field. For this reason, we herein present an in vitro model of the senescent BBB and an initial attempt to identify senescence-associated alterations within. KW - senescence KW - in vitro model KW - aging KW - CNS diseases KW - blood–brain barrier Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-267435 SN - 1432-119X VL - 156 IS - 3 ER - TY - THES A1 - Weidner, Franziska T1 - Therapeutische Hyperkapnie bei aneurysmatischer Subarachnoidalblutung (SAB) : Evaluation der optimalen Hyperkapniedauer T1 - Dose Optimization Study of Therapeutic Hypercapnia for Prevention of Secondary Ischemia After Severe Subarachnoid Hemorrhage N2 - In einer vorangegangenen Phase-1-Studie wurde beobachtet, dass bei Patienten mit schwerer aneurysmatischer SAB, die CBF durch intermittierende kontrollierte Hyperkapnie erhöht werden kann. Zudem zeigte sich in dieser vorherigen Studie nach dem Zurücksetzen der mechanischen Beatmung auf die Ausgangsparameter eine langsame und asymptotische Rückkehr der CBF zu den Ausgangsniveaus ohne einen negativen Rebound-Effekt. Diese Beobachtung legte nahe, dass eine längere Dauer der Hyperkapnie den CBF-erhöhenden Effekt verlängern kann. Die vorliegende Studie wurde als Dosisoptimierungsstudie geplant, um den Zeitpunkt zu bestimmen, zu dem der CBF ein Maximum erreicht, und unter der Annahme, dass nach diesem Maximum Puffermechanismen in Blut und Liquor zu Anpassungsmechanismen führen können, die nach dem Abbruch zu einem negativen Rebound-Effekt führen. Es ergab sich eine "Netto" - Optimaldauer der Hyperkapnieintervention von 45 Minuten. N2 - In a previous phase 1 study, it was observed that CBF can be increased by intermittent controlled hypercapnia in the days after aneurysm rupture in patients with poor to very poor SAB. After resetting mechanical ventilation to baseline parameters, CBF showed a slow and asymptotic return to baseline values without a negative rebound effect. This observation suggests that a longer duration of hypercapnia may prolong the CBF-increasing effect. This study was designed as a dose-optimization study to identify the time point at which CBF reaches a maximum and under the assumption that after this maximum, buffering mechanisms in blood and CSF could lead to adaptation mechanisms that result in a negative rebound effect after cessation of the hypercapnic challenge. An optimal duration of hypercapnia of 45 minutes was noted. KW - Hyperkapnie KW - Subarachnoidalblutung Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-238696 ER - TY - JOUR A1 - Pauli, Martin A1 - Paul, Mila M. A1 - Proppert, Sven A1 - Mrestani, Achmed A1 - Sharifi, Marzieh A1 - Repp, Felix A1 - Kürzinger, Lydia A1 - Kollmannsberger, Philip A1 - Sauer, Markus A1 - Heckmann, Manfred A1 - Sirén, Anna-Leena T1 - Targeted volumetric single-molecule localization microscopy of defined presynaptic structures in brain sections JF - Communications Biology N2 - Revealing the molecular organization of anatomically precisely defined brain regions is necessary for refined understanding of synaptic plasticity. Although three-dimensional (3D) single-molecule localization microscopy can provide the required resolution, imaging more than a few micrometers deep into tissue remains challenging. To quantify presynaptic active zones (AZ) of entire, large, conditional detonator hippocampal mossy fiber (MF) boutons with diameters as large as 10 mu m, we developed a method for targeted volumetric direct stochastic optical reconstruction microscopy (dSTORM). An optimized protocol for fast repeated axial scanning and efficient sequential labeling of the AZ scaffold Bassoon and membrane bound GFP with Alexa Fluor 647 enabled 3D-dSTORM imaging of 25 mu m thick mouse brain sections and assignment of AZs to specific neuronal substructures. Quantitative data analysis revealed large differences in Bassoon cluster size and density for distinct hippocampal regions with largest clusters in MF boutons. Pauli et al. develop targeted volumetric dSTORM in order to image large hippocampal mossy fiber boutons (MFBs) in brain slices. They can identify synaptic targets of individual MFBs and measured size and density of Bassoon clusters within individual untruncated MFBs at nanoscopic resolution. KW - mossy fiber synapses KW - CA3 pyrimidal cells KW - CA2+ channels KW - active zone KW - hippocampal KW - release KW - plasticity KW - proteins KW - platform KW - reveals Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259830 VL - 4 ER - TY - THES A1 - Gross, Franziska T1 - Verstärkung von Tumor Treating Fields durch Inhibition der MPS1 Kinase in Glioblastom-Zelllinien T1 - Augmentation of Tumor-Treating-Field (TTField) effects on glioblastoma cells by MPS1 inhibition N2 - Tumor Treating Fields (TTFields) sind alternierende Wechselfelder mit einer intermediären Frequenz und niedrigen Intensität, die zu einer Destabilisierung des Spindelapparates während der Mitose führen. Sie sind als zusätzliche Behandlungsoption bei Glioblastoma multiforme zugelassen. Der mitotische Spindelkontrollpunkt überwacht eine fehlerhafte Anheftung der Spindelfasern von Schwesterchromatiden und leitet Reparaturprozesse ein. Monopolar spindle 1 (MPS1) ist eine Schlüsselkomponente dieses Kontrollpunktes und kann den durch TTFields physikalisch induzierten Spindelschäden entgegenwirken. Durch Zellzahlmessung, Zellzyklusuntersuchungen und durchflusszytometrische Analysen als auch Fluoreszenzfärbungen konnte gezeigt werden, dass eine Inhibition von MPS1 die antimitotischen Wirkungen von TTFields verstärken kann. N2 - Tumor Treating Fields (TTFields) are alternating electric fields with low intensity and intermediate frequency approved for the therapy of glioblastoma multiforme. TTFields therapy interrupts the spindle formation through mitosis leading to misalignment of chromosomes. Spindle assembly checkpoint (SAC) and its key component monopolar spindle 1 (MPS1) regulate proper chromosomal arrangement and segregation. Here, we show that through the combination of physically interfering spindle formation by TTFields and chemical inhibition of MPS1, TTFields effects can be augmented promising a new target for multimodal treatment in glioblastoma therapy. KW - Tumortherapiefelder KW - Glioblastom KW - Mitose KW - Apoptosis KW - Aneuploidie KW - Spindle assembly checkpoint KW - Monopolar spindle 1 Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-211804 ER - TY - THES A1 - Rinne, Christoph T1 - Ischämie- und Neuroprotektion in der Akutphase der experimentellen Subarachnoidalblutung T1 - Ischemia- and neuroprotection in the acute phase of experimental subarachnoid hemorrhage N2 - Trotz jahrelanger, intensiver Forschung ist es bisher nicht gelungen, die Morbidität und Mortalität der aneurysmatischen Subarachnoidalblutung (SAB) signifikant zu senken. Der Fokus dieser Bemühungen lag in den letzten Jahrzehnten vor allem auf der frühen Erkennung und Behandlung des verzögert, typischerweise zwischen Tag 4 und 14 auftretenden, symptomatischen Vasospasmus´ und somit einer zerebralen Ischämie, die mit einer höheren Rate an klinischen Komplikationen, reduzierter Alltagsaktivität, schlechterer kognitiver Leistungsfähigkeit und einer insgesamt höheren Mortalität einhergeht sowie mit einem insgesamt schlechteren neurologischen Outcome assoziiert ist. Diese Arbeit beschäftigt sich per Tierexperiment mit der Akutphase der SAB und zweier möglicher Therapiestrategien (Hyper-HES und Hypothermie), die möglichst früh im Verlauf angewendet werden und für eine histologisch sowie neurologisch nachweisbare Verbesserung im Gesamtergebnis sorgen können. Insgesamt entsprechen sowohl die osmotischwirksame Therapie mit Hydroxyethylstärke als auch die hypotherme Therapie nach unseren Resultaten der primären Zielsetzung der Studie. Die Möglichkeit einer prinzipiell überall verfügbaren, kostengünstigen und gut steuerbaren Frühphasentherapie nach SAB ohne Kompromittierung der initialen Diagnostik und der klinischen Differentialdiagnosen scheint hier jeweils gegeben zu sein. N2 - Despite years of intensive research, morbidity and mortality from aneurysmal subarachnoid hemorrhage (SAH) was not significantly lowered. The focus of these efforts in recent decades has been primarily on the early detection and treatment of the delayed, typically between day 4 and 14, symptomatic vasospasm and thus cerebral ischemia which is associated with a higher rate of clinical complications, reduced daily activity, worse cognitive performance and overall higher mortality and associated with an overall poorer neurological outcome. This work deals with the acute phase of SAH and two possible therapy strategies (hyper-HES and hypothermia) which are used as early as possible in the course of an animal experiment and can result in a histologically and neurologically demonstrable improvement in the overall result. Overall, both the osmotically effective therapy with hydroxyethyl starch as well as the hypothermic therapy correspond to our results and the primary objective of the study. The possibility of an early-stage therapy after SAH that is available in principle everywhere, is inexpensiv and can be easily controlled without compromising the initial diagnosis and the clinical differential diagnoses seems to be given here. KW - Subarachnoidalblutung KW - Hypothermie KW - Hydroxyethylstärke KW - Tierversuch KW - Hyper-HES KW - Voluven Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-208745 ER - TY - THES A1 - Sutter, Lora T1 - Prospektive Evaluation der Verbesserung neurologischer Funktionsstörungen nach operativer Dekompression bei zervikaler Myelopathie T1 - Prospective evaluation of improvement of neurological dysfunction after operative decompression in cervical myelopathy N2 - Die zervikale spondylotische Myelopathie kann zu schweren neurologischen Funktionsstörungen führen. Vor allem durch die Störung der Feinmotorik und des Gangbilds kann es zu einer Beeinträchtigung im alltäglichen Leben kommen. Eine operative Dekompression des Rückenmarks kann ein Fortschreiten der neurologischen Symptome verhindern oder abmildern. Ziel dieser Studie war die Erfassung unterschiedlicher neurologischer Dysfunktionen bei zervikaler Myelopathie präoperativ sowie die Evaluierung der funktionellen Veränderung nach operativer Dekompression. Hierbei wurden verschiedene - objektive und subjektive - Messmethoden angewandt. Die Erfassung der feinmotorischen Dysfunktion lag dabei im Vordergrund, da diese in der Literatur bis jetzt nur unzureichend untersucht und beschrieben wurden. Daneben wurde die Regeneration der kernspintomographisch gemessenen Schädigung des Myelons nach operativer Dekompression untersucht. In dieser Studie wurde ein digitales Graphiktablett zur quantitativen und objektiven Erfassung der feinmotorischen Dysfunktion bei zervikaler Myelopathie benutzt. Eine Beeinträchtigung der Feinmotorik wurde vor allem bei komplexen Schreibaufgaben festgestellt, welche am ehesten Schreibaufgaben im alltäglichen Leben entsprechen. Im Einklang mit früheren Studien wurde auch in dieser Studie eine Störung des Gangbilds bei Patienten mit zervikaler Myelopathie festgestellt. Die Dauer der Symptome bis zur Operation konnte als einziger signifikanter Einflussfaktor für den Schweregrad der feinmotorischen Dysfunktion ausgemacht werden. Das Geschlecht, der BMI, der Beruf und Sport hatten in dieser Analyse weder einen Einfluss auf den klinischen noch auf den neuroradiologischen Schweregrad der zervikalen Myelopathie. Nach operativer Dekompression verbesserten sich die feinmotorische Funktion sowie das Gangbild der Patienten. Auch die subjektiven Scores zur Erfassung der neurologischen Funktion (European Myelopathy Score, Nurick-Score) sowie die Schmerzen (Numerische Rating-Skala) verbesserten sich postoperativ. Zudem nahm die Länge des pathologischen Signals im MRT ab. Faktoren, die einen Trend zur Korrelation mit den postoperativen Veränderungen der Funktion zeigten, waren das Alter der Patienten und die Symptomdauer. In dieser Studie konnte kein Einfluss des BMIs, der Anzahl der operierten Höhen oder der Art des Operationszugangs festgestellt werden. Obwohl die Anzahl der untersuchten Patienten begrenzt war, gestaltete sich die Gruppe heterogen (Alter, Geschlecht, BMI, Dauer der Symptome). So konnte ein möglichst breites Spektrum an Patienten mit zervikaler Myelopathie untersucht werden. Die wichtigste Limitation dieser Studie war die hohe drop-out Rate in den postoperativen Verlaufsuntersuchungen. Daher konnten die Ergebnisse der Längsschnittanalyse nur an einer kleinen Patientengruppe ermittelt werden und bei der Untersuchung von Einflussfaktoren für das postoperative Ergebnis nur Tendenzen erkannt werden. Ob diese Faktoren einen prognostischen Wert für das postoperative Ergebnis haben, müsste in weiteren Studien an einem größeren Kollektiv untersucht werden. N2 - Spondylotic cervical myelopathy may lead to severe neurological dysfunction. Especially fine motor dysfunction and gait disturbance can cause impairment in everyday life. Operative decompression of the myelon can prevent or attenuate a progression of neurological symptoms. The goal of this study was the assessment of different neurological dysfunctions in cervical myelopathy preoperative and the evaluation of functional changes after operative decompression. Various, objective and subjective, methods of measurement where used. The assessment of fine motor dysfunction was predominant because it has not been investigated and described in detail yet. Furthermore postoperative recovery of pathological findings in MRI after operative decompression was assessed. In this study a digital graphic tablet was used to investigate quantitatively and objectively fine motor dysfunction in cervical myelopathy. Impairment of fine motor function was predominantly found in complex writing tasks, which correspond to writing tasks in everyday life. As shown in previous studies we found a gait disturbance in patients with cervical myelopathy. Duration of symptoms until operation was found to be the only significant factor influencing the severity of fine motor dysfunction. Sex, BMI, occupation and sports habits had no affect on the clinical or neuroradiological severity of cervical myelopathy. After operative decompression, fine motor function and gait pattern improved. Also, subjective scores, which assess neurological function (European Myelopathy Score, Nurick score) and pain (numeric rating scale) improved postoperatively. In addition, the length of pathological signal in MRI decreased. Factors that showed a tendency to correlation with postoperative changes of function were age and duration of symptoms. In this study no influence of BMI, number of operated levels or ventral vs. dorsal approach was found. Although the number of patients was limited (n = 28), the group was heterogeneous (age, sex, BMI, duration of symptoms). Thus a relatively broad spectrum of patients with cervical myelopathy could be assessed. The most important limitation of this study was the high drop out rate in the postoperative follow-up. Therefore the results of the longitudinal analysis could only be assessed in a small group of patients, and in the assessment of factors influencing the postoperative changes only tendencies could be found. If these factors have a prognostic value for the postoperative outcome should be investigated in further studies with a larger group of patients. KW - Myelopathie KW - Feinmotorik KW - Graphiktablett KW - Zervikale Myelopathie KW - Störungen der Feinmotorik KW - kinematische Parameter KW - digitales Graphiktablett Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-199933 ER - TY - THES A1 - Fett, Susanne T1 - Expression der mitotischen Regulatorproteine Pds5A, Pds5B, Mad2A und Mad2B in astrozytären Tumoren im Kontext der chromosomalen Instabilität, Tumorprogression und Patientenprognose T1 - Expression of the mitotic regulating proteins Pds5A, Pds5B, Mad2A and Mad2B in astrocytic tumors in the context of chromosomal instability, tumor progression and patient prognosis N2 - Die zunehmende Bedeutung der Molekularbiologie zeigt sich in der neuen WHO-Klassifikation von 2016 für ZNS-Tumoren und insbesondere astrozytäre Tumoren. Dabei gehört das