TY - JOUR A1 - Sommer, Claudia A1 - Klose, Petra A1 - Welsch, Patrick A1 - Petzke, Frank A1 - Häuser, Winfried T1 - Opioids for chronic non‐cancer neuropathic pain. An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks duration JF - European Journal of Pain N2 - Background and Objective This updated systematic review evaluated the efficacy, tolerability and safety of opioids compared to placebo in chronic non‐cancer neuropathic pain. Databases and Data Treatment Clinicaltrials.gov, CENTRAL, PubMed and PsycINFO were searched from October 2013 to June 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks double‐blinded duration were analysed. Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety. Effects were summarized by a random effects model using risk differences (RD) or standardized mean differences (SMD). We added four new studies with 662 participants for a total of 16 included studies with 2,199 participants. Study duration ranged between 4 and 12 weeks. Studies with a parallel and cross‐over design: Based on low to moderate quality evidence, opioids (buprenorphine, hydromorphone, morphine, oxycodone, tramadol) provided a clinically relevant pain relief of 50% or greater and reduction of disability compared to placebo. There was no clinically relevant harm with regards to the drop out rate due to adverse and serious adverse events by opioids compared to placebo. Enriched enrolment randomized withdrawal design: Based on low to moderate quality evidence, tapentadol provided a clinically relevant pain relief of 50% or greater and reduction of disability compared to placebo in diabetic polyneuropathy. There was no clinically relevant harm with regards to the drop out rate due to adverse and serious adverse events by tapentadol compared to placebo. Conclusions Some opioids provided a short‐term substantial pain relief in highly selected patients in some neuropathic pain syndromes. Significance Some opioids (buprenorphine, morphine, oxycodone, tramadol, tapentadol) provide substantial pain relief compared to placebo in postherpetic neuralgia and peripheral neuropathies of different aetiologies for 4–12 weeks. There is insufficient evidence to support or refute the suggestion that these drugs are effective in other neuropathic pain conditions. The safety of opioids with regards to abuse and deaths in the studies analysed cannot be extrapolated to routine clinical care. Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218487 VL - 24 IS - 1 SP - 3 EP - 18 ER - TY - JOUR A1 - Sommer, Claudia A1 - Carroll, Antonia S. A1 - Koike, Haruki A1 - Katsuno, Masahisa A1 - Ort, Nora A1 - Sobue, Gen A1 - Vucic, Steve A1 - Spies, Judith M. A1 - Doppler, Kathrin A1 - Kiernan, Matthew C. T1 - Nerve biopsy in acquired neuropathies JF - Journal of the Peripheral Nervous System N2 - A diagnosis of neuropathy can typically be determined through clinical assessment and focused investigation. With technological advances, including significant progress in genomics, the role of nerve biopsy has receded over recent years. However, making a specific and, in some cases, tissue-based diagnosis is essential across a wide array of potentially treatable acquired peripheral neuropathies. When laboratory investigations do not suggest a definitive diagnosis, nerve biopsy remains the final step to ascertain the etiology of the disease. The present review highlights the utility of nerve biopsy in confirming a diagnosis, while further illustrating the importance of a tissue-based diagnosis in relation to treatment strategies, particularly when linked to long-term immunosuppressive therapies, KW - inflammatory neuropathy KW - nerve biopsy KW - nerve tumor KW - neuroleukemiosis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259555 VL - 26 IS - S2 ER - TY - JOUR A1 - Sommer, Claudia T1 - Natural course of Guillain-Barré syndrome JF - European Journal of Neurology KW - Guillain-Barré syndrome KW - intravenous immunoglobulin KW - immunomodulation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318757 VL - 29 IS - 10 SP - 2881 EP - 2882 ER - TY - THES A1 - Soda, Hassan T1 - Interdisziplinäres Schlaganfallmanagement anhand des Stroke Manager Programms – Studiendaten und Perspektiven für die Schlaganfallversorgung T1 - Interdisciplinary stroke management using the Stroke Manager program – study data and perspectives for stroke care N2 - Die Schlaganfallnachsorge in Deutschland wird von verschiedenen Leistungserbringern geprägt, die teilweise komplementäre und komplexe Dienstleistungen erbringen und sektorenübergreifend arbeiten. In Bad Neustadt wurde in Kooperation mit der Universität Würzburg und dem Zentrum für Telemedizin Bad Kissingen das Stroke Manager Programm entwickelt und evaluiert. Das strukturierte Nachsorgeprogramm Stroke Manager basiert auf einer standardisierten Informations- und Software Unterstützung von der Akutversorgung bis drei Monate nach Entlassung aus der stationären Versorgung. Anhand der Ergebnisse des Stroke Manager Programms konnte eine vergleichsweise hohe Persistenz bzgl. der stationär verordneten medikamentösen Sekundärprävention über einen Zeitraum von drei Monaten festgestellt werden, ebenso konnten wir nachweisen, dass sich das Programm positiv auf die Versorgungsqualität sowie die Patientenzufriedenheit nach Schlaganfall auswirken kann. Die im Stroke Manager-Programm betreuten Schlaganfallpatienten wiesen im Vergleich signifikante Unterschiede bei den Faktoren Rauchverhalten, Schlaganfallschweregrad und subjektive, globale Lebensqualität auf. N2 - Stroke aftercare in Germany is shaped by different service providers, some of whom provide complementary and complex services and work across sectors. In Bad Neustadt, the Stroke Manager Program was developed and evaluated in cooperation with the University of Würzburg and the Centre for Telemedicine Bad Kissingen. The structured aftercare program Stroke Manager is based on standardized information and software support from acute care up to three months after discharge from inpatient care. Based on the results of the Stroke Manager program, a comparatively high persistence of inpatient secondary drug prevention was observed over a period of three months, and we were able to demonstrate that the program can have a positive impact on the quality of care and patient satisfaction after stroke. The stroke patients treated in the Stroke Manager program showed significant differences in smoking behaviour, stroke severity and subjective, global quality of life. KW - Stroke Manager KW - medikamentöse Sekundärprävention bei stroke KW - Lebensqualität nach stroke Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242061 ER - TY - JOUR A1 - Simon, Micha A1 - Ipek, Rojda A1 - Homola, György A. A1 - Rovituso, Damiano M. A1 - Schampel, Andrea A1 - Kleinschnitz, Christoph A1 - Kuerten, Stefanie T1 - Anti-CD52 antibody treatment depletes B cell aggregates in the central nervous system in a mouse model of multiple sclerosis JF - Journal of Neuroinflammation N2 - Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) for which several new treatment options were recently introduced. Among them is the monoclonal anti-CD52 antibody alemtuzumab that depletes mainly B cells and T cells in the immune periphery. Considering the ongoing controversy about the involvement of B cells and in particular the formation of B cell aggregates in the brains of progressive MS patients, an in-depth understanding of the effects of anti-CD52 antibody treatment on the B cell compartment in the CNS itself is desirable. Methods: We used myelin basic protein (MBP)-proteolipid protein (PLP)-induced experimental autoimmune encephalomyelitis (EAE) in C57BL/6 (B6) mice as B cell-dependent model of MS. Mice were treated intraperitoneally either at the peak of EAE or at 60 days after onset with 200 μg murine anti-CD52 vs. IgG2a isotype control antibody for five consecutive days. Disease was subsequently monitored for 10 days. The antigen-specific B cell/antibody response was measured by ELISPOT and ELISA. Effects on CNS infiltration and B cell aggregation were determined by immunohistochemistry. Neurodegeneration was evaluated by Luxol Fast Blue, SMI-32, and Olig2/APC staining as well as by electron microscopy and phosphorylated heavy neurofilament serum ELISA. Results: Treatment with anti-CD52 antibody attenuated EAE only when administered at the peak of disease. While there was no effect on the production of MP4-specific IgG, the treatment almost completely depleted CNS infiltrates and B cell aggregates even when given as late as 60 days after onset. On the ultrastructural level, we observed significantly less axonal damage in the spinal cord and cerebellum in chronic EAE after anti-CD52 treatment. Conclusion: Anti-CD52 treatment abrogated B cell infiltration and disrupted existing B cell aggregates in the CNS. KW - Alemtuzumab KW - B cells KW - CD52 KW - CNS KW - EAE KW - MS Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-176120 VL - 15 IS - 225 ER - TY - JOUR A1 - Simon, Christian M. A1 - Rauskolb, Stefanie A1 - Gunnersen, Jennifer M. A1 - Holtmann, Bettina A1 - Drepper, Carsten A1 - Dombert, Benjamin A1 - Braga, Massimiliano A1 - Wiese, Stefan A1 - Jablonka, Sibylle A1 - Pühringer, Dirk A1 - Zielasek, Jürgen A1 - Hoeflich, Andreas A1 - Silani, Vincenzo A1 - Wolf, Eckhard A1 - Kneitz, Susanne A1 - Sommer, Claudia A1 - Toyka, Klaus V. A1 - Sendtner, Michael T1 - Dysregulated IGFBP5 expression causes axon degeneration and motoneuron loss in diabetic neuropathy JF - Acta Neuropathologica N2 - Diabetic neuropathy (DNP), afflicting sensory and motor nerve fibers, is a major complication in diabetes.The underlying cellular mechanisms of axon degeneration are poorly understood. IGFBP5, an inhibitory binding protein for insulin-like growth factor 1 (IGF1) is highly up-regulated in nerve biopsies of patients with DNP. We investigated the pathogenic relevance of this finding in transgenic mice overexpressing IGFBP5 in motor axons and sensory nerve fibers. These mice develop motor axonopathy and sensory deficits similar to those seen in DNP. Motor axon degeneration was also observed in mice in which the IGF1 receptor(IGF1R) was conditionally depleted in motoneurons, indicating that reduced activity of IGF1 on IGF1R in motoneurons is responsible for the observed effect. These data provide evidence that elevated expression of IGFBP5 in diabetic nerves reduces the availability of IGF1 for IGF1R on motor axons, thus leading to progressive neurodegeneration. Inhibition of IGFBP5 could thus offer novel treatment strategies for DNP. KW - Motor nerve biopsy KW - Diabetic polyneuropathy KW - Neuropathy KW - Neurotrophic factors KW - Axonal degeneration Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-154569 VL - 130 SP - 373 EP - 387 ER - TY - JOUR A1 - Silwedel, Christine A1 - Speer, Christian P. A1 - Haarmann, Axel A1 - Fehrholz, Markus A1 - Claus, Heike A1 - Schlegel, Nicolas A1 - Glaser, Kirsten T1 - Ureaplasma species modulate cytokine and chemokine responses in human brain microvascular endothelial cells JF - International Journal of Molecular Science N2 - Ureaplasma species are common colonizers of the adult genitourinary tract and often considered as low-virulence commensals. Intraamniotic Ureaplasma infections, however, facilitate chorioamnionitis and preterm birth, and cases of Ureaplasma-induced neonatal sepsis, pneumonia, and meningitis raise a growing awareness of their clinical relevance. In vitro studies are scarce but demonstrate distinct Ureaplasma-driven impacts on immune mechanisms. The current study addressed cytokine and chemokine responses upon exposure of native or lipopolysaccharide (LPS) co-stimulated human brain microvascular endothelial cells (HBMEC) to Ureaplasma urealyticum or U. parvum, using qRT-PCR, RNA sequencing, multi-analyte immunoassay, and flow cytometry. Ureaplasma exposure in native HBMEC reduced monocyte chemoattractant protein (MCP)-3 mRNA expression (p < 0.01, vs. broth). In co-stimulated HBMEC, Ureaplasma spp. attenuated LPS-evoked mRNA responses for C-X-C chemokine ligand 5, MCP-1, and MCP-3 (p < 0.05, vs. LPS) and mitigated LPS-driven interleukin (IL)-1α protein secretion, as well as IL-8 mRNA and protein responses (p < 0.05). Furthermore, Ureaplasma isolates increased C-X-C chemokine receptor 4 mRNA levels in native and LPS co-stimulated HBMEC (p < 0.05). The presented results may imply immunomodulatory capacities of Ureaplasma spp. which may ultimately promote chronic colonization and long-term neuroinflammation. KW - Ureaplasma urealyticum KW - Ureaplasma parvum KW - neuroinflammation KW - meningitis KW - blood–brain barrier KW - HBMEC Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201848 SN - 1422-0067 VL - 20 IS - 14 ER - TY - JOUR A1 - Silwedel, Christine A1 - Speer, Christian P. A1 - Haarmann, Axel A1 - Fehrholz, Markus A1 - Claus, Heike A1 - Buttmann, Mathias A1 - Glaser, Kirsten T1 - Novel insights into neuroinflammation: bacterial lipopolysaccharide, tumor necrosis factor α, and Ureaplasma species differentially modulate atypical chemokine receptor 3 responses in human brain microvascular endothelial cells JF - Journal of Neuroinflammation N2 - Background: Atypical chemokine receptor 3 (ACKR3, synonym CXCR7) is increasingly considered relevant in neuroinflammatory conditions, in which its upregulation contributes to compromised endothelial barrier function and may ultimately allow inflammatory brain injury. While an impact of ACKR3 has been recognized in several neurological autoimmune diseases, neuroinflammation may also result from infectious agents, including Ureaplasma species (spp.). Although commonly regarded as commensals of the adult urogenital tract, Ureaplasma spp. may cause invasive infections in immunocompromised adults as well as in neonates and appear to be relevant pathogens in neonatal meningitis. Nonetheless, clinical and in vitro data on Ureaplasma-induced inflammation are scarce. Methods: We established a cell culture model of Ureaplasma meningitis, aiming to analyze ACKR3 variances as a possible pathomechanism in Ureaplasma-associated neuroinflammation. Non-immortalized human brain microvascular endothelial cells (HBMEC) were exposed to bacterial lipopolysaccharide (LPS) or tumor necrosis factor-α (TNF-α), and native as well as LPS-primed HBMEC were cultured with Ureaplasma urealyticum serovar 8 (Uu8) and U. parvum serovar 3 (Up3). ACKR3 responses were assessed via qRT-PCR, RNA sequencing, flow cytometry, and immunocytochemistry. Results: LPS, TNF-α, and Ureaplasma spp. influenced ACKR3 expression in HBMEC. LPS and TNF-α significantly induced ACKR3 mRNA expression (p < 0.001, vs. control), whereas Ureaplasma spp. enhanced ACKR3 protein expression in HBMEC (p < 0.01, vs. broth control). Co-stimulation with LPS and either Ureaplasma isolate intensified ACKR3 responses (p < 0.05, vs. LPS). Furthermore, stimulation wielded a differential influence on the receptor’s ligands. Conclusions: We introduce an in vitro model of Ureaplasma meningitis. We are able to demonstrate a pro-inflammatory capacity of Ureaplasma spp. in native and, even more so, in LPS-primed HBMEC, underlining their clinical relevance particularly in a setting of co-infection. Furthermore, our data may indicate a novel role for ACKR3, with an impact not limited to auto-inflammatory diseases, but extending to infection-related neuroinflammation as well. AKCR3-induced blood-brain barrier breakdown might constitute a potential common pathomechanism. KW - atypical chemokine receptor 3 KW - human brain microvascular endothelial cells KW - meningitis KW - neuroinflammation KW - Ureaplasma species Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175952 VL - 15 IS - 156 ER - TY - JOUR A1 - Silwedel, Christine A1 - Hütten, Matthias C. A1 - Speer, Christian P. A1 - Härtel, Christoph A1 - Haarmann, Axel A1 - Henrich, Birgit A1 - Tijssen, Maud P. M. A1 - Alnakhli, Abdullah Ahmed A1 - Spiller, Owen B. A1 - Schlegel, Nicolas A1 - Seidenspinner, Silvia A1 - Kramer, Boris W. A1 - Glaser, Kirsten T1 - Ureaplasma-driven neonatal neuroinflammation: novel insights from an ovine model JF - Cellular and Molecular Neurobiology N2 - Ureaplasma species (spp.) are considered commensals of the adult genitourinary tract, but have been associated with chorioamnionitis, preterm birth, and invasive infections in neonates, including meningitis. Data on mechanisms involved in Ureaplasma-driven neuroinflammation are scarce. The present study addressed brain inflammatory responses in preterm lambs exposed to Ureaplasma parvum (UP) in utero. 7 days after intra-amniotic injection of UP (n = 10) or saline (n = 11), lambs were surgically delivered at gestational day 128–129. Expression of inflammatory markers was assessed in different brain regions using qRT-PCR and in cerebrospinal fluid (CSF) by multiplex immunoassay. CSF was analyzed for UP presence using ureB-based real-time PCR, and MRI scans documented cerebral white matter area and cortical folding. Cerebral tissue levels of atypical chemokine receptor (ACKR) 3, caspases 1-like, 2, 7, and C–X–C chemokine receptor (CXCR) 4 mRNA, as well as CSF interleukin-8 protein concentrations were significantly increased in UP-exposed lambs. UP presence in CSF was confirmed in one animal. Cortical folding and white matter area did not differ among groups. The present study confirms a role of caspases and the transmembrane receptors ACKR3 and CXCR4 in Ureaplasma-driven neuroinflammation. Enhanced caspase 1-like, 2, and 7 expression may reflect cell death. Increased ACKR3 and CXCR4 expression has been associated with inflammatory central nervous system (CNS) diseases and impaired blood–brain barrier function. According to these data and previous in vitro findings from our group, we speculate that Ureaplasma-induced caspase and receptor responses affect CNS barrier properties and thus facilitate neuroinflammation. KW - Ureaplasma parvum KW - CNS integrity KW - neonatal meningitis KW - preterm birth KW - immaturity KW - animal model Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324285 VL - 43 IS - 2 ER - TY - JOUR A1 - Silwedel, Christine A1 - Haarmann, Axel A1 - Fehrholz, Markus A1 - Claus, Heike A1 - Speer, Christian P. A1 - Glaser, Kirsten T1 - More than just inflammation: Ureaplasma species induce apoptosis in human brain microvascular endothelial cells JF - Journal of Neuroinflammation N2 - Background Ureaplasma species (spp.) are commonly regarded as low-virulent commensals but may cause invasive diseases in immunocompromised adults and in neonates, including neonatal meningitis. The interactions of Ureaplasma spp. with host defense mechanisms are poorly understood. This study addressed Ureaplasma-driven cell death, concentrating on apoptosis as well as inflammatory cell death. Methods Human brain microvascular endothelial cells (HBMEC) were exposed to Ureaplasma (U.) urealyticum serovar 8 (Uu8) and U. parvum serovar 3 (Up3). Resulting numbers of dead cells as well as mRNA levels and enzyme activity of key agents in programmed cell death were assessed by flow cytometry, RNA sequencing, and qRT-PCR, respectively. xCELLigence data were used for real-time monitoring of changes in cell adhesion properties. Results Both Ureaplasma isolates induced cell death (p < 0.05, vs. broth). Furthermore, Ureaplasma spp. enhanced mRNA levels for genes in apoptosis, including caspase 3 (Up3 p < 0.05, vs. broth), caspase 7 (p < 0.01), and caspase 9 (Up3 p < 0.01). Caspase 3 activity was increased upon Uu8 exposure (p < 0.01). Vice versa, Ureaplasma isolates downregulated mRNA levels for proteins involved in inflammatory cell death, namely caspase 1 (Uu8 p < 0.01, Up3 p < 0.001), caspase 4 (Uu8 p < 0.05, Up3 p < 0.01), NOD-like receptor pyrin domain-containing 3 (Uu8 p < 0.05), and receptor-interacting protein kinase 3 (p < 0.05). Conclusions By inducing apoptosis in HBMEC as main constituents of the blood-brain barrier, Ureaplasma spp. may provoke barrier breakdown. Simultaneous suppression of inflammatory cell death may additionally attenuate host defense strategies. Ultimate consequence could be invasive and long-term CNS infections by Ureaplasma spp. KW - Ureaplasma urealyticum KW - Ureaplasma parvum KW - Neuroinflammation KW - Meningitis KW - Caspase KW - Apoptosis KW - HBMEC Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200711 VL - 16 ER - TY - THES A1 - Siedler, Gabriela Anja T1 - Elektrisch evozierte Schmerz-assoziierte Potentiale bei Patienten mit small – und large fiber Neuropathien T1 - Pain related evoked potentials in patients with small - and large fiber neuropathies N2 - In dieser Studie wurden 108 Patienten mit PNP, 60 Patienten mit M. Fabry und 58 gesunde Kontrollpersonen mittels PREP auf eine small fiber-Pathologie untersucht. Zudem erfolgte eine PREP-Untersuchung bei 5 gesunden Probanden und 3 Patienten nach Anwendung von lokalem Capsaicin. Zur Charakterisierung der small fibers erfolgten zudem Anamnese, klinische Untersuchung, die Fragebögen NPSI, GCPS und ADS, QST und eine Hautbiopsie. In der Gruppe der Patienten mit PNP waren sowohl Patienten mit LFN, MFN und SFN unterschiedlicher Ätiologie vertreten. Patienten mit einer MFN und Patienten mit einer zu einer Mitbeteiligung der small fibers passenden Anamnese (MFN und SFN) wiesen eine verlängerte N1-Latenz nach Stimulation am Fuß auf. Bei einer reduzierten IENFD in der proximalen Hautbiopsie zeigte sich die PPA nach Stimulation im Gesicht reduziert, beide Werte korrelierten positiv miteinander. Bei Patienten mit einer demyelinisierenden PNP war die N1-Latenz nach Stimulation an der Hand verlängert, zudem war bei Patienten mit CIDP die PPA nach Stimulation an Gesicht und Hand reduziert. M. Fabry ist eine X-chromosomal vererbte lysosomale Speicherkrankheit, welche mit einer SFN einhergehen kann. Weibliche Patienten mit M. Fabry und einer subjektiven Hypohidrose als klinische Präsentation einer small fiber Pathologie wiesen eine reduzierte PPA nach Stimulation an Gesicht, Hand und Fuß auf. Über die gesamte Patientengruppe hinweg zeigte sich eine negative Korrelation der PPA nach Stimulation am Fuß mit der klinischen Schmerzpräsentation im NPSI (Summenscore, Subscores evozierte Schmerzen und Schmerzattacken), sowie bei weiblichen Patienten mit der CDT, WDT und TSL in der QST als Marker für die small fiber Funktion. Patienten mit einer längenunabhängigen Reduktion der IENFD wiesen eine niedrigere PPA nach Stimulation am Fuß auf. Ein nicht-auswertbares PREP-Potential spricht nach Ausschluss messtechnischer Artefakte für eine fortgeschrittene Nervenfaserschädigung. Probanden und Patienten zeigten nach Applikation von topischem Capsaicin eine Reduktion der PPA. PREP ist eine einfache, komplikationslos durchzuführende und objektive Methode zur Untersuchung der small fibers. Sie stellt eine sinnvolle Ergänzung zu den bereits etablierten Methoden QST und Hautbiopsie dar und bietet insbesondere für die Evaluation von Medikamenteneffekten wie z.B. von topischem Capsaicin eine vielversprechende Untersuchungsmöglichkeit. N2 - In this study, 108 patients with polyneuropathy, 60 patients with M. Fabry and 58 healthy controls underwent PREP for diagnoses of small fiber pathology. Furthermore, PREP was performed on 5 healthy controls and 3 patients after treatment with local Capsaicin. For characterization of small fibers, anamnesis, clinical examination, NPSI, GCPS, ADS, QST and skin biopsy were performed. In patients with polyneuropathy, patients with LFN, MFN and SFN of different etiology were included. Patients with MFN and patients with clinical symptoms of small fiber pathology had prolonged N1-latency after stimulation at the foot. In case of a reduced IENFD in the proximal skin biopsy, PPA after stimulation at the face was reduced, both parameters correlated. In patients with demyelinating polyneuropathy, N1-latency after stimulation at the hand was prolonged, and in patients with CIDP PPA after stimulation at face and hand was reduced. M. Fabry is an x-chromosomal inherited lysosomal storage disorder, which can induce SFN. Female patients with M. Fabry and subjective hypohidrosis as clinical presentation of small fiber pathology had a reduced PPA after stimulation at face, hand, and foot. Regarding all patients, PPA after stimulation at the foot did show a correlation to clinical symptoms in NPSI (sumscore and subscores for evoked pain and pain attacks), and in female patients with CDT, WDT, and TSL in QST as parameters of small fiber function. Patients with a non-length-dependent reduction of IENFD did show a reduced amplitude after stimulation at the foot. A non-evaluable PREP-potential gives hint on advanced nerve fiber damage after exclusion of examination errors. Patients and controls show a reduction of PPA after application of topical Capsaicin. PREP is an easy, complicationfree and objective method for examination of small fibers. It is a useful additional method alongside established methods, like QST and skin biopsy, and does provide promising possibilities, especially for examination of medication effects, like topical capsaicin. KW - Fabry-Krankheit KW - Evoziertes Potenzial KW - Polyneuropathie KW - Small fiber Neuropathie KW - A delta-Faser Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-167186 ER - TY - THES A1 - Seager, Anna T1 - Die urämische Neuropathie - ein Vitamin-B\(_{12}\)-Mangel? T1 - Uremic Neuropathy - a Vitamin B\(_{12}\) Deficiency? N2 - Eine Vielzahl von Patienten mit fortgeschrittener, beziehungsweise dialysepflichtiger Niereninsuffizienz entwickeln eine Polyneuropathie. Die Pathogenese der urämischen Neuropathie (UN) ist nicht geklärt, sodass auf der Suche nach dem Pathomechanismus auch ein Vitamin-B12-Mangel diskutiert werden muss, da dieser ähnliche Symptome wie die UN hervorrufen kann. Ziel dieser Studie war es, den Zusammenhang zwischen den Parametern des Vitamin-B12-Stoffwechsels und der UN darzustellen. In einer prospektiven Studie mit insgesamt 54 teilnehmenden Patienten wurden diese vor und nach einer Vitamin-B12-Substitution laborchemisch untersucht. Zudem erhielten die Patienten neben einer klinischen Untersuchung eine elektroneurographische Diagnostik des N. suralis und des N. tibialis, sowie eine QST-Untersuchung. N2 - Uremic neuropathy (UN) is the most common neurological disorder in end-stage renal disease. The pathophysiology of uremic neuropathy is complex and is not yet fully understood. Vitamin B12 deficiency can cause severe neurological disorders and symptoms are similar to UN. To investigate whether UN is due to Vitamin B12 deficiency, we conducted a study measuring Vitamin B12 Biomarkers on 54 dialysis patients before and after administering Vitamin B12. In addition a full neurological clinical exam, as well as electroneurography and QST were conducted before and after Vitamin B12 supplementation. KW - Urämie KW - Polyneuropathie KW - Chronische Niereninsuffizienz KW - Vitamin-B12-Mangel KW - Dialyse KW - Methylmalonsäure Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-291094 ER - TY - THES A1 - Schäfer, Sabine T1 - Die funktionelle Relevanz humoraler und zellulärer Immunreaktionen gegen Campylobacter jejuni in der Pathogenese von Immunneuropathien T1 - The functional relevance of humoral and cellulare immune responses to Campylobacter jejuni in the pathogenesis of acute neuropathies. N2 - Verschiedene mögliche Pathomechanismen einer Campylobacter jejuni-spezifischen Immunantwort bei der Entstehung akuter Immunneuropathien wurden untersucht. Neben anderen wurden für die Untersuchungen auch C. jejuni-Stämme eingesetzt, welche von Guillain-Barré- (GBS) und Miller-Fisher-syndrome (MFS) Patienten isoliert worden waren. Es wurden Ultraschall-Gesamt-Homogenate der C. jejuni Stämme sowie von Salmonella typhimurium als Kontrollbakterium hergestellt. Anschließend wurden verschiedene Proteinfraktionen isoliert und die Lipopolysaccharide (LPS) der Bakterien isoliert. Durch Immunisierung von Ratten mit diesen C. jejuni-Präparationen konnten keine Krankheitszeichen der experimentellen autoimmunen Neuritis (EAN) ausgelöst werden. Trotz Produktion hoher Titer C. jejuni-spezifischer Antikörper verlief in diesen Tieren eine anschließend durch P2-spezifische T-Lymphozyten induzierte adoptiv transferierte EAN (AT-EAN) nicht schwerer als in mit komplettem Freund´schen Adjuvans (CFA) kontrollimmunisierten Ratten. Nach Immunisierung mit C. jejuni-Protein wurden C. jejuni-spezifische T-Zellen von Lewis-Ratten gewonnen, die mit allen getesteten C. jejuni-Stämmen als Antigen reagieren, jedoch zeigten C. jejuni-spezifische Ratten-T-Zellen in vitro keine Kreuzreaktivität mit PNS-Antigenen und induzierten in vivo keine Neuritis. Im Modell der EAN läßt sich durch Füttern des Antigens eine natürliche orale Toleranz induzieren, welche die Tiere gegen eine aktiv induzierte EAN resistent macht. Die immunologische Auswirkung der enteralen Gabe von C. jejuni-LPS auf die natürliche Immuntoleranz wurde untersucht. Dabei konnte bei diskrepanten Ergebnissen keine pathogene Bedeutung von enteralen C. jejuni-Antigenen in der Ratte festgestellt werden. Zur Generation und Untersuchung C. jejuni-spezifischer monoklonaler Antikörper wurden Balb/c-Mäuse mit C. jejuni-LPS-Präparationen in CFA immunisiert und die Milzzellen dieser Tiere mit Maus-Myelomzellen fusioniert. Es konnte eine Vielzahl von monoklonalen Antikörpern etabliert werden. Selektive Spezifitäten der monoklonalen Antikörper für C. jejuni-LPS oder -protein wurden detektiert, die meisten der monoklonalen Antikörper als IgM, einige als IgG charakterisiert. Die Antikörper reagieren mit allen getesteten C. jejuni-Stämmen sowohl im ELISA als auch im Western Blot kreuz. Eine Reaktivität der Antikörper mit verschiedenen Gangliosiden konnte nicht nachgewiesen werden. Zur Untersuchung eines elektrophysiologisch fassbaren blockierenden Effektes von C. jejuni-spezifischen Antikörpern wurden Makro-patch-clamp-Untersuchungen am Mäusezwerchfell mit dialysierten Seren von C. jejuni-immunisierten Ratten durchgeführt. Einige der C. jejuni-Antiseren blockierten die präsynaptische Quantenfreisetzung partiell. Dieser Effekt war C. jejuni-spezifisch und durch Salmonella-Antiserum oder Kontrollseren CFA-immunisierter Tiere nicht induzierbar. Ein von uns generierter monoklonaler IgG-Antikörper gegen C. jejuni-LPS wurde ebenfalls in Makro-patch-clamp-Untersuchungen getestet und blockierte die Quantenfreisetzung. Weiterhin wurden humane T-Zellen gegen C. jejuni HB 93-13 generiert. Es konnte erstmals gezeigt werden, daß diese Zellen mit anderen C. jejuni-Stämmen, jedoch nicht mit Salmonellen, kreuzreagieren und ausschließlich Proteine jedoch nicht LPS erkennen. Die generierten Zellen sind alle HLA-DR restringiert und der Phänotyp wurde als CD 4+/CD 8-, /-TZR+ identifiziert. Einige der C. jejuni-spezifischen T-Zell-Linien zeigten eine starke oder partielle Kreuzreaktivität mit humanem rekombinantem P2-Protein des PNS und mit einzelnen P2-Peptiden. Dieser Befund belegt erstmals, dass durch Konfrontation mit C. jejuni eine zelluläre Immunantwort angestoßen werden kann, die in autoimmuner Weise mit Myelinprotein des PNS kreuzreagiert. N2 - The present study evaluates the putative pathogenic role of a Campylobacter jejuni directed immune response in the pathogenesis of acute neuropathies. Among other C. jejuni strains, strains isolated from Guillain-Barré- (GBS) and Miller-Fisher syndrome (MFS) patients were used for this investigation. By sonication, total homogenate of different C. jejuni strains and Salmonella typhimurium, which served as a control, were prepared. Additionally, different protein fractions and bacterial lipopolysaccharides (LPS) were isolated. Immunization of rats with C. jejuni preparations did not lead to clinical manifestation of active experimental autoimmune neuritis (EAN). Furthermore, the severity of adoptive transfer-EAN (AT-EAN), induced by adoptively transferred P2-specific T cells was not altered in rats that had been previously immunized with C. jejuni for production of high anti-C. jejuni antibody titers. C. jejuni-specific T cell lines were generated from Lewis rats immunized with C. jejuni proteins. These T cells proliferated in an antigen-specific manner in the presence of extracts from different C. jejuni strains. C. jejuni-specific rat T cells did not show any cross-reactive proliferation to peripheral nervous system (PNS) antigens. Furthermore, it was not possibe to induce neuritis by adoptive transfer of C. jejuni-specific T cells in vivo. Oral application of myelin antigens induces oral tolerance which renders rats resistant to actively induced EAN. This observation lead to analyse the immunological consequences of oral administration of C. jejuni LPS with respect to the induction of tolerance. C. jejuni/myelin-fed rats developed accelerated clinical sings of EAN compared to control animals. Thus, oral administration of C. jejuni HB 93-13 LPS inhibited the induction of myelin-specific oral tolerance. In order to investigate the humoral immune response, monoclonal C. jejuni-specific antibodies were isolated by immunization of Balb/c mice with C. jejuni LPS preparations emulsified in complete Freund´s adjuvant (CFA). Splenocytes from primed animals were fused with myeloma cells. A number of monoclonal antibodies were characterized. These monoclonal antibodies were either specific for C. jejuni LPS or C. jejuni proteins. These immunoglobulins were characterized to be predominantly IgM, but also IgG antibodies could be found. ELISA and western blot analysis verified cross-reactivity of antibodies with different C. jejuni strains. However, the antibodies were not able to recognize gangliosides. Electrophysiological investigations were used to determine a possible blocking effect of C. jejuni-specific antibodies at the neuromusculare endplate. Alteration of neuromuscular transmission at the diaphragm of mice after appling dialysed sera of C. jejuni immunized rat, were investigated using patch-clamp. Several C. jejuni antisera were able to partially block the pre-synaptic quantal release. This effect was C. jejuni-specific and was not inducible by Salmonella typhimurium antisera or control sera, obtained from CFA immunized animals. Additionally, one of the generated monoclonal C. jejuni LPS specific IgG antibodies was able to block the quantal release. Finally, we were able to generate human T cells reacting specifically with C. jejuni HB 93-13. For the first time it could be shown, that these cells respond to homogenates of other C. jejuni strains but not to Salmonella typhimurium homogenate. Specifically C. jejuni proteins but not C. jejuni LPS were recognized by the human T cell lines. The generated T cells were all HLA-DR restricted and identified to be CD4+/CD8-, /-TCR+. A few of the C. jejuni-specific T cell lines demonstrated a strong cross-reactivity to a PNS-component, the recombinant human P2-protein and single P2-peptides. This observation shows that C. jejuni induces a variety of antigen-specific and non-specific immune responses which are able to facilitate or even trigger autoimmunity against the PNS as occuring in GBS or the MFS. KW - Campylobacter jejuni KW - Immunreaktion KW - Guillain-Barr'e-Syndrom KW - Campylobacter jejuni KW - Guillain-Barré Syndrom KW - Campylobacter jejuni KW - Guillain-Barré syndrome Y1 - 2002 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-5531 ER - TY - THES A1 - Schäfer, Kristina T1 - Lässt sich eine Vaskulitische Polyneuropathie mittels B-Bild-Sonographie der Beinnerven identifizieren? T1 - Is it possible to identify a vasculitic polyneuropathy by sonography of the nerves of the lower extremities? N2 - Über die Nervensonographie wurde bereits in den 1980er Jahren erstmals berichtet. Die rasche Weiterentwicklung der Technik hat dazu geführt, dass es inzwischen zahlreiche Fallberichte und einige Studien gibt, die sich mit der Darstellung peripherer Nerven durch Ultraschall als Mittel zur Diagnose verschiedener Nervpathologien beschäftigen. Besonders bei der Diagnostik des epidemiologisch häufigen Karpaltunnelsyndroms ist die sonographische Beurteilung des N. medianus in dieser Lokalisation vielerorts bereits etablierter Bestandteil der Diagnostik. In der hier vorgelegten Studie sollte der Stellenwert der B-Bild-Sonographie peripherer Nerven am Unterschenkel für die Diagnose einer Vaskulitischen Neuropathie geprüft werden. Dazu musste zunächst die Ultraschalluntersuchung spezieller Nerven am Unterschenkel etabliert werden. Diese ist technisch deutlich anspruchsvoller als die Darstellung von Karpaltunnelsyndrom oder Armplexus. Durch die fünfmalige Untersuchung zehn junger Personen wurden ultraschalltechnisch leicht reproduzierbar anatomisch auffindbare und Anisotropie-vermeidende Abschnitte von N. suralis, N. peroneus communis, profundus, superfcialis und N. tibialis definiert und als Messpunkte der Studie zu Grunde gelegt. In die von der Ethikkommission der Medizinischen Fakultät positiv beschiedene Studie wurden 26 Patienten/-innen, die klinisch und elektrophysiologisch nachgewiesen eine Polyneuropathie hatten und bei denen zur Ursachendiagnostik eine Biopsie und histologische Aufarbeitung des N. suralis durchgeführt wurde (Abteilung für Neuropathologie des Pathologischen Instituts der Universität sowie Histologielabor der Neurologischen Universitätsklinik), sowie 26 Kontrollpersonen ohne klinischen Hinweis auf eine Polyneuropathie nach informiertem Einverständnis aufgenommen. Für jede/-n Patienten/-in wurde ein/-e Proband/-in gleichen Geschlechts mit einem Altersunterschied von höchstens fünf Jahren in die Kontrollgruppe aufgenommen. Alle 52 Untersuchten mussten erwachsen und 160 – 180 cm groß sein. Bei allen Patienten/-innen und Kontrollpersonen wurden jeweils der GD, der KD, der LD und die QSF des N. suralis am unteren Drittel der Wade und distal im Bereich des Außenknöchels, des N. tibialis nahe des Innenknöchels, des N. peroneus communis im Bereich des Fibulaköpfchens, des N. peroneus profundus am Fußrücken und nahe der Großzehen und des N. peroneus superficialis im Bereich des distalen Schienbeins bestimmt. Alle gesuchten Nerven waren bei allen Versuchspersonen eindeutig identifizierbar. Die Untersuchungen wurden durch eine Untersucherin mit demselben Gerät, geblindet für das Ergebnis der Histologie, durchgeführt. Das gewährleistete eine Konstanz in der schwierigen und mit Unsicherheiten behafteten Messung der Nervenstrukturen, was ausführlich diskutiert wird. Ein statistisch signifikanter Unterschied zwischen den sonographisch erhobenen Messdaten der PNP-Gruppe und der Kontrollgruppe konnte bei 20 der 28 Parameter gezeigt werden. Bei 11 der 28 Parameter konnte zwischen Vaskulitis-Patienten/-innen und allen anderen, also PNP-Patienten/-innen und der Kontrollgruppe, ein statistisch signifikanter Unterschied festgestellt werden. Außerdem ergab die statistische Analyse bei drei der 28 Messgrößen einen statistisch signifikanten Unterschied zwischen Patienten/-innen mit und ohne Demyelinisierung des N. suralis in der feingeweblichen Untersuchung. Die sonographischen Ergebnisse der Vakulitis-Patienten/-innen unterschieden sich nicht von denen der PNP-Patienten/-innen mit anderer Ätiologie. Es wurde auch kein statistisch signifikanter Unterschied zwischen den Werten der PNP-Patienten/-innen mit und ohne histologisch gesicherte entzündliche Komponente beobachtet. Gemäß der histologischen Untersuchung der Biopsate wurde bei sechs Patienten/-innen eine Vaskulitis diagnostiziert. Bei fünf dieser Patienten/-innen fielen teilweise Kalibersprünge im Sinne einer Zunahme der QSF oder Abflachung im Verlauf des N. suralis, N. peroneus superficialis und N. peroneus communis auf. Aber auch bei Patienten/-innen mit einer anderen Form der Polyneuropathie und einigen Kontrollpersonen waren Besonderheiten im sonographischen Bild einzelner Nerven zu beobachten. Mit der vorgelegten Untersuchung konnte zwar nicht gezeigt werden, dass die Nervensonographie einen Beitrag zur differentialdiagnostischen Abgrenzung Vaskulitischer Polyneuropathien leisten kann, der den Goldstandard invasiver Nervenbiopse entbehrlich machen könnte. Das war bei der histologischen Unterschiedlichkeit der beschädigten Nervenanatomie bei Vaskulitis aber auch nicht ernsthaft zu erwarten. Die vorgelegte Arbeit zeigt aber auch, dass kranke periphere Nerven von gesunden Nerven im Ultraschall unterscheidbar sind, wenn man wie hier systematisch mit 28 Parametern an sieben Messpunkten untersucht. Dies allerdings dauert auch für einen Geübten 40 bis 60 Minuten, so dass die Polyneuropathiediagnostik oder gar Differentialdiagnostik mittels Ultraschall aktuell noch als Forschungsinstrument an großen Fallzahlen anzusehen ist. Dabei wird es künftig für die Gruppenbildung der sonographisch Untersuchten neben ätiologischer und histologischer Gruppenbildung darauf ankommen, das Krankheitsbild besser zu definieren, d.h. Ausmaß von Demyelinisierung, Remyelinisierung und axonalem Untergang in geeignete Skalen zu fassen. Auch die Magnetresonanztomographie stellt eine Option als diagnostischer Baustein bei Vaskulitischer Polyneuropathie dar. Dieses bildgebende Verfahren kann bereits zur Diagnostik von traumatischen Nervverletzungen, Kompressionensyndromen, Raumforderungen im Bereich der Nerven und Plexusneuritis eingesetzt werden. N2 - Is it possible to identify a vasculitic polyneuropathy by sonography of the nerves of the lower extremities? KW - Ultraschalldiagnostik KW - Nervensonographie KW - Vaskulitische Polyneuropathie Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-104712 ER - TY - THES A1 - Schwab, Nicholas T1 - The importance of CD8\(^+\) T cells and antigen-presenting cells in the immune reaction of primary inflammatory versus degenerative diseases T1 - Die Bedeutung CD8\(^+\) T-Zellen und Antigen-präsentierender Zellen in der Immunreaktion primär inflammatorischer gegenüber degenerativen Erkrankungen N2 - The bidirectional influence of parenchymal cells and cells of the immune system, especially of antigen-presenting and CD8\(^+\) T cells, in situations of putative auto- immune pathogenicity and degeneration was the main topic of this thesis. In the first part, the influence of human muscle cells on antigen-presenting cells was investigated. In inflammatory myopathies prominent infiltrates of immune cells containing T cells and antigen-presenting cells like macrophages and dendritic cells are present. The hypothesis was that human myoblasts have an inhibiting influence on these antigen-presenting cells under homeostatic conditions. A dysfunction or impairment under inflammatory circumstances might contribute to the development of myopathic conditions. The surface analysis of dendritic cells cocultured with myoblasts showed that immature dendritic cells could be driven into a reversible semi- mature state with significantly elevated levels of CD80. These dendritic cells were additionally characterized by their inhibiting function on T-cell proliferation. It was also shown that the lysates of healthy myoblasts could strongly enhance the phagocytic ability of macrophages, which could help with muscle regeneration and which might be disturbed in myositis patients. The second part of this thesis was about the clonal specificity of CD8\(^+\) T cells in a mouse model with genetically induced over-expression of PLP in oligodendrocytes. Here, we could show that the cytotoxic T lymphocytes, which had previously been shown to be pathogenic, were clonally expanded in the CNS of the transgenic mice. The amino acid sequences of the corresponding receptor chains were not identical, yet showed some similarities, which could mean that these clones recognize similar antigens (or epitopes of the same antigen). The knockout of PD-1 in this setting allowed for an analysis of the importance of tissue immune regulation. It became evident that the absence of PD-1 induced a larger number of clonal expansions in the CNS, hinting towards a reduced threshold for clonal disturbance and activation in these T cells. The expansions were, however, not pathogenic by themselves. Only in the presence of tissue damage and an antigenic stimulus (in our case the overexpression of PLP), the PD-1 limitation exacerbated the immune pathogenicity. Therefore, only in the presence of a “tissue damage signal”, the dyshomeostasis of T cells lacking PD-1 achieved high pathogenetic relevance. Finally, we investigated the pathogenetic role of CD8 T cells in Rasmussen encephalitis, a rare and chronic neurological disease mainly affecting children. The analysis of the T-cell receptor repertoire in Rasmussen encephalitis patients in the peripheral CD4\(^+\) and CD8\(^+\) T-cell compartments as well as the brain revealed the involvement of T cells in the pathogenicity of this disease. Many clonal expansions in the brain matched CD8\(^+\) T-cell expansions in the periphery on the sequence level. These putatively pathogenic clones could be visualized by immunohistochemistry in the brain and were found in close proximity to astrocytes and neurons. Additionally, the expanded clones could be found in the periphery of patients for at least one year. N2 - Der Einfluss von Parenchymzellen auf Immunzellen und umgekehrt, im Besonderen von Antigen-präsentierenden Zellen und CD8\(^+\) T-Zellen, im Zusammenhang von auto- immuner Pathogenese und Degeneration war das Hauptthema dieser Dissertation. Im ersten Teil wurde der Einfluss menschlicher Muskelzellen auf Antigen- präsentierende Zellen untersucht. In entzündlichen Myopathien kommt es zu massiven Infiltraten von Immunzellen, die T-Zellen und auch Antigen-präsentierende Zellen wie Makrophagen und dendritische Zellen enthalten. Die Hypothese war, dass menschliche Myoblasten einen hemmenden Einfluss auf die Antigen-präsentierenden Zellen unter homöostatischen Bedingungen haben. Eine Störung dieses Einflusses oder eine Beeinträchtigung unter entzündlichen Rahmenbedingungen könnte eventuell zur Entwicklung eines myopathischen Zustands beitragen. In der Oberflächenanalyse der dendritischen Zellen, die mit Myoblasten kultiviert wurden, zeigte sich, dass unreife dendritische Zellen in einen halb-reifen Zustand versetzt werden konnten, der sich beispielsweise durch stark erhöhte CD80 Expression kennzeichnet. Diese dendritischen Zellen wurden weiterhin charakterisiert über ihre hemmende Funktion auf die T-Zell Proliferation. Außerdem wurde gezeigt, dass Zelllysate gesunder Myoblasten die Phagozytoserate von Makrophagen enorm verstärken, was die Regeneration des Muskelgewebes erhöhen und möglicherweise in Myositispatienten gestört sein könnte. Im zweiten Teil der Dissertation ging es um die klonale Spezifität von CD8\(^+\) T-Zellen in einem Mausmodell mit genetisch induzierter Überexpression von PLP in Oligodendrozyten. Hier konnte gezeigt werden, dass die zytotoxischen T-Zellen, deren Pathogenität Gegenstand früherer Arbeiten war, im ZNS der transgenen Mäuse klonal expandiert waren. Die Aminosäuresequenzen der TCRβ Kette der expandierten Klone waren nicht identisch, zeigten jedoch einige Ähnlichkeiten, die darauf hinweisen könnten, dass diese Klone ähnliche Antigene (oder Epitope des gleichen Antigens) erkennen. Die genetisch induzierte Abwesenheit von PD-1 ermöglichte es, in diesem Zusammenhang den Einfluss von spezifischer Immunregulation im Gewebe zu untersuchen. Es zeigte sich, dass die Deletion von PD-1 eine erhöhte Anzahl von klonalen Expansionen im ZNS der Mäuse erzeugte, was auf eine herabgesetzte Schwelle für klonale Störungen und Aktivierung schließen lässt. Diese Expansionen 
 waren jedoch für sich genommen nicht pathogen. Nur in der Anwesenheit eines Gewebeschadens und eines zusätzlicher Antigenstimulus (in unserem Fall in Form der PLP Überexpression) konnte man die erhöhte Pathogenität durch die PD-1 Deletion erkennen. Deswegen erreichten die PD-1 deletierten T-Zellen nur in der Gegenwart eines „Gewebeschaden-Signals“ hohe pathogenetische Relevanz. Schließlich untersuchten wir die pathogenetische Rolle von CD8\(^+\) T-Zellen in der Rasmussen Enzephalitis, einer seltenen, chronischen Erkrankung des Gehirns, die hauptsächlich in Kindern vorkommt. Die Analyse des T-Zell-Rezeptor Repertoires in Rasmussen Enzephalitis Patienten in peripheren CD4\(^+\) und CD8\(^+\) T-Zell Populationen und im Gehirn zeigte die Beteiligung von T-Zellen in der Pathogenese dieser Krankheit auf. Viele klonale Expansionen waren zwischen Gehirn und der peripheren CD8\(^+\) Population bis hin zur Aminosäuresequenz identisch. Diese vermutlich pathogenen Klone konnten in Gehirnbiopsien von Rasmussenpatienten histochemisch nachgewiesen werden und wurden in enger Nachbarschaft zu Astrozyten und Neuronen gefunden. Zusätzlich konnten diese expandierten Kone in der Peripherie von Patienten für die beobachteten Zeiträume (mindestens ein Jahr) nachgewiesen werden. KW - T-Lymphozyt KW - Entzündung KW - Degeneration KW - Immunsystem KW - Rasmussen-Syndrom KW - T lymphocyte KW - inflammation KW - degeneration KW - immune system KW - rasmussen encephalitis Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-37330 ER - TY - JOUR A1 - Schulte, Annemarie A1 - Blum, Robert T1 - Shaped by leaky ER: Homeostatic Ca\(^{2+}\) fluxes JF - Frontiers in Physiology N2 - At any moment in time, cells coordinate and balance their calcium ion (Ca\(^{2+}\)) fluxes. The term ‘Ca\(^{2+}\) homeostasis’ suggests that balancing resting Ca2+ levels is a rather static process. However, direct ER Ca\(^{2+}\) imaging shows that resting Ca\(^{2+}\) levels are maintained by surprisingly dynamic Ca\(^{2+}\) fluxes between the ER Ca\(^{2+}\) store, the cytosol, and the extracellular space. The data show that the ER Ca\(^{2+}\) leak, continuously fed by the high-energy consuming SERCA, is a fundamental driver of resting Ca\(^{2+}\) dynamics. Based on simplistic Ca\(^{2+}\) toolkit models, we discuss how the ER Ca\(^{2+}\) leak could contribute to evolutionarily conserved Ca\(^{2+}\) phenomena such as Ca\(^{2+}\) entry, ER Ca\(^{2+}\) release, and Ca\(^{2+}\) oscillations. KW - Ca2+ homeostasis KW - Ca2+ ion analysis KW - ER Ca2+ store KW - ER Ca2+ imaging KW - SERCA KW - store-operated Ca2+ entry KW - Ca2+ leak KW - Ca2+ oscillation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-287102 SN - 1664-042X VL - 13 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Stoll, Guido A1 - Papp, Lena A1 - Bohr, Arne A1 - Volkmann, Jens A1 - Fluri, Felix T1 - Electrical stimulation of the mesencephalic locomotor region has no impact on blood–brain barrier alterations after cerebral photothrombosis in rats JF - International Journal of Molecular Science N2 - Blood–brain barrier (BBB) disruption is a critical event after ischemic stroke, which results in edema formation and hemorrhagic transformation of infarcted tissue. BBB dysfunction following stroke is partly mediated by proinflammatory agents. We recently have shown that high frequency stimulation of the mesencephalic locomotor region (MLR-HFS) exerts an antiapoptotic and anti-inflammatory effect in the border zone of cerebral photothrombotic stroke in rats. Whether MLR-HFS also has an impact on BBB dysfunction in the early stage of stroke is unknown. In this study, rats were subjected to photothrombotic stroke of the sensorimotor cortex and implantation of a stimulating microelectrode into the ipsilesional MLR. Thereafter, either HFS or sham stimulation of the MLR was applied for 24 h. After scarifying the rats, BBB disruption was assessed by determining albumin extravasation and tight junction integrity (claudin 3, claudin 5, and occludin) using Western blot analyses and immunohistochemistry. In addition, by applying zymography, expression of pro-metalloproteinase-9 (pro-MMP-9) was analyzed. No differences were found regarding infarct size and BBB dysfunction between stimulated and unstimulated animals 24 h after induction of stroke. Our results indicate that MLR-HFS neither improves nor worsens the damaged BBB after stroke. Attenuating cytokines/chemokines in the perilesional area, as mediated by MLR-HFS, tend to play a less significant role in preventing the BBB integrity. KW - photothrombotic stroke KW - deep brain stimulation KW - mesencephalic locomotor region KW - blood-brain barrier KW - tight junctions Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201284 SN - 1422-0067 VL - 20 IS - 16 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Stoll, Guido A1 - Bohr, Arne A1 - Volkmann, Jens A1 - Fluri, Felix T1 - Electrical stimulation of the mesencephalic locomotor region attenuates neuronal loss and cytokine expression in the perifocal region of photothrombotic stroke in rats JF - International Journal of Molecular Science N2 - Deep brain stimulation of the mesencephalic locomotor region (MLR) improves the motor symptoms in Parkinson’s disease and experimental stroke by intervening in the motor cerebral network. Whether high-frequency stimulation (HFS) of the MLR is involved in non-motor processes, such as neuroprotection and inflammation in the area surrounding the photothrombotic lesion, has not been elucidated. This study evaluates whether MLR-HFS exerts an anti-apoptotic and anti-inflammatory effect on the border zone of cerebral photothrombotic stroke. Rats underwent photothrombotic stroke of the right sensorimotor cortex and the implantation of a microelectrode into the ipsilesional MLR. After intervention, either HFS or sham stimulation of the MLR was applied for 24 h. The infarct volumes were calculated from consecutive brain sections. Neuronal apoptosis was analyzed by TUNEL staining. Flow cytometry and immunohistochemistry determined the perilesional inflammatory response. Neuronal apoptosis was significantly reduced in the ischemic penumbra after MLR-HFS, whereas the infarct volumes did not differ between the groups. MLR-HFS significantly reduced the release of cytokines and chemokines within the ischemic penumbra. MLR-HFS is neuroprotective and it reduces pro-inflammatory mediators in the area that surrounds the photothrombotic stroke without changing the number of immune cells, which indicates that MLR-HFS enables the function of inflammatory cells to be altered on a molecular level. KW - photothrombotic stroke KW - deep brain stimulation KW - mesencephalic locomotor region KW - neuroprotection KW - neuronal apoptosis KW - neuroinflammation Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201355 SN - 1422-0067 VL - 20 IS - 9 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Papp, Lena A1 - Stoll, Guido A1 - Blum, Robert A1 - Volkmann, Jens A1 - Fluri, Felix T1 - Mesencephalic electrical stimulation reduces neuroinflammation after photothrombotic stroke in rats by targeting the cholinergic anti-inflammatory pathway JF - International Journal of Molecular Sciences N2 - Inflammation is crucial in the pathophysiology of stroke and thus a promising therapeutic target. High-frequency stimulation (HFS) of the mesencephalic locomotor region (MLR) reduces perilesional inflammation after photothrombotic stroke (PTS). However, the underlying mechanism is not completely understood. Since distinct neural and immune cells respond to electrical stimulation by releasing acetylcholine, we hypothesize that HFS might trigger the cholinergic anti-inflammatory pathway via activation of the α7 nicotinic acetylcholine receptor (α7nAchR). To test this hypothesis, rats underwent PTS and implantation of a microelectrode into the MLR. Three hours after intervention, either HFS or sham-stimulation of the MLR was applied for 24 h. IFN-γ, TNF-α, and IL-1α were quantified by cytometric bead array. Choline acetyltransferase (ChAT)\(^+\) CD4\(^+\)-cells and α7nAchR\(^+\)-cells were quantified visually using immunohistochemistry. Phosphorylation of NFĸB, ERK1/2, Akt, and Stat3 was determined by Western blot analyses. IFN-γ, TNF-α, and IL-1α were decreased in the perilesional area of stimulated rats compared to controls. The number of ChAT\(^+\) CD4\(^+\)-cells increased after MLR-HFS, whereas the amount of α7nAchR\(^+\)-cells was similar in both groups. Phospho-ERK1/2 was reduced significantly in stimulated rats. The present study suggests that MLR-HFS may trigger anti-inflammatory processes within the perilesional area by modulating the cholinergic system, probably via activation of the α7nAchR. KW - photothrombotic stroke KW - deep brain stimulation KW - mesencephalic locomotor region KW - neuroinflammation KW - choline acetyltransferase KW - alpha-7 nicotinic acetylcholine receptor Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259099 SN - 1422-0067 VL - 22 IS - 3 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Langhauser, Friederike A1 - Zimmermann, Lena A1 - Bellut, Maximilian A1 - Kleinschnitz, Christoph A1 - Fluri, Felix T1 - Dimethyl fumarate attenuates lymphocyte infiltration and reduces infarct size in experimental stroke JF - International journal of molecular sciences N2 - Ischemic stroke is associated with exacerbated tissue damage caused by the activation of immune cells and the initiation of other inflammatory processes. Dimethyl fumarate (DMF) is known to modulate the immune response, activate antioxidative pathways, and improve the blood–brain barrier (BBB) after stroke. However, the specific impact of DMF on immune cells after cerebral ischemia remains unclear. In our study, male mice underwent transient middle cerebral artery occlusion (tMCAO) for 30 min and received oral DMF (15 mg/kg) or a vehicle immediately after tMCAO, followed by twice-daily administrations for 7 days. Infarct volume was assessed on T2-weighted magnetic resonance images on days 1 and 7 after tMCAO. Brain-infiltrating immune cells (lymphocytes, monocytes) and microglia were quantified using fluorescence-activated cell sorting. DMF treatment significantly reduced infarct volumes and brain edema. On day 1 after tMCAO, DMF-treated mice showed reduced lymphocyte infiltration compared to controls, which was not observed on day 7. Monocyte and microglial cell counts did not differ between groups on either day. In the acute phase of stroke, DMF administration attenuated lymphocyte infiltration, probably due to its stabilizing effect on the BBB. This highlights the potential of DMF as a therapeutic candidate for mitigating immune cell-driven damage in stroke. KW - experimental stroke KW - transient middle cerebral artery occlusion model KW - dimethyl fumarate KW - cerebral inflammation Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357731 VL - 24 IS - 21 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Langhauser, Friederike A1 - Kraft, Peter A1 - Kleinschnitz, Christoph T1 - B cells do not have a major pathophysiologic role in acute ischemic stroke in mice JF - Journal of Neuroinflammation N2 - Background Lymphocytes have been shown to play an important role in the pathophysiology of acute ischemic stroke, but the properties of B cells remain controversial. The aim of this study was to unravel the role of B cells during acute cerebral ischemia using pharmacologic B cell depletion, B cell transgenic mice, and adoptive B cell transfer experiments. Methods Transient middle cerebral artery occlusion (60 min) was induced in wild-type mice treated with an anti-CD20 antibody 24 h before stroke onset, JHD\(^{−/−}\) mice and Rag1\(^{−/−}\) mice 24 h after adoptive B cell transfer. Stroke outcome was assessed at days 1 and 3. Infarct volumes were calculated from 2,3,5-triphenyltetrazolium chloride (TTC)-stained brain sections, and neurological scores were evaluated. The local inflammatory response was determined by real-time PCR and immunohistochemistry. Apoptosis was analyzed by TUNEL staining, and astrocyte activation was revealed using immunohistochemistry and Western blot. Results Pharmacologic depletion of B cells did not influence infarct volumes and functional outcome at day 1 after stroke. Additionally, lack of circulating B cells in JHD\(^{−/−}\) mice also failed to influence stroke outcome at days 1 and 3. Furthermore, reconstitution of Rag1\(^{−/−}\) mice with B cells had no influence on infarct volumes. Conclusion Targeting B cells in experimental stroke did not influence lesion volume and functional outcome during the acute phase. Our findings argue against a major pathophysiologic role of B cells during acute ischemic stroke. KW - ischemic stroke KW - transient middle cerebral artery occlusion KW - B cells Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-158155 VL - 14 IS - 112 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Kraft, Peter A1 - Bieber, Michael A1 - Kollikowski, Alexander M. A1 - Schulze, Harald A1 - Nieswandt, Bernhard A1 - Pham, Mirko A1 - Stegner, David A1 - Stoll, Guido T1 - Targeting platelet GPVI plus rt-PA administration but not α2β1-mediated collagen binding protects against ischemic brain damage in mice JF - International Journal of Molecular Science N2 - Platelet collagen interactions at sites of vascular injuries predominantly involve glycoprotein VI (GPVI) and the integrin α2β1. Both proteins are primarily expressed on platelets and megakaryocytes whereas GPVI expression is also shown on endothelial and integrin α2β1 expression on epithelial cells. We recently showed that depletion of GPVI improves stroke outcome without increasing the risk of cerebral hemorrhage. Genetic variants associated with higher platelet surface integrin α2 (ITGA2) receptor levels have frequently been found to correlate with an increased risk of ischemic stroke in patients. However until now, no preclinical stroke study has addressed whether platelet integrin α2β1 contributes to the pathophysiology of ischemia/reperfusion (I/R) injury. Focal cerebral ischemia was induced in C57BL/6 and Itga2\(^{−/−}\) mice by a 60 min transient middle cerebral artery occlusion (tMCAO). Additionally, wild-type animals were pretreated with anti-GPVI antibody (JAQ1) or Fab fragments of a function blocking antibody against integrin α2β1 (LEN/B). In anti-GPVI treated animals, intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment was applied immediately prior to reperfusion. Stroke outcome, including infarct size and neurological scoring was determined on day 1 after tMCAO. We demonstrate that targeting the integrin α2β1 (pharmacologic; genetic) did neither reduce stroke size nor improve functional outcome on day 1 after tMCAO. In contrast, depletion of platelet GPVI prior to stroke was safe and effective, even when combined with rt-PA treatment. Our results underscore that GPVI, but not ITGA2, is a promising and safe target in the setting of ischemic stroke. KW - ischemic stroke KW - integrin α2 KW - glycoprotein VI KW - recombinant tissue-type plasminogen activator KW - intracranial bleeding KW - transient middle cerebral artery occlusion Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201700 SN - 1422-0067 VL - 20 IS - 8 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Guthmann, Josua A1 - Stoll, Guido A1 - Nieswandt, Bernhard A1 - Kraft, Peter A1 - Kleinschnitz, Christoph T1 - Blocking of platelet glycoprotein receptor Ib reduces “thrombo-inflammation” in mice with acute ischemic stroke JF - Journal of Neuroinflammation N2 - Background: Ischemic stroke causes a strong inflammatory response that includes T cells, monocytes/macrophages, and neutrophils. Interaction of these immune cells with platelets and endothelial cells facilitates microvascular dysfunction and leads to secondary infarct growth. We recently showed that blocking of platelet glycoprotein (GP) receptor Ib improves stroke outcome without increasing the risk of intracerebral hemorrhage. Until now, it has been unclear whether GPIb only mediates thrombus formation or also contributes to the pathophysiology of local inflammation. Methods: Focal cerebral ischemia was induced in C57BL/6 mice by a 60-min transient middle cerebral artery occlusion (tMCAO). Animals were treated with antigen-binding fragments (Fab) against the platelet surface molecules GPIb (p0p/B Fab). Rat immunoglobulin G (IgG) Fab was used as control treatment. Stroke outcome, including infarct size and functional deficits as well as the local inflammatory response, was assessed on day 1 after tMCAO. Results: Blocking of GPIb reduced stroke size and improved functional outcome on day 1 after tMCAO without increasing the risk of intracerebral hemorrhage. As expected, disruption of GPIb-mediated pathways in platelets significantly reduced thrombus burden in the cerebral microvasculature. In addition, inhibition of GPIb limited the local inflammatory response in the ischemic brain as indicated by lower numbers of infiltrating T cells and macrophages and lower expression levels of inflammatory cytokines compared with rat IgG Fab-treated controls. Conclusion: In acute ischemic stroke, thrombus formation and inflammation are closely intertwined (“thrombo-inflammation”). Blocking of platelet GPIb can ameliorate thrombo-inflammation. KW - ischemic stroke KW - occlusion KW - transient middle cerebral artery KW - glycoprotein receptor Ib KW - thrombo-inflammation Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157582 VL - 14 IS - 18 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Gunreben, Ignaz A1 - Kleinschnitz, Christoph A1 - Kraft, Peter T1 - Immunohistochemical Analysis of Cerebral Thrombi Retrieved by Mechanical Thrombectomy from Patients with Acute Ischemic Stroke JF - International Journal of Molecular Sciences N2 - Mechanical thrombectomy is a novel treatment option for patients with acute ischemic stroke (AIS). Only a few studies have previously suggested strategies to categorize retrieved clots according to their histologic composition. However, these reports did not analyze potential biomarkers that are of importance in stroke-related inflammation. We therefore histopathologically investigated 37 intracerebral thrombi mechanically retrieved from patients with AIS, and focused on the composition of immune cells and platelets. We also conducted correlation analyses of distinctive morphologic patterns (erythrocytic, serpentine, layered, red, white, mixed appearance) with clinical parameters. Most T cells and monocytes were detected in erythrocytic and red clots, in which the distribution of these cells was random. In contrast, von Willebrand factor (vWF)-positive areas co-localized with regions of fibrin and collagen. While clots with huge amounts of vWF seem to be associated with a high National Institute of Health Stroke Scale score at admission, histologic findings could not predict the clinical outcome at discharge. In summary, we provide the first histologic description of mechanically retrieved intracerebral thrombi regarding biomarkers relevant for inflammation in ischemic stroke. KW - thrombus formation KW - immune cells KW - lymphocytes KW - mechanical thrombectomy KW - ischemic stroke KW - inflammation Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-166206 VL - 17 IS - 3 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Fluri, Felix T1 - Effects of fullerenols on mouse brain microvascular endothelial cells JF - International Journal of Molecular Sciences N2 - Fullerenols, water-soluble C60-fullerene derivatives, have been shown to exert neuroprotective effects in vitro and in vivo, most likely due to their capability to scavenge free radicals. However, little is known about the effects of fullerenols on the blood–brain barrier (BBB), especially on cerebral endothelial cells under inflammatory conditions. Here, we investigated whether the treatment of primary mouse brain microvascular endothelial cells with fullerenols impacts basal and inflammatory blood–brain barrier (BBB) properties in vitro. While fullerenols (1, 10, and 100 µg/mL) did not change transendothelial electrical resistance under basal and inflammatory conditions, 100 µg/mL of fullerenol significantly reduced erk1/2 activation and resulted in an activation of NFκB in an inflammatory milieu. Our findings suggest that fullerenols might counteract oxidative stress via the erk1/2 and NFκB pathways, and thus are able to protect microvascular endothelial cells under inflammatory conditions. KW - mouse brain microvascular endothelial cell cultur KW - adhesion molecules KW - fullerenes KW - blood-brain barrier KW - inflammation KW - tight junctions Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-158072 SN - 1422-0067 VL - 18 IS - 8 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Bittner, Stefan A1 - Meuth, Sven G. A1 - Kleinschnitz, Christoph A1 - Fluri, Felix T1 - Fingolimod (FTY720-P) does not stabilize the blood-brain barrier under inflammatory conditions in an in vitro model JF - International Journal of Molecular Sciences N2 - Breakdown of the blood-brain barrier (BBB) is an early hallmark of multiple sclerosis (MS), a progressive inflammatory disease of the central nervous system. Cell adhesion in the BBB is modulated by sphingosine-1-phosphate (S1P), a signaling protein, via S1P receptors (S1P\(_1\)). Fingolimod phosphate (FTY720-P) a functional S1P\(_1\) antagonist has been shown to improve the relapse rate in relapsing-remitting MS by preventing the egress of lymphocytes from lymph nodes. However, its role in modulating BBB permeabilityin particular, on the tight junction proteins occludin, claudin 5 and ZO-1has not been well elucidated to date. In the present study, FTY720-P did not change the transendothelial electrical resistance in a rat brain microvascular endothelial cell (RBMEC) culture exposed to inflammatory conditions and thus did not decrease endothelial barrier