Glioblastoma multiforme (GBM) mit einer äußerst ungünstigen Prognose zu den hoch-malignen Astrozytomen (WHO °IV) und ist durch eine ausgeprägte chromosomale Instabilität (CIN) gekennzeichnet. Der mitotische Spindelkontrollpunkt (SAC) und die zeitlich korrekte Auflösung der Schwesterchromatidkohäsion sorgen normalerweise für den fehlerfreien Ablauf der Mitose. Um der Ursache der CIN nachzugehen, wurden die Regulatorproteine des SAC Mad2A und Mad2B sowie der Schwesterchromatidkohäsion Pds5A und Pds5B in einem Patientenpanel immunhistochemisch untersucht. Alle vier Proteine wiesen eine hohe Expression in Proliferationszentren auf, die durch Ki67-Expression definiert wurden. Zusätzlich wurden Unterschiede in der Expressionsstärke bzw. der subzellulären Lokalisation detektiert. Pds5A könnte für die Ausbildung von Rezidiven niedriggradiger Astrozytome (low-grade astrozytoma, LGA) °II bzw. von sekundären GBM wichtig sein. Sein Ortholog war in allen Tumorentitäten gleichmäßig hoch exprimiert. Eine starke Mad2A-Expression war in allen GBM im Vergleich zu allen LGA °II signifikant vermindert und könnte durch den in GBM häufig vorkommenden Verlust von Chromosomenarm 4q bedingt sein, der das Mad2A-Gen enthält. Für sein Homolog Mad2B konnte ein signifikanter Anstieg in der Gesamt- bzw. Zytoplasmaexpression mit steigendem WHO-Grad ermittelt werden. Eine niedrige Gesamtexpression von Mad2A bzw. von Mad2B in Kern- und Zytoplasma könnte mit einem Überlebensvorteil für GBM-Patienten verbunden sein. Je nach Entität, Expressionsstärke und Expressionslokalisation gab es Korrelationen zwischen der Expression von Ki67, Pds5A, Pds5B, Mad2A und Mad2B. Die Expressionswerte dieser mitotischen Regulatorproteine könnten einerseits der Grund für, andererseits aber auch eine Konsequenz von CIN sein und eine Anpassung der Tumorzellen zur Ausbalancierung der Vor- und Nachteile genetischer Veränderungen darstellen, die ihr Überleben sichert (Rimkus et al., 2007). Damit könnten diese Regulatorproteine als neue Angriffspunkte einer noch spezifischeren Therapie in der Behandlung von astrozytären Tumoren und für die Prognose von Patienten Bedeutung erlangen. N2 - The increasing relevance of molecular biology is shown in the latest 2016 WHO-Classification of Tumors of the Central Nervous System especially in regards to astrocytic tumors. Astrocytic tumors show aneuploidy. Pds5A, Pds5B, Mad2A and Mad2B have an important influence and impact on the correct segregation of chromosomes during mitosis. Precocious dissociation of sisters 5 A and B (Pds5A and B) bind to Cohesin and are part of the regulation of sister chromatid cohesion. Mitotic arrest deficient 2 A and B (Mad2A and B) are essential key-proteins for the spindle assembly checkpoint. Incorrect expression of these proteins leads to missegregation and aneuploidy. In this work I show the expression of the proteins Pds5A, Pds5B, Mad2A and Mad2B by immunohistochemistry in proliferating centers of tissue samples of 40 patients with astrocytic tumors (low-grade astroytoma (LGA °II) and glioblastoma multiforme (GBM)). Tissue samples comprise dormant LGA °II, recurrent LGA °II and their relapses, malignant progressing LGA °II developing to secondary GBM (IDH-mutant GBM), and primary GBM (IDH-wildtype GBM). All proteins showed high expression in the proliferating centers. The expressions of the different astrocytic grades have been statistically analysed (Comparison, Survival, Correlation). The results of the expression of the regulating proteins could be relevant for new therapies and the prognosis of patients. KW - Tumor KW - Astrozytom KW - Mitose KW - Aneuploidie KW - Astrozytäre Tumore KW - Immunhistochemie KW - Pds5A und Pds5B KW - Mad2A und Mad2B Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-205416 ER - TY - THES A1 - Conrads, Nora T1 - Auswertung der Schraubenposition nach navigierter, O-Arm-kontrollierter spinaler Instrumentierung T1 - Evaluation of pedicle screw insertion accuracy using O-arm navigation N2 - In dieser Studie wurden retrospektiv zwischen Juni 2010 und Juni 2015 die Schrauben bezüglich ihrer Lage und Länge nach navigierter, O-Arm kontrollierter dorsaler Stabilisierung der Wirbelsäule untersucht. In diesem Zeitraum wurden in der Neurochirurgie des Universitätsklinikums Würzburg 2666 Schrauben bei 433 Patienten in 413 Operationen platziert, wobei 2618 Schrauben in dieser Studie ausgewertet werden konnten. Gründe für eine operative Stabilisierung der Wirbelsäule waren im Gesamtkollektiv mit 58,43% am häufigsten degenerative Veränderungen gefolgt von Traumata mit 21,94%, Tumorerkrankungen mit 11,78% und entzündlichen Veränderungen mit 7,85%. Im Bereich der HWS waren die häufigsten Operationsindikationen traumatische Verletzungen mit 46,06%, auf Höhe der BWS Tumordiagnosen mit 46,77% und im Bereich der LWS degenerative Veränderungen mit 76,82%. Die Schrauben wurden auf Höhe der BWS und LWS bezüglich ihrer Lage nach der etablierten Einteilung von Zdichavsky et al. klassifiziert. Die Grundlage dieser Klassifikation ist die Relation der Pedikelschraube zum Pedikel und die Relation der Pedikelschraube zum Wirbelkörper, wobei eine korrekte 1a-Lage vorliegt, wenn mindestens die Hälfte des Pedikelschraubendurchmessers innerhalb des Pedikels und mindestens die Hälfte des Pedikelschraubendurchmessers innerhalb des Wirbelkörpers liegt. Im Bereich der BWS lagen bereits nach dem ersten intraoperativen Scan 89,72% der Schrauben in einer 1a-Lage, nach intraoperativer Revision von 41 Schrauben sogar 93,03% der Schrauben. Auf Höhe der LWS lagen nach dem 1. intraoperativen Scan 94,88% in einer 1a-Lage, nach intraoperativer Revision von 37 Schrauben konnte der Anteil an 1a-Lagen auf 96,14% erhöht werden. In Anlehnung an die Klassifikation von Zdichavsky et al. entstand eine neue Klassifikation für die HWS mit der Überlegung, dass die Stabilität und die Gefahr für neurologische und vaskuläre Komplikationen durch die Lage der Schrauben im Knochen definiert werden kann. Auch hier liegt eine korrekte 1a-Lage vor, wenn mindestens die Hälfte des Schraubendurchmessers innerhalb des Pedikels bzw. der Massa lateralis verläuft. Nach dem ersten intraoperativen Scan lagen bereits 93,93% der Schrauben in einer 1a-Lage, nach intraoperativer Revision von 32 Schrauben lagen sogar 96,20% der Schrauben in einer 1a-Lage. Die Bewertung der Schraublänge erfolgte relativ zur Länge des Schraubeneintrittspunkts und der Vorderkante des Wirbelkörpers, wobei alle Schraubenlängen zwischen 85% und 100% als „gut“ eingestuft wurden. Im Bereich der HWS hatten demnach zu Operationsende 65,62% der Schrauben eine gute Lange, in der BWS 69,72% und in der LWS 71,92%. Aufgrund einer primären Fehllage mussten lediglich 2 Schrauben (0,08% aller Schrauben) bei einem Patienten in einer Folgeoperation revidiert werden, wobei diese Fehllage retrospektiv auch in der initialen intraoperativen Bildgebung hätte erkannt werden können. Weitere Parameter wie Operationsdauer und Operationsart, Anzahl an intraoperativer Bildgebung sowie Anzahl der verschraubten Wirbelsegmente oder intraoperative Komplikationen wurden untersucht. In der klinischen Verlaufskontrolle zeigte sich außerdem eine signifikante Verbesserung der Schmerzen, nämlich in jeder Kategorie (Bein-, Arm-, Rücken-, Nackenschmerzen) gaben mindestens 75% der nachkontrollierten Patienten eine Komplettremission oder relevante Verbesserung der Symptome an. Auch in der neurologischen Verlaufskontrolle zeigte sich bei 68,86% der Patienten in der Nachkontrolle eine Komplettremission bzw. signifikante Verbesserung der neurologischen Beschwerden. In der postoperativen radiologischen Abschlussuntersuchung zeigten sich lediglich bei 3,07% der Schrauben Auffälligkeiten in Form von Schraubenlockerung (2,40%), Schraubendislokation (0,49%) oder Schraubenbrüchen (0,19%). N2 - In this study we retrospectively analyzed the placement and length of pedicle screws after O-arm guided dorsal stabilisation at Wuerzburg Medical University Hospital between June 2010 and June 2015. Within this timeframe a total amount of 2666 pedicle screws were placed treating 433 patients who underwent 413 surgical procedures at the Department of Neurosurgery. For the whole collective our surgical indications included in descending order degenerative spine disorders (58,43 %), trauma (21,94%), spinal malignancy (11,78%) and spinal infection (7,85%). The prevalence of indications varied by region, for the cervical spine the most common indication was trauma (46,06%), whereas for the thoracic spine malignancy (46,77%) was the most common indication, followed by degenerative spine disorders (76,82%) as the main indication for surgery in the lumbar spine. The accuracy of pedicle screw placement in the lumbar and thoracic spine was classified by the established classification system by Zdichavsky et al.. Basis for this classification system is the screw's positioning in relation to the pedicle and in relation to the vertebral body. A perfect 1a positioning is achieved if the screw is placed with a minimum of 50% of its diameter within the pedicle and also with a minimum of 50% of its diameter in the vertebral body. In the thoracic spine 89,72% of the screws had a 1a positioning in the initial intraoperative scan, after intraoperative repositioning of 41 screws this number even climbed to 93,03%. In the lumbar spine region 94,88% of the screws showed a perfect 1a positioning in the initial intraoperative scan, 37 screws were repositioned so that the share of 1a positions even rised to 96,14%. Following the classification of Zdichavsky et al. a new classification system for the cervical spine has been developed bearing in mind that the stability and the risk of neurological and vascular complications could be defined by the positioning of screws within in the bone. Also in the cervical spine, a perfect 1a positioning is achieved by placing a minimum of 50% of the screw diameter within the pedicle or the lateral mass. In the initial intraoperative scan 93,93% of the screws had been placed perfectly in a 1a position, after intraoperative repositioning of 32 screws a total share of 96,20% achieved the criteria for a 1a position. The screw length was evaluated in relation to the length between the screw's entry point and the anterior vertebral body wall, whereby all screw lengths between 85% and 100% were considered "good". A "good" position at the end of the surgery could be achieved in 65,62 % in the cervical spine, in 69,72% in the thoracic spine and in 71,92% in the lumbar spine. Due to an initial misplacement only 2 screws had to be revised (0,08% of all screws) in an additional surgical procedure for one patient, albeit this misplacement retrospectively could have been discovered in the initial intraoperative scan. Additional parameters like duration of the surgical procedure, type of procedure, number of intraoperative scans, number of fused spine segments or intraoperative complications have been evaluated. Assessing the clinical outcome the results showed a significant improvement of pain levels. In every category (leg, arm, back and neck pain) a minimum of 75% of the evaluated patients showed a complete remission or a relevant alleviation of symptoms. Also in the neurological follow-up 68,86 % of patients showed a complete remission or a relevant improvement of neurological symptoms. In the postoperative radiological scan only 3,07% showed noticeable findings like screw loosening (2,40%), screw dislocation (0,49%) or broken screws (0,19%). KW - Neurochirurgie KW - Wirbelsäule KW - Zdichavsky KW - Neuronavigation KW - Revision KW - O-Arm KW - Schraubenlage KW - Schrauben-Stab-Osteosynthese KW - Pedikelschraube Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-217147 ER - TY - THES A1 - Hennig, Nelli T1 - Einfluss des Sphingosin-1-Phosphat-Rezeptor Modulators FTY720 auf Hirnschaden und Inflammation in einem Mausmodell der fokalen kortikalen Kälteläsion T1 - Influence of sphingosine-1-phosphate-receptor modulator FTY720 on brain damage and inflammation in a murine cryogenic lesion model N2 - In Anbetracht der Tatsache, dass das SHT weltweit mit steigender Inzidenz die häufigste Todesursache für junge Erwachsene darstellt, in einer Vielzahl davon mit langfristigen Folgen assoziiert ist und dabei mit großen ökonomischen Kosten verbunden ist, spielt die Erforschung der pathophysiologischen Vorgänge bei einem SHT sowie die Entwicklung effektiver Therapiestrategien akuter und chronischer Natur eine große Rolle. Da sich in den letzten Jahren gezeigt hat, dass die Reaktion des Immunsystems nach akuten Traumata ebenfalls eine bedeutsame Rolle spielt und somit in der Modulation der Immunantwort ein hilfreicher therapeutischer Ansatz liegen könnte, wurde in dieser Arbeit der als MS-Immuntherapeutikum zugelassene S1P Rezeptor Modulator FTY720 auf seine potentiellen neuroprotektiven Effekte im Rahmen eines murinen fokalen SHT-Modell untersucht. So wurde das in unserer Arbeitsgruppe bereits seit langem etablierte Modell der fokalen kortikalen Kälteläsion genutzt um bei jungen adulten männlichen Mäusen die Effekte von FTY720 in Bezug auf die Akutphase 24 h nach lokalen SHT festzustellen. Hierbei konnte kein positiver Einfluss auf das Ausmaß des lokalen Schadens, gemessen anhand von TTC-Läsionsvolumen und neuronalem Zelltod, sowie für die Störung der BHS mit konsekutiver Ödembildung beobachtet werden. Dabei wurden keine funktionellen Parameter als Korrelat für die erhaltenen Ergebnisse getestet. In Bezug auf die Immunzellinfiltration konnte eine signifikante Reduktion der immunhistochemisch untersuchten Zellpopulationen von Neutrophilen, Makrophagen und aktivierten Mikroglia 24 h nach Trauma festgestellt werden und somit zumindest die korrekte Applikation des Medikaments in adäquater Dosierung und die therapeutische Wirkung als Blockierer des Abwehrzell-Ausstroms von den lymphatischen Organen in die Blutbahn belegt werden. N2 - In view of the fact, that traumatic brain injury has an increasing incidence and the highest mortality for young adults worldwide, the research of pathophysiological processes plays an important role for developing effective therapy strategies. The last years have shown that the reaction of our immune system after acute brain traumata is important. Therefore, modulation of immune response is a helpful approach for developing medication treating patients who suffer under traumatic brain injury. In this doctoral thesis an approved medication for multiple sclerosis named FTY720 was investigated on its neuroprotective effects after focal traumatic brain injury. The effects of this sphingosine-1-phosphate-receptor modulator have been studied on young adult male mice 24 hours after focal traumatic brain injury using the well-established model of cryogenic lesion. Several parameters have been investigated. First, no positive influence could be found on the extent of brain damage measured by TTC-lesion volume and neuronal death. Second, no positive influence was discovered on blood-brain-barrier damage and consecutive oedema formation. However, a significant reduction concerning immune cell infiltration was recorded on the cell populations of neutrophils, macrophages und activated microglia. Therefore, at least correct application, adequate dosage and therapeutic effect of FTY720 as blocking agent of immune cells out of lymphatic organs into the blood stream was proven KW - Schädel-Hirn-Trauma KW - FTY720 Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-216573 ER - TY - JOUR A1 - Feldheim, Jonas A1 - Kessler, Almuth F. A1 - Schmitt, Dominik A1 - Salvador, Ellaine A1 - Monoranu, Camelia M. A1 - Feldheim, Julia J. A1 - Ernestus, Ralf-Ingo A1 - Löhr, Mario A1 - Hagemann, Carsten T1 - Ribosomal Protein S27/Metallopanstimulin-1 (RPS27) in Glioma — A New Disease Biomarker? JF - Cancers N2 - Despite its significant overexpression in several malignant neoplasms, the expression of RPS27 in the central nervous system (CNS) is widely unknown. We identified the cell types expressing RPS27 in the CNS under normal and disease conditions. We acquired specimens of healthy brain (NB), adult pilocytic astrocytoma (PA) World Health Organization (WHO) grade I, anaplastic PA WHO grade III, gliomas