permeability. In contrast, occludin was reduced in RBMEC culture after adding FTY720-P. Additionally, FTY720-P did not alter the amount of endothelial matrix metalloproteinase (MMP)-9 and MMP-2 in RBMEC cultures. Taken together, our observations support the assumption that S1P\(_1\) plays a dual role in vascular permeability, depending on its ligand. Thus, S1P\(_1\) provides a mechanistic basis for FTY720-P-associated disruption of endothelial barrierssuch as the blood-retinal barrierwhich might result in macular edema. KW - randomized controlled trial KW - Sphingosine 1-Phosphate KW - vascular permeability KW - rat brain microvascular endothelial cell culture KW - tight junctions KW - FTY720-P KW - blood-brain barrier KW - inflammation KW - novo renal transplantation KW - endothelial cells KW - experimental autoimmune encephalomyelitis KW - relapsing multiple sclerosis KW - Zonula Occludens-1 KW - matrix metalloproteinases Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-145047 VL - 16 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Bieber, Michael A1 - Franke, Maximilian A1 - Kollikowski, Alexander M. A1 - Stegner, David A1 - Heinze, Katrin G. A1 - Nieswandt, Bernhard A1 - Pham, Mirko A1 - Stoll, Guido T1 - Platelets and lymphocytes drive progressive penumbral tissue loss during middle cerebral artery occlusion in mice JF - Journal of Neuroinflammation N2 - Background In acute ischemic stroke, cessation of blood flow causes immediate tissue necrosis within the center of the ischemic brain region accompanied by functional failure in the surrounding brain tissue designated the penumbra. The penumbra can be salvaged by timely thrombolysis/thrombectomy, the only available acute stroke treatment to date, but is progressively destroyed by the expansion of infarction. The underlying mechanisms of progressive infarction are not fully understood. Methods To address mechanisms, mice underwent filament occlusion of the middle cerebral artery (MCAO) for up to 4 h. Infarct development was compared between mice treated with antigen-binding fragments (Fab) against the platelet surface molecules GPIb (p0p/B Fab) or rat immunoglobulin G (IgG) Fab as control treatment. Moreover, Rag1\(^{−/−}\) mice lacking T-cells underwent the same procedures. Infarct volumes as well as the local inflammatory response were determined during vessel occlusion. Results We show that blocking of the platelet adhesion receptor, glycoprotein (GP) Ibα in mice, delays cerebral infarct progression already during occlusion and thus before recanalization/reperfusion. This therapeutic effect was accompanied by decreased T-cell infiltration, particularly at the infarct border zone, which during occlusion is supplied by collateral blood flow. Accordingly, mice lacking T-cells were likewise protected from infarct progression under occlusion. Conclusions Progressive brain infarction can be delayed by blocking detrimental lymphocyte/platelet responses already during occlusion paving the way for ultra-early treatment strategies in hyper-acute stroke before recanalization. KW - ischemic penumbra KW - glycoprotein receptor Ib KW - T-cells KW - ischemic stroke KW - thrombo-inflammation KW - middle cerebral artery occlusion Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259172 VL - 18 IS - 1 ER - TY - THES A1 - Schubert, Anna-Lena T1 - Untersuchung potenzieller Biomarker in Haut- und Nervenbiopsaten von Patienten mit schmerzhaften und schmerzlosen Polyneuropathien T1 - Investigation of potential biomarkers in skin and sural nerve biopsies of patients with painful and painless polyneuropathies N2 - Polyneuropathien sind eine ätiologisch heterogene Erkrankung des peripheren Nervensystems. In bis zu 30% der Fälle ist eine Zuordnung zu einem bestimmten PNP Subtyp auch nach aufwändiger und zum Teil invasiver Diagnostik nicht möglich. Bislang fehlt ein diagnostischer Biomarker bei PNP, der z.B. bei der Unterscheidung zwischen einzelnen diagnostischen Subgruppen oder entzündlichen und nicht-entzündlichen Erkrankungsformen helfen könnte. In einer prospektiven Studie mit insgesamt 97 Patienten mit Neuropathien verschiedenster Ätiologie und 17 gesunden Kontrollpersonen erstellten wir Genexpressionsprofile von inflammatorischen Markern und Markern der Regeneration peripherer Nerven in Haut- und N. suralis-Biopsaten. Es wurden Inflammationsmarker (TAC1, CRMP2, AIF1, IL-6) und Marker, die in die Regeneration peripherer Nerven involviert sind (SCD, Netrin-1, DCC, UNC5H2, NEO1, Netrin-G1, Netrin-G2), mittels qRT-PCR untersucht. Alle Patienten erhielten eine N. suralis-Biopsie und/oder eine Hautbiopsie von Ober- beziehungsweise Unterschenkel. Weder in den Haut- noch in den N. suralis-Biopsaten konnten Unterschiede in der Genexpression dieser Marker zwischen einzelnen diagnostischen Subgruppen gefunden werden. Der Inflammationsmarker AIF1 war jedoch in Patienten-Hautproben sowohl proximal als auch distal höher exprimiert als bei gesunden Kontrollpersonen (p < 0,05 bzw. p < 0,01). Zudem fand sich in den Hautproben von PNP-Patienten eine deutlich reduzierte Genexpression von Regenerationsmarkern aus der Netrin-Familie verglichen mit den Hautproben gesunder Probanden (Netrin-1, DCC, UNC5H2, NEO1 sowie Netrin-G1 und G2; p < 0,05 bis p < 0,001). Ferner wies Netrin-1 in distalen Hautproben bei Patienten mit einer entzündlichen PNP eine niedrigere Genexpression auf, als bei Patienten mit einer nicht-entzündlichen Erkrankungsform (p < 0,05). Die Genexpression von NEO1 in distalen Hautproben war bei schmerzloser PNP und gesunden Kontrollpersonen höher als bei schmerzhafter PNP (p < 0,05). Sowohl eine Erhöhung bestimmter Inflammationsmarker als auch eine Verminderung von Regenerationsmarkern peripherer Nerven können bei der Pathophysiologie von Polyneuropathien involviert sein. Insbesondere Mitglieder der Netrin-Familie scheinen eine komplexe Rolle für das Axonwachstum, jedoch auch für entzündliche Prozesse zu spielen. N2 - Polyneuropathien sind eine ätiologisch heterogene Erkrankung des peripheren Nervensystems. In bis zu 30% der Fälle ist eine Zuordnung zu einem bestimmten PNP Subtyp auch nach aufwändiger und zum Teil invasiver Diagnostik nicht möglich. Bislang fehlt ein diagnostischer Biomarker bei PNP, der z.B. bei der Unterscheidung zwischen einzelnen diagnostischen Subgruppen oder entzündlichen und nicht-entzündlichen Erkrankungsformen helfen könnte. In einer prospektiven Studie mit insgesamt 97 Patienten mit Neuropathien verschiedenster Ätiologie und 17 gesunden Kontrollpersonen erstellten wir Genexpressionsprofile von inflammatorischen Markern und Markern der Regeneration peripherer Nerven in Haut- und N. suralis-Biopsaten. Es wurden Inflammationsmarker (TAC1, CRMP2, AIF1, IL-6) und Marker, die in die Regeneration peripherer Nerven involviert sind (SCD, Netrin-1, DCC, UNC5H2, NEO1, Netrin-G1, Netrin-G2), mittels qRT-PCR untersucht. Alle Patienten erhielten eine N. suralis-Biopsie und/oder eine Hautbiopsie von Ober- beziehungsweise Unterschenkel. Weder in den Haut- noch in den N. suralis-Biopsaten konnten Unterschiede in der Genexpression dieser Marker zwischen einzelnen diagnostischen Subgruppen gefunden werden. Der Inflammationsmarker AIF1 war jedoch in Patienten-Hautproben sowohl proximal als auch distal höher exprimiert als bei gesunden Kontrollpersonen (p < 0,05 bzw. p < 0,01). Zudem fand sich in den Hautproben von PNP-Patienten eine deutlich reduzierte Genexpression von Regenerationsmarkern aus der Netrin-Familie verglichen mit den Hautproben gesunder Probanden (Netrin-1, DCC, UNC5H2, NEO1 sowie Netrin-G1 und G2; p < 0,05 bis p < 0,001). Ferner wies Netrin-1 in distalen Hautproben bei Patienten mit einer entzündlichen PNP eine niedrigere Genexpression auf, als bei Patienten mit einer nicht-entzündlichen Erkrankungsform (p < 0,05). Die Genexpression von NEO1 in distalen Hautproben war bei schmerzloser PNP und gesunden Kontrollpersonen höher als bei schmerzhafter PNP (p < 0,05). Sowohl eine Erhöhung bestimmter Inflammationsmarker als auch eine Verminderung von Regenerationsmarkern peripherer Nerven können bei der Pathophysiologie von Polyneuropathien involviert sein. Insbesondere Mitglieder der Netrin-Familie scheinen eine komplexe Rolle für das Axonwachstum, jedoch auch für entzündliche Prozesse zu spielen. Polyneuropathies as frequently occurring neurologic diseases are caused by many different etiologies. Despite extensive and partly invasive diagnostic workup up to 30% of the cases can’t be assigned to one kind of neuropathic subtype. There is a strong need for diagnostic biomarkers that could help to distinguish between different subgroups of polyneuropathies, especially inflammatory and non-inflammatory ones. In a prospective study we characterized gene expression profiles of pro- inflammatory markers (TAC1, CRMP2, AIF1, IL-6) and targets involved in neuronal regeneration (SCD, Netrin-1, DCC, UNC5H2, NEO1, Netrin-G1, Netrin-G2) in skin and sural nerve biopsies of 97 patients with different subtypes of polyneuropathies and 17 healthy controls via quantitative real-time PCR. All patients underwent sural nerve and/or skin punch biopsy at the lateral thigh and lower leg. Either skin or sural nerve gene expression of the investigated targets did not differ between neuropathies of different etiologies. But the pro-inflammatory target AIF1 was upregulated in proximal and distal skin biopsies of patients compared to healthy controls (p < 0,05 / p < 0,01). Furthermore the gene expression of members of the Netrin-familiy (Netrin-1, DCC, UNC5H2, NEO1, Netrin G1 and –G2) which are involved in neuronal regeneration was decreased in skin biopsies of patients compared to healthy controls (p < 0,05 / p < 0,01 , p < 0,001). Moreover Netrin-1 showed a higher gene expression in distal skin biopsies of patients with non-inflammatory neuropathies compared to inflammatory forms of disease (p < 0,05). The gene expression level of NEO1 in distal skin biopsies of painless polyneuropathies and healthy controls was higher than in painful patients (P < 0,05). Both an increase of pro-inflammatory markers and a decrease of targets involved in neuronal regeneration seem to be involved in the pathophysiology of polyneuropathies. Especially members of the Netrin-family appear to play a complex role in the axonal outgrowth and also in pro-inflammatory processes. KW - Biomarker KW - Polyneuropathie KW - Schmerz KW - Neuropathie Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-153254 ER - TY - THES A1 - Schubert, Andrea Julia T1 - Vergleich der Ergebnisse von Karotis-Stenting und -TEA an der Universitätsklinik Würzburg T1 - Comparing the results of carotid stenting and carotid endarterectomy at the university of Würzburg N2 - Der Vergleich der Verfahren Karotisstenting und Karotis-TEA an der Universitätsklinik Würzburg zeigt, dass bei richtiger Indikationsstellung sowie ausreichender Erfahrung der Neuroradiologen, CAS eine ernstzunehmende Alternative zu CEA darstellt. Besonderes Augenmerk lag dabei auf periprozeduale Komplikationen sowie Langzeitergebnisse bezüglich Tod,Insult und Restenose. N2 - Comparing carotid artery stenting and endarterectomy at the university of Würzburg, we showed that CAS is a serious alternative to CEA if the right indication is given and when interventionalists have enough experience. Our endpoints were periprocedual complications and long-term outcomes regarding stroke, death and recurrent stenosis. KW - Carotis KW - Arteria carotis interna KW - Carotisstenose KW - Carotischirurgie KW - Endarteriektomie KW - Würzburg / Universität Würzburg KW - Vergleich KW - Stent KW - CEA KW - CAS KW - versus KW - vs KW - CEA KW - CAS KW - versus KW - vs Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-67130 ER - TY - THES A1 - Schröter, Nils T1 - Diagnostische Wertigkeit von Gb3-Ablagerungen in der Haut von Patienten mit M. Fabry T1 - The diagnostic value of Gb3-skin deposits in Patients with Fabry Disease N2 - In der vorliegenden Arbeit wurde geprüft, ob Gb3 in Hautstanzbiopsien von Patienten mit M. Fabry nachweisbar ist, die Ablagerungen quantifizierbar sind, mit der Krankheitsschwere korrelieren, und ob eine Unterscheidung von Patienten und gesunden Kontrollen anhand der dermalen Gb3-Ablagerungen möglich ist. Es wurden 84 Patienten mit M. Fabry über das FAZiT sowie 27 gesunde Kontrollen zwischen 2008 und 2013 prospektiv rekrutiert und jeweils eine proximale und eine distale Hautbiopsie entnommen. Zusätzlich erfolgten eine Anamnese, eine klinische Untersuchung, eine QST, das Ausfüllen von Fragebögen mit der Fragestellung nach Schmerz und Depression sowie eine Blutentnahme und kardiale Diagnostik. Die Immunfluoreszenz erfolgte mit Antikörpern gegen CD77, einem Marker für Gb3. Es erfolgte die verblindete, semiautomatische Quantifizierung der Gb3 Ablagerungen. Hierzu wurden pro Biopsie drei ROI ausgewählt und die Fläche der ROIs mit Gb3-Ablagerungen in Relation zu der Gesamtfläche der ROIs gesetzt. Für die Auswertung wurden die Patienten sowohl nach Geschlecht als auch nach Krankheitsschwere und einzelnen Symptomen stratifiziert Die Gb3 Ablagerungen ließen sich bevorzugt in Schweißdrüsen und Endothel nachweisen. Es fanden sich jedoch auch größere Mengen an Gb3-Ablagerungen ohne ersichtliches anatomischer Korrelat. Die Gb3-Ablagerungen wurden semiautomatisch quantifiziert. Es konnte nachgewiesen werden, dass männliche Fabry-Patienten eine deutlich größere Menge an Gb3 in den distalen Hautbiopsien zeigen als gesunde Kontrollen, Patienten mit einer eingeschränkten Nierenfunktion hatten eine größere Menge an Gb3-Ablagerungen in der Haut als Patienten mit einer uneingeschränkten Nierenfunktion. Bei Patienten mit einer SFN waren erhöhte dermale Gb3 Mengen vorhanden im Vergleich zu gesunden Kontrollen, bei Patienten ohne eine SFN fand sich dieser Unterschied nicht. Patienten mit einem niedrigen SNAP zeigten im Vergleich zu gesunden Kontrollen eine größere Menge an Gb3 in ihrer distalen Haut, bei Patienten mit einem höheren SNAP fand sich dies nicht. Aus diesen Ergebnissen ergeben sich ein mögliches weiteres Werkzeug sowohl für die Diagnosestellung als auch für das Monitoring der Erkrankung, sowie weiterführend auch ein möglicher Indikator für den Therapieerfolg der ERT. N2 - Fabry disease (FD) is an X-chromosomally linked disease which leads to deposits of globotriaosylceramide 3 (Gb3) in several tissues. The aim of this study was to prove, that these deposits can be shown in the skin of patients with FD via immunofluorescence, that Gb3 deposits can be quantified, that patients with FD have more Gb3-deposits in their skin than healthy controls and that the amount of Gb3 deposits in skin correlates with disease severity. 84 patients were prospectively recruited in the Würzburg Fabry Center for Interdisciplinary Therapy as well as 27 healthy controls. Every patient received a skin biopsy from a proximal and a distal location, a physical examination as well as a thorough anamnesis, filled out questionnaires regarding pain and symptoms hinting for depression and underwent cardiac diagnostics. Immunofluorescence double stains were done for Gb3 and protein-gene-product 9.5 as well as for Gb3 and von Willebrand factor. We quantified the amount of Gb3 semi-automatically in three predetermined regions of interest. We could show, that Gb3 can be visualized and quantified in the skin of patients with FD using immunofluorescence. Furthermore, male patients with FD had a higher Gb3 load in their distal skin than healthy controls (p<0.05). Male patients with FD and an impaired renal function had a higher Gb3 load in their distal skin (p<0.05). Similarly, it was shown, that male patients with a small fiber neuropathy had a higher load of Gb3 in their distal skin than male patients without a small-fiber neuropathy (p<0.05). In conclusion it can be stated, that the quantification of Gb3 via immunofluorescence could be used in the diagnostics of FD and might be of value as a biomarker in the course of the disease. KW - Fabry-Krankheit KW - Biomarker KW - Haut KW - Immunfluoreszenz KW - Hautbiopsie Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-160552 ER - TY - THES A1 - Schröder, Barbara Christiane T1 - Untersuchungen zur pharmakologischen Hemmung der Zytokin-induzierbaren NO-Synthase in kultivierten Mikroglia-Zellen und Makrophagen T1 - Investigations of pharmacological inhibition of cytokine-inducible nitric oxide synthase in cultivated microglia and macrophages N2 - Mikrogliazellen fungieren als Makrophagen im ZNS, wo sie verschiedene Abwehrfunktionen gegen Mikroorganismen übernehmen, Zellreste beseitigen und eine wichtige Rolle bei Autoimmunerkrankungen des ZNS spielen. Mikrogliazellen exprimieren unter anderem eine NO-Synthase, die durch Zytokine induzierbar ist. Da NO für Neurone und Oligodendrozyten toxisch sein kann, waren wir daran interessiert, Substanzen zu identifizieren, die eine hemmende Wirkung auf die zytokin-induzierbare NO-Synthase in Makrophagen und Mikrogliazellen haben. Unter den getesteten Zytokinen, Wachstumsfaktoren, Neuropeptiden, Chemokinen und Tyrosinkinase-Hemmern war lediglich der Tyrosinkinaseinhibitor Methyl-2,5-Dihydroxycinnamat als NO-Synthase-Hemmstoff erfolgreich. Da die NO-Produktion eine Rolle in der Pathogenese der Experimentellen Autoimmunen Enzephalomyelitis (EAE) und der Experimentellen Autoimmunen Neuritis (EAN) spielt, war auch die Möglichkeit eines therapeutischen Einsatzes des NO-Synthase-Inhibitors von Interesse. Dieser scheint jedoch im Falle von Methyl-2,5-Dihydroxycinnamat aufgrund seiner Toxizität in höherer Konzentration und des daraus resultierenden engen Therapeutischen Dosisfensters sehr eingeschränkt. N2 - Microglial cells are resident macrophages in the central nervous system which serve specific functions in the defense of the CNS against microorganisms, the removal of tissue debris in neurodegenerative diseases and in autoimmune inflammatory disorders of the brain. Microglia express a cytokine.inducible isoform of nitric oxide synthase, which leads to the production of nitric oxide. Since NO is toxic to neurons and oligodendrocytes, we were interested to find down-regulating substances in order to identify a novel antagonist of the cytokine-inducible nitric oxide synthase in macrophages and microglial cells. We tested several cytokines, growth factors, neuropeptides, chemokines and tyrosine kinase inhibitors. We found that only the tyrosine kinase inhibitor methyl-.2,5- dihydroxycinnamate suppressed cytokine-induced NO production by rat microglial cells and murine macrophages, while all other substances were ineffective. Since NO production plays a role in the pathogenesis of experimental autoimmune encephalomyelitis and experimental autoimmune neuritis, we were also interested in a possible therapeutic use of the NO synthase inhibitor found. Since methyl-2,5- dihydroxycinnamate is toxic in higher concentration, there might be a small window and no possibility of therapeutic use. KW - Mikroglia KW - iNOS-Synthase KW - Methyl-2 KW - 5-Dihydroxycinnamat KW - Microglia KW - inducible nitric oxide synthase KW - Methyl-2 KW - 5-dihydroxycinnamate Y1 - 2002 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-6837 ER - TY - JOUR A1 - Schrewe, L. A1 - Lill, C. M. A1 - Liu, T. A1 - Salmen, A. A1 - Gerdes, L. A. A1 - Guillot-Noel, L. A1 - Akkad, D. A. A1 - Blaschke, P. A1 - Graetz, C. A1 - Hoffjan, S. A1 - Kroner, A. A1 - Demir, S. A1 - Böhme, A. A1 - Rieckmann, P. A1 - El Ali, A. A1 - Hagemann, N. A1 - Hermann, D. M. A1 - Cournu-Rebeix, I. A1 - Zipp, F. A1 - Kümpfel, T. A1 - Buttmann, M. A1 - Zettl, U. K. A1 - Fontaine, B. A1 - Bertram, L. A1 - Gold, R. A1 - Chan, A. T1 - Investigation of sex-specific effects of apolipoprotein E on severity of EAE and MS JF - Journal of Neuroinflammation N2 - Background: Despite pleiotropic immunomodulatory effects of apolipoprotein E (apoE) in vitro, its effects on the clinical course of experimental autoimmune encephalomyelitis (EAE) and multiple sclerosis (MS) are still controversial. As sex hormones modify immunomodulatory apoE functions, they may explain contentious findings. This study aimed to investigate sex-specific effects of apoE on disease course of EAE and MS. Methods: MOG\(_{35-55}\) induced EAE in female and male apoE-deficient mice was assessed clinically and histopathologically. apoE expression was investigated by qPCR. The association of the MS severity score (MSSS) and APOE rs429358 and rs7412 was assessed across 3237 MS patients using linear regression analyses. Results: EAE disease course was slightly attenuated in male apoE-deficient (apoE\(^{-/-}\)) mice compared to wildtype mice (cumulative median score: apoE\(^{-/-}\) = 2 [IQR 0.0-4.5]; wildtype = 4 [IQR 1.0-5.0]; n = 10 each group, p = 0.0002). In contrast, EAE was more severe in female apoE\(^{-/-}\) mice compared to wildtype mice (cumulative median score: apoE\(^{-/-}\) = 3 [IQR 2.0-4.5]; wildtype = 3 [IQR 0.0-4.0]; n = 10, p = 0.003). In wildtype animals, apoE expression during the chronic EAE phase was increased in both females and males (in comparison to naive animals; p < 0.001). However, in MS, we did not observe a significant association between MSSS and rs429358 or rs7412, neither in the overall analyses nor upon stratification for sex. Conclusions: apoE exerts moderate sex-specific effects on EAE severity. However, the results in the apoE knock-out model are not comparable to effects of polymorphic variants in the human APOE gene, thus pinpointing the challenge of translating findings from the EAE model to the human disease. KW - immune KW - apoE KW - gender KW - inflammation KW - association studies in genetics KW - apoe KW - CNS disease KW - system KW - multiple sclerosis KW - MSSS KW - experimental autoimmune encephalomyelitis KW - disease severity KW - cognitive function KW - Alzheimer disease Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-136252 VL - 12 IS - 234 ER - TY - THES A1 - Schreiber, David Lukas T1 - CSF-1-Rezeptor Inhibitor als Therapieansatz in Mausmodellen für Charcot-Marie-Tooth Neuropathien Typ 1 T1 - CSF-1-Receptor Inhibitor as treatment approach in mouse models for Charcot-Marie-Tooth neuropathies typ 1 N2 - Charcot-Marie-Tooth Neuropathien sind die häufigsten hereditären Erkrankungen des peripheren Nervensystems und dennoch bis heute nicht therapierbar. Die Lebensqualität der Patienten ist durch motorische und sensorische Defizite der Extremitäten häufig stark eingeschränkt. Ursache können unter anderem Mutationen in Schwann-Zellen sein, die zu dem typischen Bild von Demyelinisierung und axonalem Schaden führen. In den letzten Jahren konnte in Mausmodellen das Immunsystem als wichtiger Mediator in der Pathogenese der CMT 1 Subtypen A, B und X identifiziert werden. Insbesondere Makrophagen spielen eine tragende Rolle bei dem Verlust der axonalen Integrität, bei der Schädigung der Myelinscheiden, sowie bei der Dedifferenzierung von Schwann-Zellen. Entscheidender Faktor für Proliferation und Aktivierung der Makrophagen ist hierbei das Zytokin CSF-1, dessen korrespondierender Rezeptor auf Makrophagen exprimiert wird. Der CSF-1/CSF1R Signalweg bietet somit einen vielversprechenden Angriffspunkt. In der vorliegenden Arbeit wurden Mausmodelle der CMT 1 Subtypen A, B und X mit einem niedermolekularen CSF-1-Rezeptor Inhibitor behandelt. Anschließend erfolgte eine funktionelle und strukturelle Auswertung der peripheren Nerven. Das beste Ansprechen auf die Therapie zeigten Cx32def Mutanten. Strukturell fielen ein verringerter axonaler Schaden und eine verbesserte axonale Regenerationsfähigkeit sowie erhaltene neuromuskuläre Synapsen auf. Funktionell äußerte sich dies in verbesserten elektrophysiologischen Parametern und einem Krafterhalt, welcher als klinischer Parameter die größte Relevanz für betroffene Patienten hat und somit besonders hervorzuheben ist. Auch P0het Mutanten zeigten Verbesserungen nach der CSF1RI Behandlung. Anders als bei Cx32def Tieren zeigte sich hier jedoch vor allem ein Erhalt der Myelinintegrität. Weiterhin wirkte sich die Therapie positiv auf elektrophysiologische Parameter und Krafttests aus. Vor allem besonders stark betroffene Individuen schienen hierbei von der CSF1RI Behandlung zu profitieren. Bei PMP22tg Mutanten hingegen konnten keine positiven Effekte der CSF1RI Behandlung nachgewiesen werden. Strukturelle und funktionelle Parameter behandelter Tiere unterschieden sich nicht von unbehandelten. Diese Ergebnisse unterstreichen die Relevanz der sekundären Entzündungsreaktion in CMT 1 Neuropathien als wichtigen Mediator in der Pathogenese. Weiterhin konnte gezeigt werden, dass eine Intervention im CSF-1/CSF1R Signalweg einen vielversprechenden möglichen Ansatz für die Therapie der bisher nicht behandelbaren CMT 1 Subypen X und B darstellt. Unausweichlich ist hierbei ein möglichst früher Therapiestart vor Ausprägung der ersten molekularen und histologischen Veränderungen. Im Hinblick auf die nicht die Lebenserwartung reduzierende Erkrankung muss ferner eine Minimierung der Nebenwirkungen der Therapie gewährleistet sein. Besonders hervorzuheben ist hier die Verwendung eines Inhibitors, welcher nicht in das zentrale Nervensystem vordringen kann und somit die Funktion der Mikroglia nicht beeinträchtigt. N2 - Charcot-Marie-Tooth neuropathies are the most abundant inherited disorders of the peripheral nervous system, caused by a various number of mutations in schwann cell proteins which lead to the typical outcome with demyelination and axonal damage. Affected Patients suffer from motor and sensory deficits of the upper and lower extremities. To this day there is no specific therapy available. Within the last years the immune system has been identified as a mediator in the pathogenesis oft the CMT 1 subtypes A, B and X. It was shown that macrophages play a crucial role in demyelination, loss of axonal integrity and schwann cell dedifferentiation. As main factor for macrophage proliferation and differentiation cytokine CSF-1 has been identified which corresponding receptor is expressed on the outer surface oft he macrophages. Hence the CSF-1/CSF1R signalling pathway represent a promising target for pharmacological approaches. In this study we treated mouse models of CMT 1 subtypes A, B and X with a small-molecule CSF-1-receptor inhibitor, followed by histological and functional evaluation of peripheral nerves and muscles. The best response to the treatment was observed in Cx32def mutants. The treatment resulted in reduced axonal damage, improved axonal regeneration and preserved neuromuscular junctions. In addition we found improved functional parameters in grip strength testing and in electrophysiological studies. In contrast to Cx32def mutants, the characteristic feature observed in P0het mutants after CSF-1-receptor inhibitor treatment was preserved myelin integrity. Especially strongly affected individuals seemed to benefit from the treatment. PMP22tg mutants did not respond to CSF-1-receptor inhibitor treatment. The results of this study emphaize the importance of low-grade secondary inflammation as a desease amplifier in CMT 1 neuropathies. Furthermore we could show that targeting the CSF-1/CSF1RI signalling pathway might represent a promising treatment approach for CMT 1 subtypes X and B. It should be started preferably in early childhood before the developement of the typical histopathological alterations. KW - CSF-1 KW - Charcot-Marie-Tooth-Hoffmann-Syndrom KW - Makrophage KW - Immunsystem KW - CSF-1 KW - Makrophagen KW - Charcot-Marie-Tooth Neuropathie KW - Heriditäre sensomotorische Neuropathie KW - CSF-1 Rezeptor Inhibitor KW - Macrophage KW - Charcot-Marie-Tooth Neuropathy KW - Heriditary sensor and motor neuropathy KW - CSF-1 receptor inhibitor Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-174931 ER - TY - JOUR A1 - Schreglmann, Sebastian R. A1 - Burke, Derek A1 - Batla, Amit A1 - Kresojevic, Nikola A1 - Wood, Nicholas A1 - Heales, Simon A1 - Bhatia, Kailash P. T1 - Cerebellar and Midbrain Lysosomal Enzyme Deficiency in Isolated Dystonia JF - Movement Disorders KW - dystonia KW - lysosomal enzyme KW - diagnostics Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318743 VL - 37 IS - 4 SP - 875 EP - 877 ER - TY - JOUR A1 - Schreglmann, Sebastian R. A1 - Bhatia, Kailash P. T1 - HOPS-Associated Neurological Disorders: Lysosomal Dysfunction as an Emerging Concept Underlying Dystonia JF - Movement Disorders Clinical Practice KW - dystonia KW - homotypic fusion and protein sorting KW - lysosomal dysfunction Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318736 VL - 9 IS - 4 SP - 452 EP - 453 ER - TY - THES A1 - Schramm, Axel T1 - Sensomotorische Integration bei zervikalen Dystonien T1 - Sensorimotor integration in cervical dystonia N2 - Zervikale Dystonien gehören zu den häufigsten Formen fokaler Dystonien. Diese sind durch anhaltende, unwillkürliche Muskelkontraktionen gekennzeichnet, welche zu verdrehenden oder repetitiven Bewegungen oder abnormalen Haltungen des Kopfes führen. Ein seit über 100 Jahren beobachtetes Phänomen stellt hierbei die Möglichkeit dar, mittels sogenannter "sensibler Trickmanöver", welche meistens in einer leichten Berührung von Arealen im Kopfbereich bestehen, die pathologische Muskelaktivität zu reduzieren und damit die Kopfposition zu normalisieren. Ziel der vorliegenden Arbeit war es, eine breite und vor allem erstmalig quantitative Charakterisierung von wirksamen Trickmanövern vorzunehmen und so verschiedene Einflußgrößen auf die Wirksamkeit solcher Tricks zu untersuchen. Hierzu wurden die Muskelaktivitäten der vier wichtigsten den Kopf drehenden Muskeln mittels Oberflächen-EMG abgeleitet und die Veränderungen bei Trickapplikation unterschiedlicher Lokalisation, Modalität und bei verschiedenen Ausgangspositionen ermittelt. 1) Hinsichtlich der Lokalisation ergaben sich über alle Patienten gemittelt keine signifikante Seitendifferenz, und auch bei individuellem Vergleich zeigten sich bei rund 50% der Patienten keine signifikanten Unterschiede zwischen kontralateraler und ipsilateraler Trickapplikation. Unter den getesteten Applikationsorten grenzte sich das Areal "Wange" mit durchschnittlich 33%iger Reduktion der gesamten EMG-Aktivität signifikant gegen die Areale "Kinn" (-23%) und "Hals" (-23%) ab und war bei 79% der Patienten am besten wirksam. 2) Bei weiterer Untersuchung verschiedener Trickmodalitäten auf dem für jeden Patienten individuell wirksamsten Areal waren neben dem klassischen Trickmanöver (-42%) auch die Verwendung eines Plastikstabes durch den Patienten (-43%) oder Untersucher (-32%), sowie nicht-sensible Manöver wie das Heben des Armes ohne eigentliche Berührung (-18%) und die bloße Vorstellung einer Trickapplikation (-20%) hochsignifikant wirksam. Allerdings korrelierten sensible und (wie die beiden letztgenannten) nicht-sensible Tricks nicht miteinander, was auf einen prinzipiell unterschiedlichen Wirkmechanismus hinweisen könnte. Visuelle Rückkopplung über einen Spiegel hatte im Gegensatz dazu keine Wirkung. 3) Bezüglich der Bedeutung der Kopfposition für Muskelaktivität und Trickwirksamkeit zeigte sich bereits bei willkürlicher Einnahme einer Neutralposition ohne Trickanwendung eine signifikante Reduktion agonistischer Muskelaktivität (-30%), die allerdings von einer leichten antagonistischen Aktivierung begleitet war (+2,4%). Überraschenderweise war die Applikation eines Tricks um so wirksamer, je weiter der Kopf zu Beginn auf die zur dystonen Drehrichtung kontralateralen Seite gedreht war. Demgegenüber ließ sich bei Trickapplikation in dystoner Maximalposition kaum mehr eine Wirkung nachweisen (-12%). Die vorliegenden Ergebnisse sprechen aufgrund der unspezifischen Wirkung verschiedenster Trickmanöver (2) und Lokalisationen (1) für die Einbeziehung höherer sensomotorischer Integrationszentren wie z. B. des Parietalcortex in den Wirkmechanismus. Sensible Trickmanöver könnten bei auf die pathologische Kopfposition adaptierten sensiblen Afferenzen Zusatzinformationen über die Kopfposition im Vergleich zum Rumpf liefern. Möglicherweise sind diese umso wirksamer, je weiter sich der Kopf noch auf der kontralateralen Seite befindet (3), da in dieser Situation die dystone Muskelaktivität noch gering und das sensible Mismatch, über welches sensible Stimuli modulierend einwirken könnten, maximal ist. Nach den vorgelegten Ergebnissen läßt sich erstmals ein zweiphasiger Ablauf der Trickwirkung postulieren: Der in einer ersten Phase teils willkürlich in eine günstige Ausgangsposition gebrachte Kopf kann durch die Anwendung sensibler Stimuli oder Imagination in einer zweiten Phase mit geringerer Anstrengung und unter Ausnutzung kortikaler sensomotorischer Servomechanismen stabilisiert werden. Im Rahmen der vorgelegten Studie konnte das Verständnis für therapeutisch nutzbare sensible Trickmanöver verbessert und somit Patienten unterschiedliche Trickstrategien an die Hand gegeben werden. Die Identifikation der zentralen Rolle höherer integrativer Zentren wie dem Parietalcortex im Rahmen des Wirkmechanismus, könnte dabei Ausgangspunkt für neue Therapieansätze in Form einer gezielten Beeinflussung solcher Areale sein. N2 - Sensory tricks in cervical dystonia frequently lead to a marked reduction of dystonic muscle activity, a fact that has been described as „geste antagonistique“ more than a century ago. In order to evaluate the impact of the degree of head rotation as well as mode and location on the efficacy of such sensory tricks, agonistic and antagonistic muscle activities in 26 patients with predominantly rotational torticollis have been systematically analyzed using a 4-channel surface EMG. In the subgroup of 19 patients with a clinically effective trick, touching the neck, chin or cheek on the ipsi- and contralateral side of head rotation all led to a significant (p<0.002) reduction of agonistic and antagonistic EMG activity. Patients without a clinically effective trick showed no significant change in EMG-activity. There was a strong correlation between the efficacy of a trick manoeuvre and the head position. No significant reduction during trick application was seen at the maximum dystonic head position while trick application in a neutral or even contralateral position led to a highly reduction of EMG-activity. Besides typical trick manoeuvres such as manually touching the sensitive area, other stimuli also led to significant reduction of EMG activity: use of a plastic stick instead of the finger by the patient (p<0.001) or by the investigator (p<0.001), elevating the arm and holding the finger close to the respective skin area without touching it (p<0,002), as well as mere thinking of performing the trick manoeuvre (p<0.002). As conclusion trigger mechanisms for tricks in cervical dystonia seem to be rather unspecific involving higher centres of sensorimotor integration. Based on these findings a 2-phase-model is proposed: In a first step normalization of head posture by stronger counterpressure or volitional antagonistic muscle activity might partly reduce dystonic activity, so that in a second step stabilisation of this head position applying a sensory trick manoeuvre is possible. Challenging the central adaption on distorted sensorimotor information in the nearby neutral head position seems to be the critical mechanism. KW - Dystonie KW - Torticollis KW - Trick KW - Geste KW - sensomotorisch KW - dystonia KW - torticollis KW - sensory KW - trick KW - geste Y1 - 2002 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-4722 ER - TY - THES A1 - Schneider, Katharina T1 - Nachweis und Analyse von Phospho-Alpha-Synuclein-Ablagerungen in Hautnerven von Patienten mit Morbus Parkinson oder Multisystematrophie T1 - Proof and analysis of phospho-alpha-synuclein in the skin of patients with Parkinsons' disease or multiple system atrophy N2 - Zielsetzung der Studie war es, Ablagerungen des phosphorylierten Alpha-Synucleins in der Haut von Patienten mit Morbus Parkinson und atypischen Parkinson-Syndromen zu untersuchen und deren Auswirkungen auf das periphere Nervensystem zu erforschen. Dazu wurden Hautbiopsien von 92 Patienten mit Morbus Parkinson, 12 Patienten mit MSA und 13 Patienten mit einer Tauopathie sowie 83 gesunden Kontrollpersonen immunhisto-chemisch gefärbt und unter dem Mikroskop untersucht. Mit einer Sensitivität von 52 % für den Morbus Parkinson und 67 % für die MSA bei hoher Spezifität stellt der Nachweis von Phospho-Alpha-Synuclein in den kleinen Nervenfasern der Haut einen geeigneten Biomarker dar. Während die Ablagerungen des phosphorylierten Alpha-Synucleins bei Patienten mit Morbus Parkinson eher in autonomen Strukturen nachweisbar waren, fanden sie sich bei Patienten mit MSA eher in sub- und intraepidermal gelegenen Nervenfasern. Phospho-Alpha-Synuclein konnte in allen untersuchten Nervenfasersubtypen nachgewiesen werden, also in CGRP-, SP-, TH- und VIP-positiven Fasern. Bei den in der vorliegenden Studie untersuchten Parkinson-Patienten waren keine Veränderungen in der sensiblen Neurographie des Nervus suralis erkennbar. Die intraepidermale Nervenfaserdichte sowie die Innervation der Schweißdrüsen waren jedoch teilweise vermindert und auch in der QST zeigten sich Auffälligkeiten. Ein Zusammenhang zu dem Vorhandensein von Phospho-Alpha-Synuclein-Ablagerungen konnte jedoch nur für die Innervation der Musculi arrectores pilorum hergestellt werden. Bei der Untersuchung der pathophysiologischen Hintergründe, durch die Phospho-Alpha-Synuclein-Ablagerungen zu Nervenfaserschädigungen führen, konnten die Hinweise auf eine Beteiligung von axonalen Transportproteinen, Mikrotubuli oder Mitochondrien nicht erhärtet werden. N2 - The aim of this study was to examine dermal phospho-alpha-synuclein deposits of patients with Parkinson's disease or multiple system atrophy. KW - Synuclein KW - Parkinson-Krankheit KW - Alpha-Synuclein Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-169694 ER - TY - JOUR A1 - Schnabel, Renate B. A1 - Camen, Stephan A1 - Knebel, Fabian A1 - Hagendorff, Andreas A1 - Bavendiek, Udo A1 - Böhm, Michael A1 - Doehner, Wolfram A1 - Endres, Matthias A1 - Gröschel, Klaus A1 - Goette, Andreas A1 - Huttner, Hagen B. A1 - Jensen, Christoph A1 - Kirchhof, Paulus A1 - Korosoglou, Grigorius A1 - Laufs, Ulrich A1 - Liman, Jan A1 - Morbach, Caroline A1 - Navabi, Darius Günther A1 - Neumann-Haefelin, Tobias A1 - Pfeilschifter, Waltraut A1 - Poli, Sven A1 - Rizos, Timolaos A1 - Rolf, Andreas A1 - Röther, Joachim A1 - Schäbitz, Wolf Rüdiger A1 - Steiner, Thorsten A1 - Thomalla, Götz A1 - Wachter, Rolf A1 - Haeusler, Karl Georg T1 - Expert opinion paper on cardiac imaging after ischemic stroke JF - Clinical Research in Cardiology N2 - This expert opinion paper on cardiac imaging after acute ischemic stroke or transient ischemic attack (TIA) includes a statement of the "Heart and Brain" consortium of the German Cardiac Society and the German Stroke Society. The Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork (AFNET) endorsed this paper. Cardiac imaging is a key component of etiological work-up after stroke. Enhanced echocardiographic tools, constantly improving cardiac computer tomography (CT) as well as cardiac magnetic resonance imaging (MRI) offer comprehensive non- or less-invasive cardiac evaluation at the expense of increased costs and/or radiation exposure. Certain imaging findings usually lead to a change in medical secondary stroke prevention or may influence medical treatment. However, there is no proof from a randomized controlled trial (RCT) that the choice of the imaging method influences the prognosis of stroke patients. Summarizing present knowledge, the German Heart and Brain consortium proposes an interdisciplinary, staged standard diagnostic scheme for the detection of risk factors of cardio-embolic stroke. This expert opinion paper aims to give practical advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on expert opinion, reported case series, and clinical experience. KW - cardiac imaging KW - echocardiography KW - ischemic stroke KW - transient ischemic attack KW - expert opinion KW - magnetic resonance imaging KW - computed tomography Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266662 SN - 1861-0692 VL - 110 IS - 7 ER - TY - JOUR A1 - Schmidbauer, Moritz L. A1 - Ferse, Caroline A1 - Salih, Farid A1 - Klingner, Carsten A1 - Musleh, Rita A1 - Kunst, Stefan A1 - Wittstock, Matthias A1 - Neumann, Bernhard A1 - Schebesch, Karl-Michael A1 - Bösel, Julian A1 - Godau, Jana A1 - Lochner, Piergiorgio A1 - Adam, Elisabeth H. A1 - Jahnke, Kolja A1 - Knier, Benjamin A1 - Schirotzek, Ingo A1 - Müllges, Wolfgang A1 - Notz, Quirin A1 - Dengl, Markus A1 - Güldner, Andreas A1 - Onur, Oezguer A. A1 - Garcia Borrega, Jorge A1 - Dimitriadis, Konstantinos A1 - Günther, Albrecht T1 - COVID-19 and intracranial hemorrhage: a multicenter case series, systematic review and pooled analysis JF - Journal of Clinical Medicine N2 - Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) profoundly impacts hemostasis and microvasculature. In the light of the dilemma between thromboembolic and hemorrhagic complications, in the present paper, we systematically investigate the prevalence, mortality, radiological subtypes, and clinical characteristics of intracranial hemorrhage (ICH) in coronavirus disease (COVID-19) patients. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review of the literature by screening the PubMed database and included patients diagnosed with COVID-19 and concomitant ICH. We performed a pooled analysis, including a prospectively collected cohort of critically ill COVID-19 patients with ICH, as part of the PANDEMIC registry (Pooled Analysis of Neurologic Disorders Manifesting in Intensive Care of COVID-19). Results: Our literature review revealed a total of 217 citations. After the selection process, 79 studies and a total of 477 patients were included. The median age was 58.8 years. A total of 23.3% of patients experienced the critical stage of COVID-19, 62.7% of patients were on anticoagulation and 27.5% of the patients received ECMO. The prevalence of ICH was at 0.85% and the mortality at 52.18%, respectively. Conclusion: ICH in COVID-19 patients is rare, but it has a very poor prognosis. Different subtypes of ICH seen in COVID-19, support the assumption of heterogeneous and multifaceted pathomechanisms contributing to ICH in COVID-19. Further clinical and pathophysiological investigations are warranted to resolve the conflict between thromboembolic and hemorrhagic complications in the future. KW - COVID-19 KW - intracranial hemorrhage KW - prognosis KW - anticoagulation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-255236 SN - 2077-0383 VL - 11 IS - 3 ER - TY - THES A1 - Schmid, Harriet T1 - Die Wirkung des Phosphodiesterase-IV-Inhibitors Mesopram auf Faktoren der Blut-Hirn-Schranke T1 - Effects of the Phosphodiesterase-IV-Inhibitor Mesopram on factors of the blood-brain-barrier N2 - Multiple Sklerose ist eine chronisch degenerative Erkrankung des ZNS, deren Therapie-möglichkeiten noch immer begrenzt sind. In der vorliegenden Arbeit wurde in vitro der selektive PDE-IV-Inhibitor Mesopram untersucht, welcher bereits in einer Phase II Studie bei Patienten mit klinisch gesicherter MS zum Einsatz kommt. Anhand von HBMEC’s, die als ein Model der menschlichen BHS gelten, konnten TJ’s (ZO-1, Claudin-3, Occludin), Adhäsionsmoleküle (ICAM, VCAM, MCAM), Zytokine und Chemokine (AR, Il-6, MCP-1, Il-8) und MMP-2 nachgewiesen werden. Diese Faktoren sind bei der Zerstörung der BHS in der Pathologie der MS beteiligt. Die Idee dieser Arbeit war es, durch die spezifische PDE-IV-Inhibition mit Mesopram die untersuchten Faktoren der BHS so zu beeinflussen, dass eine weitere Permeabilitätserhöhung verhindert werden könnte. Da es sich bei MS um eine inflammatorische Erkrankung handelt und TNFα in MS-Läsionen gefunden wird, wurde in dieser Arbeit TNFα als inflammatorischer Stimulus verwendet. Unter TNFα-Stimulation wurden die meisten der genannten Faktoren vermehrt exprimiert. Keine Veränderung unter TNFα zeigten Occludin, ZO-1, VCAM und MMP-2. Die HBMEC’s wurden über 24 und 48 h mit TNFα und Mesopram stimuliert. Es konnte in den unterschiedlichen Auswertungen (ELISA, FACS, Western Blot, Zymographie) keine regulatorische Modulation der verschiedenen Faktoren unter Mesopram-induzierter cAMP-Erhöhung nachgewiesen werden. N2 - Multiple Sklerose ist eine chronisch degenerative Erkrankung des ZNS, deren Therapie-möglichkeiten noch immer begrenzt sind. In der vorliegenden Arbeit wurde in vitro der selektive PDE-IV-Inhibitor Mesopram untersucht, welcher bereits in einer Phase II Studie bei Patienten mit klinisch gesicherter MS zum Einsatz kommt. Anhand von HBMEC’s, die als ein Model der menschlichen BHS gelten, konnten TJ’s (ZO-1, Claudin-3, Occludin), Adhäsionsmoleküle (ICAM, VCAM, MCAM), Zytokine und Chemokine (AR, Il-6, MCP-1, Il-8) und MMP-2 nachgewiesen werden. Diese Faktoren sind bei der Zerstörung der BHS in der Pathologie der MS beteiligt. Die Idee dieser Arbeit war es, durch die spezifische PDE-IV-Inhibition mit Mesopram die untersuchten Faktoren der BHS so zu beeinflussen, dass eine weitere Permeabilitätserhöhung verhindert werden könnte. Da es sich bei MS um eine inflammatorische Erkrankung handelt und TNFα in MS-Läsionen gefunden wird, wurde in dieser Arbeit TNFα als inflammatorischer Stimulus verwendet. Unter TNFα-Stimulation wurden die meisten der genannten Faktoren vermehrt exprimiert. Keine Veränderung unter TNFα zeigten Occludin, ZO-1, VCAM und MMP-2. Die HBMEC’s wurden über 24 und 48 h mit TNFα und Mesopram stimuliert. Es konnte in den unterschiedlichen Auswertungen (ELISA, FACS, Western Blot, Zymographie) keine regulatorische Modulation der verschiedenen Faktoren unter Mesopram-induzierter cAMP-Erhöhung nachgewiesen werden. KW - Blut-Hirn-Schranke KW - Phosphodiesterasehemmer KW - Multiple Sklerose KW - blood-brain-barrier KW - multiple sclerosis KW - phosphodiesterase inhibitor Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-26345 ER - TY - THES A1 - Schmid, Benedikt T1 - Relation between cerebral arterio-venous transit time and neuropsychological performance in patients with vascular dementia T1 - Beziehung zwischen zerebraler arterio-venöser Transitzeit und neuropsychologischer Testleistung bei Patienten mit vaskulärer Demenz N2 - Dementia, or any form of degenerative cognitive decline, is one of the major problems in present, and even more will be in future medicine. With Alzheimer's disease (AD) being the most prevalent, Vascular Dementia is the second most entity of dementing processes in the elderly. As diagnostic criteria are still imprecise and in many cases do not embrace early stages of the disease, recent studies have proposed more detailed classifications of the newly created condition Vascular Cognitive Impairment (VCI). Of all conditions subsumed under this term, subcortical small-vessel alterations are the most common cause for cognitive decline. The diagnosis of dementia / cognitive impairment is presently often made in late stages of the disease, when therapeutical options are poor. Thus, early detection of changes of the subcortical small vessels is desirable, when there is still time to identify and aggressively treat risk factors and underlying conditions like diabetes, hyper- or hypotension, and hyperlipidemia. This study aimed to evaluate whether cTT correlates to cognitive dysfunction, i.e. if cTT is fit as an early diagnostic tool for VCI. The study cohort included 38 patients from the Neurological Clinic of the Würzburg University hospital admitted due to diagnoses other than dementia or stroke. As a result of this study it turned out that cTT is certainly capable of fulfilling the task to easily and effectively detect and evaluate possible microvascular lesions of the brain with respect to the actual clinical relevance for the patient. When compared to the other proposed diagnostic tools, neuropsychological testing and MRI, the advantages of cTT are obvious: its measurement is a low-cost and quick procedure which would spare both patients and examiners a long neuropsychological exam or complement it. cTT is safe to assess as the only possible risks derive from the use of the contrast agent, which are rare and easily manageable. It has also proven to be more accurate in showing the extent of cognitive impairment than MRI. Finally, it is widely available. The only prerequisite is an ultrasound machine capable of transcranial color-coded duplex sonography. No cost-intensive procedures like MRI are needed. So, with neuropsychological testing remaining the gold standard, cTT here proved to be a reliable alternative which is more time- and cost-effective than MRI. N2 - Demenzen und alle anderen Formen kongnitiver Leistungseinschränkungen gehören heute zu den bedeutendsten medizinischen Herausforderungen und werden in der Zukunft noch weiter an Bedeutung gewinnen. Die häufigste der Demenzerkrankungen bei älteren Patienten ist die Alzheimer-Krankheit, gefolgt von den vaskulären Demenzen. Da die Diagnosekriterien in vielen Fällen noch unpräzise sind und vor allem frühe Stadien der Erkrankung nicht erfassen, wurden in der neueren Literatur detailliertere Untergruppen der neu eingeführten Entität „vaskuläre kognitive Funktionsstörung“ (vascular cognitive impairment, VCI) etabliert. Subkortikale Veränderungen an den kleinsten Gefäßen stellen unter allen Pathologien, die unter diesem Begriff subsumiert sind, die häufigste Ursache für kognitive Leistungseinschränkungen dar. Die Diagnose Demenz bzw. VCI wird oft erst in späten Stadien der Krankheit gestellt, wenn die therapeutischen Mittel bereits stark begrenzt sind. Deshalb wäre eine Möglichkeit zur frühen Entdeckung subkortikaler Gefäßveränderungen wünschenswert in einem Stadium der Krankheit, in dem es noch möglich ist, Risikofaktoren wie Diabetes mellitus, arterielle Hyper- und Hypotonie und Fettstoffwechselstörungen auszumachen und konseqeuent zu behandeln. Das Ziel dieser Studie war es zu untersuchen, ob cTT mit dem Ausmaß kognitiver Dysfunktion korreliert, ob also cTT als frühes diagnostisches Verfahren für vaskuläre demenzielle Prozesse geeignet ist. Die Studienpopulation umfasste 38 Patienten aus der Klinik und Poliklinik für Neurologie der Universität Würzburg. Ein Ergebnis dieser Studie ist, dass die cTT sicherlich in der Lage ist, einfach und zuverlässig mögliche mikrovaskuläre Schädigungen des Gehirns auch im Hinblick auf ihre tatsächliche klinische Relevanz zu entdecken. Im Vergleich mit anderen Diagnoseverfahren (Testpsychologie und MRT) sind die Vorteile der cTT offensichtlich: die Messung ist ein kostengünstiges und schnelles Verfahren, das sowohl Patienten als auch Untersuchern eine langwierige neuropsychologische Untersuchung erspart. Die Messung der cTT ist ein sicheres Verfahren, da die wenigen aus der Anwendung des Kontrastmittels sich ergebenden Risiken selten und gegebenenfalls leicht behandelbar sind. Zudem erwies sich die cTT als präziser bei der Aufgabe, das Ausmaß kognitiver Dysfunktion zu messen, als es die MRT vermochte. Zuletzt ist die cTT auch flächendeckend verfügbar. Die einzige Voraussetzung ist ein Duplex-fähiges Ultraschallgerät. Kostenintesive Untersuchungen wie die MRT können vermieden werden. Wenn auch die Testpsychologie der Goldstandard bleiben wird, erwies sich die cTT als zuverlässige Alternative die im Vergleich zur MRT sowohl Zeit als auch Kosten spart. KW - Demenz KW - Psychologische Diagnostik KW - Neuropsychologie KW - Ultraschall KW - Ultraschalldiagnostik KW - dementia KW - neuropsychology KW - ultrasound Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-71234 ER - TY - JOUR A1 - Schischlevskij, Pavel A1 - Cordts, Isabell A1 - Günther, René A1 - Stolte, Benjamin A1 - Zeller, Daniel A1 - Schröter, Carsten A1 - Weyen, Ute A1 - Regensburger, Martin A1 - Wolf, Joachim A1 - Schneider, Ilka A1 - Hermann, Andreas A1 - Metelmann, Moritz A1 - Kohl, Zacharias A1 - Linker, Ralf A. A1 - Koch, Jan Christoph A1 - Stendel, Claudia A1 - Müschen, Lars H. A1 - Osmanovic, Alma A1 - Binz, Camilla A1 - Klopstock, Thomas A1 - Dorst, Johannes A1 - Ludolph, Albert C. A1 - Boentert, Matthias A1 - Hagenacker, Tim A1 - Deschauer, Marcus A1 - Lingor, Paul A1 - Petri, Susanne A1 - Schreiber-Katz, Olivia T1 - Informal caregiving in amyotrophic lateral sclerosis (ALS): a high caregiver burden and drastic consequences on caregivers' lives JF - Brain Sciences N2 - Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that causes progressive autonomy loss and need for care. This does not only affect patients themselves, but also the patients’ informal caregivers (CGs) in their health, personal and professional lives. The big efforts of this multi-center study were not only to evaluate the caregivers' burden and to identify its predictors, but it also should provide a specific understanding of the needs of ALS patients' CGs and fill the gap of knowledge on their personal and work lives. Using standardized questionnaires, primary data from patients and their main informal CGs (n = 249) were collected. Patients' functional status and disease severity were evaluated using the Barthel Index, the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and the King’s Stages for ALS. The caregivers' burden was recorded by the Zarit Burden Interview (ZBI). Comorbid anxiety and depression of caregivers were assessed by the Hospital Anxiety and Depression Scale. Additionally, the EuroQol Five Dimension Five Level Scale evaluated their health-related quality of life. The caregivers' burden was high (mean ZBI = 26/88, 0 = no burden, ≥24 = highly burdened) and correlated with patients' functional status (r\(_p\) = −0.555, p < 0.001, n = 242). It was influenced by the CGs' own mental health issues due to caregiving (+11.36, 95% CI [6.84; 15.87], p < 0.001), patients' wheelchair dependency (+9.30, 95% CI [5.94; 12.66], p < 0.001) and was interrelated with the CGs' depression (r\(_p\) = 0.627, p < 0.001, n = 234), anxiety (r\(_p\) = 0.550, p < 0.001, n = 234), and poorer physical condition (r\(_p\) = −0.362, p < 0.001, n = 237). Moreover, female CGs showed symptoms of anxiety more often, which also correlated with the patients' impairment in daily routine (r\(_s\) = −0.280, p < 0.001, n = 169). As increasing disease severity, along with decreasing autonomy, was the main predictor of caregiver burden and showed to create relevant (negative) implications on CGs' lives, patient care and supportive therapies should address this issue. Moreover, in order to preserve the mental and physical health of the CGs, new concepts of care have to focus on both, on not only patients but also their CGs and gender-associated specific issues. As caregiving in ALS also significantly influences the socioeconomic status by restrictions in CGs' work lives and income, and the main reported needs being lack of psychological support and a high bureaucracy, the situation of CGs needs more attention. Apart from their own multi-disciplinary medical and psychological care, more support in care and patient management issues is required. KW - amyotrophic lateral sclerosis (ALS) KW - informal caregiving KW - caregiver burden KW - functional status KW - decreasing autonomy KW - depression KW - anxiety KW - health-related quality of life KW - socioeconomic status KW - psychological support Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-240981 SN - 2076-3425 VL - 11 IS - 6 ER - TY - THES A1 - Scheytt, Sarah T1 - Quantifizierung von GAP 43 positiven intraepidermalen Nervenfasern bei Patienten mit Polyneuropathie und gesunden Kontrollen T1 - Quantification of GAP 43 positive intraepidermal nerve fibers in patients with neuropathy and healthy controls N2 - Polyneuropathien (PNP) sind mit einer Prävalenz von bis zu 7% in der Gesamtbevölkerung eine häufige Diagnose. Bei der Ursachenabklärung der PNP hat sich in den letzten Jahren die immunhistochemische Bestimmung der intraepidermalen Nervenfaserdichte aus Hautstanzbiopsien mittels einer axonalen PGP 9.5 Färbung etabliert. Ein zusätzlicher Marker ist GAP 43 - ein axonales Protein, das von regenerierenden Nervenfasern exprimiert wird. In der vorliegenden Studie wurde die Dichte von PGP 9.5 und GAP 43 positiven Nervenfasern anhand immunhistochemischer Färbungen an Hautstanzbiopsien vom lateralen Unter- und Oberschenkel von Patienten mit PNP unterschiedlicher Genese und von gesunden Kontrollen quantifiziert. Wir konnten zeigen, dass PNP Patienten im Vergleich zu Kontrollpersonen deutlich weniger GAP 43 positive Nervenfasern in ihren Hautbiopsien aufweisen. Obwohl sich bei PNP Patienten absolut gesehen weniger GAP 43 positive Nervenfasern fanden, war der Anteil an GAP 43 positiven Nervenfasern im Vergleich zur Kontrollgruppe höher, was mit einer gesteigerten regenerativen Aktivität in geschädigten Nervenfasern zusammenhängen kann. In der Patienten- und Kontrollgruppe fanden sich mehr PGP 9.5 und GAP 43 positive Nervenfasern am Ober- als am Unterschenkel, was durch die grundsätzlich dichtere Innervation proximaler Hautareale bedingt ist und bei PNP Patienten durch den im Krankheitsverslauf typischerweise längenabhängigen Verlust der peripheren kutanen Innervation noch verstärkt wird. Die Analyse potentieller Einflussfaktoren ergab beim Unterschenkel für beide Färbungen eine negative Korrelation zwischen Alter und Nervenfaserdichte. Das Geschlecht und das Vorhandensein von Schmerzen hatten keinen Einfluss auf die Hautinnervation. Die Arbeit zeigt anhand des bisher größten Patienten- und Kontrollkollektivs, dass regenerierende intraepidermale Nervenfasern mittels einer Immunhistochemie für GAP 43 zuverlässig quantifizierbar sind. Bei künftigen longitudinalen Studien kann nun ein möglicher Zusammenhang zwischen der Dichte GAP 43 positiver Nervenfasern und der Prognose bzw. dem Ansprechen auf Therapien untersucht werden. N2 - Polyneuropathies (NP) are a common neurological disease with a prevalence of 7%. In the diagnosis of NPs the determination of intraepidermal nerve fiber density in skin punch biopsies with an immunhistochemical staining for PGP 9.5 is an established procedure. An additional marker is GAP 43 - an axonal protein, that is expressed by regenerating nerve fibers. In this study we determined the densitiy of PGP 9.5 and GAP 43 positive nerve fibers with immunhistochemical staining on skin punch biopsies of the lateral lower leg an thigh from patients with NP and healthy controls. We showed, that NP patients had less GAP 43 positive nerve fibers in skin biopsies compared to healthy controls. Although NP patients had in absolute terms less GAP 43 positive nerve fibers, they had proportionately more GAP 43 positive nerve fibers compared to healthy controls. This may be due to a higher regenerating activity in damaged nerve fibers. In the patient- and controlgroup there were more PGP 9.5 and GAP 43 positive nerve fibers on the thigh compared to the lower leg due to a generally higher innervation of proximal skin areas. This is intensified in NP patients by the for the disease typical length dependent loss of peripheral skin innervation. The analysis of potential influencing factors showed in the lower leg a negative correlation between age and nerve fiber density. Gender and the existence of pain showed no influence on skin innervation. This study shows with the to date biggest patient- and controlcollective, that regenerating intraepidermal nerve fibers are reliably quantifiable with an immunhistochemical staining for GAP 43. For future longitudinal studies there should be analysed, if there is a possible relationship between the densitiy of GAP 43 nerve fibers and the prognosis or the treatment response of NP. KW - Polyneuropathie KW - Hautbiopsie KW - GAP 43 KW - skin biopsy KW - Neuropathy Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-94782 ER - TY - THES A1 - Schanz, Stefan T1 - Rehabilitation des Schlaganfalls – Evaluation eines interdisziplinären Behandlungskonzepts auf einer spezialisierten Station T1 - Stroke rehabilitation – evaluation of an interdisciplinary treatment concept on a specialized ward N2 - Die Rehabilitation von Schlaganfallpatienten erfordert ein interdisziplinäres Vorgehen. Dies ist im klinischen Alltag oft nur schwer umsetzbar. Im Jahr 2011 wurde daher im Neurologischen Rehabilitationszentrum Quellenhof in Bad Wildbad ein spezielles Behandlungskonzept für Schlaganfallpatienten entwickelt. Mit dieser Studie sollte die Wirksamkeit dieses neuen Konzepts untersucht werden. Dabei wurde die Behandlung im Schlaganfallkonzept mit der bisher üblichen Behandlung verglichen. Zielparameter waren der Barthel-Index und die modifizierte Rankin-Skala bei Aufnahme und bei Entlassung. Die Ergebnisse zeigen, dass sowohl die bisherige Behandlung als auch die Behandlung im Schlaganfallkonzept effektiv sind. Im Schlaganfallkonzept konnte jedoch ein größerer Zugewinn an alltagsrelevanten Fähigkeiten erzielt werden; zudem berichteten Pflegekräfte und Therapeuten eine verbesserte Zusammenarbeit. Somit steigert das Schlaganfallkonzept nicht nur die Alltagskompetenz der Patienten, sondern auch den Wissenstransfer zwischen den Berufsgruppen und die Interdisziplinarität. N2 - Rehabilitation of patients with stroke requires an interdisciplinary approach that is difficult to implement in everyday clinical life. Therefore, in 2011 the Neurological Rehabilitation Center Quellenhof in Bad Wildbad established a unique therapy concept. This study investigated the efficacy of this newly developed concept by comparing it to usual treatment. Main outcome parameters were the Barthel-Index and the modified Rankin-Scale at admission and discharge. The results show that the therapy in the usual treatment group as well as in the newly developed concept group is effective. However, therapy in the newly developed concept group leads to more progress in the activities of daily living of patients and also improved knowledge and cooperation within the rehabilitation team. KW - Schlaganfall KW - Rehabilitation KW - Barthel-Index modifizierte Rankin-Skala KW - stroke KW - rehabilitation KW - Barthel-Index modified Rankin-Scale Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260011 ER - TY - JOUR A1 - Schanbacher, Constanze A1 - Bieber, Michael A1 - Reinders, Yvonne A1 - Cherpokova, Deya A1 - Teichert, Christina A1 - Nieswandt, Bernhard A1 - Sickmann, Albert A1 - Kleinschnitz, Christoph A1 - Langhauser, Friederike A1 - Lorenz, Kristina T1 - ERK1/2 activity is critical for the outcome of ischemic stroke JF - International Journal of Molecular Sciences N2 - Ischemic disorders are the leading cause of death worldwide. The extracellular signal-regulated kinases 1 and 2 (ERK1/2) are thought to affect the outcome of ischemic stroke. However, it is under debate whether activation or inhibition of ERK1/2 is beneficial. In this study, we report that the ubiquitous overexpression of wild-type ERK2 in mice (ERK2\(^{wt}\)) is detrimental after transient occlusion of the middle cerebral artery (tMCAO), as it led to a massive increase in infarct volume and neurological deficits by increasing blood–brain barrier (BBB) leakiness, inflammation, and the number of apoptotic neurons. To compare ERK1/2 activation and inhibition side-by-side, we also used mice with ubiquitous overexpression of the Raf-kinase inhibitor protein (RKIP\(^{wt}\)) and its phosphorylation-deficient mutant RKIP\(^{S153A}\), known inhibitors of the ERK1/2 signaling cascade. RKIP\(^{wt}\) and RKIP\(^{S153A}\) attenuated ischemia-induced damages, in particular via anti-inflammatory signaling. Taken together, our data suggest that stimulation of the Raf/MEK/ERK1/2-cascade is severely detrimental and its inhibition is rather protective. Thus, a tight control of the ERK1/2 signaling is essential for the outcome in response to ischemic stroke. KW - ERK1/2 KW - tMCAO KW - ischemic stroke KW - RKIP Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-283991 SN - 1422-0067 VL - 23 IS - 2 ER - TY - JOUR A1 - Saudek, František A1 - Cahová, Monika A1 - Havrdová, Terezie A1 - Zacharovová, Klára A1 - Daňková, Helena A1 - Voska, Luděk A1 - Lánská, Věra A1 - Üçeyler, Nurcan A1 - Sommer, Claudia T1 - Preserved Expression of Skin Neurotrophic Factors in Advanced Diabetic Neuropathy Does Not Lead to Neural Regeneration despite Pancreas and Kidney Transplantation JF - Journal of Diabetes Research N2 - Diabetic peripheral neuropathy (DPN) is a common complication of diabetes with potential severe consequences. Its pathogenesis involves hyperglycemia-linked mechanisms, which may include changes in the expression of neurotrophic growth factors. We analyzed the expression of 29 factors potentially related to nerve degeneration and regeneration in skin biopsies from 13 type 1 diabetic pancreas and kidney recipients with severe DPN including severe depletion of intraepidermal nerve fibers (IENF) in lower limb skin biopsies (group Tx1 1st examination). The investigation was repeated after a median 28-month period of normoglycemia achieved by pancreas transplantation (group Tx1 2nd examination). The same tests were performed in 13 stable normoglycemic pancreas and kidney recipients 6-12 years posttransplantation (group Tx2), in 12 matched healthy controls (group HC), and in 12 type 1 diabetic subjects without severe DPN (group DM). Compared to DM and HC groups, we found a significantly higher (p < 0.05-0.001) expression of NGF (nerve growth factor), NGFR (NGF receptor), NTRK1 (neurotrophic receptor tyrosine kinase 1), GDNF (glial cell-derived neurotrophic factor), GFRA1 (GDNF family receptor alpha 1), and GFAP (glial fibrillary acidic protein) in both transplant groups (Tx1 and Tx2). Enhanced expression of these factors was not normalized following the median 28-month period of normoglycemia (Tx1 2nd examination) and negatively correlated with IENF density and with electrophysiological indices of DPN (vibration perception threshold, electromyography, and autonomic tests). In contrast to our expectation, the expression of most of 29 selected factors related to neural regeneration was comparable in subjects with severe peripheral nerve fiber depletion and healthy controls and the expression of six factors was significantly upregulated. These findings may be important for better understanding the pathophysiology of nerve regeneration and for the development of intervention strategies. KW - Nerve growth-factorcopy KW - Corneal confocal microscopy KW - Factor messenger-RNA KW - Schwann-cells KW - Gene-expression KW - Receptors KW - Identification KW - Innervation KW - Mechanisms KW - Gland Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227469 VL - 2018 IS - 2309108 ER - TY - JOUR A1 - Samper Agrelo, Iria A1 - Schira-Heinen, Jessica A1 - Beyer, Felix A1 - Groh, Janos A1 - Bütermann, Christine A1 - Estrada, Veronica A1 - Poschmann, Gereon A1 - Bribian, Ana A1 - Jadasz, Janusz J. A1 - Lopez-Mascaraque, Laura A1 - Kremer, David A1 - Martini, Rudolf A1 - Müller, Hans Werner A1 - Hartung, Hans Peter A1 - Adjaye, James A1 - Stühler, Kai A1 - Küry, Patrick T1 - Secretome analysis of mesenchymal stem cell factors fostering oligodendroglial differentiation of neural stem cells in vivo JF - International Journal of Molecular Sciences N2 - Mesenchymal stem cell (MSC)-secreted factors have been shown to significantly promote oligodendrogenesis from cultured primary adult neural stem cells (aNSCs) and oligodendroglial precursor cells (OPCs). Revealing underlying mechanisms of how aNSCs can be fostered to differentiate into a specific cell lineage could provide important insights for the establishment of novel neuroregenerative treatment approaches aiming at myelin repair. However, the nature of MSC-derived differentiation and maturation factors acting on the oligodendroglial lineage has not been identified thus far. In addition to missing information on active ingredients, the degree to which MSC-dependent lineage instruction is functional in vivo also remains to be established. We here demonstrate that MSC-derived factors can indeed stimulate oligodendrogenesis and myelin sheath generation of aNSCs transplanted into different rodent central nervous system (CNS) regions, and furthermore, we provide insights into the underlying mechanism on the basis of a comparative mass spectrometry secretome analysis. We identified a number of secreted proteins known to act on oligodendroglia lineage differentiation. Among them, the tissue inhibitor of metalloproteinase type 1 (TIMP-1) was revealed to be an active component of the MSC-conditioned medium, thus validating our chosen secretome approach. KW - neural stem cells KW - mesenchymal stem cells KW - transplantation KW - oligodendroglia KW - glial fate modulation KW - myelin KW - spinal cord KW - secretome KW - TIMP-1 Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-285465 SN - 1422-0067 VL - 21 IS - 12 ER - TY - JOUR A1 - Sadovnick, A. Dessa A1 - Traboulsee, Anthony L. A1 - Bernales, Cecily Q. A1 - Ross, Jay P. A1 - Forwell, Amanda L. A1 - Yee, Irene M. A1 - Guillot-Noel, Lena A1 - Fontaine, Bertrand A1 - Cournu-Rebeix, Isabelle A1 - Alcina, Antonio A1 - Fedetz, Maria A1 - Izquierdo, Guillermo A1 - Matesanz, Fuencisla A1 - Hilven, Kelly A1 - Dubois, Bénédicte A1 - Goris, An A1 - Astobiza, Ianire A1 - Alloza, Iraide A1 - Antigüedad, Alfredo A1 - Vandenbroeck, Koen A1 - Akkad, Denis A. A1 - Aktas, Orhan A1 - Blaschke, Paul A1 - Buttmann, Mathias A1 - Chan, Andrew A1 - Epplen, Joerg T. A1 - Gerdes, Lisa-Ann A1 - Kroner, Antje A1 - Kubisch, Christian A1 - Kümpfel, Tania A1 - Lohse, Peter A1 - Rieckmann, Peter