WHO grade II/III with or without isocitrate dehydrogenase (IDH) mutation, and glioblastoma multiforme (GBM). RPS27 protein expression was examined by immunohistochemistry and double-fluorescence staining and its mRNA expression quantified by RT-PCR. Patients’ clinical and tumor characteristics were collected retrospectively. RPS27 protein was specifically expressed in tumor cells and neurons, but not in healthy astrocytes. In tumor tissue, most macrophages were positive, while this was rarely the case in inflamed tissue. Compared to NB, RPS27 mRNA was in mean 6.2- and 8.8-fold enhanced in gliomas WHO grade II/III with (p < 0.01) and without IDH mutation (p = 0.01), respectively. GBM displayed a 4.6-fold increased mean expression (p = 0.02). Although RPS27 expression levels did not affect the patients’ survival, their association with tumor cells and tumor-associated macrophages provides a rationale for a future investigation of a potential function during gliomagenesis and tumor immune response. KW - glioblastoma multiforme KW - low-grade glioma KW - astrocytoma KW - recurrence KW - relapse KW - mRNA KW - protein KW - brain KW - expression KW - MPS1 Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-203648 SN - 2072-6694 VL - 12 IS - 5 ER - TY - JOUR A1 - Curtaz, Carolin J. A1 - Schmitt, Constanze A1 - Herbert, Saskia-Laureen A1 - Feldheim, Jonas A1 - Schlegel, Nicolas A1 - Gosselet, Fabien A1 - Hagemann, Carsten A1 - Roewer, Norbert A1 - Meybohm, Patrick A1 - Wöckel, Achim A1 - Burek, Malgorzata T1 - Serum-derived factors of breast cancer patients with brain metastases alter permeability of a human blood-brain barrier model JF - Fluids and Barriers of the CNS N2 - Background The most threatening metastases in breast cancer are brain metastases, which correlate with a very poor overall survival, but also a limited quality of life. A key event for the metastatic progression of breast cancer into the brain is the migration of cancer cells across the blood-brain barrier (BBB). Methods We adapted and validated the CD34\(^+\) cells-derived human in vitro BBB model (brain-like endothelial cells, BLECs) to analyse the effects of patient serum on BBB properties. We collected serum samples from healthy donors, breast cancer patients with primary cancer, and breast cancer patients with, bone, visceral or cerebral metastases. We analysed cytokine levels in these sera utilizing immunoassays and correlated them with clinical data. We used paracellular permeability measurements, immunofluorescence staining, Western blot and mRNA analysis to examine the effects of patient sera on the properties of BBB in vitro. Results The BLECs cultured together with brain pericytes in transwells developed a tight monolayer with a correct localization of claudin-5 at the tight junctions (TJ). Several BBB marker proteins such as the TJ proteins claudin-5 and occludin, the glucose transporter GLUT-1 or the efflux pumps PG-P and BCRP were upregulated in these cultures. This was accompanied by a reduced paracellular permeability for fluorescein (400 Da). We then used this model for the treatment with the patient sera. Only the sera of breast cancer patients with cerebral metastases had significantly increased levels of the cytokines fractalkine (CX3CL1) and BCA-1 (CXCL13). The increased levels of fractalkine were associated with the estrogen/progesterone receptor status of the tumour. The treatment of BLECs with these sera selectively increased the expression of CXCL13 and TJ protein occludin. In addition, the permeability of fluorescein was increased after serum treatment. Conclusion We demonstrate that the CD34\(^+\) cell-derived human in vitro BBB model can be used as a tool to study the molecular mechanisms underlying cerebrovascular pathologies. We showed that serum from patients with cerebral metastases may affect the integrity of the BBB in vitro, associated with elevated concentrations of specific cytokines such as CX3CL1 and CXCL13. KW - Metastatic breast cancer KW - Blood–brain barrier KW - In vitro models KW - CX3CL1 KW - CXCL13 Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229940 VL - 17 ER - TY - JOUR A1 - Flemming, S. A1 - Hankir, M. A1 - Ernestus, R.-I. A1 - Seyfried, F. A1 - Germer, C.-T. A1 - Meybohm, P. A1 - Wurmb, T. A1 - Vogel, U. A1 - Wiegering, A. T1 - Surgery in times of COVID-19 — recommendations for hospital and patient management JF - Langenbeck's Archives of Surgery N2 - Background The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), has escalated rapidly to a global pandemic stretching healthcare systems worldwide to their limits. Surgeonshave had to immediately react to this unprecedented clinical challenge by systematically repurposing surgical wards. Purpose To provide a detailed set of guidelines developed in a surgical ward at University Hospital Wuerzburg to safelyaccommodate the exponentially rising cases of SARS-CoV-2 infected patients without compromising the care of emergencysurgery and oncological patients or jeopardizing the well-being of hospital staff. Conclusions The dynamic prioritization of SARS-CoV-2 infected and surgical patient groups is key to preserving life whilemaintaining high surgical standards. Strictly segregating patient groups in emergency rooms, non-intensive care wards andoperating areas prevents viral spread while adequately training and carefully selecting hospital staff allow them to confidentlyand successfully undertake their respective clinical duties. KW - SARS-CoV-2 KW - COVID-19 KW - Surgery Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231766 SN - 1435-2443 VL - 405 ER - TY - JOUR A1 - Rösing, Nils A1 - Salvador, Ellaine A1 - Güntzel, Paul A1 - Kempe, Christoph A1 - Burek, Malgorzata A1 - Holzgrabe, Ulrike A1 - Soukhoroukov, Vladimir A1 - Wunder, Christian A1 - Förster, Carola T1 - Neuroprotective Effects of Isosteviol Sodium in Murine Brain Capillary Cerebellar Endothelial Cells (cerebEND) After Hypoxia JF - Frontiers in Cellular Neuroscience N2 - Ischemic stroke is one of the leading causes of death worldwide. It damages neurons and other supporting cellular elements in the brain. However, the impairment is not only confined to the region of assault but the surrounding area as well. Besides, it also brings about damage to the blood-brain barrier (BBB) which in turn leads to microvascular failure and edema. Hence, this necessitates an on-going, continuous search for intervention strategies and effective treatment. Of late, the natural sweetener stevioside proved to exhibit neuroprotective effects and therapeutic benefits against cerebral ischemia-induced injury. Its injectable formulation, isosteviol sodium (STVNA) also demonstrated favorable results. Nonetheless, its effects on the BBB have not yet been investigated to date. As such, this present study was designed to assess the effects of STVNA in our in vitro stroke model of the BBB.The integrity and permeability of the BBB are governed and maintained by tight junction proteins (TJPs) such as claudin-5 and occludin. Our data show increased claudin-5 and occludin expression in oxygen and glucose (OGD)-deprived murine brain capillary cerebellar endothelial cells (cerebEND) after STVNa treatment. Likewise, the upregulation of the transmembrane protein integrin-αv was also observed. Finally, cell volume was reduced with the simultaneous administration of STVNA and OGD in cerebEND cells. In neuropathologies such as stroke, the failure of cell volume control is a major feature leading to loss of cells in the penumbra as well as adverse outcomes. Our initial findings, therefore, point to the neuroprotective effects of STVNA at the BBB in vitro, which warrant further investigation for a possible future clinical intervention. KW - isosteviol sodium KW - hypoxia KW - cerebEND cells KW - blood brain barrier KW - neuroprotection Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-215013 SN - 1662-5102 VL - 14 ER - TY - JOUR A1 - Nattmann, Anja A1 - Breun, Maria A1 - Monoranu, Camelia M. A1 - Matthies, Cordula A1 - Ernestus, Ralf-Ingo A1 - Löhr, Mario A1 - Hagemann, Carsten T1 - Analysis of ADAM9 regulation and function in vestibular schwannoma primary cells JF - BMC Research Notes N2 - Objective Recently, we described a disintegrin and metalloproteinase 9 (ADAM9) overexpression by Schwann cells of vestibular schwannoma (VS) and suggested that it might be a marker for VS tumor growth and invasiveness. This research note provides additional data utilizing a small cohort of VS primary cultures and tissue samples. We examined whether reconstitution of Merlin expression in VS cells regulates ADAM9 protein expression and performed lentiviral ADAM9 knock down to investigate possible effects on VS cells numbers. Moreover, the co-localization of ADAM9 and Integrins α6 and α2β1, respectively, was examined by immunofluorescence double staining. Results ADAM9 expression was not regulated by Merlin in VS. However, ADAM9 knock down led to 58% reduction in cell numbers in VS primary cell cultures (p < 0.0001). While ADAM9 and Integrin α2β1 were co-localized in only 22% (2 of 9) of VS, ADAM9 and Integrin α6 were co-localized in 91% (10 of 11) of VS. Therefore, we provide first observations on possible regulatory functions of ADAM9 expression in VS. KW - vestibular schwannoma KW - pathogenesis KW - ADAM9 KW - knock down KW - integrin KW - immunofuorescence double staining KW - Merlin KW - primary cell culture Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231213 VL - 13 ER - TY - JOUR A1 - Vogt, Marius A1 - Girschick, Hermann A1 - Schweitzer, Tilmann A1 - Benoit, Clemens A1 - Holl-Wieden, Annette A1 - Seefried, Lothar A1 - Jakob, Franz A1 - Hofmann, Christine T1 - Pediatric hypophosphatasia: lessons learned from a retrospective single-center chart review of 50 children JF - Orphanet Journal of Rare Diseases N2 - Background Hypophosphatasia (HPP) is a rare, inherited metabolic disorder caused by loss-of-function mutations in the ALPL gene that encodes the tissue-nonspecific alkaline phosphatase TNAP (ORPHA 436). Its clinical presentation is highly heterogeneous with a remarkably wide-ranging severity. HPP affects patients of all ages. In children HPP-related musculoskeletal symptoms may mimic rheumatologic conditions and diagnosis is often difficult and delayed. To improve the understanding of HPP in children and in order to shorten the diagnostic time span in the future we studied the natural history of the disease in our large cohort of pediatric patients. This single centre retrospective chart review included longitudinal data from 50 patients with HPP diagnosed and followed at the University Children's Hospital Wuerzburg, Germany over the last 25 years. Results The cohort comprises 4 (8%) perinatal, 17 (34%) infantile and 29 (58%) childhood onset HPP patients. Two patients were deceased at the time of data collection. Diagnosis was based on available characteristic clinical symptoms (in 88%), low alkaline phosphatase (AP) activity (in 96%), accumulating substrates of AP (in 58%) and X-ray findings (in 48%). Genetic analysis was performed in 48 patients (31 compound heterozygous, 15 heterozygous, 2 homozygous mutations per patient), allowing investigations on genotype-phenotype correlations. Based on anamnestic data, median age at first clinical symptoms was 3.5 months (min. 0, max. 107), while median time to diagnosis was 13 months (min. 0, max. 103). Common symptoms included: impairment of motor skills (78%), impairment of mineralization (72%), premature loss of teeth (64%), musculoskeletal pain and craniosynostosis (each 64%) and failure to thrive (62%). Up to now 20 patients started medical treatment with Asfotase alfa. Conclusions Reported findings support the clinical perception of HPP being a chronic multi-systemic disease with often delayed diagnosis. Our natural history information provides detailed insights into the prevalence of different symptoms, which can help to improve and shorten diagnostics and thereby lead to an optimised medical care, especially with promising therapeutic options such as enzyme-replacement-therapy with Asfotase alfa in mind. KW - hypophosphatasia KW - alkaline phosphatase KW - asfotase alfa KW - rare bone disease KW - osteomalacia KW - rickets Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230505 VL - 15 ER - TY - THES A1 - Vadokas, Georg Dimitris T1 - Experimentelle Subarachnoidalblutung bei Ratten: Methylprednisolon und Minozyklin zur Behandlung der „Early Brain Injury“ T1 - Experimental Subarachnoid Hemorrhage in Rats: Methylprednisolone and Minocycline for the Treatment of "Early Brain Injury" N2 - Frühe entzündliche Vorgänge scheinen eine große Rolle in der Entstehung der globalen Hirnschädigung in der Frühphase nach einer Subarachnoidalblutung (SAB) zu spielen. Ziel der vorliegenden Arbeit war es den Effekt der anti-inflammatorischen Medikamente Methylprednisolon und Minozyklin auf die Gehirndurchblutung und frühe Hirnschädigung nach SAB zu untersuchen. Hierzu wurde ein randomisiertes und kontrolliertes Tierexperiment durchgeführt. Mit Hilfe des endovaskulären Perforationsmodells wurde bei männlichen Sprague-Dawley-Ratten eine SAB ausgelöst. Den Tieren wurde 30 Minuten nach Auftreten der SAB Methylprednisolon, Minozyklin oder Kochsalzlösung intraperitoneal verabreicht. Sowohl Methylprednisolon als auch Minozyklin verminderten den Anteil Caspase 3 positiver Zellen in immunhistochemischen Färbungen der Hippocampie der Versuchstiere signifikant. In Bezug auf die klinische Untersuchung, den intrakraniellen Druck und die Hirndurchblutung der Ratten ergaben sich keine signifikanten Unterschiede zwischen den Versuchsgruppen. Die Ergebnisse suggerieren, dass Methylprednisolon und Minozyklin den akuten Zellschaden nach SAB reduzieren. Daher könnten sich beide Mittel als geeignet für die Therapie der „Early Brain Injury“ nach SAB erweisen. Weitere Studien zum besseren Verständnis der zugrunde liegenden Wirkmechanismen von Methylprednisolon und Minozyklin auf die Frühphase der SAB sind nötig. N2 - Early inflammatory processes may play an important role in the development of early brain injury (EBI) after subarachnoid hemorrhage (SAH). The aim of this study was to investigate the effect of early treatment with methylprednisolone and minocycline on cerebral perfusion and global braindamage after SAH. We performed a randomized and controlled experiment using male Sprague-Dawley rats. The animals were subjected to SAH using the endovascular filament model. 