A1 - Zettl, Uwe K. A1 - Zipp, Frauke A1 - Bertram, Lars A1 - Lill, Christina M. A1 - Fernandez, Oscar A1 - Urbaneja, Patricia A1 - Leyva, Laura A1 - Alvarez-Cermeño, Jose Carlos A1 - Arroyo, Rafael A1 - Garagorri, Aroa M. A1 - García-Martínez, Angel A1 - Villar, Luisa M. A1 - Urcelay, Elena A1 - Malhotra, Sunny A1 - Montalban, Xavier A1 - Comabella, Manuel A1 - Berger, Thomas A1 - Fazekas, Franz A1 - Reindl, Markus A1 - Schmied, Mascha C. A1 - Zimprich, Alexander A1 - Vilariño-Güell, Carles T1 - Analysis of Plasminogen Genetic Variants in Multiple Sclerosis Patients JF - G3: Genes Genomes Genetics N2 - Multiple sclerosis (MS) is a prevalent neurological disease of complex etiology. Here, we describe the characterization of a multi-incident MS family that nominated a rare missense variant (p.G420D) in plasminogen (PLG) as a putative genetic risk factor for MS. Genotyping of PLG p.G420D (rs139071351) in 2160 MS patients, and 886 controls from Canada, identified 10 additional probands, two sporadic patients and one control with the variant. Segregation in families harboring the rs139071351 variant, identified p.G420D in 26 out of 30 family members diagnosed with MS, 14 unaffected parents, and 12 out of 30 family members not diagnosed with disease. Despite considerably reduced penetrance, linkage analysis supports cosegregation of PLG p.G420D and disease. Genotyping of PLG p.G420D in 14446 patients, and 8797 controls from Canada, France, Spain, Germany, Belgium, and Austria failed to identify significant association with disease (P = 0.117), despite an overall higher prevalence in patients (OR = 1.32; 95% CI = 0.93–1.87). To assess whether additional rare variants have an effect on MS risk, we sequenced PLG in 293 probands, and genotyped all rare variants in cases and controls. This analysis identified nine rare missense variants, and although three of them were exclusively observed in MS patients, segregation does not support pathogenicity. PLG is a plausible biological candidate for MS owing to its involvement in immune system response, blood-brain barrier permeability, and myelin degradation. Moreover, components of its activation cascade have been shown to present increased activity or expression in MS patients compared to controls; further studies are needed to clarify whether PLG is involved in MS susceptibility. KW - multiple sclerosis KW - genetics KW - linkage KW - association KW - plasminogen Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-165405 VL - 6 IS - 7 ER - TY - THES A1 - Ruschil, Christoph T1 - Der Einfluss von Autoantikörpern gegen Aquaporin 4 bei der Pathogenese der Neuromyelitis optica T1 - The function of autoantibodies targeting aquaporin-4 in the pathogenesis of neuromyelitis optica N2 - Neuromyelitis optica (NMO) ist eine schwerwiegende Autoimmunerkrankung des zentralen Nervensystems, deren pathogene Ursache in Zusammenhang mit Autoantikörpern gegen Aquaporin 4 (AQP4) steht. In einem intrathekalen Passiv-Transfermodell der Ratte wurden die Auswirkungen von NMO-Immunglobulin (IgG) aus Plasmapheresematerial und rekombinanten Antikörpern gegen AQP4 sowie der Effekt von additiver Applikation von humanem Komplement untersucht. NMO-IgG, rekombinante Antikörper und modifizierte Antikörper ohne Fähigkeit zur Aktivierung der Komplementkaskade waren bei repetitiver Applikation in der Lage, auch ohne additives humanes Komplement NMO-ähnliche progrediente motorische Symptome zu induzieren. Durch Ko-Injektion von humanem Komplement konnte keine signifikante Exazerbation der Pathologie bewirkt werden. MRT-Studien zeigten lokale Schrankenstörungen am Ort der höchsten Antikörperkonzentration. In histologischen Aufarbeitungen von Rückenmarksschnitten zeigten sich lokale Deposition an humanem IgG, ein dazu korrelierender Verlust an AQP4 sowie eine darüber hinausgehende Reduktion des Glutamattransporters EAAT2, während GFAP-reaktive Astrozyten tendenziell hypertroph und vermehrt waren. Auch bei additiver Applikation von humanem Komplement wiesen die Läsionsareale im Gegensatz zu histopathologischen Befunden bei NMO-Patienten und anderen Tiermodellen nur eine geringe Ablagerung von aktivem Komplement und wenig Infiltration durch ED1-positive Makrophagen auf. Da in einem Kontrollexperiment mit intrazerebraler intraparenchymaler Applikation von NMO-IgG die beschriebene additive Zytotoxizität von humanem Komplement reproduziert werden konnte, erscheint die Verwendbarkeit des intrathkalen Modells zur Evaluation der Wirkung von humanem Komplement bei Autoimmunerkrankungen mit intraspinalen Zielepitopen nicht geeignet. Die Ergebnisse lassen sich als Komplement-unabhängige intrinsische Wirkungen von Antikörpern gegen AQP4 deuten, die in einer Reduktion der Oberflächenexpresseion von AQP4 und EAAT2 resultieren und zu einer progredienten Myelopathie führen. Neben der bekannten Antikörper-induzierten Komplement-abhängigen Zytotoxizität könnten diese Effekte einen bislang nicht beschriebenen zusätzlichen Pathomechanismus bei der NMO darstellen. N2 - Neuromyelitis optica (NMO) is a severe autoimmune disorder of the central nervous system that is causally linked to autoantibodies against aquaporin-4 (AQP4). In a intrathecal passive transfer rat model the effects of purified patient NMO-immunoglobuline (IgG) and recombinant anti-AQP4-antibodies were studied as well as those of additional application of human complement. Repetitive application of NMO-IgG, recombinant antibodies and modified antibodies without the ability of activation of the complement cascade caused NMO-like progressive symptoms. Additional application of human complement did not exacerbate the pathologic symptoms. MRI-studies revealed local spinal cord lesions at the site of the highest antibody concentration. Histopathological analysis of the spinal cord showed local deposition of human IgG, a corresponding loss of AQP4 and - even more pronounced - of the excitatory amino acid transporter 2 (EAAT2), whereas immunoreactivity to the astrocytic marker glial fibrillary acid protein (GFAP) was increased. Even by additional application of human complement, only little deposition of activated complement und poor infiltration by ED1-positive macrophages was observed. However, direct intracerebral application of NMO-IgG revealed complement dependent cytotoxicity as described previously; therefore the intrathecal passive transfer model is not suited to evaluate the effects of human complement in autoimmune disorders with intraspinal targets. The results can be interpreted as intrinsic effects of anti-AQP4-antibodies that are independent of complement activation and that reduce expressivity of AQP4 und EAAT2 and cause a progressive myelopathy. Additionally to the previously described antibody and complement dependent cytotoxicity, these effects might be a new pathogenic pathway in neuromyelitis optica. KW - Autoantikörper KW - AQP KW - Komplement KW - Neuromyelitis optica KW - Passiv-Transfer KW - autoantibodies KW - NMO KW - Aquaporin 4 KW - AQP4 KW - Komplement KW - EAAT2 KW - passiv transfer KW - complement Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-105787 ER - TY - JOUR A1 - Ruck, Tobias A1 - Bittner, Stefan A1 - Afzali, Ali Maisam A1 - Göbel, Kerstin A1 - Glumm, Sarah A1 - Kraft, Peter A1 - Sommer, Claudia A1 - Kleinschnitz, Christoph A1 - Preusse, Corinna A1 - Stenzel, Werner A1 - Wiendl, Heinz A1 - Meuth, Sven G. T1 - The NKG2D-IL-15 signaling pathway contributes to T-cell mediated pathology in inflammatory myopathies JF - Oncotarget N2 - NKG2D is an activating receptor on T cells, which has been implicated in the pathogenesis of autoimmune diseases. T cells are critically involved in idiopathic inflammatory myopathies (IIM) and have been proposed as specific therapeutic targets. However, the mechanisms underlying T cell-mediated progressive muscle destruction in IIM remain to be elucidated. We here determined the involvement of the NKG2D - IL-15 signaling pathway. Primary human myoblasts expressed NKG2D ligands, which were further upregulated upon inflammatory stimuli. In parallel, shedding of the soluble NKG2D ligand MICA (sMICA) decreased upon inflammation potentially diminishing inhibition of NKG2D signaling. Membrane-related expression of IL-15 by myoblasts induced differentiation of naive CD8\(^+\) T cells into highly activated, cytotoxic \(CD8^+NKG2D^{high}\) T cells demonstrating NKG2D-dependent lysis of myoblasts in vitro. \(CD8^+NKG2D^{high}\) T cell frequencies were increased in the peripheral blood of polymyositis (PM) patients and correlated with serum creatinine kinase concentrations, while serum sMICA levels were not significantly changed. In muscle biopsy specimens from PM patients expression of the NKG2D ligand MICA/B was upregulated, IL-15 was expressed by muscle cells, CD68\(^+\) macrophages as well as CD4\(^+\) T cells, and \(CD8^+NKG2D^+\) cells were frequently detected within inflammatory infiltrates arguing for a local signaling circuit in the inflammatory muscle milieu. In conclusion, the NKG2D - IL-15 signaling pathway contributes to progressive muscle destruction in IIM potentially opening new therapeutic avenues. KW - MIC ligands KW - pathology section KW - T cell activation KW - idiopathic inflammatory myopathies KW - polymyositis KW - IL-15 KW - NKG2D KW - receptor KW - expression KW - lymphokine-activated killer KW - human muscle-cells KW - multiple sclerosis KW - celiac disease KW - tumor immunity KW - NKG2D ligands KW - cutting edge Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-136047 VL - 6 IS - 41 ER - TY - JOUR A1 - Rovituso, Damiano M. A1 - Duffy, Catharina E. A1 - Schroeter, Michael A1 - Kaiser, Claudia C. A1 - Kleinschnitz, Christoph A1 - Bayas, Antonios A1 - Elsner, Rebecca A1 - Kuerten, Stefanie T1 - The brain antigen-specific B cell response correlates with glatiramer acetate responsiveness in relapsing-remitting multiple sclerosis patients JF - Scientific Reports N2 - B cells have only recently begun to attract attention in the immunopathology of multiple sclerosis (MS). Suitable markers for the prediction of treatment success with immunomodulatory drugs are still missing. Here we evaluated the B cell response to brain antigens in n = 34 relapsing-remitting MS (RRMS) patients treated with glatiramer acetate (GA) using the enzyme-linked immunospot technique (ELISPOT). Our data demonstrate that patients can be subdivided into responders that show brain-specific B cell reactivity in the blood and patients without this reactivity. Only in patients that classified as B cell responders, there was a significant positive correlation between treatment duration and the time since last relapse in our study. This correlation was GA-specific because it was absent in a control group that consisted of interferon-\(\beta\) (IFN-\(\beta\))-treated RRMS patients (n = 23). These data suggest that GA has an effect on brain-reactive B cells in a subset of patients and that only this subset benefits from treatment. The detection of brain-reactive B cells is likely to be a suitable tool to identify drug responders. KW - cortical pathology KW - natural history KW - disability KW - expression KW - antibodies KW - disease KW - lesions KW - trial KW - multiple sclerosis Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-148172 VL - 5 IS - 14265 ER - TY - THES A1 - Rott, Evelyn T1 - Experimentelle autoimmune Enzephalomyelitis in beta2 Mikroglobulin knock-out Mäusen : axonaler Schaden entsteht unabhängig von MHC-I Expression T1 - EAE in beta-2 microglobulin-deficient mice: axonal damage is not dependent on MHC-I restricted immune responses N2 - CD4 T-Zellen wurden lange als die vor allem pathogen wirkenden Immunzellen bei chronisch entzündlichen ZNS-Erkrankungen angesehen. Wir untersuchten die Wirkung von CD8 T-Zellen in der EAE (exp. autoimmunen Enzephalomyelitis = Tiermodell der Multiplen Sklerose) anhand von beta2-Mikroglobulin knock-out Mäusen (fehlende CD8 T-Zellen). Ergebnis: im Vergleich zu den Wildtyptieren zeigten die Knock-outs eine signifikant stärker ausgeprägte Erkrankung bei der mit verschiedenen Antigenen (MOG, MBP) induzierten EAE mit erhöhter Mortalität. Histologisch fnad sich eine vermehrte Infiltration von Makrophagen und Mikroglia. Die Demyelinisierung war bei den Knock-outs stärker ausgeprägt, ebenso auch der axonale Schaden. Das Fehlen von funktionellen CD8 T-Zellen führte demnach zu einer Verstärkung der autoimmunen Gewebsschädigung im ZNS. N2 - There is accumulating evidence that CD8-positive (CD8+) T-cells and MHC-I expression may also play a role in neurodegeneration associated with multiple sclerosis (MS). We investigated the role of MHC-I and CD8+ T-cells by studying experimental autoimmune encephalomyelitis (EAE) in beta-2 microglobulin knockout mice induced by myelin oligodendrocyte glycoprotein (MOG) peptide 35-55 or whole rat myelin basic protein (rMBP). For both encephalitogens and even after reconstitution of the immune system with MHC-I-positive bone marrow and transfer of mature CD8+ T-cells (iMHC-I+ CD8+ beta2m-/- mice), the disease course in beta2m-/- mice was significantly more severe with a 10-fold increased mortality in the beta2m-/- mice as compared to wild-type C57BL/6 mice. EAE in beta2m-/- mice caused more severe demyelination after immunization with MOG than with rMBP and axonal damage was more marked with rMBP as well as MOG even in iMHC-I+ CD8+ beta2m-/- mice. Immunocytochemical analysis of spinal cord tissue revealed a significant increase in macrophage and microglia infiltration in beta2m-/- and iMHC-I+ CD8+ beta2m-/- mice. The different pattern of T-cell infiltration was underscored by a 2.5-fold increase in CD4-positive (CD4+) T-cells in beta2m-/- mice after induction of MOG 35-55 EAE. We conclude that lack of functional MHC-I molecules and CD8+ T-cells aggravates autoimmune tissue destruction in the CNS. Enhanced axonal damage speaks for pathways of tissue damage independent of CD8+ T-cells and neuronal MHC-I expression. KW - EAE KW - beta2 Mikroglobulin knock-out Mäuse KW - axonaler Schaden KW - axonal damage KW - beta2 microglobulin knock-out mice Y1 - 2005 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-19500 ER - TY - THES A1 - Rost, Anna-Lena T1 - Akute erregerbedingte Meningoenzephalitiden am Universitätsklinikum Würzburg von 2006-2015 T1 - Acute pathogen-induced meningoencephalitides at the University Hospital of Würzburg between 2006-2015 N2 - Am Universitätsklinikum Würzburg wurden zwischen 2006-2015 447 Fälle einer akuten erregerbedingten Meningoenzephalitis in den Kliniken der Neurologie, Kinderklinik, Neurochirurgie und Psychiatrie behandelt. Es konnten sowohl Fälle durch Bakterien als auch Fälle durch Viren, Parasiten und Pilze gesichert werden. Diese Arbeit beschreibt die lokale Epidemiologie akuter erregerbedingter Meningoenzephalitiden. N2 - At the University Hospital of Würzburg, 447 cases of acute pathogen-induced meningoencephalitis were treated in the clinics of neurology, pediatrics, neurosurgery and psychiatry between 2006-2015. Cases due to bacteria as well as cases due to viruses, parasites and fungi were secured. This paper describes the local epidemiology of acute pathogen-induced meningoencephalitides. KW - Meningoenzephalitis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-240846 ER - TY - THES A1 - Rosen, Sandra T1 - Der Einsatz von Abciximab (ReoPro®) in der Akutbehandlung von ischämischen Hirninfarkten mit und ohne vorangehende Thrombolysebehandlung mit rt-PA T1 - Abciximab (Reopro®) in treatment of acute ischemic stroke with or without previous thrombolysis with rt-PA N2 - Abciximab wurde, in Phase II-Studien, in der Behandlung der akuten cerebralen Ischämie erprobt und es erscheint bisher sicher und effektiv. Obwohl die Effektivität in der Abciximab in Acute Ischemic Stroke Studie nicht prospektiv untersucht wurde, ist jedoch ein Trend zu einem verbessertem Outcome zu beobachten. In unserer Untersuchung wurden 65 Patienten mit cerebralen Ischämien in verschiedenen Gefäßterritorien mit Abciximab behandelt. Die Patienten zeigten entweder Zeichen und Symptome einer Crescendo-TIA, eines progressive stroke außerhalb des "3-Stunden-Zeitfensters" für eine Thrombolyse oder eine erneute Verschlechterung nach zunächst erfolgreicher Thrombolyse. Alle Patienten wurden anhand der modified Rankin Scale (mRS) zum Zeitpunkt des Eintreffens in der Klinik und am Tag der Entlassung von der Stroke Unit untersucht. Ergebnisse: 88% der Patienten (57/65) verbesserten sich um im Mittel 2,3 Punkte bezogen auf die mRS. 71% der Patienten (46/65) erreichten eine mRS von 0-2. Es wurden keine fatalen oder symptomatischen intracerebralen Blutungen beobachtet. Fazit: In dieser nicht-randomisierten Untersuchung über die Akuttherapie der cerebralen Ischämie, zeigte die Behandlung mit Abciximab alleine oder in Kombination mit Thrombolyse eine klinische Verbesserung in 88% der Patienten. Blutungskomplikationen waren selten und nie schwerwiegend. Diese Ergebnisse unterstützen die Forderung nach weiteren placebokontrollierten, randomisierten Studien von Abciximab in der Akutbehandlung der cerebralen Ischämie. N2 - Abciximab has been studied, in phase II trials, for the treatment of acute ischemic stroke and appears to have a favorable safety profile. Although efficacy was not prospektively evaluated in the Abciximab in Acute Ischemic Stroke trial, a trend towards improved outcome was observed. In our experience, sixty-five patients, diagnosed with ischemic stroke in various vascular territories, were treated with abciximab. Patients demonstrated signs and symptoms of either crescendo TIA, progressive stroke outside the time window indicated for thrombolysis or reocclusion after initial successful thrombolysis. All patients were assessed according to the modified Rankin Scale (mRS) at the time of admission and at the time of discharge from the stroke unit. Results: Clinical improvement was seen in 88% of patients (57/65) with the mean mRS decreasing from 4.2 to 1.9. 71% of patients (46/65) achieved mRS 0-2. There were no fatal or symptomatic intracerebral bleeding complications. Conclusion: In this non-randomized, open-label study of acute cerebral ischemia, abciximab alone or in combination with thrombolytic therapy demonstrated clinical improvement in 88% of patients. Hemorrhagic complications were rare and never serious. These results support the need for additional well-controlled, randomized trials evaluating abciximab for the treatment of acute ischemic stroke. KW - Abciximab KW - GP-IIb/IIIa-Antagonist KW - cerebrale Ischämie KW - Thrombolyse KW - abciximab KW - GP-IIb/IIIa-antagonist KW - ischemic stroke KW - thrombolysis Y1 - 2005 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-17514 ER - TY - JOUR A1 - Rolfes, Leoni A1 - Ruck, Tobias A1 - David, Christina A1 - Mencl, Stine A1 - Bock, Stefanie A1 - Schmidt, Mariella A1 - Strecker, Jan-Kolja A1 - Pfeuffer, Steffen A1 - Mecklenbeck, Andreas-Schulte A1 - Gross, Catharina A1 - Gliem, Michael A1 - Minnerup, Jens A1 - Schuhmann, Michael K. A1 - Kleinschnitz, Christoph A1 - Meuth, Sven G. T1 - Natural Killer Cells Are Present in Rag1\(^{−/−}\) Mice and Promote Tissue Damage During the Acute Phase of Ischemic Stroke JF - Translational Stroke Research N2 - Rag1\(^{−/−}\) mice, lacking functional B and T cells, have been extensively used as an adoptive transfer model to evaluate neuroinflammation in stroke research. However, it remains unknown whether natural killer (NK) cell development and functions are altered in Rag1\(^{−/−}\) mice as well. This connection has been rarely discussed in previous studies but might have important implications for data interpretation. In contrast, the NOD-Rag1\(^{null}\)IL2rg\(^{null}\) (NRG) mouse model is devoid of NK cells and might therefore eliminate this potential shortcoming. Here, we compare immune-cell frequencies as well as phenotype and effector functions of NK cells in Rag1\(^{−/−}\) and wildtype (WT) mice using flow cytometry and functional in vitro assays. Further, we investigate the effect of Rag1\(^{−/−}\) NK cells in the transient middle cerebral artery occlusion (tMCAO) model using antibody-mediated depletion of NK cells and adoptive transfer to NRG mice in vivo. NK cells in Rag1\(^{−/−}\) were comparable in number and function to those in WT mice. Rag1\(^{−/−}\) mice treated with an anti-NK1.1 antibody developed significantly smaller infarctions and improved behavioral scores. Correspondingly, NRG mice supplemented with NK cells were more susceptible to tMCAO, developing infarctions and neurological deficits similar to Rag1−/− controls. Our results indicate that NK cells from Rag1−/− mice are fully functional and should therefore be considered in the interpretation of immune-cell transfer models in experimental stroke. Fortunately, we identified the NRG mice, as a potentially better-suited transfer model to characterize individual cell subset-mediated neuroinflammation in stroke. KW - infarction KW - middle cerebral artery occlusion KW - animal model KW - inflammation KW - natural killer cells Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-308924 SN - 1868-4483 SN - 1868-601X VL - 13 IS - 1 ER - TY - THES A1 - Ritter, Christian T1 - Pathomechanismen von Antikörpern gegen Aquaporin 4 in einem Tiermodell für die Neuromyelitis Optica T1 - Pathomechanism of antibodies against aquaporin 4 in an animal model for neuromyelitis opitca N2 - Die Neuromyelitis Optica (NMO) ist eine schwerwiegende autoimmune Erkrankung des zentralen Nervensystems (ZNS), die mit rezidivierenden Optikusneuritiden und Querschnittsmyelitiden einhergeht. Als serologischer Biomarker wurden Autoantikörper gegen Aquaporin 4 (anti-AQP4-AK) identifiziert. Mit Hilfe eines passiv-Transfer Rattenmodelles mit implantierten intrathekalen Kathetern wurden aufgereinigte IgG Fraktionen (NMO-IgG) von Plasmapheresematerial anti-AQP4-AK positiver NMO Patienten verabreicht. Zum Nachweis der Antigen-Spezifität wurden in weiteren Versuchsgruppen rekombinante IgG-AK gegen AQP4 appliziert. Die repetitive Injektion von NMO-IgG oder anti-AQP4-AK führte zu einer signifikanten klinischen Verschlechterung und einer reduzierten motorischen Leistungsfähigkeit der Versuchstiere im Vergleich zu Kontrollen. Mittels Magnetresonanztomographie konnten exemplarisch Kontrastmittel-aufnehmende Läsionsareale im Rückenmark der Versuchstiere im Bereich der Katheterspitze detektiert werden. Histopathologisch zeigte sich in diesen Läsionsbereichen eine Anreicherung von intrathekal applizierten humanen IgG, ein Verlust der Expression von AQP4 und des Glutamattransporters EAAT2. Im Gegensatz zu der bisher bekannten, Komplement-induzierten Gewebedestruktion bei NMO-Patienten mit entzündlichen Läsionen wurde hier keine Depletion von Astrozyten oder Komplementaktivierung beobachtet. Stattdessen kam es in den hier beschriebenen Arealen mit IgG-Ablagerung zu einer Hypertrophie und Vermehrung der GFAP-positiven Astrozyten. Die Ergebnisse lassen auf eine pathophysiologisch relevante, intrinsische und komplement-unabhängige Wirkung von anti-AQP4-AK schließen. N2 - Neuromyelitis optica (NMO) is a severe autoimmune disease of the central nervous system (CNS). As a biomarker autoantibodies against AQP4 (anti-AQP4-Abs) have been identified. Via passiv-transfer animal model with intrathecally implanted catheters, purified IgG fractions (NMO-IgG) from anti-AQP4-Abs positive patients have been applicated. Repetitive injection of NMO-IgG led to a significant clinical disease induction along with reduced motor function. Via MRI-scan lesions in the spinal cord could be identified. Histopathological analysis revealed a loss of AQP4 and glutamat transporter EAAT2. Complement induced tissue inflammation hasn't been observed. These results reveal a pathophysiological relevant, intrinsic and complement independent effect of anti-AQP4-Abs. KW - Autoantikörper KW - Aquaporin4 KW - Neuromyelitis Optica KW - Autoantikörper KW - Aquaporin4 KW - Neuromyelitis Optica KW - Autoantibodies KW - Aquaporin4 Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-85526 ER - TY - JOUR A1 - Rickert, V. A1 - Wagenhäuser, L. A1 - Nordbeck, P. A1 - Wanner, C. A1 - Sommer, C. A1 - Rost, S. A1 - Üçeyler, N. T1 - Stratification of Fabry mutations in clinical practice: a closer look at α‐galactosidase A‐3D structure JF - Journal of Internal Medicine N2 - Background Fabry disease (FD) is an X‐linked lysosomal storage and multi‐system disorder due to mutations in the α‐galactosidase A (α‐GalA) gene. We investigated the impact of individual amino acid exchanges in the α‐GalA 3D‐structure on the clinical phenotype of FD patients. Patients and methods We enrolled 80 adult FD patients with α‐GalA missense mutations and stratified them into three groups based on the amino acid exchange location in the α‐GalA 3D‐structure: patients with active site mutations, buried mutations and other mutations. Patient subgroups were deep phenotyped for clinical and laboratory parameters and FD‐specific treatment. Results Patients with active site or buried mutations showed a severe phenotype with multi‐organ involvement and early disease manifestation. Patients with other mutations had a milder phenotype with less organ impairment and later disease onset. α‐GalA activity was lower in patients with active site or buried mutations than in those with other mutations (P < 0.01 in men; P < 0.05 in women) whilst lyso‐Gb3 levels were higher (P < 0.01 in men; <0.05 in women). Conclusions The type of amino acid exchange location in the α‐GalA 3D‐structure determines disease severity and temporal course of symptom onset. Patient stratification using this parameter may become a useful tool in the management of FD patients. KW - Fabry disease KW - Fabry genotype KW - Fabry phenotype KW - lyso‐Gb3 KW - α‐GalA 3D‐structure Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218125 VL - 288 IS - 5 SP - 593 EP - 604 ER - TY - THES A1 - Reymann, Stephan Andreas T1 - Pathophysiologische Rolle und therapeutische Relevanz von Plasmakallikrein beim experimentellen Schlaganfall T1 - Pathophysiological role and therapeutic relevance of plasma kallikrein in experimental stroke N2 - Die Rolle thromboinflammatorischer Vorgänge in der Pathogenese des ischämischen Schlaganfalls ist in den letzten Jahren immer mehr in den wissenschaftlichen Fokus gerückt. Plasmakallikrein (PK) spaltet von hochmolekularem Kininogen (KNG) Bradykinin (BK) ab und ist dadurch Ausgangspunkt des proinflammatorischen Kallikrein-Kinin-Systems (KKS). Zum anderen kann es den Gerinnungsfaktor XII (FXII) aktivieren, den Ausgangspunkt der intrinsischen Gerinnungskaskade. Es initiiert also sowohl inflammatorische als auch thrombotische Vorgänge. Daher wurde in dieser Arbeit der Effekt einer Blockade PKs in einem Mausmodell der fokalen zerebralen Ischämie untersucht – und zwar sowohl durch genetische Depletion als auch durch pharmakologische Blockade. Beide Ansätze brachten einen nachhaltigen protektiven Effekt in Bezug auf Infarktgrößen und funktionelles Outcome, ohne die Blutungsgefahr zu erhöhen. N2 - Recent scientific evidence raises the question whether ischemic stroke is a thromboinflammatory disease. Plasma kallikrein (PK) cleaves high–molecular-weight kininogen to release bradykinin (BK) and is a key constituent of the proinflammatory contact-kinin system. In addition, PK can activate coagulation factor XII, the origin of the intrinsic coagulation cascade. Thus, PK triggers 2 important pathological pathways of stroke formation, thrombosis and inflammation. Therefore we investigated the consequences of both genetic and pharmacological PK inhibition in a model of ischemic stroke and found out that PK-inhibition leads to significantly smaller brain infarctions and less severe neurological deficits compared with controls without an increase in infarct-associated hemorrhage. KW - Plasmakallikrein KW - Schlaganfall KW - Plasmakallikrein ischämischer Schlaganfall Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-135834 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 - BOOK A1 - Reiners, Karlheinz T1 - Neuropathie und Motorik N2 - No abstract available KW - Nervenregeneration ; Periphere Nervenverletzung ; Neuromuskuläre Krankheit ; Axonverletzung ; Entmarkung Y1 - 1990 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-33843 ER - TY - JOUR A1 - Rauschenberger, Vera A1 - von Wardenburg, Niels A1 - Schaefer, Natascha A1 - Ogino, Kazutoyo A1 - Hirata, Hiromi A1 - Lillesaar, Christina A1 - Kluck, Christoph J. A1 - Meinck, Hans‐Michael A1 - Borrmann, Marc A1 - Weishaupt, Andreas A1 - Doppler, Kathrin A1 - Wickel, Jonathan A1 - Geis, Christian A1 - Sommer, Claudia A1 - Villmann, Carmen T1 - Glycine Receptor Autoantibodies Impair Receptor Function and Induce Motor Dysfunction JF - Annals of Neurology N2 - Objective Impairment of glycinergic neurotransmission leads to complex movement and behavioral disorders. Patients harboring glycine receptor autoantibodies suffer from stiff‐person syndrome or its severe variant progressive encephalomyelitis with rigidity and myoclonus. Enhanced receptor internalization was proposed as the common molecular mechanism upon autoantibody binding. Although functional impairment of glycine receptors following autoantibody binding has recently been investigated, it is still incompletely understood. Methods A cell‐based assay was used for positive sample evaluation. Glycine receptor function was assessed by electrophysiological recordings and radioligand binding assays. The in vivo passive transfer of patient autoantibodies was done using the zebrafish animal model. Results Glycine receptor function as assessed by glycine dose–response curves showed significantly decreased glycine potency in the presence of patient sera. Upon binding of autoantibodies from 2 patients, a decreased fraction of desensitized receptors was observed, whereas closing of the ion channel remained fast. The glycine receptor N‐terminal residues \(^{29}\)A to \(^{62}\)G were mapped as a common epitope of glycine receptor autoantibodies. An in vivo transfer into the zebrafish animal model generated a phenotype with disturbed escape behavior accompanied by a reduced number of glycine receptor clusters in the spinal cord of affected animals. Interpretation Autoantibodies against the extracellular domain mediate alterations of glycine receptor physiology. Moreover, our in vivo data demonstrate that the autoantibodies are a direct cause of the disease, because the transfer of human glycine receptor autoantibodies to zebrafish larvae generated impaired escape behavior in the animal model compatible with abnormal startle response in stiff‐person syndrome or progressive encephalitis with rigidity and myoclonus patients. KW - glycine receptor autoantibodies KW - behavioral disorders KW - neurology Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-216005 VL - 88 IS - 3 SP - 544 EP - 561 ER - TY - JOUR A1 - Rauschenberger, Vera A1 - Piro, Inken A1 - Kasaragod, Vikram Babu A1 - Hörlin, Verena A1 - Eckes, Anna-Lena A1 - Kluck, Christoph J. A1 - Schindelin, Hermann A1 - Meinck, Hans-Michael A1 - Wickel, Jonathan A1 - Geis, Christian A1 - Tüzün, Erdem A1 - Doppler, Kathrin A1 - Sommer, Claudia A1 - Villmann, Carmen T1 - Glycine receptor autoantibody binding to the extracellular domain is independent from receptor glycosylation JF - Frontiers in Molecular Neuroscience N2 - Glycine receptor (GlyR) autoantibodies are associated with stiff-person syndrome and the life-threatening progressive encephalomyelitis with rigidity and myoclonus in children and adults. Patient histories show variability in symptoms and responses to therapeutic treatments. A better understanding of the autoantibody pathology is required to develop improved therapeutic strategies. So far, the underlying molecular pathomechanisms include enhanced receptor internalization and direct receptor blocking altering GlyR function. A common epitope of autoantibodies against the GlyRα1 has been previously defined to residues 1A-33G at the N-terminus of the mature GlyR extracellular domain. However, if other autoantibody binding sites exist or additional GlyR residues are involved in autoantibody binding is yet unknown. The present study investigates the importance of receptor glycosylation for binding of anti-GlyR autoantibodies. The glycine receptor α1 harbors only one glycosylation site at the amino acid residue asparagine 38 localized in close vicinity to the identified common autoantibody epitope. First, non-glycosylated GlyRs were characterized using protein biochemical approaches as well as electrophysiological recordings and molecular modeling. Molecular modeling of non-glycosylated GlyRα1 did not show major structural alterations. Moreover, non-glycosylation of the GlyRα1N38Q did not prevent the receptor from surface expression. At the functional level, the non-glycosylated GlyR demonstrated reduced glycine potency, but patient GlyR autoantibodies still bound to the surface-expressed non-glycosylated receptor protein in living cells. Efficient adsorption of GlyR autoantibodies from patient samples was possible by binding to native glycosylated and non-glycosylated GlyRα1 expressed in living not fixed transfected HEK293 cells. Binding of patient-derived GlyR autoantibodies to the non-glycosylated GlyRα1 offered the possibility to use purified non-glycosylated GlyR extracellular domain constructs coated on ELISA plates and use them as a fast screening readout for the presence of GlyR autoantibodies in patient serum samples. Following successful adsorption of patient autoantibodies by GlyR ECDs, binding to primary motoneurons and transfected cells was absent. Our results indicate that the glycine receptor autoantibody binding is independent of the receptor’s glycosylation state. Purified non-glycosylated receptor domains harbouring the autoantibody epitope thus provide, an additional reliable experimental tool besides binding to native receptors in cell-based assays for detection of autoantibody presence in patient sera. KW - glycine receptor KW - autoantibodies KW - glycosylation KW - extracellular domain KW - adsorption Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304206 VL - 16 ER - TY - JOUR A1 - Rauschenberger, Lisa A1 - Knorr, Susanne A1 - Pisani, Antonio A1 - Hallett, Mark A1 - Volkmann, Jens A1 - Ip, Chi Wang T1 - Second hit hypothesis in dystonia: Dysfunctional cross talk between neuroplasticity and environment? JF - Neurobiology of Disease N2 - One of the great mysteries in dystonia pathophysiology is the role of environmental factors in disease onset and development. Progress has been made in defining the genetic components of dystonic syndromes, still the mechanisms behind the discrepant