30 minutes after SAH, they were randomly assigned to receive an intraperitoneal injection of methylprednisolone, minocycline or saline. Treatment with methylprednisolone or minocycline did not result in a significant improvement of cerebral perfusion, intracranial pressure or neurological recovery. Hippocampal damage significantly attenuated in both methylprednisolone and minocycline treated animals. Therefore, early treatment with the anti-inflammatory drugs methylprednisolone or minocycline in the acute phase after SAH has the potential to reduce brain damage and exert a neuroprotective effect. KW - Subarachnoidalblutung KW - Neuroprotektion KW - Methylprednisolon KW - Minozyklin KW - Early Brain Injury Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-207191 ER - TY - JOUR A1 - Kessler, Almuth F. A1 - Feldheim, Jonas A1 - Schmitt, Dominik A1 - Feldheim, Julia J. A1 - Monoranu, Camelia M. A1 - Ernestus, Ralf-Ingo A1 - Löhr, Mario A1 - Hagemann, Carsten T1 - Monopolar Spindle 1 Kinase (MPS1/TTK) mRNA Expression is Associated with Earlier Development of Clinical Symptoms, Tumor Aggressiveness and Survival of Glioma Patients JF - Biomedicines N2 - Inhibition of the protein kinase MPS1, a mitotic spindle-checkpoint regulator, reinforces the effects of multiple therapies against glioblastoma multiforme (GBM) in experimental settings. We analyzed MPS1 mRNA-expression in gliomas WHO grade II, III and in clinical subgroups of GBM. Data were obtained by qPCR analysis of tumor and healthy brain specimens and correlated with the patients’ clinical data. MPS1 was overexpressed in all gliomas on an mRNA level (ANOVA, p < 0.01) and correlated with tumor aggressiveness. We explain previously published conflicting results on survival: high MPS1 was associated with poorer long term survival when all gliomas were analyzed combined in one group (Cox regression: t < 24 months, p = 0.009, Hazard ratio: 8.0, 95% CI: 1.7–38.4), with poorer survival solely in low-grade gliomas (LogRank: p = 0.02, Cox regression: p = 0.06, Hazard-Ratio: 8.0, 95% CI: 0.9–66.7), but not in GBM (LogRank: p > 0.05). This might be due to their lower tumor volume at the therapy start. GBM patients with high MPS1 mRNA-expression developed clinical symptoms at an earlier stage. This, however, did not benefit their overall survival, most likely due to the more aggressive tumor growth. Since MPS1 mRNA-expression in gliomas was enhanced with increasing tumor aggressiveness, patients with the worst outcome might benefit best from a treatment directed against MPS1. KW - glioblastoma multiforme KW - low-grade glioma KW - astrocytoma KW - recurrence KW - multifocal growth KW - mRNA expression KW - MPS1 KW - TTK KW - therapy Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-236105 VL - 8 IS - 7 ER - TY - THES A1 - Schmidt, Andreas T1 - Nah- und Fernfeldableitungen der Hörbahn bei Operationen von Vestibularisschwannomen T1 - Nearfield and farfield monitoring of auditory function in vestibular schwannoma surgery N2 - Einführung und Zielsetzung: Die intraoperative Ableitung von ABRs (auditory brainstem responses) ist eine Standardmethode für das Monitoring der Hörbahn bei der Operation von Vestibularisschwannomen. Als Fernfeldtechnologie zeigt sich diese Methode jedoch oft limitiert. Ziel dieser Arbeit ist, den zusätzlichen Einsatz einer nicht-invasiven Elektrocochleographie (ECochG) als Nahfeldtechnologie zu evaluieren. Methoden: Hierzu erfolgte retrospektive Auswertung und Klassifikation von elektrophysiologischen Monitoring Daten von 69 Patienten, welche zwischen 2010 und 2014 mittels retrosigmoidalen Zugang am Vestibularisschwannom operiert wurden. Die ECochG wurde bei diesen Patienten simultan zu den ABR mit einer ans Trommelfell platzierten Kugelelektrode abgeleitet. Die Patientenselektion für diese Studie erfolgte vor allem nach dem Wunsch des Patienten gehörerhaltend operiert zu werden, unabhängig von Tumorausdehnung (von klein bis Hirnstamm komprimierend) oder der präoperativer Hörqualität. Es erfolgte Korrelation mit der prä- und postoperativen Hörqualität. Ergebnisse: Präoperativ zeigen die ABR- und ECochG-Klassen nahezu dieselbe Verteilung und Korrelation mit der präoperativen Hörklasse. Allerdings zeigt, wie initial vermutet, die postoperative ECochG schwächere Korrelation mit der postoperativen Hörqualität, als die ABRs: 25 von 43 Patienten mit postoperativer Taubheit zeigten in der ECochG am Ende der OP immer noch cochleäre Potentiale. Neben der cochleären Funktion kann mit der nicht-invasiven ECochG die Hörbahn analog zum ABR dargestellt werden. Die Identifizierbarkeit besonders der späteren Komponenten (Welle III und V) ist mit der nicht-invasiven Elektrocochleographie mindestens genauso gut möglich wie mit den ABR. Weiter liefert die ECochG signifikant größere Amplituden. Der Vergleich der ABR- mit den ECochG-Klassen liefert stark positive Korrelationen. Dies gilt vor allem für die Klassen 1 bis 3, in denen die Welle V noch vorhanden ist. Schlussfolgerung: Die signifikant größeren Amplituden der ECochG erlauben kürzere Messzeiten. Dies bietet intraoperativ Sicherheit für den Fall von Artefakten oder technischen Störungen sowie Vorteile in technisch schwierigen Phasen der OP. Neben der cochleären Funktion kann mit der ECochG die Hörbahn analog zum ABR bis in den Hirnstamm erfasst und überwacht werden. Die ECochG kann die ABR Ableitung nicht gänzlich ersetzen, da ihre Verlässlichkeit bei elektrisch darstellbarer Beeinträchtigung der Hörbahn sinkt. Wann immer eine Welle V vorhanden ist, ist Monitoring mit der nicht-invasiven ECochG genauso gut möglich wie mit ABR. N2 - Introduction and goals: Monitoring of auditory brainstem responses (ABR) is a standard method during vestibular schwannoma surgery. As a farfield technique it bears some limitations. The goal of this study is to evaluate additional use of extra-tympanic electrocochleography (ECochG) as a nearfield technology. Methods: For this purpose electrophysiological monitoring data from 69 patients with vestibular schwannomas operated by the retrosigmoid approach between 2010 and 2014 were retrospectively evaluated and classified. ECochG was recorded simultaneously to ABR using an extra-tympanic ball electrode placed at the tympanum. Patient selection for this study was based on individual strong interest in hearing conserving surgery and independent of tumor extension (small to brainstem compressive) or hearing quality. The results were correlated with hearing quality before and after surgery. Results: Preoperative ABR and ECochG classes show a quite similar distribution and positive correlation with the preoperative hearing class. But, as expected, postoperative ECochG was less reliable than ABR in correlation with postoperative hearing quality: 25 of 43 patients with postoperative deafness showed an end-operative ECochG with a preserved cochlea potential. Recording of auditory function by non-invasive ECochG may be applied beyond the control of cochlea function. The identification of the later components (wave III and V) in ECochG is possible in the same way as with ABR. ECochG also provides significantly larger amplitudes. Analysis of ABR and ECochG classes identifies a very close positive correlation especially for classes 1 to 3, where wave V is still present. Conclusion: The significantly larger amplitudes of the ECochG allow shorter measurement times. This is especially useful in technically difficult phases during surgery. In addition to the cochlear function ECochG can be used for monitoring the auditory pathway down to the brain stem analogous to the ABR. ECochG cannot completely replace the ABR monitoring as its reliability decreases when electrical impairments occur. Whenever a wave V can be registered monitoring with the non-invasive ECochG is just as possible as with ABR. KW - Vestibularisschwannom KW - Akustikustumor KW - Elektrocochleographie KW - Akustisch evoziertes Potenzial KW - ABR KW - auditory brainstem responses KW - electrocochleography KW - Intraoperatives Monitoring KW - Neuromonitoring Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-216732 ER - TY - JOUR A1 - Jungwirth, Gerhard A1 - Yu, Tao A1 - Moustafa, Mahmoud A1 - Rapp, Carmen A1 - Warta, Rolf A1 - Jungk, Christine A1 - Sahm, Felix A1 - Dettling, Steffen A1 - Zweckberger, Klaus A1 - Lamszus, Katrin A1 - Senft, Christian A1 - Loehr, Mario A1 - Keßler, Almuth F. A1 - Ketter, Ralf A1 - Westphal, Manfred A1 - Debus, Juergen A1 - von Deimling, Andreas A1 - Simon, Matthias A1 - Unterberg, Andreas A1 - Abdollahi, Amir A1 - Herold-Mende, Christel T1 - Identification of KIF11 as a Novel Target in Meningioma JF - Cancers N2 - Kinesins play an important role in many physiological functions including intracellular vesicle transport and mitosis. The emerging role of kinesins in different cancers led us to investigate the expression and functional role of kinesins in meningioma. Therefore, we re-analyzed our previous microarray dataset of benign, atypical, and anaplastic meningiomas (n = 62) and got evidence for differential expression of five kinesins (KIFC1, KIF4A, KIF11, KIF14 and KIF20A). Further validation in an extended study sample (n = 208) revealed a significant upregulation of these genes in WHO°I to °III meningiomas (WHO°I n = 61, WHO°II n = 88, and WHO°III n = 59), which was most pronounced in clinically more aggressive tumors of the same WHO grade. Immunohistochemical staining confirmed a WHO grade-associated upregulated protein expression in meningioma tissues. Furthermore, high mRNA expression levels of KIFC1, KIF11, KIF14 and KIF20A were associated with shorter progression-free survival. On a functional level, knockdown of kinesins in Ben-Men-1 cells and in the newly established anaplastic meningioma cell line NCH93 resulted in a significantly inhibited tumor cell proliferation upon siRNA-mediated downregulation of KIF11 in both cell lines by up to 95% and 71%, respectively. Taken together, in this study we were able to identify the prognostic and functional role of several kinesin family members of which KIF11 exhibits the most promising properties as a novel prognostic marker and therapeutic target, which may offer new treatment options for aggressive meningiomas. KW - meningioma KW - KIF KW - kinesin KW - KIF11 KW - NCH93 Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-197402 SN - 2072-6694 VL - 11 IS - 4 ER - TY - THES A1 - Klein, Philipp T1 - Kephalometrische Verlaufsuntersuchungen bei Kindern vor und nach operativer Versorgung einer isolierten Sagittalnahtsynostose T1 - Long term cephalometric follow up of children with operated isolated sagittal synostosis N2 - In dieser retrospektiven Arbeit wurde das Schädelwachstum von Patienten mit einer operierten nonsyndromalen prämaturen Sagittalnahtsynostose untersucht. Hierzu wurden die prä- und postoperativ angefertigten Röntgenaufnahmen von 37 Kindern, die zwischen 1995 und 2008 im Cranio-Fazialen Zentrum der Universitätsklinik Würzburg operiert wurden, vermessen und ausgewertet. Die Patienten wurden nach der gewählten Operationstechnik in zwei Gruppen unterteilt. Die erste Gruppe wurde mittels einer medianen Kraniektomie therapiert. Bei der zweiten Gruppe wurde die mediane Kraniektomie durch ein Kippen des Stirnsegmentes erweitert. Nach der statistischen Auswertung ergaben sich im postoperativen Verlauf signifikante Unterschiede zwischen beiden Operationstechniken. Es konnte gezeigt werden, dass ein adjuvantes Kippen der Stirn gegenüber einer alleinigen breiten medianen Kraniektomie zu keiner Verbesserung der Schädelausformung führt. Darüber hinaus ist zu vermuten, dass das Kippen des Stirnsegmentes die Wahrscheinlichkeit eines Rezidivs erhöht. N2 - In this retrospective work, cranial growth of patients with operated nonsyndromal prematurary sagittal suture synostosis was investigated. For this purpose, the pre- and postoperative radiographs of 37 children operated between 1995 and 2008 in the Cranio-Facial Center of the University Hospital Würzburg were measured and evaluated. The patients were divided into two groups according to the surgical technique chosen. The first group was treated with a median craniectomy. In the second group, median craniectomy was augmented by tilting the forehead segment. Statistical evaluation showed significant differences between the two surgical techniques during the postoperative period. It could be shown that an adjuvant tipping of the forehead compared to a sole wide median craniectomy does not lead to an improvement of the skull formation. In addition, it is likely that tilting the forehead segment increases the likelihood of recurrence. KW - Sagittalnahtsynostose KW - isoliert KW - Kephalometrie Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-188079 ER - TY - JOUR A1 - Pasos, Uri E. Ramirez A1 - Steigerwald, Frank A1 - Reich, Martin M. A1 - Matthies, Cordula A1 - Volkmann, Jens A1 - Reese, René T1 - Levodopa modulates functional connectivity in the upper beta band between bubthalamic nucleus and muscle activity in tonic and phasic motor activity patterns in Parkinson’s disease JF - Frontiers in Human Neuroscience N2 - Introduction: Striatal dopamine depletion disrupts basal ganglia function and causes Parkinson’s disease (PD). The pathophysiology of the dopamine-dependent relationship between basal ganglia signaling and motor control, however, is not fully understood. We obtained simultaneous recordings of local field potentials (LFPs) from the subthalamic nucleus (STN) and electromyograms (EMGs) in patients with PD to investigate the impact of dopaminergic state and movement on long-range beta functional connectivity between basal ganglia and lower motor neurons. Methods: Eight PD patients were investigated 3 months after implantation of a deep brain stimulation (DBS)-system capable of recording LFPs via chronically-implanted leads (Medtronic, ACTIVA PC+S®). We analyzed STN spectral power and its coherence with EMG in the context of two different movement paradigms (tonic wrist extension vs. alternating wrist extension and flexion) and the effect of levodopa (L-Dopa) intake using an unbiased data-driven approach to determine regions of interest (ROI). Results: Two ROIs capturing prominent coherence within a grand average coherogram were identified. A trend of a dopamine effect was observed for the first ROI (50–150 ms after movement start) with higher STN-EMG coherence in medicated patients. Concerning the second ROI (300–500 ms after movement start), an interaction effect of L-Dopa medication and movement task was observed with higher coherence in the isometric contraction task compared to alternating movements in the medication ON state, a pattern which was reversed in L-Dopa OFF. Discussion: L-Dopa medication may normalize functional connectivity between remote structures of the motor system with increased upper beta coherence reflecting a physiological restriction of the amount of information conveyed between remote structures. This may be necessary to maintain simple movements like isometric contraction. Our study adds dynamic properties to the complex interplay between STN spectral beta power and the nucleus’ functional connectivity to remote structures of the motor system as a function of movement and dopaminergic state. This may help to identify markers of neuronal activity relevant for more individualized programming of DBS therapy. KW - Parkinson’s disease KW - subthalamic nucleus KW - deep brain stimulation KW - local field potentials KW - dopamine KW - movement Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201540 VL - 13 IS - 223 ER - TY - JOUR A1 - Hagemann, Carsten A1 - Neuhaus, Nikolas A1 - Dahlmann, Mathias A1 - Kessler, Almuth F. A1 - Kobelt, Dennis A1 - Herrmann, Pia A1 - Eyrich, Matthias A1 - Freitag, Benjamin A1 - Linsenmann, Thomas A1 - Monoranu, Camelia M. A1 - Ernestus, Ralf-Ingo A1 - Löhr, Mario A1 - Stein, Ulrike T1 - Circulating MACC1 transcripts in glioblastoma patients predict prognosis and treatment response JF - Cancers N2 - Glioblastoma multiforme is the most aggressive primary brain tumor of adults, but lacksreliable and liquid biomarkers. We evaluated circulating plasma transcripts of metastasis-associatedin colon cancer-1 (MACC1), a prognostic biomarker for solid cancer entities, for prediction of clinicaloutcome and therapy response in glioblastomas. MACC1 transcripts were significantly higher inpatients compared to controls. Low MACC1 levels clustered together with other prognosticallyfavorable markers. It was associated with patients’ prognosis in conjunction with the isocitratedehydrogenase (IDH) mutation status: IDH1 R132H mutation and low MACC1 was most favorable(median overall survival (OS) not yet reached), IDH1 wildtype and high MACC1 was worst (medianOS 8.1 months), while IDH1 wildtype and low MACC1 was intermediate (median OS 9.1 months).No patients displayed IDH1 R132H mutation and high MACC1. Patients with low MACC1 levelsreceiving standard therapy survived longer (median OS 22.6 months) than patients with high MACC1levels (median OS 8.1 months). Patients not receiving the standard regimen showed the worstprognosis, independent of MACC1 levels (low: 6.8 months, high: 4.4 months). Addition of circulatingMACC1 transcript levels to the existing prognostic workup may improve the accuracy of outcomeprediction and help define more precise risk categories of glioblastoma patients. KW - metastasis-associated in colon cancer 1 (MACC1) KW - glioblastoma multiforme KW - liquid biopsy KW - therapy response KW - prognostic marker Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-197327 SN - 2072-6694 VL - 11 IS - 6 ER - TY - JOUR A1 - Linsenmann, Thomas A1 - Monoranu, Camelia M. A1 - Alkonyi, Balint A1 - Westermaier, Thomas A1 - Hagemann, Carsten A1 - Kessler, Almuth F. A1 - Ernestus, Ralf-Ingo A1 - Löhr, Mario T1 - Cerebellar liponeurocytoma - molecular signature of a rare entity and the importance of an