relationship between dystonic genotype and phenotype remain largely unclear. Within this review, the preclinical and clinical evidence for environmental stressors as disease modifiers in dystonia pathogenesis are summarized and critically evaluated. The potential role of extragenetic factors is discussed in monogenic as well as adult-onset isolated dystonia. The available clinical evidence for a "second hit" is analyzed in light of the reduced penetrance of monogenic dystonic syndromes and put into context with evidence from animal and cellular models. The contradictory studies on adult-onset dystonia are discussed in detail and backed up by evidence from animal models. Taken together, there is clear evidence of a gene-environment interaction in dystonia, which should be considered in the continued quest to unravel dystonia pathophysiology. KW - dystonia KW - second hit KW - pathophysiology KW - gene-environment interaction Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265028 VL - 159 ER - TY - JOUR A1 - Rauschenberger, Lisa A1 - Behnke, Jennifer A1 - Grotemeyer, Alexander A1 - Knorr, Susanne A1 - Volkmann, Jens A1 - Ip, Chi Wang T1 - Age-dependent neurodegeneration and neuroinflammation in a genetic A30P/A53T double-mutated α-synuclein mouse model of Parkinson’s disease JF - Neurobiology of Disease N2 - The pathogenesis of Parkinson's disease (PD) is closely interwoven with the process of aging. Moreover, increasing evidence from human postmortem studies and from animal models for PD point towards inflammation as an additional factor in disease development. We here assessed the impact of aging and inflammation on dopaminergic neurodegeneration in the hm\(^{2}\)α-SYN-39 mouse model of PD that carries the human, A30P/A53T double-mutated α-synuclein gene. At 2–3 months of age, no significant differences were observed comparing dopaminergic neuron numbers of the substantia nigra (SN) pars compacta of hm\(^{2}\)α-SYN-39 mice with wildtype controls. At an age of 16–17 months, however, hm\(^{2}\)α-SYN-39 mice revealed a significant loss of dopaminergic SN neurons, of dopaminergic terminals in the striatum as well as a reduction of striatal dopamine levels compared to young, 2–3 months transgenic mice and compared to 16–17 months old wildtype littermates. A significant age-related correlation of infiltrating CD4+ and CD8\(^{+}\) T cell numbers with dopaminergic terminal loss of the striatum was found in hm\(^{2}\)α-SYN-39 mice, but not in wildtype controls. In the striatum of 16–17 months old wildtype mice a slightly elevated CD8\(^{+}\) T cell count and CD11b\(^{+}\) microglia cell count was observed compared to younger aged mice. Additional analyses of neuroinflammation in the nigrostriatal tract of wildtype mice did not yield any significant age-dependent changes of CD4\(^{+}\), CD8\(^{+}\) T cell and B220\(^{+}\) B cell numbers, respectively. In contrast, a significant age-dependent increase of CD8\(^{+}\) T cells, GFAP\(^{+}\) astrocytes as well as a pronounced increase of CD11b+ microglia numbers were observed in the SN of hm\(^{2}\)α-SYN-39 mice pointing towards a neuroinflammatory processes in this genetic mouse model for PD. The findings in the hm\(^{2}\)α-SYN-39 mouse model strengthen the evidence that T cell and glial cell responses are involved in the age-related neurodegeneration in PD. The slow and age-dependent progression of neurodegeneration and neuroinflammation in the hm\(^{2}\)α-SYN-39 PD rodent model underlines its translational value and makes it suitable for studying anti-inflammatory therapies. KW - Parkinson's disease KW - neuroinflammation KW - neurodegeneration Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300629 VL - 171 ER - TY - JOUR A1 - Raslan, Furat A1 - Albert-Weißenberger, Christiane A1 - Westermaier, Thomas A1 - Saker, Saker A1 - Kleinschmitz, Christoph A1 - Lee, Jin-Yul T1 - A modified double injection model of cisterna magna for the study of delayed cerebral vasospasm following subarachnoid hemorrhage in rats N2 - Delayed cerebral vasospasm following subarachnoid hemorrhage (SAH) is a serious medical complication, characterized by constriction of cerebral arteries leading to varying degrees of cerebral ischemia. Numerous clinical and experimental studies have been performed in the last decades; however, the pathophysiologic mechanism of cerebral vasospasm after SAH still remains unclear. Among a variety of experimental SAH models, the double hemorrhage rat model involving direct injection of autologous arterial blood into the cisterna magna has been used most frequently for the study of delayed cerebral vasospasm following SAH in last years. Despite the simplicity of the technique, the second blood injection into the cisterna magna may result in brainstem injury leading to high mortality. Therefore, a modified double hemorrhage model of cisterna magna has been developed in rat recently. We describe here step by step the surgical technique to induce double SAH and compare the degree of vasospasm with other cisterna magna rat models using histological assessment of the diameter and cross-sectional area of the basilar artery KW - Medizin KW - Cerebral vasospasm KW - Cisterna magna KW - Double hemorrhage model KW - Rat KW - Subarachnoid Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-76038 ER - TY - THES A1 - Ramthor, Mathias T1 - Therapeutischer Einfluß von zwei Antidepressiva auf das Schmerzverhalten von Ratten mit einer chronischen Konstriktionsläsion des N. ischiadicus T1 - Therapeutic Effect of Two Antidepressants on Pain-Related Behaviour of Rats With a Chronic Constriction Injury of The Sciatic Nerve N2 - In dieser Arbeit sollte an weiblichen Sprague Dawley Ratten untersucht werden, ob sich durch die Antidepressiva Amitriptylin und Venlafaxin Schmerzverhalten nach Nervenläsion verringern läßt und wenn ja, welche Mechanismen dieser Wirkung zugrunde liegen. Den Tieren wurde einseitig der N. ischiadicus nach dem Nervenläsionsmodell der Chronic-Constriction-Injury (CCI) operiert. Das Schmerzverhalten der mit Antidepressiva behandelten Tiere wurde über zwei bis drei Wochen verblindet im Vergleich mit plazebobehandelten Tieren untersucht. Das Ausmaß von Hitzehyperalgesie und taktiler Allodynie wurde durch die Anwendung etablierter Testverfahren quantifiziert. Amitriptylin hatte in der Dosis von zweimal täglich 10 mg/kg KG i.p. keinen relevanten Effekt auf das Schmerzverhalten der Tiere. Eine akute Gabe von Amitriptylin bei Tieren, die zuvor über 19 Tage chronisch mit Amitriptylin behandelt worden waren, reduzierte die taktile Allodynie geringgradig und hatte keinen Einfluß auf die Hitzehyperalgesie. Venlafaxin in der Dosis von zweimal täglich 25 mg/kg KG p.o. reduzierte in einigen Teilversuchen mäßiggradig die Hitzehyperalgesie und die taktile Allodynie nach CCI. Auf diesen Ergebnissen aufbauend wurde versucht, die Wirkung der chronischen Venlafaxin-Medikation durch Kombination mit zusätzlich akut verabreichten alpha-adrenergen- bzw. µ-Opiat-Rezeptor-agonistischen Substanzen zu verstärken. Die Kombination von Venlafaxin mit dem alpha-2A-Rezeptoragonisten Clonidin ergab eine Wirkungsverstärkung in Bezug auf die Reduktion der Hitzehyperalgesie, wobei sich zusätzlich eine Eigenwirkung von Clonidin nachweisen ließ. Der µ-Opiat-Rezeptor-Agonist Morphin führte hingegen zu keiner signifikanten Wirkungsverstärkung in Kombination mit Venlafaxin. Im Anschluß an die jeweilige Testreihe wurde den Tieren Nervengewebe entnommen, welches nach immunhistochemischer Färbung für alpha-2A- und µ-Rezeptoren morphometrisch evaluiert wurde. Dies diente der Untersuchung der Hypothese, daß den o.g. Wirkungen eine Vermehrung der entsprechenden Rezeptoren bei Venlafaxin-behandelten Tieren zugrunde lag. Die chronische postoperative Gabe von Venlafaxin hatte keinen Einfluß auf die Anzahl von alpha-2A-Rezeptor-immunreaktiven Neuronen im Spinalganglion CCI-operierter Ratten. Allerdings ließ sich unter der Medikation die Immunreaktivität für alpha-2A-Rezeptoren vermehrt in großkalibrigen Spinalganglienneuronen nachweisen. Die chronische postoperative Gabe von Venlafaxin führte zudem zu einer Zunahme von µ-Opiat-Rezeptoren im ipsilateralen N. ischiadicus CCI-operierter Ratten. Im Spinalganglion ergab sich nach Venlafaxinbehandlung keine Veränderung der Anzahl der µ-Rezeptor-immunreaktiven Neurone. Allerdings konnte durch chronische Venlafaxin-Medikation eine Phänotyp-Verschiebung mit Auftreten von µ-Rezeptor-Immunreaktivität in großkalibrigen Neuronen, wie sie nach CCI ohne Venlafaxinbehandlung auftrat, verhindert werden. Die Ergebnisse der Arbeit zeigen, daß die chronische, zweimal tägliche Anwendung der Antidepressiva Amitriptylin und Venlafaxin das Schmerz-assoziierte Verhalten von Ratten nach einer peripheren Nervenläsion inkonstant und nur in unzureichendem Ausmaß beeinflussen. Unabhängig davon wurden in den immunhistochemischen Untersuchungen Veränderungen in der Verteilung µ- und alpha-adrenerger Rezeptoren in Spinalganglionzellen und Ischiasnerv beobachtet, die auf eine kontinuierliche Venlafaxin-Medikation zurückzuführen zu sein scheinen. Berücksichtigt man vor diesem Hintergrund die Tatsache, daß sich die Venlafaxinwirkung durch den alpha-2A-Agonisten Clonidin verstärken ließ, so bieten diese Zusammenhänge eine mögliche Erklärung für die zugrundeliegenden Mechanismen der Wirkungsvermittlung von Antidepressiva in der Behandlung einer schmerzhaften Mononeuropathie. N2 - The main intention of the present study was to show if administration of the antidepressants amitriptyline and venlafaxine possibly alters pain-related behaviour of Sprague-Dawley rats with an experimental peripheral mononeuropathy. The possible underlying mechanisms of such action were of further interest and therefore investigated. All animals were inflicted an experimental mononeuropathy on sciatic nerve according to the Chronic-Constriction-Injury-Model (CCI) as described by Bennett and Xie. The resulting pain-related behaviour - such as allodynia and hyperalgesia - was quantified by established test-procedures with antidepressant-treated rats tested against placebo-treated animals over a time-course of two to three weeks. Chronic administration of amitriptyline, at a dose of 10 mg/kg bodyweight i.p. twice daily, showed no effect on pain-related behaviour of rats; whereas an additional acute booster-dose on postoperative day 19 reduced tactile allodynia in a significant manner in this setup. Chronic distribution of venlafaxine - at 25 mg/kg bodyweight, p.o. twice daily - reduced heat-hyperalgesia and tactile allodynia in the CCI-model moderately in a few of the carried out experiments. Expecting enhanced effectiveness chronic therapy with venlafaxine was combined with acute administration of alpha-adrenergic- or µ-opiate-receptor-agonists. Combination of venlafaxine with clonidine – an alpha-2A-receptor-agonist – showed an enhanced reduction of heat-hyperalgesia in CCI-operated rats compared to monotherapy as well as an effectiveness of clonidine alone. Contrarily, combination of venlafaxine with µ-opiate-receptor-agonist morphine showed no enhancement of analgesia. Following each experimental setup nerve-tissue of the used animals was obtained and microscopically evaluated after immunhistochemical staining for alpha-2A- and µ-opiate-receptors. This approach was meant to verify the hypothesis that attenuation of neuropathic-pain by venlafaxine may be due to mechanisms including quantitative alterations in alpha-adrenergic- or opiate-receptor-quantity. Chronic administration of venlafaxine showed no quantitative impact on alpha-2A-receptor-immunoreactivity in neurons of the dorsal-root-ganglion (DRG) of CCI-operated rats, but immunoreactivity showed an remarkable shift towards neurons with a wider caliber. Furthermore chronic administration of venlafaxine led to a quantitative increase in µ-opiate-receptor-immunoreactivity in ipsilateral sciatic nerve of CCI-operated rats. Also no such quantitative alterations in receptor-immunoreactivity could be shown for DRG-neurons, phenotype-switch towards neurons of wide caliber - as seen in ipsilateral DRG of untreated CCI-rats – was apparently prevented by chronic administration of venlafaxine. In total this experimental study showed that the chronic, twice daily administration of the antidepressant drugs amitriptyline and venlafaxine has an inconstant and dissatifying effect on attenuating pain-related behaviour of CCI-operated rats. Irrespective from these results immunhistochemical staining of peripheral nerve-tissue and DRG showed alterations in the allocation of µ- and alpha-adrenergic-receptor-immunoreactivity which tended to be dependent on precedent venlafaxine-administration. Bearing in mind aforementioned enhancement of venlafaxine-effectiveness by coadministration of clonidine, one could presume that said implications may be a possible explanation for a mechanism of antidepressant action in alleviating pain in an experimental peripheral mononeuropathy. KW - Neuropathie KW - Schmerz KW - CCI KW - Amitriptylin KW - Venlafaxin KW - Neuropathy KW - pain KW - CCI KW - amitriptyline KW - venlafaxine Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-23739 ER - TY - THES A1 - Ramirez Pasos, Uri Eduardo T1 - Subthalamic Nucleus Neural Synchronization and Connectivity during Limbic Processing of Emotional Pictures: Evidence from Invasive Recordings in Patients with Parkinson's Disease T1 - Synchronisierung und Konnektivität des Nucleus subthalamicus während limbischer Bearbeitung affektiver Bilder: Evidenz aus invasiven Aufzeichnungen in Patienten mit Morbus Parkinson N2 - In addition to bradykinesia and tremor, patients with Parkinson’s disease (PD) are known to exhibit non-motor symptoms such as apathy and hypomimia but also impulsivity in response to dopaminergic replacement therapy. Moreover, a plethora of studies observe differences in electrocortical and autonomic responses to both visual and acoustic affective stimuli in PD subjects compared to healthy controls. This suggests that the basal ganglia (BG), as well as the hyperdirect pathway and BG thalamocortical circuits, are involved in affective processing. Recent studies have shown valence and dopamine-dependent changes in synchronization in the subthalamic nucleus (STN) in PD patients during affective tasks. This thesis investigates the role of dopamine, valence, and laterality in STN electrophysiology by analyzing event-related potentials (ERP), synchronization, and inter-hemispheric STN connectivity. STN recordings were obtained from PD patients with chronically implanted electrodes for deep brain stimulation during a passive affective picture presentation task. The STN exhibited valence-dependent ERP latencies and lateralized ‘high beta’ (28–40 Hz) event-related desynchronization. This thesis also examines the role of dopamine, valence, and laterality on STN functional connectivity with the anterior cingulate cortex (ACC) and the amygdala. The activity of these limbic structures was reconstructed using simultaneously recorded electroencephalographic signals. While the STN was found to establish early coupling with both structures, STN-ACC coupling in the ‘alpha’ range (7–11 Hz) and uncoupling in the ‘low beta’ range (14–21 Hz) were lateralized. Lateralization was also observed at the level of synchrony in both reconstructed sources and for ACC ERP amplitude, whereas dopamine modulated ERP latency in the amygdala. These results may deepen our current understanding of the STN as a limbic node within larger emotional-motor networks in the brain.
 N2 - Neben Bradykinese und Tremor weisen Patienten mit Morbus Parkinson (PD) bekannterweise nicht-motorische Symptome auf wie Apathie und Hypomimie, aber auch Impulsivität, welche durch Dopaminersatztherapien bedingt ist. Viele Studien belegen außerdem Unterschiede von kortikalen und autonomen Reaktionen auf sowohl visuelle als auch akustische Reize bei Patienten mit PD im Vergleich zu gesunden Kontrollgruppen. Dies legt nahe, dass sich die Basalganglien (BG), und auch die hyperdirekte Verbindung sowie die BG-thalamokortikalen Schleifen, an der Affektbearbeitung beteiligen. Jüngere Studien haben Valenz- und Dopamin-bedingte Veränderungen der Synchronisierung im Nucleus subthalamicus (STN) von Parkinson-Patienten bei affektiven Aufgaben belegt. Diese Promotionsarbeit untersucht die Rolle von Dopamin, Valenz und Lateralität in der STN-Elektrophysiologie mittels Analysen von ereigniskorrelierten Potentialen (ERP), Synchronisierung und interhemisphärischer funktioneller Konnektivität. STN-Aufzeichnungen wurden von Patienten mit dauerhaft implantierten Elektroden für die Tiefenhirnstimulation während einer passiven Aufgabe abgeleitet, bei den ihnen Bilder mit emotionalen Inhalten gezeigt wurden. Der STN wies Valenz-bedingte ERP-Latenz und lateralisierte ereigniskorrelierte Desynchronisierung in ‘hohem Beta’ (28–40 Hz) auf. Diese Dissertation untersucht auch die Rolle von Dopamin, Valenz und Lateralität bezüglich der funktionellen Konnektivität zwischen dem STN und dem Gyrus cinguli pars anterior (ACC) sowie der Amygdala. Die Aktivität dieser Strukturen wurde aus simultanen elektroenzephalographischen Aufzeichnungen rekonstruiert. Obwohl eine STN-Kopplung mit beiden Strukturen auftritt, war die STN-ACC-Kopplung im ‘Alpha’- Bereich (7–11 Hz) und die Entkopplung im ‘niedrigen Beta’-Bereich (14–21 Hz) lateralisiert. Lateralisierung wurde auch an der Synchronisierung in beiden rekonstruierten Quellen und an der ACC-ERP-Amplitude festgestellt, wohingegen Dopamin die ERP-Latenz in der Amygdala modulierte. Diese Ergebnisse mögen das gegenwärtige Wissen vom STN als limbischem Knoten innerhalb größerer affektiv-motorischer Schleifen im Gehirn vertiefen. KW - Nucleus subthalamicus KW - subthalamic nucleus KW - Emotionales Verhalten KW - functional connectivity KW - oscillations KW - emotion KW - Affekt KW - Elektrophysiologie Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-169850 ER - TY - THES A1 - Raban, Rebecca Emmi Hildegard T1 - Sicherheit und Wirksamkeit von intrathekalem Triamcinolon bei Patienten mit chronisch-progredienter Multipler Sklerose : eine retrospektive Longitudinalstudie T1 - Safety and efficacy of intrathecal triamcinolone in chronic progressive multiple sclerosis - a retrospective longitudinal study N2 - Im Zeitraum von 2004 bis 2016 erhielten an der Neurologischen Universitätsklinik Würzburg Patienten mit einer chronisch progredienten Multiplen Sklerose insgesamt 595 Injektionen von intrathekalem Triamcinolonacetonid. Diese Arbeit befasst sich mit Sicherheit, Nebenwirkungen und Wirksamkeit der intrathekalen Therapieform. N2 - In the period from 2004 to 2016 patients with chronic progressive multiple sclerosis at the Neurological University Clinic Würzburg received a total of 595 injections of intrathecal triamcinolone acetonide. This work deals with safety, side effects and effectiveness of intrathecal therapy. KW - Intrathekale Applikation KW - Triamcinolon KW - Multiple Sklerose KW - intrathekal KW - intrathecal KW - Volon A KW - chronische Multiple Sklerose KW - triamcinolone acetonide KW - progressive multiple sclerosis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-220478 ER - TY - JOUR A1 - Quarta, Serena A1 - Vogl, Christian A1 - Constantin, Cristina E. A1 - Üçeyler, Nurcan A1 - Sommer, Claudia A1 - Kress, Michaela T1 - Genetic evidence for an essential role of neuronally expressed IL-6 signal transducer gp130 in the induction and maintenance of experimentally induced mechanical hypersensitivity \(in\) \(vivo\) and \(in\) \(vitro\) JF - Molecular Pain N2 - Tenderness and mechanical allodynia are key symptoms of malignant tumor, inflammation and neuropathy. The proinflammatory cytokine interleukin-6 (IL-6) is causally involved in all three pathologies. IL-6 not only regulates innate immunity and inflammation but also causes nociceptor sensitization and hyperalgesia. In general and in most cell types including immune cells and sensory neurons, IL-6 binds soluble mu receptor subunits which heteromerizes with membrane bound IL-6 signal transducer gp130. In the present study, we used a conditional knock-out strategy to investigate the importance of signal transducer gp130 expressed in C nociceptors for the generation and maintenance of mechanical hypersensitivity. Nociceptors were sensitized to mechanical stimuli by experimental tumor and this nociceptor sensitization was preserved at later stages of the pathology in control mice. However, in mice with a conditional deletion of gp130 in Nav1.8 expressing nociceptors mechanical hypersensitivity by experimental tumor, nerve injury or inflammation recovery was not preserved in the maintenance phase and nociceptors exhibited normal mechanical thresholds comparable to untreated mice. Together, the results argue for IL-6 signal transducer gp130 as an essential prerequisite in nociceptors for long-term mechanical hypersensitivity associated with cancer, inflammation and nerve injury. KW - Leukemia Inhibitory Factor KW - Mediated Inflammatory Hyperalgesia KW - Necrosis-factor-Alpha KW - Oncostatin-M-Receptor KW - Rat Sensory Neurons KW - Rheumatoid-Arthritis KW - Interleukin-6-Deficient mice KW - Peripheral Inflammation KW - Thermal Hyperalgesia KW - Heat Hyperalgesia KW - proinflammatory cytokine KW - Interleukin-6 KW - chronic pain KW - nociceptor sensitization KW - hyperalgesia KW - allodynia Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-140380 VL - 7,73 ER - TY - JOUR A1 - Pötter-Nerger, Monika A1 - Reese, Rene A1 - Steigerwald, Frank A1 - Heiden, Jan Arne A1 - Herzog, Jan A1 - Moll, Christian K. E. A1 - Hamel, Wolfgang A1 - Ramirez-Pasos, Uri A1 - Falk, Daniela A1 - Mehdorn, Maximilian A1 - Gerloff, Christian A1 - Deuschl, Günther A1 - Volkmann, Jens T1 - Movement-Related Activity of Human Subthalamic Neurons during a Reach-to-Grasp Task JF - Frontiers in Human Neuroscience N2 - The aim of the study was to record movement-related single unit activity (SUA) in the human subthalamic nucleus (STN) during a standardized motor task of the upper limb. We performed microrecordings from the motor region of the human STN and registered kinematic data in 12 patients with Parkinson’s disease (PD) undergoing deep brain stimulation surgery (seven women, mean age 62.0 ± 4.7 years) while they intraoperatively performed visually cued reach-to-grasp movements using a grip device. SUA was analyzed offline in relation to different aspects of the movement (attention, start of the movement, movement velocity, button press) in terms of firing frequency, firing pattern, and oscillation. During the reach-to-grasp movement, 75/114 isolated subthalamic neurons exhibited movement-related activity changes. The largest proportion of single units showed modulation of firing frequency during several phases of the reach and grasp (polymodal neurons, 45/114), particularly an increase of firing rate during the reaching phase of the movement, which often correlated with movement velocity. The firing pattern (bursting, irregular, or tonic) remained unchanged during movement compared to rest. Oscillatory single unit firing activity (predominantly in the theta and beta frequency) decreased with movement onset, irrespective of oscillation frequency. This study shows for the first time specific, task-related, SUA changes during the reach-to-grasp movement in humans. KW - subthalamic nucleus KW - deep brain stimulation KW - Parkinson’s disease KW - neurophysiology KW - beta oscillation KW - reach-to-grasp movement Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-170361 VL - 11 IS - 436 ER - TY - JOUR A1 - Puschmann, Anne-Katrin A1 - Sommer, Claudia T1 - Hypervigilance or avoidance of trigger related cues in migraineurs? - A case-control study using the emotional stroop task N2 - Background: “Negative affect” is one of the major migraine triggers. The aim of the study was to assess attentional biases for negative affective stimuli that might be related to migraine triggers in migraine patients with either few or frequent migraine and healthy controls. Methods: Thirty-three subjects with frequent migraine (FM) or with less frequent episodic migraine, and 20 healthy controls conducted two emotional Stroop tasks in the interictal period. In task 1, general affective words and in task 2, pictures of affective faces (angry, neutral, happy) were used. For each task we calculated two emotional Stroop indices. Groups were compared using one-way ANOVAs. Results: The expected attentional bias in migraine patients was not found. However, in task 2 the controls showed a significant attentional bias to negative faces, whereas the FM group showed indices near zero. Thus, the FM group responded faster to negative than to positive stimuli. The difference between the groups was statistically significant. Conclusions: The findings in the FM group may reflect a learned avoidance mechanism away from affective migraine triggers. KW - Migräne Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-69103 ER - TY - JOUR A1 - Puschmann, Anne-Katrin A1 - Sommer, Claudia T1 - Hypervigilance or avoidance of trigger related cues in migraineurs? - A case-control study using the emotional stroop task JF - BMC Neurology N2 - Background "Negative affect" is one of the major migraine triggers. The aim of the study was to assess attentional biases for negative affective stimuli that might be related to migraine triggers in migraine patients with either few or frequent migraine and healthy controls. Methods Thirty-three subjects with frequent migraine (FM) or with less frequent episodic migraine, and 20 healthy controls conducted two emotional Stroop tasks in the interictal period. In task 1, general affective words and in task 2, pictures of affective faces (angry, neutral, happy) were used. For each task we calculated two emotional Stroop indices. Groups were compared using one-way ANOVAs. Results The expected attentional bias in migraine patients was not found. However, in task 2 the controls showed a significant attentional bias to negative faces, whereas the FM group showed indices near zero. Thus, the FM group responded faster to negative than to positive stimuli. The difference between the groups was statistically significant. Conclusions The findings in the FM group may reflect a learned avoidance mechanism away from affective migraine triggers. KW - migraineur KW - cue Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-137750 VL - 11 IS - 141 ER - TY - THES A1 - Purrer, Veronika T1 - Nicht-motorische Begleitsymptome bei Patienten mit Essentiellen Tremor T1 - Non-motor symptoms in patients with essential tremor N2 - Der essentielle Tremor (ET) ist eine der häufigsten Bewegungsstörungen, welcher lange Zeit als rein motorische Störung angesehen wurde. Aufgrund zunehmender Belege über nicht-motorisch Begleitsymptome wandelte sich dieses Bild jedoch in den letzten Jahren zunehmend. In der vorliegenden Arbeit untersuchten wir 113 Probanden aus der Allgemeinbevölkerung mit klinisch definitiven oder wahrscheinlichen ET anhand einer breiten Batterie neuro-psychologischer Testverfahren. Es gelang hierbei signifikante Unterschiede im Vergleich zu gesunden Eichstichproben im Hinblick auf neuro-psychologische Charakteristika, wie Apathie, Ängstlichkeit und exekutive Dysfunktion, sowie deren negativen Einfluss auf die Lebensqualität der Probanden darzustellen. Bisher werden im klinischen Alltag nicht-motorische Begleitphänomene beim ET nicht regelhaft erfasst; aufgrund unserer Ergebnisse und der Relevanz vor allem im Hinblick auf die Lebensqualität des Einzelnen halten wir jedoch die Erfassung und gegebenenfalls Behandlung dieser Symptome für ebenso relevant. N2 - Essential tremor (ET) is one of the most common movement disorders, which was previously considered a purely motor disorder. Due to increasing evidence of non-motor symptoms, however, this picture has changed recently. In the present study we investigated 113 subjects from the general population with clinically definite or probable ET using a broad battery of neuro-psychological screening tools. Thereby, significant differences in neuro-psychological characteristics, such as apathy, anxiety and executive dysfunction, as well as their negative impact on the quality of life of the subjects could be demonstrated in comparison to healthy samples. Up to now, non-motor symptoms in ET are generally not been recorded in the clinical routine; however, based on our findings and the relevance to the individual's quality of life in particular, we consider the assessment and, where appropriate, treatment of these symptoms to be equally relevant. KW - Essentieller Tremor KW - Nicht-motorische Begleitsymptome KW - ET Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-193665 ER - TY - JOUR A1 - Pritchard, Rory A. A1 - Falk, Lovissa A1 - Larsson, Mathilda A1 - Leinders, Mathias A1 - Sorkin, Linda S. T1 - Different phosphoinositide 3-kinase isoforms mediate carrageenan nociception and inflammation JF - Pain N2 - Phosphoinositide 3-kinases (PI3Ks) participate in signal transduction cascades that can directly activate and sensitize nociceptors and enhance pain transmission. They also play essential roles in chemotaxis and immune cell infiltration leading to inflammation. We wished to determine which PI3K isoforms were involved in each of these processes. Lightly anesthetized rats (isoflurane) were injected subcutaneously with carrageenan in their hind paws. This was preceded by a local injection of 1% DMSO vehicle or an isoform-specific antagonist to PI3K-α (compound 15-e), -β (TGX221), -δ (Cal-101), or -γ (AS252424). We measured changes in the mechanical pain threshold and spinal c-Fos expression (4 hours after injection) as indices of nociception. Paw volume, plasma extravasation (Evans blue, 0.3 hours after injection), and neutrophil (myeloperoxidase; 1 hour after injection) and macrophage (CD11b+; 4 hour after injection) infiltration into paw tissue were the measured inflammation endpoints. Only PI3K-γ antagonist before treatment reduced the carrageenan-induced pain behavior and spinal expression of c-Fos (P ≤ 0.01). In contrast, pretreatment with PI3K-α, -δ, and-γ antagonists reduced early indices of inflammation. Plasma extravasation PI3K-α (P ≤ 0.05), -δ (P ≤ 0.05), and -γ (P ≤ 0.01), early (0-2 hour) edema -α (P ≤ 0.05), -δ (P ≤ 0.001), and -γ (P ≤ 0.05), and neutrophil infiltration (all P ≤ 0.001) were all reduced compared to vehicle pretreatment. Later (2-4 hour), edema and macrophage infiltration (P ≤ 0.05) were reduced by only the PI3K-δ and -γ isoform antagonists, with the PI3K-δ antagonist having a greater effect on edema. PI3K-β antagonism was ineffective in all paradigms. These data indicate that pain and clinical inflammation are pharmacologically separable and may help to explain clinical conditions in which inflammation naturally wanes or goes into remission, but pain continues unabated. KW - c-Fos KW - macrophage KW - neutrophil KW - plasma extravasation KW - pain KW - edema Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-150248 VL - 157 IS - 1 ER - TY - JOUR A1 - Pritchard, Rory A. A1 - Falk, Lovissa A1 - Larsson, Mathilda A1 - Leinders, Mathias A1 - Sorkin, Linda S. T1 - Different phosphoinositide 3-kinase isoforms mediate carrageenan nociception and inflammation JF - Pain N2 - Phosphoinositide 3-kinases (PI3Ks) participate in signal transduction cascades that can directly activate and sensitize nociceptors and enhance pain transmission. They also play essential roles in chemotaxis and immune cell infiltration leading to inflammation. We wished to determine which PI3K isoforms were involved in each of these processes. Lightly anesthetized rats (isoflurane) were injected subcutaneously with carrageenan in their hind paws. This was preceded by a local injection of 1% DMSO vehicle or an isoform-specific antagonist to PI3K-α (compound 15-e), -β (TGX221), -δ (Cal-101), or -γ (AS252424). We measured changes in the mechanical pain threshold and spinal c-Fos expression (4 hours after injection) as indices of nociception. Paw volume, plasma extravasation (Evans blue, 0.3 hours after injection), and neutrophil (myeloperoxidase; 1 hour after injection) and macrophage (CD11b+; 4 hour after injection) infiltration into paw tissue were the measured inflammation endpoints. Only PI3K-γ antagonist before treatment reduced the carrageenan-induced pain behavior and spinal expression of c-Fos (P <= 0.01). In contrast, pretreatment with PI3K-α, -δ, and -γ antagonists reduced early indices of inflammation. Plasma extravasation PI3K-α (P <= 0.05), -δ (P <= 0.05), and -γ (P <= 0.01), early (0-2 hour) edema -α (P <= 0.05), -δ (P <= 0.001), and -γ (P <= 0.05), and neutrophil infiltration (all P <= 0.001) were all reduced compared to vehicle pretreatment. Later (2-4 hour), edema and macrophage infiltration (P <= 0.05) were reduced by only the PI3K-δ and -γ isoform antagonists, with the PI3K-δ antagonist having a greater effect on edema. PI3K-β antagonism was ineffective in all paradigms. These data indicate that pain and clinical inflammation are pharmacologically separable and may help to explain clinical conditions in which inflammation naturally wanes or goes into remission, but pain continues unabated. KW - c-Fos KW - Edema KW - Macrophage KW - Neutrophil KW - Plasma extravasation KW - Pain KW - PI3K isoforms Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-191312 VL - 157 IS - 1 ER - TY - THES A1 - Preisshofen, Tobias T1 - Apoptosemessungen bei Thymompatienten mit und ohne Myasthenia Gravis T1 - patient with thymoma N2 - Thmyome komen sehr selten mit und ohne Myasthenia Gravis vor und sind ein gutes Beispiel für Autoimmunerkrankungen N2 - Thymoma are very rare KW - Thymom KW - Mysthenia Gravis KW - thymoma Y1 - 2005 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-15973 ER - TY - THES A1 - Pracher, Florian T1 - Verhalten von C-Fasern der Maus während repetitiver elektrischer Stimulation : Bedeutung für die Fasererregbarkeit und die Rolle von Ih und Nav1.8 T1 - Behaviour of c-fibres in mice during repetitive electrical stimulation: contribution to fibre excitability and role of Ih and Nav1.8 N2 - Die Axone im peripheren Nerven unterliegen während elektrischer Erregung kontinuierlichen dynamischen Änderungen ihrer Membraneigenschaften. Auf ein Aktionspotential folgt zunächst die absolute und die relative Refraktärperiode, dann eine Periode der Übererregbarkeit („superexcitability“) und schliesslich die Zeit der späten Untererregbarkeit („delayed subexcitability“). Stimuliert man unmyelinisierte Nervenfasern über einen längeren Zeitraum, so kommt es zu einer kontinuierlichen Erhöhung der Reizschwelle und damit einhergehend zu einer Zunahme der Latenz (=“activity dependent slowing“). Dabei bestehen Unterschiede zwischen den einzelnen funktionellen Faserklassen. In dieser Arbeit konnte erstmals bei Ableitung von C-Fasern in C57BL/6 Mäusen in vitro gezeigt werden, dass hitzeunempfindliche CM- und CMC-Fasern während elektrischer Stimulation eine geringere Latenzzunahme erfuhren als hitzesensible CMH- und CMHC-Fasern, auch in der Fasererholung bestanden Unterschiede zwischen beiden Gruppen. Dass in diesem Porozess Ih–Kanäle die Latenzzunahme v.a. bei den hitzeunempfindlichen Fasern limitieren, konnte in Experimenten mit den Ih-Kanal-Blockern CsCl (5mM) und ZD 7288 (1-50µM) gezeigt werden. In Ableitungen von C-Fasern in Mäusen mit Inaktivierung des Gens von Nav1.8 kam es vor allem bei den hitzeempfindlichen Fasern häufiger zu Leitungsblocks, die Latenzänderungen waren geringer als bei den Wildtyp-Tieren. Ströme durch diesen Kanal scheinen einerseits für die Leitungssicherheit der Fasern eine Rolle zu spielen, andererseits scheinen sie auch über einen erhöhten Natriumeinstrom während des Aktionspotentials und damit einer stärkeren Aktivierung der Na+/K+-ATPase die Dauer der Refraktärperiode zu beeinflussen. Beide Mechanismen beeinflussen somit die Reizschwelle und damit die Erregbarkeit einer Faser. Sowohl die Kinetik von Ih als auch die von Nav1.8 wird durch Entzündungsmediatoren beeinflusst, damit werden sie zu interessanten Kandidaten bei der Sensibilisierung von Fasern im Rahmen von inflammatorischen und neuropathischen Schmerzen. N2 - During electrical stimulation axons of a peripheral nerve are subject to dynamic changes of their membrane properties. An action potential is directly followed by the absolute and relative refractory period, subsequently a period of superexcitability and finally a period of delayed subexcitability. Stimulating an unmyelinated nerve fibre over a longer period of time leads to a continuous increase of threshold together with a prolongation of latency, a phenomena named activity dependent slowing. These properties differ for distinct functional fibre classes. Here, using recordings of C-fibres in C57Bl6 mice in vitro it could be shown for the first time that heat-insensitive CM- and CMC-fibres showed a smaller latency increase following electric stimulation than heat-sensitive CMH- and CMHC-fibres. Corresponding differences in recovery between both groups could be observed. In experiments with the Ih–channel blockers CsCl (5 mM) and ZD 7288 (1-50µM) it could be shown that currents through Ih–channels limited the latency increase especially in heat-insensitive units. In recordings of C-fibres in mice with an inactivation of the gene encoding for Nav1.8 the number of conduction blocks increased and the latency shifts decreased compared to fibres recorded in wild type mice. Therefore on the one hand currents carried by this channel seem to be important for conduction safety, on the other hand they seem to influence the duration of the refractory period through an increased sodium influx during the action potential and a consequent increased activation of the sodium pump. Both mechanisms therefore determine threshold and excitability of a fibre. The kinetics of Ih as well as that of Nav1.8 are effected by mediators of inflammation which makes them interesting candidates for fibre sensitisation in inflammatory and neuropathic pain. KW - C-Faser KW - Erregbarkeit KW - Latenzänderung KW - Ih KW - Nav1.8 KW - c-fibre KW - excitability KW - recovery KW - latency shift KW - activity-dependent slowing Y1 - 2004 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-7933 ER - TY - JOUR A1 - Pozzi, Nicoló Gabriele A1 - Bolzoni, Francesco A1 - Biella, Gabriele Eliseo Mario A1 - Pezzoli, Gianni A1 - Ip, Chi Wang A1 - Volkmann, Jens A1 - Cavallari, Paolo A1 - Asan, Esther A1 - Isaias, Ioannis Ugo T1 - Brain noradrenergic innervation supports the development of Parkinson’s tremor: a study in a reserpinized rat model JF - Cells N2 - The pathophysiology of tremor in Parkinson’s disease (PD) is evolving towards a complex alteration to monoaminergic innervation, and increasing evidence suggests a key role of the locus coeruleus noradrenergic system (LC-NA). However, the difficulties in imaging LC-NA in patients challenge its direct investigation. To this end, we studied the development of tremor in a reserpinized rat model of PD, with or without a selective lesioning of LC-NA innervation with the neurotoxin DSP-4. Eight male rats (Sprague Dawley) received DSP-4 (50 mg/kg) two weeks prior to reserpine injection (10 mg/kg) (DR-group), while seven male animals received only reserpine treatment (R-group). Tremor, rigidity, hypokinesia, postural flexion and postural immobility were scored before and after 20, 40, 60, 80, 120 and 180 min of reserpine injection. Tremor was assessed visually and with accelerometers. The injection of DSP-4 induced a severe reduction in LC-NA terminal axons (DR-group: 0.024 ± 0.01 vs. R-group: 0.27 ± 0.04 axons/um\(^2\), p < 0.001) and was associated with significantly less tremor, as compared to the R-group (peak tremor score, DR-group: 0.5 ± 0.8 vs. R-group: 1.6 ± 0.5; p < 0.01). Kinematic measurement confirmed the clinical data (tremor consistency (% of tremor during 180 s recording), DR-group: 37.9 ± 35.8 vs. R-group: 69.3 ± 29.6; p < 0.05). Akinetic–rigid symptoms did not differ between the DR- and R-groups. Our results provide preliminary causal evidence for a critical role of LC-NA innervation in the development of PD tremor and foster the development of targeted therapies for PD patients. KW - Parkinson’s disease KW - tremor KW - locus coeruleus KW - noradrenaline KW - reserpinized rat model Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357721 SN - 2073-4409 VL - 12 IS - 21 ER - TY - THES A1 - Pozzi, Nicoló Gabriele T1 - Parkinson’s disease revisited: multiple circuitopathies T1 - Neuinterpretation des Morbus Parkinson als multiple Netzwerkerkrankung N2 - Parkinson’s disease (PD) is among the most common neurodegenerative conditions, and it is characterized by the progressive loss of dopaminergic neurons and a great variability in clinical expression. Despite several effective medications, it still causes disability as all patients show treatment-resistant symptoms and complications. A possible reason for this therapeutic-burden and great clinical variability lies in a probable misconception about its pathophysiology, one that focuses on neurodegeneration, while largely neglecting its functional consequences and the related compensatory changes. In this thesis, I expand on the hypothesis that some PD symptoms have a dysfunctional origin and reflect derangements of neural network dynamics, the means by which brain coordination supports any motor behaviour. In particular, I have investigated resting tremor and freezing of gait, two common symptoms with an enigmatic mechanism and suboptimal management. In the case of tremor, I predicted a pathological change in response to dopamine loss, which included the activation of noradrenergic (NA) neurons of the locus coeruleus (LC) projecting to the cerebellum. This compensatory LC activation that supports dopaminergic neurons might indeed come at the expense of tremor development. To assess the role of LC-NA in tremor development, I recorded tremor occurrence in the reserpinized rat model of PD, one of very few showing tremor, after selective lesioning (with the neurotoxin DSP-4) of the LC-NA terminal axons. DSP-4 induced a severe reduction of LC-NA terminal axons in the cerebellar cortex and this was associated with a significant reduction in tremor development. Unlike its development, tremor frequency and the akinetic rigid signs did not differ between the groups, thus suggesting a dopaminergic dependency. These findings suggest that the LC-NA innervation of the cerebellum has a critical role for PD tremor, possibly by exerting a network effect, which gates the cerebello-thalamic-cortical circuit into pathological oscillations upon a dopaminergic loss in the basal ganglia. In contrast, for the study of freezing of gait, I worked with human PD subjects and deep brain stimulation, a therapeutic neuromodulation device that in some prototypes also allows the recording of neural activity in freely-moving subjects. Gait freezing is a disabling PD symptom that suddenly impairs effective stepping, thus causing falls and disability. Also in this study, I hypothesized that the underlying pathophysiology may be represented by dysfunctional neural network dynamics that abruptly impair locomotor control by affecting the communication in the supraspinal locomotor network. To test this hypothesis, I investigated the coupling between the cortex and the subthalamic nucleus, two main nodes of the supraspinal locomotor network, in freely-moving subjects PD patients and also performed molecular brain imaging of striatal dopamine receptor density and kinematic measurements. I found that in PD patients, walking is associated with cortical-subthalamic stable coupling in a low-frequency band (i.e. θ-α rhythms). In contrast, these structures decoupled when gait freezing occurred in the brain hemisphere with less dopaminergic innervation. These findings suggest that freezing of gait is a “circuitopathy”, with dysfunctional cortical-subcortical communication. Altogether the results of my experiments support the hypothesis that the pathophysiology of PD goes beyond neurodegenerative (loss-of-function) processes and that derangement of neural network dynamics coincides with some disabling PD symptoms, thus suggesting that PD can be interpreted as the combination of multiple circuitopathies. N2 - Die Parkinson-Krankheit ist eine neurodegenerative Erkrankung mit einem progressiven Verlust dopaminerger Neurone, die trotz wirksamer Medikamente zur Einschränkung in der Lebensqualität führen kann. Eine mögliche Ursache für diese unzureichende Behandlung der Symptome liegt in einem möglichen Missverständnis über die Pathophysiologie der Krankheit, die sich auf die Neurodegeneration konzentriert. Bei der Parkinson-Krankheit können jedoch funktionelle Veränderungen aufgrund der Neurodegeneration sowie die damit verbundenen kompensatorischen Modifikationen sehr wichtig sein. Der Fokus meiner Dissertation liegt in der Bearbeitung der Hypothese, dass einige Symptome der Parkinson-Krankheit einen dysfunktionellen Ursprung haben können. Insbesodere habe ich den Ruhetremor und das Freezing-Phänomen, das eine Blockade des Gehens bedeutet, untersucht, um zu erklären, ob ein Störung der neuronalen Netzwerkdynamik diese Symptome verursachen kann. In dieser Arbeit wurde zuerst die Entwicklung des Ruhetremors bei der Parkinson-Krankheit untersucht. Meine Hypothese war, dass eine Aktivierung von projizierenden noradrenergen Fasern des Locus-Coeruleus zum Cerebellum das Auftreten des Tremors verursachen kann, welches durch den Verlust dopaminerger Neurone verursacht wird. Da die Aktivität des Locus-Coeruleus bei Patienten mit Parkisnon-Krankheit nicht messbar ist, wurde dies in einem Parkinson-Rattenmodell untersucht. Die Ratten wurden etweder mit Reserpin oder mit Reserpine plus eine Neurotoxin gegen noradrenerger Neuronen (DSP-4) behandelt. Diese Behandlung mit DSP-4 führte zur Degeneration noradrenerger Terminalen im Locus-Coeruleus. Das Auftreten von Tremor zwischen die beiden Gruppen von Ratten war unterschiedlich. Insbesondere entwickelten DSP-4 behandelte Ratten einen niedrigen Ruhetremor. Dieses Ergebnis deutet darauf hin, dass die noradrenerge Innervation des Cerebellums vom Locus-Ceruleus für das Auftreten des Ruhetremors eine große Rolle spielt. In der Frequenz des Tremors sowie in den akinetischen Symptomen konnte kein Unterschied zwischen den Gruppen festgestellt werden. Das zeigt, dass diese akinetischen Symptome vom Dopaminverlust abhängig sind. Die Kombination von Tremor und akinetischen Symptomen kann aufgrund eines patologischen Netzwerkeffekts entstehen, welche vom Verlust dopaminerger Neurone in den Basalganglien im Zusammenspiel mit der kompensatorischen Aktivierung noradrenerger Neurone des Locus-Coeruleus verursacht werden kann. Des Weiteren wurde der Ursprung des Freezing-Phänomens bei Patienten, die an der Parkinson-Krankheit leiden und eine therapeutische Behandlung mittels Tiefer Hirnstimulation (THS) bekommen haben, untersucht. Insbesodere konnten mittels neuer THS-Prototypen Messungen neuronaler Aktivität von Bewegungen durchgeführt werden. In dieser Studie stellte ich die Hypothese auf, dass die Pathophysiologie des Freezings durch eine fehlerhafte neuronale Dynamik der Bewegungsnetzwerke erklärt werden kann. Um dies zu testen, wurde die Kommunikation zwischen den zwei Hauptknoten des Bewegungsnetzwerkes, dem Kortex und dem Nucleus Subthalamicus, bei THS behandelten Parkinson-Patienten während des Gehens und den Freezing-Episoden untersucht. Zudem wurde bei diesen Patienten eine molekulare Darstellung der dopaminergen Rezeptoren in den Basalganglien durchgeführt. Zusätzlich wurden kinematischen Messungen der Bewegungen vorgenommen, die eine präzise Beschreibung des Freezings ermöglichen. Es konnte gezeigt werden, dass bei Patienten mit der Parkinson-Krankheit ein Zusammenhang von stabiler Kommunikation zwischen dem Kortex und dem Nucleus Subthalamicus bei einer bestimten Frequenz (d.h. θ-α-Rhythmen) beim Gehen besteht. Beim Auftreten des Freezing-Phänomens konnte diese Kommunikation in der Gehirnhemisphäre mit weniger dopaminerger Innervation nicht mehr nachgewiesen werden. Diese Ergebnisse deuten darauf hin, dass das Freezing-Phänomen eine „Circuitopathie“ ist, in der eine fehlerhafte Kommunikation zwischen kortikalen und subkortikalen Arealen zur Bewegungsblockade führen kann. Insgesamt stützen die Ergebnisse meiner Experimente die Hypothese, dass die Pathophysiologie der Parkinson-Krankheit sowohl über neurodegenerative Prozesse (Zellverlust) als auch über Störungen der neuronalen Netzwerkdynamik (Funktionsverlust) hinausgeht. Das deutet darauf hin, dass die Parkison-Krankheit als „Circuitopathie“ interpretiert werden kann. KW - Parkinson-Krankheit KW - freezing of gait KW - resting tremor KW - circuitopathies Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-216715 ER - TY - JOUR A1 - Pozzi, Nicoló G. A1 - Palmisano, Chiara A1 - Reich, Martin M. A1 - Capetian, Philip A1 - Pacchetti, Claudio A1 - Volkmann, Jens A1 - Isaias, Ioannis U. T1 - Troubleshooting gait disturbances in Parkinson’s disease with deep brain stimulation JF - Frontiers in Human Neuroscience N2 - Deep brain stimulation (DBS) of the subthalamic nucleus or the globus pallidus is an established treatment for Parkinson’s disease (PD) that yields a marked and lasting improvement of motor symptoms. Yet, DBS benefit on gait disturbances in PD is still debated and can be a source of dissatisfaction and poor quality of life. Gait disturbances in PD encompass a variety of clinical manifestations and rely on different pathophysiological bases. While gait disturbances arising years after DBS surgery can be related to disease progression, early impairment of gait may be secondary to treatable causes and benefits from DBS reprogramming. In this review, we tackle the issue of gait disturbances in PD patients with DBS by discussing their neurophysiological basis, providing a detailed clinical characterization, and proposing a pragmatic programming approach to support their management. KW - Parkinson’s disease KW - freezing of gait (FOG) KW - deep brain stimulation (DBS) KW - subthalamic nucleus (STN) KW - globus pallidus pars interna (GPi) KW - pedunculopontine nucleus (PPN) Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-274007 SN - 1662-5161 VL - 16 ER - TY - JOUR A1 - Politei, Juan M. A1 - Bouhassira, Didier A1 - Germain, Dominique P. A1 - Goizet, Cyril A1 - Guerrero-Sola, Antonio A1 - Hilz, Max J. A1 - Hutton, Elspeth J. A1 - Karaa, Amel A1 - Liuori, Rocco A1 - Üceyler, Nurcan A1 - Zeltzer, Lonnie K. A1 - Burlina, Alessandro T1 - Pain in fabry disease: practical recommendations for diagnosis and treatment JF - CNS Neuroscience & Therapeutics N2 - Aims: Patients with Fabry disease (FD) characteristically develop peripheral neuropathy at an early age, with pain being a crucial symptom of underlying pathology. However, the diagnosis of pain is challenging due to the heterogeneous and nonspecific symptoms. Practical guidance on the diagnosis and management of pain in FD is needed. Methods: In 2014, experts met to discuss recent advances on this topic and update clinical guidance. Results: Emerging disease-specific tools, including FabryScan, Fabry-specific Pediatric Health and Pain Questionnaire, and Wurzburg Fabry Pain Questionnaire, and more general tools like the Total Symptom Score can aid diagnosis, characterization, and monitoring of pain in patients with FD. These tools can be complemented by more objective and quantifiable sensory testing. In male and female patients of any age, pain related to FD can be an early indication to start disease-specific enzyme replacement therapy before potentially irreversible organ damage to the kidneys, heart, or brain occurs. Conclusion: To improve treatment outcomes, pain should be diagnosed early in unrecognized or newly identified FD patients. Treatment should include: (a) enzyme replacement therapy controlling the progression of underlying pathology; (b) adjunctive, symptomatic pain management with analgesics for chronic neuropathic and acute nociceptive, and inflammatory or mixed pain; and (c) lifestyle modifications. KW - Enzyme replacement therapy KW - Small fiber dysfunction KW - System involvement KW - Outcome survey KW - Fabry disease KW - Randomized controlled-trial KW - Chronic neuropathic pain KW - Agalsidase beta KW - Screening questionnaire KW - Dose reduction KW - Adult patients KW - Diagnosis KW - Pain KW - Peripheral nervous system Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-188127 VL - 22 IS - 7 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 - Poh, Eugenia Z. A1 - Green, Courtney A1 - Agostinelli, Luca A1 - Penrose-Menz, Marissa A1 - Karl, Ann-Kathrin A1 - Harvey, Alan R. A1 - Rodger, Jennifer T1 - Manipulating the level of sensorimotor stimulation during LI-rTMS can improve visual circuit reorganisation in adult ephrin-A2A5\(^{-/-}\) Mice JF - International Journal of Molecular Sciences N2 - Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that has the potential to treat a variety of neurologic and psychiatric disorders. The extent of rTMS-induced neuroplasticity may be dependent on a subject’s brain state at the time of stimulation. Chronic low intensity rTMS (LI-rTMS) has previously been shown to induce beneficial structural and functional reorganisation within the abnormal visual circuits of ephrin-A2A5\(^{-/-}\) mice in ambient lighting. Here, we administered chronic LI-rTMS in adult ephrin-A2A5\(^{-/-}\) mice either in a dark environment or concurrently with voluntary locomotion. One day after the last stimulation session, optokinetic responses were assessed and fluorescent tracers were injected to map corticotectal and geniculocortical projections. We found that LI-rTMS in either treatment condition refined the geniculocortical map. Corticotectal projections were improved in locomotion+LI-rTMS subjects, but not in dark + LI-rTMS and sham groups. Visuomotor behaviour was not improved in any condition. Our results suggest that the beneficial reorganisation of abnormal visual circuits by rTMS can be significantly influenced by simultaneous, ambient visual input and is enhanced by concomitant physical exercise. Furthermore, the observed pathway-specific effects suggest that regional molecular changes and/or the relative proximity of terminals to the induced electric fields influence the outcomes of LI-rTMS on abnormal circuitry. KW - LI-rTMS KW - neuroplasticity KW - visual pathways KW - topography KW - visual activity KW - locomotion KW - brain state Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-284090 SN - 1422-0067 VL - 23 IS - 5 ER - TY - THES A1 - Pizon, Dorothea T1 - Prognose des raumfordernden Mediainfarktes bei konservativer vs. operativer Therapie am Universitätsklinikum Würzburg 1993-2005 T1 - Prognosis of conservative vs. surgical treatment of the space-occupying middle cerebral artery infarction at the University Hospital Wuerzburg 1993-2005 N2 - In dieser Studie wurden Schlaganfallpatienten untersucht, die einen ausgedehnten Infarkt im Versorgungsgebiet der A.cerebri media erlitten und wegen Bewusstseinstrübung (sog. Maligner Mediainfarkt) auf der Neurologischen Intensivstation des Universitätsklinikums Würzburg im Zeitraum von 1991 bis 2005 behandelt wurde, um herauszufinden, welchen Einfluss eine operative Behandlung auf den kritisch erhöhten Hirnsdrucks zusätzlich zur konservativen Intensivtherapie auf Mortalität sowie langfristige Lebensqualität hatte. Insgesamt konnten die Daten von 292 Patienten ausgewertet werden, wovon 259 konservativ und 33 operativ behandelt worden waren. Es zeigte sich insgesamt, dass eine stillschweigende günstige Selektion für eine Trepanation sprach (jünger, eher keine Aphasie, weniger Komorbiditäten). Die Hemikraniektomie senkte die Mortalität in der Akutphase hochsignifikant (K: 22, 4%, T: 3,0%; p=0,009). Sie hatte erwartungsgemäß auch einen positiven Einfluss auf das Vigilanzniveau: die Quote von wachen Patienten war bei Entlassung der Trepanierten um 66% höher als bei Aufnahme, bei den konservativ Behandelten war sie nur um 33,3 % gestiegen. Das vorherrschende Symptom bei Aufnahme und Entlassung war eine motorische bzw. sensomotorische Hemiparese. Der Anteil der Aphasiker bei den 201 konservativ therapierten Patienten, die den stationären Aufenthalt überlebt haben, ist von bei Aufnahme 56,2% auf bei Entlassung 48,6% gesunken. Bei den 32 trepanierten Patienten ist er dagegen mit 50% gleich geblieben, obwohl 2/3 aller Patienten an der nicht-dominanten Hemisphäre operiert worden waren. Es war und ist auch nicht zu erwarten, dass eine Entlastung von Hirndruck qualitativ die hirninfarktbedingten Symptome beseitigt. Die Nachbefragung der Patienten fand im Schnitt 64,7 Monate nach erlittenem Mediainfarkt statt. Inzwischen waren von den 259 konservativ Behandelten 47,1% verstorben, von den 33 Hemikraniektomierten nur 24,2%. Die poststationäre Mortalität im weiteren Verlauf war anteilsmäßig gering (K: 24%, T: 21,2%). Die Überlebensdauer der Trepanierten war dreimal so lang wie die der nicht operierten (K: 11,6 Monate, T: 34,4 Monate). Diese Unterschiede im Langzeitüberleben sind wahrscheinlicher auf die geringeren Komorbiditäten der Trepanierten zurückzuführen, als auf die stattgehabte Operation an sich. Allerdings ist nicht auszuschließen, dass die durch Trepanation frühzeitiger verbesserte Wachheit sich auch günstig auf lebensverkürzende Folgekomplikationen ausgewirkt haben könnte. In der Nachbefragung zeigte sich, dass bezüglich der erworbenen körperlichen Funktionsdefizite, gemessen am Barthel Index, zwischen den beiden Kollektiven kein signifikanter Unterschied bestand. Die ehemals konservativ behandelten Patienten kamen auf durchschnittlich 75, die trepanierten Patienten auf 60 von 100 Punkten. Im Lebensalltag schlägt sich dieser Unterschied von 15 Punkten relevant nieder, aber insgesamt liegen beide Patientenkollektive im Bereich einer leichten bis nicht vorhandenen Abhängigkeit. Die vergleichbaren Langzeitdaten von Patienten mit Mediainfarkt liegen in einem ähnlichen Bereich. Erstmalig werden hier Langzeitdaten solcher Patienten über die Lebensqualität vorgelegt, gemessen mit dem SF-36. Nachvollziehbar zeigte sich ein deutlicher Unterschied zur Lebensqualität der Durchschnittsbevölkerung, insbesondere im Bereich der körperlichen Belastbarkeit. Für uns unerwartet günstig fielen die Antworten auf der eher psychologischen Ebene aus. Es zeigten sich bei allen Punkten des SF-36 keine signifikanten Unterschiede zwischen dem konservativ behandelten und den hemikraniektomierten Patienten, so dass die Operation als solche keinen eigenständigen Einfluss auf die langfristige Lebensqualität nahm. Zusammengefasst verbesserte die osteoklastische Trepanation des raumfordernden malignen Mediainfarkts die Überlebenschance in der Akutphase signifikant, was mit inzwischen publizierten kontrollierten Studienergebnissen übereinstimmt. Der Langzeitverlauf nach überlebter Akutkrankheit gestaltet sich unabhängig von der Trepanation. Es gibt aufgrund der erworbenen Behinderung eine weiterhin relativ hohe längerfristige Sterblichkeit. Bemerkenswert ist, dass die Selbsteinschätzung der Lebensqualität von Patienten mit einer erheblichen infarktbedingen körperlichen Behinderung psychologisch-emotional nur geringfügig von der Selbstwahrnehmung in der nicht- behinderten Durchschnittsbevölkerung. Dass bedeutet, dass Spekulationen über die zukünftige Lebensqualität keinen Einfluss auf die Operationsindikation nehmen sollten. N2 - In this retrospective study we looked at the sub-group of stroke patients who suffered a large infarction in the area of the middle cerebral artery and were treated in neurological intensive care between 1991 and 2005 due to imminent or already existent decreased conscious level (so called malignant middle cerebral artery infarction) (n=292). The aim was to find out what influence a surgical treatment has on stroke-related increased intracerebral pressure additionally to the usual conservative intesive therapy with regards to acute and longterm survival. In total data from 292 intensiv care patients was evaluated, which consisted of 259 purely conservatively and 33 surgically treated patients. 
Altogether there was a positive selection for surgically treated patients (younger, no aphasia, less comorbidities). Decompressive hemicraniectomy lowered the mortality in the acute phase significantly (c: 22.4%, h: 3.0%; p=0.009). As expected decompressive hemicraniectomy also positively influenced the conscious level: the number of fully alert patients on discharge was 66% higher than on admission. In the group of the conservatively treated patients this number was only 33% higher (on discharge: c: 87% and h: 90.6% fully alert).The mean physical findings on discharge from neurological intensive care showed no significant difference between the conservatively and surgically treated group. The main symptoms were – as on admission – a motor or sensomotor hemiparesis. The prevalence of aphasia dropped in the group of 201 conservatively patients who survived the hospital stay from 56.2% on admission to 48.% on discharge (p= 0.5). In the 32 patients after hemicraniectomy who survived the hospital admission the number of aphasic patients did not change from admission to discharge (50%). It is not expected that a release of intracerebral pressure completely resolves stroke-connected symptoms. During the stay on intensive care physical and neuropsychological function was not systemically assessed using stroke function scales so we cannot comment on how the symptoms changed quantatively after the treatment. There is a possibility that arguments would be pro-hemicraniectomy. On average 64.7 months passed between the stroke and the follow-up examination. In the meantime 47.1% of the 259 conservatively treated patients had died. Of 33 patients after decompressive hemicraniectomy only 24.2% had died (p=0.01). There was a significant difference in the hospital mortality (c: 24%, h: 21.2%). The longterm mortality showed a smaller difference (c: 24%, h: 21.2%). The survival period of the surgically treated patients was three times longer (c: 11.6%, h: 34.4 months). The difference in survival length is most likely due to less comorbidities in the surgically treated patients than to the hemicraniectomy itself. However it can also not be ruled out that due to the earlier achieved improvement of conscious level postoperatively potential future complications could be prevented. With regards to acquired physical functional deficits, measured with the Barthel index, both groups did not reveal any significant difference (p=0.10). The mean Barthel index in the conservatively treated patients was 75 out of 100 and 60 out of 100 in the patients after decompressive hemicraniectomy. That means that patients from both groups were either independent or slightly dependant from other people in their every day life. For the first time we were presenting longterm data on subjective quality of life from patients after middle cerebral artery infarction, measured with the SF-36 health survey [Bullinger et al. 1998]. As expected there was a major difference between our patient group and a comparable average population, especially in areas like “physical function”. The results on a more psychological level like “vitality” and “mental health” were better than expected. They only mildly differed from the average population. The SF-36 health survey did not show any significant difference between the conservatively treated and the surgically treated group. That indicates how the decompressive hemicraniectomy alone did not have an influence on longterm quality of life. In summary the survival rate was inreased significantly by decompressive hemicraniectomy in malignant middle cerebral artery infarction at the University Hospital Wuerzburg between 1991 and 2005, which was also confirmed by other publicated controlled studies [Jüttler et al. 2007; Vahedi et al. 2007; Fandino et al. 2004]. It is remarkable that the subjective quality of life of patients with a considerable disability differs only slightly from the perception of a non-impaired control group. That means that speculations about a future quality of life should not influence a decision for or against decompressive hemicraniectomy. KW - Arteria cerebri media KW - Schlaganfall KW - Arteria carotis interna KW - Carotisstenose KW - Trepanation KW - Infarkt KW - Hirndruck KW - Hirnödem KW - Sekundärprävention KW - Barthel Index KW - Rehabilitation KW - Matched pairs KW - dekompressive Hemikraniektomie KW - maligner Mediainfarkt KW - Dekompressionskraniektomie KW - Middle cerebral artery infarction KW - malignant middle cerebrial artery infarction KW - decompressive hemicraniectomy KW - Barthel Index Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-70232 ER - TY - JOUR A1 - Piroth, Tobias A1 - Boelmans, Kai A1 - Amtage, Florian A1 - Rijntjes, Michel A1 - Wierciochin, Anna A1 - Musacchio, Thomas A1 - Weiller, Cornelius A1 - Volkmann, Jens A1 - Klebe, Stephan T1 - Adult-Onset Niemann-Pick Disease Type C: Rapid Treatment Initiation Advised but Early Diagnosis Remains Difficult JF - Frontiers in Neurology N2 - Niemann–Pick type C disease (NP-C) presents with heterogeneous neurological and psychiatric symptoms. Adult onset is rare and possibly underdiagnosed due to frequent lack of specific and obvious key symptoms. For both early and adolescent/adult onset, the available data from studies and case reports describe a positive effect of Miglustat (symptom relief or stabilization). However, due to the low frequency of NP-C, experience with this therapy is still limited. We describe two adult-onset cases of NP-C. In both cases, vertical supranuclear gaze palsy was not recognized at symptom onset. Correct diagnosis was delayed from onset of symptoms by more than 10 years. The video demonstrates the broad spectrum of symptoms in later stages of the disease. Compared with published data, the treatment outcome observed in our cases after delayed initiation of Miglustat therapy was disappointing, with continuing disease progression in both cases. Thus, early treatment initiation could be necessary to achieve a good symptomatic effect. Hence, early biochemical testing for NP-C should be considered in patients suffering from atypical neurological/neuropsychological and psychiatric symptoms, even in cases of uncertainty. KW - Niemann–Pick disease type C KW - adult-onset KW - NPC1 gene KW - NPC2 gene KW - plasma oxysterols Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-171001 VL - 8 IS - 108 ER - TY - JOUR A1 - Piro, Inken A1 - Eckes, Anna-Lena A1 - Kasaragod, Vikram Babu A1 - Sommer, Claudia A1 - Harvey, Robert J. A1 - Schaefer, Natascha A1 - Villmann, Carmen T1 - Novel Functional Properties of Missense Mutations in the Glycine Receptor β Subunit in Startle Disease JF - Frontiers in Molecular Neuroscience N2 - Startle disease is a rare disorder associated with mutations in GLRA1 and GLRB, encoding glycine receptor (GlyR) α1 and β subunits, which enable fast synaptic inhibitory transmission in the spinal cord and brainstem. The GlyR β subunit is important for synaptic localization via interactions with gephyrin and contributes to agonist binding and ion channel conductance. Here, we have studied three GLRB missense mutations, Y252S, S321F, and A455P, identified in startle disease patients. For Y252S in M1 a disrupted stacking interaction with surrounding aromatic residues in M3 and M4 is suggested which is accompanied by an increased EC\(_{50}\) value. By contrast, S321F in M3 might stabilize stacking interactions with aromatic residues in M1 and M4. No significant differences in glycine potency or efficacy were observed for S321F. The A455P variant was not predicted to impact on subunit folding but surprisingly displayed increased maximal currents which were not accompanied by enhanced surface expression, suggesting that A455P is a gain-of-function mutation. All three GlyR β variants are trafficked effectively with the α1 subunit through intracellular compartments and inserted into the cellular membrane. In vivo, the GlyR β subunit is transported together with α1 and the scaffolding protein gephyrin to synaptic sites. The interaction of these proteins was studied using eGFP-gephyrin, forming cytosolic aggregates in non-neuronal cells. eGFP-gephyrin and β subunit co-expression resulted in the recruitment of both wild-type and mutant GlyR β subunits to gephyrin aggregates. However, a significantly lower number of GlyR β aggregates was observed for Y252S, while for mutants S321F and A455P, the area and the perimeter of GlyR β subunit aggregates was increased in comparison to wild-type β. Transfection of hippocampal neurons confirmed differences in GlyR-gephyrin clustering with Y252S and A455P, leading to a significant reduction in GlyR β-positive synapses. Although none of the mutations studied is directly located within the gephyrin-binding motif in the GlyR β M3-M4 loop, we suggest that structural changes within the GlyR β subunit result in differences in GlyR β-gephyrin interactions. Hence, we conclude that loss- or gain-of-function, or alterations in synaptic GlyR clustering may underlie disease pathology in startle disease patients carrying GLRB mutations. KW - glycine receptor KW - hyperekplexia KW - startle disease