accurate diagnosis JF - Interdisciplinary Neurosurgery N2 - Background: Cerebellar liponeurocytoma is an extremely rare tumour entity of the central nervous system. It is histologically characterised by prominent neuronal/neurocytic differentiation with focal lipidisation and corresponding histologically to WHO grade II. It typically develops in adults, and usually shows a low proliferative potential. Recurrences have been reported in almost 50% of cases, and in some cases the recurrent tumour may display increased mitotic activity and proliferation index, vascular proliferations and necrosis. Thus pathological diagnosis of liponeurocytoma is challenging. This case presentation highlights the main clinical, radiographic and pathological features of a cerebellar liponeurocytoma. Case presentation: A 59-year-old, right-handed woman presented at our department with a short history of persistent headache, vertigo and gait disturbances. Examination at presentation revealed that the patient was awake, alert and fully oriented. The cranial nerve status was normal. Uncertainties were noted in the bilateral finger-to-nose testing with bradydiadochokinesis on both sides. Strength was full and no pronator drift was observed. Sensation was intact. No signs of pyramidal tract dysfunction were detected. Her gait appeared insecure. The patient underwent surgical resection. Afterward no further disturbances could be detected. Conclusions: To date >40 cases of liponeurocytoma have been reported, including cases with supratentorial location. A review of the 5 published cases of recurrent cerebellar. Liponeurocytoma revealed that the median interval between the first and second relapse was rather short, indicating uncertain malignant potential. The most recent WHO classification of brain tumours (2016) classifies the cerebellar liponeurocytoma as a separate entity and assigns the tumour to WHO grade II. Medulloblastoma is the most important differential diagnosis commonly seen in children and young adults. In contrast, cerebellar liponeurocytoma is typically diagnosed in adults. The importance of accurate diagnosis should not be underestimated especially in the view of possible further therapeutic interventions and for the determination of the patient's prognosis. KW - liponeurocytoma KW - neurocytoma KW - medulloblastoma KW - molecular signature Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-177652 VL - 16 ER - TY - JOUR A1 - Vadokas, Georg A1 - Koehler, Stefan A1 - Weiland, Judith A1 - Lilla, Nadine A1 - Stetter, Christian A1 - Westermaier, Thomas T1 - Early antiinflammatory therapy attenuates brain damage after SAH in rats JF - Translational Neuroscience N2 - Background Early inflammatory processes may play an important role in the development of early brain injury (EBI) after subarachnoid hemorrhage (SAH). Experimental studies suggest that anti-inflammatory and membrane-stabilizing drugs might have beneficial effects, although the underlying mechanisms are not fully understood. The aim of this study was to investigate the effect of early treatment with methylprednisolone and minocycline on cerebral perfusion and EBI after experimental SAH. Methods Male Sprague-Dawley rats were subjected to SAH using the endovascular filament model. 30 minutes after SAH, they were randomly assigned to receive an intravenous injection of methylprednisolone (16mg/kg body weight, n=10), minocycline (45mg/kg body weight, n=10) or saline (n=11). Mean arterial blood pressure (MABP), intracranial pressure (ICP) and local cerebral blood flow (LCBF) over both hemispheres were recorded continuously for three hours following SAH. Neurological assessment was performed after 24 hours. Hippocampal damage was analyzed by immunohistochemical staining (caspase 3). Results Treatment with methylprednisolone or minocycline did not result in a significant improvement of MABP, ICP or LCBF. Animals of both treatment groups showed a non-significant trend to better neurological recovery compared to animals of the control group. Mortality was reduced and hippocampal damage significantly attenuated in both methylprednisolone and minocycline treated animals. Conclusion The results of this study suggest that inflammatory processes may play an important role in the pathophysiology of EBI after SAH. Early treatment with the anti-inflammatory drugs methylprednisolone or minocycline in the acute phase of SAH has the potential to reduce brain damage and exert a neuroprotective effect. KW - subarachnoid hemorrhage KW - early brain injury KW - methylprednisolone KW - minocycline KW - neuroprotection Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201440 VL - 10 IS - 1 ER - TY - THES A1 - Dösch, Janine Dorothee T1 - Ergebnisse von 100 konsekutiven endovaskulären Aneurysmaausschaltungen (EVAR) mit dem Endurant® - Stentgraft unter klinischen Alltagsbedingungen T1 - Clinical results of 100 patients with abdominal aortic aneurysm treated with the Endurant® stent graft N2 - Die endovaskuläre Behandlung (EVAR) des abdominellen Aortenaneurysmas (AAA) hat sich den vergangenen Jahren zur Standardtherapie etabliert. Die Vielzahl an verfügbaren Stentgrafts wird in der Regel in Zulassungsstudien und Registern, die die Gefahr eines Selektionsbias beinhalten, evaluiert und spiegelt oftmals den klinischen Nutzen nur unzureichend wider. Ziel dieser Arbeit war es zu evaluieren, ob unter klinischen Alltagsbedingungen die kurz- und mittelfristigen Ergebnisse nach Endurant® Stentgraftimplantation mit denen des 1262 Patienten umfassenden ENGAGE-Registers vergleichbar sind. Diese Arbeit beinhaltet die Daten der ersten, konsekutiven 100 Patienten (91,0 % Männer und mittleres Patientenalter von 73,1 ± 8,4 Jahren), die im Zeitraum Februar 2009 bis August 2014 mit dem Endurant® Stentgraft (Medtronic, Inc., Minneapolis, MN, USA) an der Universitätsklinik Würzburg unter klinischen Alltagsbedingungen behandelt wurden. Präoperativ wies das Patientenkollektiv einen mittleren Aortenaneurysmadurchmesser von 57,2 mm ± 11,9 mm, eine mittlere proximale Aortenhalslänge von 27,8 mm ± 13,7 mm und einen mittleren proximalen Aortenhalsdurchmesser von 24,0 mm ± 3,4 mm auf. Die infrarenale Angulation betrug 22,0 ± 15,6 Grad und war signifikant unterschiedlich zu ENGAGE. Die klinische Alltagssituation, die diese Studie im Gegensatz zum großen, weltweiten ENGAGE-Register bietet, ergibt sich durch den Einschluss von Notfalleingriffen bei rupturierten AAA (5 %) und der Durchführung von operativen Ausbildungseingriffen an einer Universitätsklinik. Bezüglich der technischen und klinischen Erfolgsrate, sowie der Operationsdauer resultierten somit signifikante Unterschiede. Intraoperativ zeigten sich in 24 % ein Endoleak-Typ-II und in jeweils 3 % ein Endoleak-Typ-I bzw. Endoleak-Typ-III. Im Nachbeobachtungszeitraum verkleinerte sich der maximale Aneurysmadurchmesser in 43,9 % der Fälle um mehr als 3 mm und 7,3 % der Patienten dagegen wiesen eine Zunahme des Aneurysmadurchmessers auf. Die Reinterventionsrate lag im Patientenkollektiv bei 13,4 %. Die 30-Tages-Letalitätsrate lag mit 2 % über der des ENGAGE-Registers mit 1,3 %. EVAR mit dem Endurant®-Stentgraft ist bei sorgfältiger Einhaltung der „instruction for use“ auch außerhalb von prospektiven Studien und großen Registern eine sichere und effektive Behandlung. Große Register wie ENGAGE sind wichtig, jedoch nicht in allen Aspekten „real world“. Eine Überprüfung der Ergebnisse im klinischen Alltag ist somit weiterhin erforderlich. N2 - The purpose of this study was to evaluate and compare the outcomes in 100 patients with abdominal aortic aneurysms (AAAs) treated with the Endurant® stent graft (Medtronic, Inc., Minneapolis, MN, USA) at the Department of Vascular Surgery, University Hospital Wuerzburg versus the results of the large Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE). Between February 2009 and August 2014, 100 patients (91 men (91.0% of total); mean age 73.1 ± 8.4 years, range 53 to 89 years) with an AAA underwent an endovascular aneurysm repair (EVAR) using the Endurant® stent graft. The mean aneurysm diameter was 57.2 ± 11.9 mm; the mean proximal neck length was 27.8 ± 13.7 mm; the mean proximal neck diameter was 24.0 ± 3.4 mm. The mean infrarenal angulation was with 22.0 ± 15.6 degrees significant different compared to ENGAGE. Before and after the procedure and during the follow-up, computer tomography scans, digital subtraction angiography and/or color-coded duplex sonography were performed. Outcome analysis included survival, endoleaks, aneurysm expansion >3 mm, secondary intervention. Clinical data, AAA characteristics, presence of endoleaks and other EVAR-related complications were noted. Real-world conditions were provided by including ruptured AAAs and supervised surgery as a teaching hospital. As a result significant differences in primary technical and clinical success and procedural duration were observed between ENGAGE and this study. Primary type II endoleaks were observed in 24.0%, type I endoleak in 3.0% and type III endoleaks in 3.0%. Secondary interventions were required in 13.4%. Aneurysm-related mortality was reported in 2.0% compared to 1.3% in ENGAGE. Maximal aneurysm diameter decreased >3 mm in 43.9% and increased >3 mm in 7.3% of patients. The Endurant® stent graft used under instructions for use proved to be a safe and effective endovascular treatment for AAA. Nevertheless, further evaluation of outcomes in real-world clinical practice, beside large registries as ENGAGE, is needed to provide results of EVAR in real-world conditions. KW - Bauchaorta KW - EVAR KW - Aneurysma KW - Endurant® KW - Stentgraft Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175107 ER - TY - JOUR A1 - Breun, Maria A1 - Monoranu, Camelia M. A1 - Kessler, Almuth F. A1 - Matthies, Cordula A1 - Löhr, Mario A1 - Hagemann, Carsten A1 - Schirbel, Andreas A1 - Rowe, Steven P. A1 - Pomper, Martin G. A1 - Buck, Andreas K. A1 - Wester, Hans-Jürgen A1 - Ernestus, Ralf-Ingo A1 - Lapa, Constantin T1 - [\(^{68}\)Ga]-Pentixafor PET/CT for CXCR4-mediated imaging of vestibular schwannomas JF - Frontiers in Oncology N2 - We have recently demonstrated CXCR4 overexpression in vestibular schwannomas (VS). This study investigated the feasibility of CXCR4-directed positron emission tomography/computed tomography (PET/CT) imaging of VS using the radiolabeled chemokine ligand [\(^{68}\)Ga]Pentixafor. Methods: 4 patients with 6 primarily diagnosed or pre-treated/observed VS were enrolled. All subjects underwent [\(^{68}\)Ga]Pentixafor PET/CT prior to surgical resection. Images were analyzed visually and semi-quantitatively for CXCR4 expression including calculation of tumor-to-background ratios (TBR). Immunohistochemistry served as standard of reference in three patients. Results: [\(^{68}\)Ga]Pentixafor PET/CT was visually positive in all cases. SUV\(_{mean}\) and SUV\(_{max}\) were 3.0 ± 0.3 and 3.8 ± 0.4 and TBR\(_{mean}\) and TBR\(_{max}\) were 4.0 ± 1.4 and 5.0 ± 1.7, respectively. Histological analysis confirmed CXCR4 expression in tumors. Conclusion: Non-invasive imaging of CXCR4 expression using [\(^{68}\)Ga]Pentixafor PET/CT of VS is feasible and could prove useful for in vivo assessment of CXCR4 expression. KW - vestibular schwannoma KW - CXCR4 KW - PET/CT KW - molecular imaging KW - Pentixafor Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201863 VL - 9 IS - 503 ER - TY - JOUR A1 - Feldheim, Jonas A1 - Kessler, Almuth F. A1 - Monoranu, Camelia M. A1 - Ernestus, Ralf-Ingo A1 - Löhr, Mario A1 - Hagemann, Carsten T1 - Changes of O\(^6\)-Methylguanine DNA Methyltransferase (MGMT) promoter methylation in glioblastoma relapse—a meta-analysis type literature review JF - Cancers N2 - Methylation of the O6-methylguanine DNA methyltransferase (MGMT) promoter has emerged as strong prognostic factor in the therapy of glioblastoma multiforme. It is associated with an improved response to chemotherapy with temozolomide and longer overall survival. MGMT promoter methylation has implications for the clinical course of patients. In recent years, there have been observations of patients changing their MGMT promoter methylation from primary tumor to relapse. Still, data on this topic are scarce. Studies often consist of only few patients and provide rather contrasting results, making it hard to draw a clear conclusion on clinical implications. Here, we summarize the previous publications on this topic, add new cases of changing MGMT status in relapse and finally combine all reports of more than ten patients in a statistical analysis based on the Wilson score interval. MGMT promoter methylation changes are seen in 115 of 476 analyzed patients (24%; CI: 0.21–0.28). We discuss potential reasons like technical issues, intratumoral heterogeneity and selective pressure of therapy. The clinical implications are still ambiguous and do not yet support a change in clinical practice. However, retesting MGMT methylation might be useful for future treatment decisions and we encourage clinical studies to address this topic KW - glioblastoma multiforme (GBM) KW - glioma KW - relapse KW - temozolomide KW - MGMT promoter methylation KW - therapy KW - resistance KW - recurrence Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-193040 SN - 2072-6694 VL - 11 IS - 12 ER - TY - JOUR A1 - Löhr, Mario A1 - Kessler, Almuth F. A1 - Monoranu, Camelia-Maria A1 - Grosche, Jens A1 - Linsenmann, Thomas A1 - Ernestus, Ralf-Ingo A1 - Härtig, Wolfgang T1 - Primary brain amyloidoma, both a neoplastic and a neurodegenerative disease: a case report JF - BMC Neurology N2 - Background Scattered extracellular deposits of amyloid within the brain parenchyma can be found in a heterogeneous group of diseases. Its condensed accumulation in the white matter without evidence for systemic amyloidosis is known as primary brain amyloidoma (PBA). Although originally considered as a tumor-like lesion by its space-occupying effect, this condition displays also common hallmarks of a neurodegenerative disorder. Case presentation A 50-year-old woman presented with a mild cognitive decline and seizures with a right temporal, irregular and contrast-enhancing mass on magnetic resonance imaging. Suspecting a high-grade glioma, the firm tumor was subtotally resected. Neuropathological examination showed no glioma, but distinct features of a neurodegenerative disorder. The lesion was composed of amyloid AL λ aggregating within the brain parenchyma as well as the adjacent vessels, partially obstructing the vascular lumina. Immunostaining confirmed a distinct perivascular inflammatory reaction. After removal of the PBA, mnestic impairments improved considerably, the clinical course and MRI-results are stable in the 8-year follow-up. Conclusion Based on our histopathological findings, we propose to regard the clinicopathological entity of PBA as an overlap between a neoplastic and neurodegenerative disorder. Since the lesions are locally restricted, they might be amenable to surgery with the prospect of a definite cure. KW - amyloidoma KW - neurooncology KW - brain tumor KW - neurodegenerative disease KW - neurovascular unit Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200341 VL - 19 ER - TY - THES A1 - Müller-Ritz, Johanna T1 - Veränderungen im MGMT-Status von humanen Glioblastomzelllinien T1 - Changes in the MGMT status of human glioblastoma cell lines N2 - Aufgrund seiner infausten Prognose und des häufigen Auftretens nimmt das GBM unter den Hirntumoren eine besondere Rolle ein. Viele intrazelluläre Signalwege und Tumormarker sind bereits gut erforscht und verstanden. Hierzu gehört auch der epigenetisch determinierte Methylierungsgrad des MGMT-Genpromotors. Die Bestimmung des MGMT-Status gehört bei allen Patienten mittlerweile zur Standarddiagnostik, um den Effekt der Radiochemotherapie auf den Tumor zu prognostizieren. Ist der MGMT-Genpromotor unmethyliert, haben alkylierende Substanzen wie TMZ nur einen geringen Effekt auf die Tumorzellen. Solche Patienten profitieren kaum von der Standardtherapie nach dem Stupp-Schema. Es sind jedoch Fälle aufgetreten, bei denen sich der Methylierungsgrad des MGMT-Genpromotors im Behandlungsverlauf der Patienten verändert hat. Aufgrund dessen untersuchte ich in meiner Arbeit, ob man Änderungen im MGMT-Genmethylierungsstatus und in der MGMT-Genexpression auf mRNA-und Proteinebene unter Nachahmung der Standardtherapie experimentell auslösen kann. Mit den verwendeten Versuchsansätzen konnte ich in der Zellkultur keine Veränderungen feststellen. Lediglich auf mRNA-Ebene konnte nach 5 Tagen fraktionierter Bestrahlung bei der methylierten Zelllinie U87 eine leichte Steigerung der MGMT-mRNA-Expression verzeichnet werden. Diese Expressionssteigerung stand allerdings nicht im Zusammenhang mit einer Änderung des MGMT-Methylierungsstatus und spiegelte sich auch nicht auf Proteinebene wider. Dieses Ergebnis lässt weitere Forschungen in die Richtung der therapieinduzierten Änderungen am MGMT-Genpromotor sinnvoll erscheinen, um letztendlich die Therapie am Patienten effektiver und individueller zu gestalten und das mediane Überleben sowie dieLebensqualität unter der Behandlung vor allem für Patienten mit unmethyliertem MGMT-Genpromotor zu verbessern. N2 - Due to its inaccurate prognosis and frequent occurrence, GBM plays a special role among brain tumors. Many intracellular signaling pathways and tumor markers are already well understood and understood. This includes the epigenetically determined degree of methylation of the MGMT gene promoter. Determination of MGMT status has become standard diagnostic practice in all patients to predict the effect of chemoradiotherapy on the tumor. If the MGMT gene promoter is unmethylated, alkylating agents such as TMZ have little effect on the tumor cells. Such patients hardly benefit from the standard therapy according to the Stupp-Scheme. However, cases have occurred in which the degree of methylation of the MGMT gene promoter has changed in the course of treatment of patients. As a result, I investigated in my work whether it is possible to experimentally trigger changes in MGMT gene methylation status and in MGMT gene expression at mRNA and protein level, following the standard therapy. With the experimental approaches I was unable to detect any changes in the cell culture. Only at the mRNA level could a slight increase in MGMT mRNA expression be recorded after 5 days of fractionated irradiation in the methylated cell line U87. However, this expression increase was not associated with a change in MGMT methylation status and was not reflected at the protein level. This result suggests further research into the therapy-induced changes in the MGMT gene promoter to ultimately make patient therapy more effective and individualized, and to improve median survival and quality of life under treatment, especially for patients with unmethylated MGMT gene promoter. KW - MGMT Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-162862 ER - TY - THES A1 - Salur, Irmak T1 - Therapie des Hirnschadens nach Neurotrauma mit dem humanen C1-Inhibitor Berinert T1 - Therapy of brain damage after experimental traumatic brain injury with the human C1 inhibitor Berinert N2 - Bei einem SHT handelt es sich um eine mechanische Schädigung des Hirngewebes, verursacht durch eine Gewalteinwirkung auf den Kopf. Diese initiale Schädigung des Hirngewebes weitet sich nachfolgend aus. Wirksame Therapien, um diese sekundären Pathomechanismen zu inhibieren, gibt es nicht. Sofern das SHT überlebt wird, ist es eine der häufigsten Ursachen für bleibende Behinderungen. Wichtige Pathomechanismen, welche zur Ausweitung der Hirnschädigung beitragen, sind das posttraumatische Hirnödem und Entzündungsreaktionen. Beides wird durch die Aktivierung des so-genannten Kallikrein-Kinin-Systems begünstigt. In der vorliegenden Arbeit wurde dieses System 1 Stunde nach experimentellem SHT durch die Applikation des C1-Inhibitors gehemmt und am nachfolgenden Tag die Auswirkungen bewertet. Die Ergebnisse zeigen, dass diese Behandlung nach der Hirnverletzung zu einer Reduktion des Hirnödems und der Entzündungsreaktion führt. Die Bildung von Thromben in den Hirngefäßen ist geringer als in Kontrolltieren, vermutlich da der C1-Inhibitor auch die intrinsische Gerinnungs-kaskade hemmt. Insgesamt führt die Behandlung zu kleineren Hirnläsionen als in entsprechenden Kontrolltieren. Hiermit stellt der C1-Inhibitor ein potenzieller Therapieansatz bei SHT dar. Jedoch bleibt es offen, inwiefern sich diese Ergebnisse auf das menschliche SHT übertragen lassen. N2 - Traumatic brain injury is a mechanical disruption of brain tissue caused by a violent effect on the head. This initial damage to the brain tissue subsequently expands. There are no effective therapies to inhibit these secondary pathomechanisms. The brain injury is one of the major causes of death and disability. Posttraumatic cerebral edema and inflammatory reactions are important pathomechanisms that contribute to the expansion of brain damage. Both are enhanced by the activation of the kallikrein-kinin system. In the present study, this system was inhibited 1 hour after experimental brain injury by the application of the C1 inhibitor and the effects were evaluated on the following day. The results show that this treatment leads to a reduction of brain edema and inflammatory response after brain injury. The formation of microthrombi in the brain vessels is less than in control animals, presumably because the C1 inhibitor also inhibits the intrinsic coagulation cascade. Overall, the treatment leads to smaller brain lesions than in control animals. The C1 inhibitor thus represents a potential therapeutic target for traumatic brain injury. However, it remains unclear how these results can be transferred to human brain injury. KW - Schädel-Hirn-Trauma KW - C1-Inhibitor Berinert KW - Schädel-Hirn-Trauma KW - Kontakt-Kinin-System Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-173759 ER - TY - THES A1 - Füllgraf, Hannah Christine T1 - Untersuchung des Pyruvatdehydrogenasekomplexes in der Frühphase nach experimenteller Subarachnoidalblutung T1 - Analysis of Pyruvate Dehydrogenase Enzyme Activity Following Experimental Subarachnoid Hemorrhage (SAH) N2 - In der hier vorliegenden Arbeit konnte zum ersten Mal eine Reduktion der Aktivität des PDHC in der Frühphase nach einer SAB im Tierversuch in der Ratte gezeigt werden. Da der PDHC bei der effizienten aeroben Energiegewinnung durch die Einschleusung von Pyruvat in den Zitratzyklus, den entscheidenden Enzymkomplex darstellt, könnte eine Aktivitätsminderung des PDHC ein möglicher Faktor für einen sekundären Hirnschaden und neuronalen Zellschaden nach einer SAB sein. Dass der lange als entscheidend für das schlechte Outcome von SAB-Patienten verantwortlich gemachte verzögerte Vasospasmus nach einer SAB alleine nicht für den sekundären Hirnschaden im Rahmen dieser Erkrankung herhalten kann, wird dadurch unterstrichen, dass der Vasospasmus mittlerweile gut therapiert werden kann, diese Therapie das Outcome der SAB aber nicht signifikant verbessert hat. Eine metabolische Komponente des sekundären Hirnschadens, möglicherweise kombiniert mit einer arteriellen Vasokonstriktion, sollte nach den Ergebnissen dieser Studie durchaus in Betracht gezogen werden. Die Ergebnisse stellen den PDHC als mögliches Ziel für eine neuroprotektive Therapie der SAB heraus. Eine suffiziente Stimulierung des PDHC oder ein Schutz des Enzymkomplexes vor Inaktivierung oder Schädigung könnte in der Frühphase der SAB protektiv wirken. Die Ergebnisse der hier vorliegenden Arbeit sind somit von klinischer Relevanz und sollten Anlass zu weiteren, auch klinischen Studien im Bereich der Funktionsbeeinflus-sung des PDHC geben. Weiterhin scheint eine Untersuchung weiterer metabolischer Schritte gewinnbringend, um weitere mögliche Angriffspunkte einer gezielten Therapie zu identifizieren. N2 - In summary, this study shows for the first time a reduced activity of pyruvate dehydrogenase complex (PDHC) during the early phase after subarachnoid hemorrhage (SAH) induced in rats. PDHC catalyses the reaction of pyruvate to AcetylCoA. This reaction is mandatory for aerobic oxidation via Krebs cycle. Concerning this reaction PDHC essential for aerobic oxidation. A functional impairment of PDHC could be a reason for secondary brain damage and neuronal cell death following SAH. Secondary vasospasm, which was made responsible for worse outcome for many years, can be treated now. As this treatment is not able to improve outcome significantly vasospasm itself is not exclusively responsible for secondary brain damage. Our results indicate that a metabolic component of secondary brain damage possibly in combination with an arterial constriction should be considered. Our findings highlight PDHC as a possible target for neuroprotective therapy of SAH. A sufficient stimulation of PDHC or a protection of the enzyme complex could protect the brain in early phase after SAH. Therefore these results are of clinical relevance and should lead to further studies including clinical trials regarding functional interaction of PDHC. In addition investigation to identify further metabolic steps should contribute to the development of a more targeted therapy. KW - Subarachnoidalblutung KW - Pyruvatdehydrogenase-Komplex KW - Frühphase nach experimenteller Subarachnoidalblutung Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-160216 ER - TY - THES A1 - Wolber, Wanja Andrej T1 - Neuronales Differenzierungspotential muriner androgenetischer Embryonaler- Stammzellen in „vitro“ und in „vivo“ T1 - Neural Differentiation of Androgenetic Murine ES Cell-Derived Neural Progenitor Cells in vitro and in vivo N2 - In dieser Arbeit wurde gezeigt, dass aus uniparentalen, embryonalen Stammzellen mit fehlender maternal geprägter Genexpression (AG-Zellen) differenzierte neuronale Progenitorzellen (pNPCs) eine ähnliche neuronale Kapazität wie wildtypische Progenitorzellen haben. Sie bilden nach histomorphologischen Kriterien in vitro adulte Neurone mit Ausbildung eines synaptischen Netzwerks. In elektrophysiologischen PatchClamp- Untersuchungen wurde gezeigt, dass diese Zellen, ähnlich dem wildtypischen Pendant, spannungsabhängige Natrium- und Kaliumkanälen besitzen, ein negatives Membranpotential haben und bei Stimulation mit repetitiven Aktionspotentialen reagieren. Nach Transplantation in einem Schädel-Hirn- Trauma-Modell konnten nach drei Monaten in vivo Donorzellen mit neuraler Morphologie und der Expression von jungen, neuronalen und glialen Proteinen gefunden werden. Die Teratombildung ist im Vergleich zum Wildtyp unverändert, eine maligne Entartung mit invasivem Wachstum oder ausgedehnter Metastasierung konnte nicht gefunden werden. Aus AG-Zellen generierte neuronale Progenitorzellen sind ein starkes Instrument, um neuronale genomische Prägung zu untersuchen. Außerdem könnte die regenerative Kapazität für eine patientenspezifische Zellersatztherapie genutzt werden. N2 - We have shown that uniparental maternal [AG-origin] embryonic stem cells can give rise to neural progenitor cells [pNPCs] and have a similar ability to form neural tissue compared to wildtype progenitor cells. In vitro they can develop into adult neurons that form a synaptic network. In patch clamp experiments it could be shown that these cells produce a similar amount of voltage gated sodium- and potassium channels, have a negative membrane potential and form multiple action potentials after depolarisation. Three month after transplantation donor cells with expression of early neural development could be found in a transplantation modell afterbrain trauma. The frequency of teratoma forming does not vary compared to wildtype cells. Neural progenitor cells derived from AG-ES cells are a strong tool to study neural genomic imprinting. Their regenerative capacity could be used for a patient specific cell replacement therapy. KW - Uniparentale Stammzellen Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-165929 ER - TY - JOUR A1 - Kessler, Almuth F. A1 - Frömbling, Greta E. A1 - Gross, Franziska A1 - Hahn, Mirja A1 - Dzokou, Wilfrid A1 - Ernestus, Ralf-Ingo A1 - Löhr, Mario A1 - Hagemann, Carsten T1 - Effects of tumor treating fields (TTFields) on glioblastoma cells are augmented by mitotic checkpoint inhibition JF - Cell Death Discovery N2 - Tumor treating fields (TTFields) are approved for glioblastoma (GBM) therapy. TTFields disrupt cell division by inhibiting spindle fiber formation. Spindle assembly checkpoint (SAC) inhibition combined with antimitotic drugs synergistically decreases glioma cell growth in cell culture and mice. We hypothesized that SAC inhibition will increase TTFields efficacy. Human GBM cells (U-87 MG, GaMG) were treated with TTFields (200 kHz, 1.7 V/cm) and/or the SAC inhibitor MPS1-IN-3 (IN-3, 4 µM). Cells were counted after 24, 48, and 72 h of treatment and at 24 and 72 h after end of treatment (EOT). Flow cytometry, immunofluorescence microscopy, Annexin-V staining and TUNEL assay were used to detect alterations in cell cycle and apoptosis after 72 h of treatment. The TTFields/IN-3 combination decreased cell proliferation after 72 h compared to either treatment alone (−78.6% vs. TTFields, P = 0.0337; −52.6% vs. IN-3, P = 0.0205), and reduced the number of viable cells (62% less than seeded). There was a significant cell cycle shift from G1 to G2/M phase (P < 0.0001). The apoptotic rate increased to 44% (TTFields 14%, P = 0.0002; IN-3 4%, P < 0.0001). Cell growth recovered 24 h after EOT with TTFields and IN-3 alone, but the combination led to further decrease by 92% at 72 h EOT if IN-3 treatment was continued (P = 0.0288). The combination of TTFields and SAC inhibition led to earlier and prolonged effects that significantly augmented the efficacy of TTFields and highlights a potential new targeted multimodal treatment for GBM. Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-325744 VL - 4 ER - TY - THES A1 - Hartmann, Jasmin T1 - Neuroprotektion in der Frühphase nach Subarachnoidalblutung: Untersuchung potenzieller Therapieformen im Tiermodell T1 - Neuroprotection in the early phase after subarachnoid hemorrhage: potential therapeutic options in a rat model N2 - Ausgehend von der Hypothese, dass die in dieser Arbeit eingesetzten Substanzen Natriumnitroprussid, Magnesium und Clazosentan aus pathophysiologischen Überlegungen dem in der Frühphase nach SAB auftretenden Perfusionsdefizit entgegenwirken und neuroprotektive Wirkung entfalten können, hat diese Arbeit das Ziel verfolgt, konkrete Therapieansätze zu entwickeln, die für die Behandlung der frühen Durchblutungsstörung nach einer SAB geeignet sein könnten. Ebenso sollte das neuroprotektive Potenzial dieser Substanzen, bei denen es sich um klinisch bereits getestete Medikamente handelt, evaluiert werden. Hierzu wurden drei Versuchsreihen unternommen, die folgende Ergebnisse erbrachten: Die Gabe des NO-Donators Natriumnitroprussid erwies sich als die zerebrale Perfusion in der Frühphase nach SAB signifikant steigernd. Damit einhergehend zeigte sich eine signifikante Reduktion der neuronalen Schädigung im Hippocampus. Insgesamt legt diese Arbeit also das therapeutische Potential dieser Substanz für die Frühphase nach SAB nahe. Für Magnesium konnte im Rahmen dieser Arbeit kein perfusionssteigernder Effekt festgestellt werden. Die hier erhobenen Daten weisen allerdings auf ein mögliches neuroprotektives Potential dieser Substanz hin, sodass weitere Studien größeren Umfangs angestrebt werden sollten, um eine neuroprotektive Wirkung verifizieren zu können. Von dem ETA-Antagonisten Clazosentan wurden drei Dosierungen auf ihr neuroprotektives und perfusionssteigerndes Potential hin getestet. Hinsichtlich des perfusionssteigernden Effektes erwies sich die Maximaldosis zwar als deutlich überlegen, verfehlte jedoch zu den Zeitpunkten 120, 150 und 180 Minuten nach SAB knapp das Signifikanzniveau. Ein neuroprotektives Potential kann auf Grundlage einer knappen Signifikanz in der H&E-Färbung vermutet, aber nicht sicher konstatiert, werden. Das Ziel dieses größer angelegten Projekts ist die Entwicklung einer Kombinationstherapie aus unterschiedlichen Methoden und Medikamenten. Basierend auf den hier vorgestellten Ergebnissen kommen von den in dieser Arbeit untersuchten Substanzen insbesondere der NO-Donator Natriumnitroprussid, aber auch der ETA-Antagonist Clazosentan in Frage. Als mögliche Kombinationspartner könnten Prostazyklin-Agonisten oder Thrombozytenaggregationshemmer eingesetzt werden. Daneben sind die Anwendung einer moderaten Hypothermie sowie die Gabe hyperonkotischer Lösungen therapeutische Ansätze, die im weiteren Verlauf dieses Projekts untersucht werden. N2 - Based upon the hypothesis that the substances used in this work can counteract the early perfusion deficit after subarachnoid hemorrhage and have neuroprotective potential this work was conducted to develop concrete therapeutic options for the early period of subarachoid hemorrhage. Additionaly, this work aimed at investigating the neuroprotective potential of the three substances sodium nitroprusside, magnesium and Clazosentan. To summarize it we found the following: First, intravenous sodium nitroprusside (SNP) increased the early perfusion deficit in rats after subarachnoid hemorrrhage. Matching this result, we found significantly less injured hippocampal neurons in the SNP treated group. So, an immediate therapy with SNP potentially has therapeutic effect in patients suffering from subarachnoid hemorrhage. Second, we did not find a beneficial effect on the perfusion deficit early after experimental subarachnoid hemorrhage in the animals treated with magnesium. Still, this work showed a potential neuroprotective effect for the substance. So, further investigations are necessary to make sure this result is reliable. Third, we included three groups treated with Clazosentan using different doses. All in all, the group treated with the maximal dose of 10 μg showed the best result according to the early perfusion deficit. Still, we cannot state a significantly improved perfusion compared to the placebo treated animals. It also might have neuroprotective potential but based upon our results we cannot make sure. All in all, since the pathophysiology after subarachnoid hemorrhage is very complex any substance immediately given to patients suffering from a subarachnoid hemorrhage should be given in combination with at least one other substance which has not the same mechanism of action. KW - Neurochirurgie KW - Neurologie KW - Notfall KW - Hirnblutung KW - Subarachnoidalblutung Neuroprotektion Frühphase Nitroprussid Notfall Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-153936 ER - TY - THES A1 - Flemming, Johannes T1 - Der Einfluss von Erythropoetin auf die neuronale Differenzierung von murinen, induzierten pan neuralen Progenitorzellen T1 - The impact of erythropoietin on the neural differentiation from murin, induced pan neural progenitor cells N2 - Die Forschung mit induzierten pluripotenten Stammzellen (ipS) wurde in den letzten Jahren ein wichtiger Bestandteil der Stammzellforschung. Bisher sind nur wenige Möglichkeiten bekannt, wie man die unspezifische Proliferation der aus ipS differenzierten pan neuralen Progenitorzellen kontrollieren kann. Um dies weiter zu untersuchen, wurden murine induzierte Stammzellen, die mit den 4 Faktoren Oct4, Klf4, Sox2 und c-Myc reprogrammiert wurden, untersucht. In diversen Forschungsreihen konnte zudem gezeigt werden, dass Erythropoetin (EPO) einen Einfluss auf das Zellüberleben, die Proliferation und die Differenzierung neuronaler Zellen hat. Ob dieser Einfluss auch bei induzierten pan neuralen pluripotenten Progenitorzellen zu beobachten ist, wird in dieser Arbeit untersucht. Anhand eines Zellviabilitätsversuchs (MTT-Assay) wurde untersucht, ob die Stoffwechselaktivität durch EPO (0,1U/ml, 1 U/ml und 10 U/ml) im Vergleich zur Kontrollgruppe gesteigert werden kann. Dabei zeigte sich eine deutliche Zunahme nach 24 Stunden bei 1 und 10 U/ml EPO. Der Einfluss von EPO auf die Proliferation der Zellen wurde an Neurosphären unter Einsatz verschiedener EPO-Konzentrationen (0,1U/ml, 1U/ml und 10U/ml) sowie ohne EPO (Kontrollgruppe) untersucht. Dabei zeigte sich eine Reduzierung der Sphärenanzahl mit einem Durchmesser von >100µm bei zunehmender EPO-Konzentration. Im Gegensatz hierzu stieg die Anzahl der Sphären mit einem Durchmesser von 50-100µm. Die neuronale Differenzierung wurde durch den Zellfortsatz-Versuch mit Tuj1 positiven Zellfortsätzen in einer Monolayer-Kultur beobachtet. Dabei zeigte sich unter EPO eine Zunahme der Zellen mit einem Fortsatz. Ebenso wurde eine Durchflusszytometrie zum Nachweis der Proliferationshemmung durch EPO durchgeführt. Dazu wurden die Zellen mit CFSE markiert und mit einer EPO- oder Kontrolllösung versetzt. Dabei zeigte sich bei zunehmender EPO-Konzentration eine deutliche Zunahme der CFSE-Konzentration nach 48 und 72 Stunden. Der Nachweis, dass die Zellen auf EPO reagieren, wurde durch einen Western Blot erbracht. Dieser zeigte, dass die verwendeten 4F induzierte pan neurale Progenitorzellen (4F ipNP-Zellen) einen funktionellen EPO-Rezeptor besitzen, dessen Expression durch EPO deutlich gesteigert werden kann. Es konnte gezeigt werden, dass EPO die Proliferation der Zellen vermindert, gleichzeitig aber auch die Zellviabilität und die Zelldifferenzierung erhöht. Diese Ergebnisse sind jedoch von vielen Faktoren abhängig, sodass noch einiges auf diesem Gebiet zu erforschen bleibt. N2 - In the last years induced stem cells have become an important part of the stem cell research. Until now there are just few possibilities known of how to control the unspecific proliferation of differentiated pan neural progenitor cells. For further research induced murine stem cells which have been reprogramed with the 4 factors oct4, klf4, sox2 and c-myc were used. Other research showed that Erythropoetin (EPO) has an impact on cell survival, proliferation and differentiation of neuronal cells. This thesis analyzes if EPO also shows these effects on induced pan neural progenitor cells. The cell viability has been analyzed via an MTT-assay. The results showed an increase of activity of the cell metabolism after 24 hours with 1 and 10U/ml EPO compared to a placebo group. The impact of EPO on the proliferation of cells has been analyzed on neurosphere cultures. Therefore groups of neurophere cultures treated with different EPO concentrations (0,1U/ml, 1U/ml and 10U/ml) were compared to a placebo group. The results showed a reduction of neurospheres with a diameter from >100µm when the EPO concentration was increased. On the contrary the number of neurospheres with a diameter from 50-100µm increased. The neuronal differentiation has been analyzed with a Tuj1 positive cell process assay in a monolayer culture. The number of cells with one process increased in the EPO group compared to the placebo group. Additionally a FACS was used to proof the proliferation inhibition of EPO. Therefore the cells were marked with CFSE and added to a placebo or EPO (1U/ml and 3U/ml) solution. A significant rise of CFSE concentration with an increasing EPO concentration after 48 and 72 hours could be shown. A western blot further showed the impact of EPO on the cells: It was shown that the used 4 factor induced pan neural progenitor cells (4F ipnp-cells) possess a functional EPO receptor whose expression can be raised through EPO. It was shown that EPO reduces the proliferation, but increases the cell viability and cell proliferation. These results are dependent on many factors. Therefore more research is needed. KW - induzierte Stammzellen KW - induced stem cells KW - Erythropoetin KW - neuronale Differenzierung KW - Proliferation KW - erythropoietin KW - neuonal differentiation KW - proliferation Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-151268 ER - TY - THES A1 - Wetter, Christin T1 - Das Erkennen des drohenden Hörverlustes nach Vestibularisschwannom-Operation T1 - The discovery of impending hearing loss after vestibularisschwannom operation N2 - Die Ableitung Akustisch evozierter Potentiale (AEP) durch intraoperatives Monitoring wird regelhaft bei der Operation von Vestibularisschwannomen mit dem Ziel des Hörerhaltes durchgeführt. Trotz AEP-Erhalt am Ende der Operation wurden Fälle mit postoperativer Taubheit beobachtet. Bisher ist es unklar, ob es sich um falsch positive AEP-Befunde oder Fälle von sekundärer Taubheit handelt. Diese Pilotstudie, bei der zu definierten Zeitpunkten postoperativ AEP-Messungen durchgeführt wurden, zeigt erhebliche Veränderungen der AEP-Befunde im postoperativen Verlauf. Es fanden sich Patienten mit verbesserten AEP-Befunden, aber auch verschlechterten AEP bis zum vollständigen Verlust aller AEP-Komponenten. Ob ein sekundärer Hörverlust durch frühzeitiges Erkennen von AEP-Veränderungen verhindert werden kann, wird Inhalt von weiteren Studien sein. N2 - Auditory brainstem response (ABR) monitoring is regularly used in surgery of vestibular schwannoma to achieve hearing preservation. Despite ABR preservation at the end of surgery there are cases with postoperative deafness. To date it is unclear whether these are false positive ABR data or cases of secondary hearing loss. In this pilot study we focused on the early postoperative phase and possible ABR changes in this period. This pilot study identifies considerable change of ABR formation occurring in a considerable proportion of patients early after vestibular schwannoma resection. Obviously, in some patients the end-operative state of the ABR is not the final state. Some patients show a postoperative improvement and some a deterioration towards a complete loss of all ABR components. Whether secondary hearing loss could be presented by early detection, will be a matter of further studies. KW - Kleinhirnbrückenwinkeltumor KW - Kleinhirnbrückenwinkel KW - Vestibularisschwannom KW - Akustisch evozierte Potentiale Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-151569 ER - TY - JOUR A1 - Hopp, Sarah A1 - Nolte, Marc W. A1 - Stetter, Christian A1 - Kleinschnitz, Christoph A1 - Sirén, Anna-Leena A1 - Albert-Weissenberger, Christiane T1 - Alleviation of secondary brain injury, posttraumatic inflammation, and brain edema formation by inhibition of factor XIIa JF - Journal of Neuroinflammation N2 - Background: Traumatic brain injury (TBI) is a devastating neurological condition and a frequent cause of permanent disability. Posttraumatic inflammation and brain edema formation, two pathological key events contributing to secondary brain injury, are mediated by the contact-kinin system. Activation of this pathway in the plasma is triggered by activated factor XII. Hence, we set out to study in detail the influence of activated factor XII on the abovementioned pathophysiological features of TBI. Methods: Using a cortical cryogenic lesion model in mice, we investigated the impact of genetic deficiency of factor XII and inhibition of activated factor XII with a single bolus injection of recombinant human albumin-fused Infestin-4 on the release of bradykinin, the brain lesion size, and contact-kinin system-dependent pathological events. We determined protein levels of bradykinin, intracellular adhesion molecule-1, CC-chemokine ligand 2, and interleukin-1β by enzyme-linked immunosorbent assays and mRNA levels of genes related to inflammation by quantitative real-time PCR. Brain lesion size was determined by tetrazolium chloride staining. Furthermore, protein levels of the tight junction protein occludin, integrity of the blood-brain barrier, and brain water content were assessed by Western blot analysis, extravasated Evans Blue dye, and the wet weight-dry weight method, respectively. Infiltration of neutrophils and microglia/activated macrophages into the injured brain lesions was quantified by immunohistological stainings. Results: We show that both genetic deficiency of factor XII and inhibition of activated factor XII in mice diminish brain injury-induced bradykinin release by the contact-kinin system and minimize brain lesion size, blood-brain barrier leakage, brain edema formation, and inflammation in our brain injury model. Conclusions: Stimulation of bradykinin release by activated factor XII probably plays a prominent role in expanding secondary brain damage by promoting brain edema formation and inflammation. Pharmacological blocking of activated factor XII could be a useful therapeutic principle in the treatment of TBI-associated pathologic processes by alleviating posttraumatic inflammation and brain edema formation. KW - factor XII KW - focal brain lesion KW - brain edema Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157490 VL - 14 IS - 39 ER - TY - JOUR A1 - Lilla, Nadine A1 - Füllgraf, Hannah A1 - Stetter, Christian A1 - Köhler, Stefan A1 - Ernestus, Ralf-Ingo A1 - Westermaier, Thomas T1 - First Description of Reduced Pyruvate Dehydrogenase Enzyme Activity Following Subarachnoid Hemorrhage (SAH) JF - Frontiers in Neuroscience N2 - Object: Several previous studies reported metabolic derangements and an accumulation of metabolic products in the early phase of experimental subarachnoid hemorrhage (SAH), which may contribute to secondary brain damage. This may be a result of deranged oxygen utilization due to enzymatic dysfunction in aerobic glucose metabolism. This study was performed to investigate, if pyruvate dehydrogenase enzyme (PDH) is affected in its activity giving further hints for a derangement of oxidative metabolism. Methods: Eighteen male Sprague-Dawley rats were randomly assigned to one of two experimental groups (n = 9): (1) SAH induced by the endovascular filament model and (2) sham-operated controls. Mean arterial blood pressure (MABP), intracranial pressure (ICP), and local cerebral blood flow (LCBF; laser-Doppler flowmetry) were continuously monitored from 30 min before until 3 h after SAH. Thereafter, the animals were sacrificed and PDH activity was measured by ELISA. Results: PDH activity was significantly reduced in animals subjected to SAH compared to controls. Conclusion: The results of this study demonstrate for the first time a reduction of PDH activity following SAH, independent of supply of substrates and may be an independent factor contributing to a derangement of oxidative metabolism, failure of oxygen utilization, and secondary brain damage. KW - secondary brain damage KW - aerobic glycolysis KW - CBF KW - metabolism KW - PDH KW - SAH Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157636 VL - 11 IS - 37 ER - TY - JOUR A1 - Dietl, Sebastian A1 - Schwinn, Stefanie A1 - Dietl, Susanne A1 - Riedl, Simone A1 - Deinlein, Frank A1 - Rutkowski, Stefan A1 - von Bueren, Andre O. A1 - Krauss, Jürgen A1 - Schweitzer, Tilmann A1 - Vince, Giles H. A1 - Picard, Daniel A1 - Eyrich, Matthias A1 - Rosenwald, Andreas A1 - Ramaswamy, Vijay A1 - Taylor, Michael D. A1 - Remke, Marc A1 - Monoranu, Camelia M. A1 - Beilhack, Andreas A1 - Schlegel, Paul G. A1 - Wölfl, Matthias T1 - MB3W1 is an orthotopic xenograft model for anaplastic medulloblastoma displaying cancer stem cell- and Group 3-properties JF - BMC Cancer N2 - Background Medulloblastoma is the most common malignant brain tumor in children and can be divided in different molecular subgroups. Patients whose tumor is classified as a Group 3 tumor have a dismal prognosis. However only very few tumor models are available for this subgroup. Methods We established a robust orthotopic xenograft model with a cell line derived from the malignant pleural effusions of a child suffering from a Group 3 medulloblastoma. Results Besides classical characteristics of this tumor subgroup, the cells display cancer stem cell characteristics including neurosphere formation, multilineage differentiation, CD133/CD15 expression, high ALDH-activity and high tumorigenicity in immunocompromised mice with xenografts exactly recapitulating the original tumor architecture. Conclusions This model using unmanipulated, human medulloblastoma cells will enable translational research, specifically focused on Group 3 medulloblastoma. KW - cancer stem cells KW - anaplastic medulloblastoma KW - group 3 KW - orthotopic xenograft KW - animal model KW - brain tumor KW - children Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-145877 VL - 16 IS - 115 ER - TY - THES A1 - Fuchs, Steffen Eberhard T1 - Die Bedeutung von MACC1 für die Pathogenese und klinische Prognose humaner Glioblastome T1 - Impact of MACC1 for pathogenesis and prognosis of human glioblastoma N2 - Das Glioblastoma multiforme (GBM) ist der primäre maligne Hirntumor mit der höchsten Prävalenz bei Erwachsenen. Dieser astrozytäre Tumor ist durch ein besonders schnelles Wachstum und ein äußerst invasives Verhalten charakterisiert. Deshalb beträgt das mediane Überleben nach Diagnose trotz interdisziplinärer Therapie nur ungefähr 14,6 Monate. Metastasis Associated in Colon Cancer-1 (MACC1) ist ein neuer prognostischer Marker für Metastasierung im kolorektalen Karzinom. Es ist ein transkriptioneller Regulator von Met, dem Rezeptor des Hepatocyte Growth Factor (HGF). Überexpression von MACC1 führt zur Induktion von Migration und Proliferation. Es wurde gezeigt, dass MACC1 auch in anderen Tumorentitäten wie dem Magenkarzinom, Bronchialkarzinom und hepatozellulärem Karzinom verstärkt exprimiert ist. Jedoch gab es bisher noch keine Daten über die Rolle von MACC1 in astrozytären Tumoren. Obwohl GBM nur selten metastasieren, ist ihr aggressives und invasives Verhalten mit dem von metastasierenden Tumoren vergleichbar. Deshalb war das Ziel dieser Arbeit zu zeigen, dass MACC1 auch eine wichtige Rolle in der Pathogenese von Glioblastomen spielen könnte. Die MACC1-Expression von Glioblastomen wurde zunächst in silico mit frei zugänglichen Microarray-Platformen analysiert. Von Gewebeproben humaner niedergradiger Astozytome (LGA) und GBM wurde die MACC1- und Met-Expression mittels PCR bestimmt. Die Analyse der Expression auf Proteinebene wurde durch Immunhistochemie (IHC) von Patientengewebe durchgeführt. Funktionelle Analysen folgten in Form eines Sphäroidmigrationsassays von primären GBM Zellkulturen. Weiterhin wurde MACC1 in zwei GBM-Zelllinien stabil überexprimiert und deren Migration und Proliferation in Echtzeit gemessen. Komplettiert wurden die funktionellen Versuche durch einen Koloniebildungsassay. Die Expression von MACC1 stieg mit zunehmendem WHO-Grad auf mRNA- und Proteinebene an. Die Analyse von MACC1 durch IHC erlaubte eine Differenzierung nicht nur zwischen ruhenden LGA und LGA welche später ein Rezidiv bildeten, bzw. Progress zeigten, sondern auch zwischen primären und sekundären GBM. Eine hohe MACC1-Expression war mit einer ungünstigen klinischen Prognose der Patienten assoziiert. Die endogene Expression von MACC1 korrelierte mit der Migrationsaktivität primärer GBM-Zellkulturen. Die Überexpression von MACC1 in GBM-Zelllinien induzierte Proliferation, Migration und Koloniebildung und korrelierte somit mit Schlüsseleigenschaften maligner Zellen. Zusammenfassend zeigen die Ergebnisse dieser Arbeit zum ersten Mal eine essentielle Rolle von MACC1 für die Pathogenese von Glioblastomen. Deshalb könnte MACC1 ein potentielles neues therapeutisches Ziel für die Behandlung von Glioblastomen sein und eventuell sogar als neuer prognostischer Marker dienen. N2 - Glioblastoma multiforme (GBM) is the primary malignant brain tumor with the highest prevalence in adults. This astrocytic tumor is characterized by a particular rapid growth and a highly invasive behavior. Thus, it leads to a median survival of only about 14.6 months after diagnosis despite a multidisciplinary treatment consisting of surgery, radiation, and chemotherapy. Metastasis Associated in Colon Cancer-1 (MACC1) is a new prognostic indicator of metastasis formation in colon carcinoma. It is a transcriptional regulator of Met, the receptor of the Hepatocyte Growth Factor (HGF). An overexpression of MACC1 leads to an acceleration of migration and proliferation. Recently, MACC1 was also shown to be upregulated in other tumor entities such as gastric, lung, and hepatocellular carcinoma. However, there were no data available yet which address a potential role of MACC1 in human astrocytic tumors. Although GBM rarely metastasize, their invasive and migratory behavior is comparable to those of metastasizing tumors. Therefore, the aim of this study was to show that MACC1 may also play an important role in glioblastoma pathogenesis. GBM microarray platforms were screened for MACC1 expression. PCR measurements were performed to study the MACC1 and Met expression in tissue samples of human low grade astrocytoma (LGA) and GBM. Immunohistochemistry (IHC) of paraffin- embedded glioma patients‘ tissue samples was carried out to analyze MACC1 expression on the protein level. Finally, functional analyses were performed by a spheroid migration assay with primary GBM cell cultures. Additionally, MACC1 was stably overexpressed in two GBM cell lines. Subsequent real-time measurements of the cells‘ migration, proliferation, and colony formation abilities were performed. MACC1 expression increased concomitantly with augmenting WHO grading of the tumors on the mRNA- and protein-level. Analysis of MACC1 expression by IHC allowed a distinction between dormant and recurrent or progressing LGA, respectively. Moreover, a differentiation could also been made between primary and secondary GBM. A strong expression of MACC1 corresponded with a poor patients‘ survival. Endogenous expression of MACC1 correlated with migration of GBM primary cell cultures. Overexpression of MACC1 in GBM cell lines led to an increased proliferation, migration, and colony formation activity. Taken together, the results of this work indicate for the first time a crucial role of MACC1 for the pathogenesis of glioblastoma. Its expression correlates with hallmarks of cancer cells like proliferation and migration along with affecting GBM-patients‘ prognosis. Therefore, MACC1 may represent a putative new target for treatment of glioblastoma and may even serve as a new prognostic marker. KW - Onkologie KW - Glioblastom KW - MACC1 Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-143790 ER - TY - JOUR A1 - Hassouna, I. A1 - Ott, C. A1 - Wüstefeld, L. A1 - Offen, N. A1 - Neher, R. A. A1 - Mitkovski, M. A1 - Winkler, D. A1 - Sperling, S. A1 - Fries, L. A1 - Goebbels, S. A1 - Vreja, I. C. A1 - Hagemeyer, N. A1 - Dittrich, M. A1 - Rossetti, M. F. A1 - Kröhnert, K. A1 - Hannke, K. A1 - Boretius, S. A1 - Zeug, A. A1 - Höschen, C. A1 - Dandekar, T. A1 - Dere, E. A1 - Neher, E. A1 - Rizzoli, S. O. A1 - Nave, K.-A. A1 - Sirén, A.-L. A1 - Ehrenreich, H. T1 - Revisiting adult neurogenesis and the role of erythropoietin for neuronal and oligodendroglial differentiation in the hippocampus JF - Molecular Psychiatry N2 - Recombinant human erythropoietin (EPO) improves cognitive performance in neuropsychiatric diseases ranging from schizophrenia and multiple sclerosis to major depression and bipolar disease. This consistent EPO effect on cognition is independent of its role in hematopoiesis. The cellular mechanisms of action in brain, however, have remained unclear. Here we studied healthy young mice and observed that 3-week EPO administration was associated with an increased number of pyramidal neurons and oligodendrocytes in the hippocampus of similar to 20%. Under constant cognitive challenge, neuron numbers remained elevated until >6 months of age. Surprisingly, this increase occurred in absence of altered cell proliferation or apoptosis. After feeding a \(^{15}\)N-leucine diet, we used nanoscopic secondary ion mass spectrometry, and found that in EPO-treated mice, an equivalent number of neurons was defined by elevated \(^{15}\)N-leucine incorporation. In EPO-treated NG2-Cre-ERT2 mice, we confirmed enhanced differentiation of preexisting oligodendrocyte precursors in the absence of elevated DNA synthesis. A corresponding analysis of the neuronal lineage awaits the identification of suitable neuronal markers. In cultured neurospheres, EPO reduced Sox9 and stimulated miR124, associated with advanced neuronal differentiation. We are discussing a resulting working model in which EPO drives the differentiation of non-dividing precursors in both (NG2+) oligodendroglial and neuronal lineages. As endogenous EPO expression is induced by brain injury, such a mechanism of adult neurogenesis may be relevant for central nervous system regeneration. KW - neural stem-cells KW - recombinat-human-erythropoietin KW - cognitive functions KW - pyramidal neurons KW - nervous-sytem KW - brain-injury KW - mouse-brain KW - progenitors KW - mice KW - memory Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-186669 VL - 21 IS - 12 ER - TY - JOUR A1 - Hopp, Sarah A1 - Albert-Weissenberger, Christiane A1 - Mencl, Stine A1 - Bieber, Michael A1 - Schuhmann, Michael K. A1 - Stetter, Christian A1 - Nieswandt, Bernhard A1 - Schmidt, Peter M. A1 - Monoranu, Camelia-Maria A1 - Alafuzoff, Irina A1 - Marklund, Niklas A1 - Nolte, Marc W. A1 - Sirén, Anna-Leena A1 - Kleinschnitz, Christoph T1 - Targeting coagulation factor XII as a novel therapeutic option in brain trauma JF - Annals of Neurology N2 - Objective: Traumatic brain injury is a major global public health problem for which specific therapeutic interventions are lacking. There is, therefore, a pressing need to identify innovative pathomechanism-based effective therapies for this condition. Thrombus formation in the cerebral microcirculation has been proposed to contribute to secondary brain damage by causing pericontusional ischemia, but previous studies have failed to harness this finding for therapeutic use. The aim of this study was to obtain preclinical evidence supporting the hypothesis that targeting factor XII prevents thrombus formation and has a beneficial effect on outcome after traumatic brain injury. Methods: We investigated the impact of genetic deficiency of factor XII and acute inhibition of activated factor XII with a single bolus injection of recombinant human albumin-fused infestin-4 (rHA-Infestin-4) on trauma-induced microvascular thrombus formation and the subsequent outcome in 2 mouse models of traumatic brain injury. Results: Our study showed that both genetic deficiency of factor XII and an inhibition of activated factor XII in mice minimize trauma-induced microvascular thrombus formation and improve outcome, as reflected by better motor function, reduced brain lesion volume, and diminished neurodegeneration. Administration of human factor XII in factor XII-deficient mice fully restored injury-induced microvascular thrombus formation and brain damage. Interpretation: The robust protective effect of rHA-Infestin-4 points to a novel treatment option that can decrease ischemic injury after traumatic brain injury without increasing bleeding tendencies. KW - Molecular-weight heparin KW - Thrombus formation KW - Cerebral-ischemia KW - in-vivo KW - Intravascular coagulation KW - Hemodynamic depression KW - Head-injury KW - Rats KW - Model KW - Mice Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-188800 VL - 79 IS - 6 ER - TY - JOUR A1 - Israel, Ina A1 - Ohsiek, Andrea A1 - Al-Momani, Ehab A1 - Albert-Weissenberger, Christiane A1 - Stetter, Christian A1 - Mencl, Stine A1 - Buck, Andreas K. A1 - Kleinschnitz, Christoph A1 - Samnick, Samuel A1 - Sirén, Anna-Leena T1 - Combined [\(^{18}\)F]DPA-714 micro-positron emission tomography and autoradiography imaging of microglia activation after closed head injury in mice JF - Journal of Neuroinflammation N2 - Background Traumatic brain injury (TBI) is a major cause of death and disability. Neuroinflammation contributes to acute damage after TBI and modulates long-term evolution of degenerative and regenerative responses to injury. The aim of the present study was to evaluate the relationship of microglia activation to trauma severity, brain energy metabolism, and cellular reactions to injury in a mouse closed head injury model using combined in vivo PET imaging, ex vivo autoradiography, and immunohistochemistry. Methods A weight-drop closed head injury model was used to produce a mixed diffuse and focal TBI or a purely diffuse mild TBI (mTBI) in C57BL6 mice. Lesion severity was determined by evaluating histological damage and functional outcome using a standardized neuroscore (NSS), gliosis, and axonal injury by immunohistochemistry. Repeated intra-individual in vivo μPET imaging with the specific 18-kDa translocator protein (TSPO) radioligand [\(^{18}\)F]DPA-714 was performed on day 1, 7, and 16 and [\(^{18}\)F]FDG-μPET imaging for energy metabolism on days 2–5 after trauma using freshly synthesized radiotracers. Immediately after [\(^{18}\)F]DPA-714-μPET imaging on days 7 and 16, cellular identity of the [\(^{18}\)F]DPA-714 uptake was confirmed by exposing freshly cut cryosections to film autoradiography and successive immunostaining with antibodies against the microglia/macrophage marker IBA-1. Results Functional outcome correlated with focal brain lesions, gliosis, and axonal injury. [\(^{18}\)F]DPA-714-μPET showed increased radiotracer uptake in focal brain lesions on days 7 and 16 after TBI and correlated with reduced cerebral [\(^{18}\)F]FDG uptake on days 2–5, with functional outcome and number of IBA-1 positive cells on day 7. In autoradiography, [\(^{18}\)F]DPA-714 uptake co-localized with areas of IBA1-positive staining and correlated strongly with both NSS and the number of IBA1-positive cells, gliosis, and axonal injury. After mTBI, numbers of IBA-1 positive cells with microglial morphology increased in both brain hemispheres; however, uptake of [\(^{18}\)F]DPA-714 was not increased in autoradiography or in μPET imaging. Conclusions [\(^{18}\)F]DPA-714 uptake in μPET/autoradiography correlates with trauma severity, brain metabolic deficits, and microglia activation after closed head TBI. KW - neuroinflammation KW - TBI KW - immunohistochemistry KW - weight drop KW - PET KW - diffuse KW - focal KW - TSPO KW - autoradiography KW - IBA-1 Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146606 VL - 13 IS - 140 ER - TY - JOUR A1 - Lapa, Constantin A1 - Lückerath, Katharina A1 - Kleinlein, Irene A1 - Monoranu, Camelia Maria A1 - Linsenmann, Thomas A1 - Kessler, Almuth F. A1 - Rudelius, Martina A1 - Kropf, Saskia A1 - Buck, Andreas K. A1 - Ernestus, Ralf-Ingo A1 - Wester, Hans-Jürgen A1 - Löhr, Mario A1 - Herrmann, Ken T1 - \(^{68}\)Ga-Pentixafor-PET/CT for Imaging of Chemokine Receptor 4 Expression in Glioblastoma JF - Theranostics N2 - Chemokine receptor-4 (CXCR4) has been reported to be overexpressed in glioblastoma (GBM) and to be associated with poor survival. This study investigated the feasibility of non-invasive CXCR4-directed imaging with positron emission tomography/computed tomography (PET/CT) using the radiolabelled chemokine receptor ligand \(^{68}\)Ga-Pentixafor. 15 patients with clinical suspicion on primary or recurrent glioblastoma (13 primary, 2 recurrent tumors) underwent \(^{68}\)Ga-Pentixafor-PET/CT for assessment of CXCR4 expression prior to surgery. O-(2-\(^{18}\)F-fluoroethyl)-L-tyrosine (\(^{18}\)F-FET) PET/CT images were available in 11/15 cases and were compared visually and semi-quantitatively (SUV\(_{max}\), SUV\(_{mean}\)). Tumor-to-background ratios (TBR) were calculated for both PET probes. \(^{68}\)Ga-Pentixafor-PET/CT results were also compared to histological CXCR4 expression on neuronavigated surgical samples. \(^{68}\)Ga-Pentixafor-PET/CT was visually positive in 13/15 cases with SUV\(_{mean}\) and SUV\(_{max}\) of 3.0±1.5 and 3.9±2.0 respectively. Respective values for \(^{18}\)F-FET were 4.4±2.0 (SUV\(_{mean}\)) and 5.3±2.3 (SUV\(_{max}\)). TBR for SUV\(_{mean}\) and SUV\(_{max}\) were higher for \(^{68}\)Ga-Pentixafor than for \(^{18}\)F-FET (SUV\(_{mean}\) 154.0±90.7 vs. 4.1±1.3; SUV\(_{max}\) 70.3±44.0 and 3.8±1.2, p<0.01), respectively. Histological analysis confirmed CXCR4 expression in tumor areas with high \(^{68}\)Ga-Pentixafor uptake; regions of the same tumor without apparent \(^{68}\)Ga-Pentixafor uptake showed no or low receptor expression. In this pilot study, \(^{68}\)Ga-Pentixafor retention has been observed in the vast majority of glioblastoma lesions and served as readout for non-invasive determination of CXCR4 expression. Given the paramount importance of the CXCR4/SDF-1 axis in tumor biology, \(^{68}\)Ga-Pentixafor-PET/CT might prove a useful tool for sensitive, non-invasive in-vivo quantification of CXCR4 as well as selection of patients who might benefit from CXCR4-directed therapy. KW - imaging KW - chemokine receptor-4 KW - glioblastoma KW - positron emission tomography/computed tomography KW - \(^{68}\)Ga-Pentixafor Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-168174 VL - 6 IS - 3 ER -