KW - gephyrin Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-246676 SN - 1662-5099 VL - 14 ER - TY - JOUR A1 - Pham, Mirko A1 - Helluy, Xavier A1 - Kleinschnitz, Christoph A1 - Kraft, Peter A1 - Bartsch, Andreas J. A1 - Jakob, Peter A1 - Nieswandt, Bernhard A1 - Bendszus, Martin A1 - Guido, Stoll T1 - Sustained Reperfusion after Blockade of Glycoprotein-Receptor-Ib in Focal Cerebral Ischemia: An MRI Study at 17.6 Tesla JF - PLoS ONE N2 - Background: Inhibition of early platelet adhesion by blockade of glycoprotein-IB (GPIb) protects mice from ischemic stroke. To elucidate underlying mechanisms in-vivo, infarct development was followed by ultra-high field MRI at 17.6 Tesla. Methods: Cerebral infarction was induced by transient-middle-cerebral-artery-occlusion (tMCAO) for 1 hour in C57/BL6 control mice (N = 10) and mice treated with 100 mg Fab-fragments of the GPIb blocking antibody p0p/B 1 h after tMCAO (N = 10). To control for the effect of reperfusion, additional mice underwent permanent occlusion and received anti-GPIb treatment (N = 6; pMCAO) or remained without treatment (N = 3; pMCAO). MRI 2 h and 24 h after MCAO measured cerebral-blood-flow (CBF) by continuous arterial-spin labelling, the apparent-diffusion-coefficient (ADC), quantitative-T2 and T2-weighted imaging. All images were registered to a standard mouse brain MRI atlas and statistically analysed voxel-wise, and by cortico-subcortical ROI analysis. Results: Anti-GPIb treatment led to a relative increase of postischemic CBF vs. controls in the cortical territory of the MCA (2 h: 44.2 +/- 6.9 ml/100g/min versus 24 h: 60.5 +/- 8.4; p = 0.0012, F((1,18)) = 14.63) after tMCAO. Subcortical CBF 2 h after tMCAO was higher in anti-GPIb treated animals (45.3 +/- 5.9 vs. controls: 33.6 +/- 4.3; p = 0.04). In both regions, CBF findings were clearly related to a lower probability of infarction (Cortex/Subcortex of treated group: 35%/65% vs. controls: 95%/100%) and improved quantitative-T2 and ADC. After pMCAO, anti-GPIb treated mice developed similar infarcts preceded by severe irreversible hypoperfusion as controls after tMCAO indicating dependency of stroke protection on reperfusion. Conclusion: Blockade of platelet adhesion by anti-GPIb-Fab-fragments results in substantially improved CBF early during reperfusion. This finding was in exact spatial correspondence with the prevention of cerebral infarction and indicates in-vivo an increased patency of the microcirculation. Thus, progression of infarction during early ischemia and reperfusion can be mitigated by anti-platelet treatment. KW - Von-Willebrand-factor KW - Experimental stroke KW - Magnetic-resonance KW - Arterial water KW - Brain KW - Perfusion KW - Mice KW - Inflammation KW - Coefficient KW - mechanisms Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-142608 VL - 6 IS - 4 ER - TY - JOUR A1 - Pham, Mirko A1 - Helluy, X. A1 - Braeuninger, S. A1 - Jakob, P. A1 - Stoll, G. A1 - Kleinschnitz, Christoph A1 - Bendszus, M. T1 - Outcome of experimental stroke in C57Bl/6 and Sv/129 mice assessed by multimodal ultra-high field MRI N2 - Transgenic mice bred on C57Bl/6 or Sv/129 genetic background are frequently used in stroke research. It is well established that variations in cerebrovascular anatomy and hemodynamics can influence stroke outcome in different inbred mouse lines. We compared stroke development in C57Bl/6 and Sv/129 mice in the widely used model of transient middle cerebral artery occlusion (tMCAO) by multimodal ultra-high field magnetic resonance imaging (MRI). C57Bl/6 and Sv/129 mice underwent 60 min of tMCAO and were analyzed by MRI 2 h and 24 h afterwards. Structural and functional images were registered to a standard anatomical template. Probability maps of infarction were rendered by automated segmentation from quantitative T2-relaxometric images. Whole-brain segmentation of infarction was accomplished manually on high-resolution T2-weighted (T2-w) RARE images. Cerebral perfusion (cerebral blood flow, CBF) was measured quantitatively by modified continuous arterial-spin-labeling (CASL) and apparent diffusion coefficients (ADC) by spin-echo diffusion-weighted imaging (DWI). Probabilities of cortical (95.1% ± 3.1 vs. 92.1% ± 2.5; p > 0.05) and subcortical (100% vs. 100%; p > 0.05) infarctions at 24 h were similar in both groups as was the whole-brain volumetric extent of cerebral infarction. In addition, CBF and ADC values did not differ between C57Bl/6 and Sv/129 mice at any time point or region of interest. The C57Bl/6 and Sv/129 genetic background is no major confounding factor of infarct size and cerebral perfusion in the tMCAO model. KW - NMR-Tomographie Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68115 ER - TY - JOUR A1 - Petzke, Frank A1 - Klose, Petra A1 - Welsch, Patrick A1 - Sommer, Claudia A1 - Häuser, Winfried T1 - Opioids for chronic low back pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks of double‐blind duration JF - European Journal of Pain N2 - Background and Objective This updated systematic review evaluated the efficacy, tolerability and safety of opioids compared to placebo in non‐malignant chronic low back pain. Databases and Data Treatment Clinicaltrials.gov, CENTRAL, MEDLINE and PsycINFO were searched from October 2013 to May 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks of double‐blinded duration were analysed. Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety. Effects were summarized by a random effects model using risk differences or standardized mean differences. We added nine new studies with 2,980 participants for a total of 21 studies with 7,650 participants. Study duration ranged between 4 and 15 weeks. Studies with a parallel and cross‐over design: Based on very low to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater, but a clinically relevant reduction of disability compared to placebo. Enriched enrolment randomized withdrawal (EERW) design: Based on very low to low‐quality evidence, opioids provided a clinically relevant pain relief of 50% or greater, but not a clinically relevant reduction of disability compared to placebo. There was no clinically relevant harm with regard to serious adverse events by opioids compared to placebo in studies with parallel/cross‐over and EERW design. There was a relevant harm with regard to drop out rates due to adverse events in studies with parallel/cross‐over, but not in studies with EERW design. Conclusions Opioids may provide a safe and clinically relevant pain relief for 4–15 weeks in highly selected patients. Significance Within the context of randomized controlled trials of 4–15 weeks, opioids provided a clinically relevant pain relief of 30% or greater and a clinically relevant reduction of disability compared to placebo in non‐malignant chronic low back pain. Number needed to treat for an additional drop out due to side effects was 11 (95% confidence interval: 6–33). Assessment of abuse and addiction was incomplete. The frequency of serious adverse events including deaths did not differ from placebo. KW - opioids KW - back pain KW - systematic review Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218498 VL - 24 IS - 3 SP - 497 EP - 517 ER - TY - JOUR A1 - Peterka, Manuel A1 - Odorfer, Thorsten A1 - Schwab, Michael A1 - Volkmann, Jens A1 - Zeller, Daniel T1 - LSVT-BIG therapy in Parkinson's disease: physiological evidence for proprioceptive recalibration JF - BMC Neurology N2 - Background There is growing evidence for proprioceptive dysfunction in patients with Parkinson's disease (PD). The Lee Silvermann Voice Treatment-BIG therapy (LSVT-BIG), a special training program aiming at an increase of movement amplitudes in persons with PD (PwPD), has shown to be effective on motor symptoms. LSVT-BIG is conceptionally based on improving bradykinesia, in particular the decrement of repetitive movements, by proprioceptive recalibration. Objective To assess proprioceptive impairment in PwPD as compared to matched controls and to probe potential recalibration effects of the LSVT-BIG therapy on proprioception. Methods Proprioceptive performance and fine motor skills were assessed in 30 PwPD and 15 matched controls. Measurements with significant impairment in PwPD were chosen as outcome parameters for a standardized 4 weeks amplitude-based training intervention (LSVT-BIG) in 11 PwPD. Proprioceptive performance served as primary outcome measure. Secondary outcome measures included the motor part of the MDS-UPDRS, the nine-hole-peg test, and a questionnaire on quality of life. Post-interventional assessments were conducted at weeks 4 and 8. Results Compared to the control group, PwPD showed significantly larger pointing errors. After 4 weeks of LSVT-BIG therapy and even more so after an additional 4 weeks of continued training, proprioceptive performance improved significantly. In addition, quality of life improved as indicated by a questionnaire. Conclusion LSVT-BIG training may achieve a recalibration of proprioceptive processing in PwPD. Our data indicates a probable physiological mechanism of a symptom-specific, amplitude-based behavioral intervention in PwPD. KW - Proprioception KW - Amplitude KW - Training KW - Pointing error KW - LSVT-big therapy Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230084 VL - 20 ER - TY - THES A1 - Peterka, Manuel T1 - Propriozeptive Störungen bei Morbus Parkinson – Explorative Untersuchungen zu Art, Ausmaß und potenzieller Rekalibrierung mithilfe der LSVT-BIG-Therapie T1 - Propriozeptive disorders in Parkinon’s disease - Explorative assessment of character, extent and possible recalibration through LSVT-BIG-Therapy N2 - Beim idiopathischen Parkinson Syndrom (IPS) gewinnen nicht-motorische Symptome in Forschung und Klinik zunehmend an Bedeutung. So findet sich in der Literatur vermehrt Evidenz, dass die Propriozeption bei Patienten mit IPS (PmIPS) gestört ist. Verschiedene klinische und neuroanatomische Studien weisen darauf hin, dass es beim IPS zu einer fehlerhaften sensomotorischen Integration von propriozeptiven Informationen in den Basalganglien kommt. Zudem gibt es Hinweise, dass die passiv-sensible Wahrnehmung von Propriozeption pathologisch verändert ist. Außerdem wird vermutet, dass durch propriozeptives Training eine Verbesserung der Parkinsonsymptomatik erreicht werden kann. Ein spezielles Trainingsprogramm, die LSVT-BIG-Therapie, bei der gezielt trainiert wird, Bewegungen mit einer großen Amplitude durchzuführen, konnte motorische Symptome und Mobilität beim IPS effektiv verbessern. In der vorliegenden Arbeit stellten wir folgende Hypothesen auf: Das IPS geht mit einer fehlerhaften sensomotorischen Integration von Propriozeption einher. Die afferente propriozeptive Wahrnehmung ist ebenfalls pathologisch verändert. Eine propriozeptive Rekalibrierung ist mithilfe der LSVT-BIG-Therapie möglich. Für die Überprüfung dieser Hypothesen schlossen wir 30 PmIPS und 15 gesunde Probanden in unsere Fall-Kontroll-Studie ein und führten eine Eingangsuntersuchung durch. 11 PmIPS absolvierten anschließend eine vierwöchige LSVT-BIG-Therapie. Die Folgeuntersuchungen fanden 4 und 8 Wochen nach der Eingangsuntersuchung statt. 78 Diese beinhalteten neuropsychologische Testungen, außerdem die Bestimmung der Lebensqualität, die Erhebung des motorischen Teils der Movement Disorder Society Unified Parkinson´s Disease Rating Scale (MDS-UPDRS III), Untersuchungen zur Feinmotorik, die Durchführung einer diagnostischen Transkraniellen Magnetstimulation (TMS) sowie Testverfahren zur Propriozeption, darunter sowohl Zeigeversuche, als auch die Bestimmung der Position einer Extremität, ohne visuelle Kontrolle. Die Ergebnisse zeigten, dass die IPS-Gruppe gegenüber der gesunden Kontrollgruppe signifikant größere Zeigefehler machte, wohingegen die Bestimmung der Position einer Extremität in beiden Gruppen vergleichbar präzise möglich war. Zusätzlich zeigte eine von sieben Messungen der Feinmotorik einen signifikanten Unterschied zwischen PmIPS und Kontrollen. Die Messungen der TMS erbrachten hingegen keine signifikant messbaren Unterschiede zwischen den Gruppen. In den Folgeuntersuchungen nach therapeutischer Intervention ergaben die Zeigeübungen eine signifikante Verbesserung der BIG-Gruppe im Zeitverlauf. Die Untersuchungen zu Feinmotorik und MDS-UPDRS III ergaben zwar eine tendenzielle Verbesserung durch die LSVT-BIG-Therapie, waren jedoch statistisch nicht signifikant. Die Lebensqualität der PmIPS in der BIG-Gruppe verbesserte sich signifikant nach Intervention. Die Ergebnisse sprechen für die Hypothese der fehlerhaften propriozeptiven Integration beim Morbus Parkinson. Dies zeigte sich für aktive sensomotorische Tasks, nicht hingegen in der passiv-sensiblen propriozeptiven Testung. Auch wenn weitere Studien mit größeren Kohorten benötigt werden, legt unsere Studie nahe, dass die LSVT-BIG-Therapie mit einer propriozeptiven Rekalibrierung einhergeht. Damit erklärt sich möglicherweise der nachhaltige Erfolg der Therapie. N2 - There is growing evidence for proprioceptive dysfunction in patients with Parkinson’s disease (PD). Several clinical and neuranatomical studies conclude, that the sensorimotor integration of proprioception is impaired at the level of the basal ganglia. Moreover, passive perception of propriozeptive information has shown to be altered in PD. The Lee Silvermann Voice Treatment-BIG therapy (LSVT-BIG), a special training program aiming at an increase of movement amplitudes in persons with PD (PwPD), has shown to be effective on motor symptoms. LSVT-BIG is conceptionally based on improving bradykinesia, in particular the decrement of repetitive movements, by proprioceptive recalibration. The aim of our research was to assess proprioceptive impairment in PwPD as compared to matched controls and to probe potential recalibration effects of the LSVT-BIG therapy on proprioception. The following methods were used. Proprioceptive performance, fine motor skills and transcranial magnetic stimulation were assessed in 30 PwPD and 15 matched controls. Measurements with significant impairment in PwPD were chosen as outcome parameters for a standardized 4 weeks amplitude-based training intervention (LSVT-BIG) in 11 PwPD. Proprioceptive performance served as primary outcome measure. Secondary outcome measures included the motor part of the MDS-UPDRS, the nine-hole-peg test, and a questionnaire on quality of life. Post-interventional assessments were conducted at weeks 4 and 8. The results show, that compared to the control group, PwPD produced significantly larger pointing errors. However, PwPD and matched controls did not differ in indicating wrist position. After 4 weeks of LSVT-BIG therapy and even more so after an additional 4 weeks of continued training, proprioceptive performance improved significantly. In addition, quality of life improved as indicated by a questionnaire. Accordingly, we can conlcude that sensorimotor integration of propriozeption is altered but not passsive perception of propriozeptive information. Furthermore, LSVT-BIG training may achieve a recalibration of proprioceptive processing in PwPD. Our data indicates a probable physiological mechanism of a symptom-specific, amplitude-based behavioral intervention in PwPD. KW - Propriozeption KW - Parkinson-Krankheit KW - Physiotherapie Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-226129 ER - TY - JOUR A1 - Peseschkian, Tara A1 - Cordts, Isabell A1 - Günther, René A1 - Stolte, Benjamin A1 - Zeller, Daniel A1 - Schröter, Carsten A1 - Weyen, Ute A1 - Regensburger, Martin A1 - Wolf, Joachim A1 - Schneider, Ilka A1 - Hermann, Andreas A1 - Metelmann, Moritz A1 - Kohl, Zacharias A1 - Linker, Ralf A. A1 - Koch, Jan Christoph A1 - Büchner, Boriana A1 - Weiland, Ulrike A1 - Schönfelder, Erik A1 - Heinrich, Felix A1 - Osmanovic, Alma A1 - Klopstock, Thomas A1 - Dorst, Johannes A1 - Ludolph, Albert C. A1 - Boentert, Matthias A1 - Hagenacker, Tim A1 - Deschauer, Marcus A1 - Lingor, Paul A1 - Petri, Susanne A1 - Schreiber-Katz, Olivia T1 - A nation-wide, multi-center study on the quality of life of ALS patients in Germany JF - Brain Sciences N2 - Improving quality of life (QoL) is central to amyotrophic lateral sclerosis (ALS) treatment. This Germany-wide, multicenter cross-sectional study analyses the impact of different symptom-specific treatments and ALS variants on QoL. Health-related QoL (HRQoL) in 325 ALS patients was assessed using the Amyotrophic Lateral Sclerosis Assessment Questionnaire 5 (ALSAQ-5) and EuroQol Five Dimension Five Level Scale (EQ-5D-5L), together with disease severity (captured by the revised ALS Functional Rating Scale (ALSFRS-R)) and the current care and therapies used by our cohort. At inclusion, the mean ALSAQ-5 total score was 56.93 (max. 100, best = 0) with a better QoL associated with a less severe disease status (β = −1.96 per increase of one point in the ALSFRS-R score, p < 0.001). “Limb-onset” ALS (lALS) was associated with a better QoL than “bulbar-onset” ALS (bALS) (mean ALSAQ-5 total score 55.46 versus 60.99, p = 0.040). Moreover, with the ALSFRS-R as a covariate, using a mobility aid (β = −7.60, p = 0.001), being tracheostomized (β = −14.80, p = 0.004) and using non-invasive ventilation (β = −5.71, p = 0.030) were associated with an improved QoL, compared to those at the same disease stage who did not use these aids. In contrast, antidepressant intake (β = 5.95, p = 0.007), and increasing age (β = 0.18, p = 0.023) were predictors of worse QoL. Our results showed that the ALSAQ-5 was better-suited for ALS patients than the EQ-5D-5L. Further, the early and symptom-specific clinical management and supply of assistive devices can significantly improve the individual HRQoL of ALS patients. Appropriate QoL questionnaires are needed to monitor the impact of treatment to provide the best possible and individualized care. KW - Amyotrophic Lateral Sclerosis (ALS) KW - Amyotrophic Lateral Sclerosis Assessment Questionnaire 5 (ALSAQ-5) KW - ALS treatment KW - “bulbar-onset” ALS (bALS) KW - “limb-onset” ALS (lALS) KW - EuroQol Five Dimension Five Level Scale (EQ-5D-5L) KW - health-related quality of life (HRQoL) KW - quality of life (QoL) KW - symptom-specific treatment KW - assistive devices Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234147 SN - 2076-3425 VL - 11 IS - 3 ER - TY - THES A1 - Pausch, Jonas Franz T1 - Präferentielle Lokalisation von Makrophagen im räumlichen Umfeld von Ranvier'schen Schnürringen - Morphologische Analysen zur räumlichen Verteilung von Makrophagen in Mausmodellen für erbliche Neuropathien T1 - Preferential localisation of macrophages near nodes of Ranvier - morpholocgical analyses in mose models for ihertited peripheral neuropathie N2 - Die Charcot-Marie-Tooth Typ 1 Erkrankungen sind eine genetisch heterogene Gruppe, aktuell nicht kurativ therapierbarer, erblicher Neuropathien des Peripheren Nervensystems. Klinische Manifestationen reichen von Sensibilitäts-störungen, verminderten Muskeleigenreflexen, sowie fortschreitenden Lähmungen, bis hin zu Muskelatrophie und bedeuten für die betroffenen Patienten eine starke Einschränkung der Lebensqualität. Anhand früherer Studien wurde Makrophagen, als Teil des angeborenen Immunsystems, eine entscheidende Rolle in der Pathogenese dreier CMT1-Unterformen zugeschrieben. Abgesehen von den morphologischen Manifestationen der demyelinisierenden CMT1-Erkrankungen, wie simultanes Auftreten von Dedifferenzierung, sowie Hypo-, und Demyelinisierung erkrankter Schwann-Zellen, sind pathologische Veränderungen der Domänengliederung der Ranvier’schen Schnürringe betroffener Nervenfasern ebenfalls von der Aktivierung pathogener Makrophagen abhängig. Auf der Basis verschiedener veröffentlichter Studien, welche sowohl demyelinisierende Erkrankungen des ZNS, aber auch primär durch axonale Schäden gekennzeichnete Erkrankungen des PNS beinhalten, besteht ein möglicher räumlicher Zusammenhang zwischen Architekturstörungen der RS und aktivierten pathogenen Mikrogliazellen bzw. Makrophagen. In dieser Studie konnte, anhand morphologischer Analysen von peripherem Nervengewebe, in Wt-Mäusen erstmals eine unerwartete präferentielle Lokalisation von Makrophagen im räumlichen Umfeld von RS beobachtet werden. Hierbei scheint, trotz des Fehlens einer direkten Zell-Zell-Interaktion zwischen Makrophagen und RS, vor allem im Hinblick auf die ebenfalls im räumlichen Umfeld von RS nachweisbare EZM und Fibroblasten, eine funktionelle Relevanz der assoziierten Makrophagen für die Aufrechterhaltung der Domänengliederung bzw. elektrophysiologischen Eigenschaften myelinisierter peripherer Nervenfasern denkbar. Im Gegensatz dazu wurde trotz der signifikanten Zunahme der Makrophagenanzahlen in den drei untersuchten CMT1-Mausmodellen keine erhöhte räumliche Assoziation mit den RS der mutierten Schwann-Zellen beobachtet. Vielmehr konnten anhand des Vergleiches mit wildtypischen Kontrollmäusen signifikant erniedrigte Assoziationsraten beider Strukturen in den CMT1-Modelltieren festgestellt werden. Folglich scheint die von der Einwanderung und Aktivierung pathogener Makrophagen abhängige Störung der Domänengliederung der RS der mutierten Schwann-Zellen, nicht durch eine direkte Interaktion bzw. räumliche Assoziation von Makrophagen mit RS ausgelöst zu werden. N2 - The Charcot-Marie-Tooth neuropathies are a heterogenous group of inherited neuropathies oft he peripheral nervous system currenly incurable. Clinical symptoms vary from sensory loss, reduced tendon reflexes, muscular atrophy to progressive disability. According to different studies macrophages, as a part oft he innate immune system, play a crucial role in the pathogenesis of three different CMT-1 subtypes. Apart from morphological changes like dedifferentiation as well as hypo- and demyelination of diseased Schwann-cells, pathological alterations of nodes of Ranvier are also driven by activated marophages. As already described for demyelinating disoders oft he CNS, as well as neruodegenerative disorders oft he PNS, we investigated the spatial association of macrophages with diseased nodes of Ranvier. According to morphological analysis of peripheral nerve tissue this study is the first to describe an unexpected preferential spatial localization of macrophages near nodes of Ranvier in healthy nerves. Despite direct cell-cell interactions macrohages might play a functional role regarding the turnover of ECM and fibroblasts surrounding nodes of Ranvier, as well as the maintenance oft he architecture and electrophysiological features of peripheral nerve fibers. KW - Makrophagen KW - Erbliche Neuropathien KW - Charcot-Marie-Tooth KW - Ranvier'sche Schnürringe KW - CMT KW - Ranvier'sche Schnürringe Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-143801 ER - TY - THES A1 - Patzkó, Ágnes T1 - CSF-1 receptor as a target for the treatment of Charcot-Marie-Tooth disease 1 T1 - CSF-1 Rezeptor als Target für die Behandlung der Charcot-Marie-Tooth Krankheit Typ 1 N2 - Previous studies by our group revealed that chronic low grade inflammation implicating phagocytosing macrophages is a highly relevant mechanism in the pathogenesis of Charcot-Marie-Tooth disease. The lack of CSF-1, the primary regulator of macrophage function and survival, led to a robust and persistent amelioration of the phenotype in two authentic mouse models of CMT. Moreover, a close contact between CSF-1 producing fibroblasts and endoneurial macrophages carrying CSF-1R has been confirmed in nerve biopsies of CMT patients, further supporting the clinical significance of this pathway. In the current study we treated 3 distinct mouse models of CMT1: the PMP22tg mice as a model for CMT1A, the P0+/- mice as a model for CMT1B and the Cx32def mice as a model for CMT1X, with a CSF-1R specific kinase (c-FMS) inhibitor (800-1200 mg PLX5622/ kg chow) according to different treatment regimes mimicking an ideal early onset treatment, a late onset treatment and the withdrawal of the drug. Using the above mentioned doses of PLX5622, we documented a dramatic decrease in macrophage numbers in the PNS of all 3 myelin mutants, except for the quadriceps nerve of Cx32def mice. Fibroblast numbers remained unchanged in treated animals. Surprisingly, in spite of the decrease in the number of detrimental macrophages we could not detect an unequivocal phenotypic improvement. CMAP amplitudes were reduced in both wild type and myelin mutant mice treated with CSF-1R inhibitor in comparison to untreated littermates. Corresponding to the electrophysiological findings, the axon number and the percentage of large diameter axons were reduced in the quadriceps nerve of treated P0+/- and Cx32def mice. By contrast we observed a higher number of fully myelinated axons, in parallel with a decrease in the percentage of demyelinated (and hypermyelinated in PMP22tg mice) fibers in the ventral roots of P0+/- mice treated with CSF-1R inhibitor from 3 months up to 6 months of age and PMP22tg animals treated from 9 months up to 15 months of age. Our results indicate that CSF-1R inhibitor has the potential to improve the demyelinating phenotype of at least two models of CMT1. Nevertheless, further studies are necessary (for example with lower doses of the inhibitor) to minimize or even eliminate the putative neurotoxic effect we observed with high dose treatment conditions. N2 - Vorhergehende Studien unserer Gruppe haben gezeigt, dass eine niedriggradige Entzündung, die von phagozytierenden Makrophagen ausgeht, von ausserordentlicher Bedeutung für die Pathogenese der Charcot-Marie-Tooth Krankheit ist. In Abwesenheit von CSF-1, des primären Regulators für Funktion und Überleben von Makrophagen, trat eine stabile und dauerhafte Verbesserung des Phänotyps in den zwei etablierten CMT Mausmodellen auf. Darüber hinaus konnte ein enger Kontakt zwischen CSF-1-produzierenden Fibroblasten und Makrophagen, die den zugehörigen Rezeptor CSF-1Rexprimieren, in Nervbiopsien von CMT Patienten bestätigt werden, was die klinische Relevanz dieses Mechanismus weiter verdeutlicht. In der aktuellen Studie wurden drei verschiedene CMT1 Mausmodelle, PMP22tg Mäuse als Modell für CMT1A, P0+/- Mäuse als Modell für CMT1B und Cx32-defiziente Mäuse als Modell für CMT1X, mit einem Inhibitor der CSF-1R spezifischen Kinase (c-FMS) (800-1200 mg PLX5622/kg Futter) behandelt. Der Inhibitor wurde gemäß den verschiedenen Behandlungsmethoden eingesetzt, um den Verlauf eineridealerweise frühzeitigen und einer spät-beginnenden Behandlung und des Entzug des Medikaments zu imitieren. Nach der Behandlung mit PLX5622 konnten wir im PNS aller drei Myelin-Mutanten, mit Ausnahme des N. quadriceps von Cx32-defizienten Mäusen, einen drastischen Rückgang der Makrophagenanzahl feststellen. Die Anzahl der Fibroblasten blieb in den behandelten Tieren unverändert. Überraschenderweise konnten wir, trotz des Rückgangs der Anzahl an schädlichen Makrophagen, keine einheitliche Verbesserung des Phänotyps dokumentieren. CMAP Amplituden waren nach CSF-1R Inhibitor Behandlung sowohl in Wild-Typ Mäusenals auch in den Myelin-Mutanten geringer als in unbehandelten Kontrolltieren. Passend zu den elektrophysiologischen Ergebnissen war die Anzahl an Axonen und die Prozentzahl an großkalibrigen Axonen im N. quadriceps von behandelten P0+/- und Cx32-defizienten Mäusen reduziert.Im Gegensatz dazu war eine erhöhte Menge an normalmyelinisierten Axonen, mit einer gleichzeitigen Reduktiondemyelinisierter Fasern (und hypermyelinisierten in PMP22tg Mäusen) in den ventralen Spinalwurzeln von P0+/- Mäusen zu beobachten, die mit dem CSF-1R Inhibitor im Alter von 3 bis 6 Monaten behandelt worden waren sowie bei PMP22tg Mäusen, die im Alter von 9 bis 15 Monaten den Inhibitor erhalten hatten. Unsere Ergebnisse deuten an, dass der CSF-1R Inhibitor das Potential besitzt, zumindest in zwei Modellen von CMT1 den demyelinisierenden Phänotyp zu verbessern. Dennoch müssen weitere Studien durchgeführt werden (z.B. die Verwendung einer niedrigeren Dosis des Inhibitors), um den möglichen neurotoxischen Effekt, der bei oben genannten Behandlungsbedingungen zu beobachten war, zu minimieren oder ganz zu beheben. KW - Makrophage KW - Charcot-Marie-Tooth KW - Charcot-Marie-Tooth disease KW - Myelin KW - CSF-1 Rezeptor KW - Neuropathie KW - macrophage KW - CSF-1 receptor KW - neuropathy KW - myelin Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-85325 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 - THES A1 - Papagianni, Aikaterini T1 - Schmerz-assoziierte elektrisch evozierte Potentiale (PREP) bei Patienten mit neuropathischen Schmerzsyndromen T1 - Pain-related evoked potentials (PREP) in patients with neuropathic pain N2 - In der vorliegenden Studie wurden 32 Patienten (19 Frauen, 13 Männer, medianes Alter 50 Jahren, Spanne: 26-83 Jahre) mit einem klinisch akralen neuropathischen Schmerzsyndrom unterschiedlicher Genese mittels QST, PREP und Hautbiopsie untersucht. Unser Patientenkollektiv bestand aus drei Subgruppen: sechsen Patienten erfüllten die Kriterien einer SFN, acht Patienten hatten eine Neuropathie der großkalibrigen Nervenfasern mit zusätzlicher Beeinträchtigung der kleinkalibrigen Nervenfasern und weitere acht Patienten hatten ein akrales Schmerzsyndrom mit neuropathischen Charakteristika, ohne vorbekannte Diagnose einer Neuropathie der groß- oder kleinkalibrigen Nervenfasern. Die Patienten wurden mittels klinischer neurologischer Untersuchung, elektrophysiologischer Tests, QST, PREP und Hautbiopsie untersucht. Die Patientendaten wurden jeweils mit Daten großer Kontrollgruppen verglichen, die wir in unserer Klinik unter Angehörigen und Freunden unserer Patienten mit deren Einwilligung rekrutiert hatten. QST und die Hautbiopsie waren bei Patienten mit SFN und PNP jeweils auffällig, bei akralem Schmerzsyndrom unklarer Ätiologie hingegen unauffällig. Nach elektrischer kutaner Stimulation aller drei Körperregionen zeigte sich eine Amplitudenminderung der PREP-Reizantwort in allen Patientensubgruppen (7,5 µV in der SFN-Gruppe, 3,8 µV in der PNP-Gruppe, und 11,3 µV bei den Patienten mit akralem Schmerzsyndrom). Somit konnten wir zeigen, dass eine Kleinfaserpathologie in der Studienpopulation von Patienten mit neuropathischem Schmerzsyndrom besteht. Nur die Amplitudenminderung der PREP bildet diese Pathologie ab. Diese Daten erlauben uns die eingangs aufgestellte Hypothese, dass PREP zur Diagnostik bei Frage nach Kleinfaserbeteiligung geeignet ist, positiv zu belegen. PREP ist eine nicht-invasive Methode für die Evaluation der Funktion v.a. der Aδ-Faser mit standardisiertem Ablaufprotokoll zur Erhebung von reproduzierbaren Daten. Sie kann bei Patienten mit der Anamnese eines akralen neuropathischen Schmerzsyndroms einen objektiven Hinweis auf eine Dysfunktion der kleinkalibrigen Nervenfasern, auch wenn bereits etablierte Methoden (QST und Hautbiopsie) unauffällig bleiben, erbringen. Entsprechend können die PREP eine wertvolle Ergänzung der klinischen Untersuchungsbatterie für die Evaluation der Funktion der kleinkalibrigen Nervenfasern sein. N2 - 32 adult patients (19 female, 13 male, median age 50 years, range 26-83) suffering from acral neuropathic pain were examined with QST, PREP and skin punch biopsy. Applying current diagnostic criteria and the results of the neurophysiological studies, 16/32 (50%) patients were classified as having idiopathic SFN (Devigili et al., 2008), 8/32 (25%) patients had a mixed fiber neuropathy (MFN, i.e. large and small fiber neuropathy), and 8/32 (25%) patients had neuropathic pain without signs of a large fiber neuropathy or SFN. Patients with SFN and mixed fiber neuropathy were having pathological findings in the skin punch biopsy (reduction of the intraepidermal nerve fiber density-IENFD), while normal findings were seen in patients with acral neuropathic pain Pain related evoked potentials after electrical skin stimulation at three body regions (face, hand, foot) revealed reduction of the peak-to-peak amplitude (PPA) in all patient-groups. Therefore, PREP was the only test providing findings of a small fiber impairment in patients with acral neuropathic pain even when QST and skin punch biopsy remained normal. PREP, as non-invasive method for the evaluation of the Aδ-pathways can be proposed as a valuable additional test for the evaluation of small fiber dysfunction in patients with neuropathic pain syndromes. KW - PREP KW - neuropathischer Schmerz KW - small-fiber-Neuropathie KW - pain related evoked potentials KW - small fiber neuropathy KW - neuropathic pain KW - Schmerz-assoziierte elektrisch evozierte Potentiale Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-159728 ER - TY - JOUR A1 - Palmisano, Chiara A1 - Kullmann, Peter A1 - Hanafi, Ibrahem A1 - Verrecchia, Marta A1 - Latoschik, Marc Erich A1 - Canessa, Andrea A1 - Fischbach, Martin A1 - Isaias, Ioannis Ugo T1 - A fully-immersive virtual reality setup to study gait modulation JF - Frontiers in Human Neuroscience N2 - Objective: Gait adaptation to environmental challenges is fundamental for independent and safe community ambulation. The possibility of precisely studying gait modulation using standardized protocols of gait analysis closely resembling everyday life scenarios is still an unmet need. Methods: We have developed a fully-immersive virtual reality (VR) environment where subjects have to adjust their walking pattern to avoid collision with a virtual agent (VA) crossing their gait trajectory. We collected kinematic data of 12 healthy young subjects walking in real world (RW) and in the VR environment, both with (VR/A+) and without (VR/A-) the VA perturbation. The VR environment closely resembled the RW scenario of the gait laboratory. To ensure standardization of the obstacle presentation the starting time speed and trajectory of the VA were defined using the kinematics of the participant as detected online during each walking trial. Results: We did not observe kinematic differences between walking in RW and VR/A-, suggesting that our VR environment per se might not induce significant changes in the locomotor pattern. When facing the VA all subjects consistently reduced stride length and velocity while increasing stride duration. Trunk inclination and mediolateral trajectory deviation also facilitated avoidance of the obstacle. Conclusions: This proof-of-concept study shows that our VR/A+ paradigm effectively induced a timely gait modulation in a standardized immersive and realistic scenario. This protocol could be a powerful research tool to study gait modulation and its derangements in relation to aging and clinical conditions. KW - gait modulation KW - virtual reality KW - obstacle avoidance KW - gait analysis KW - kinematics Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-267099 SN - 1662-5161 VL - 16 ER - TY - JOUR A1 - Palmisano, Chiara A1 - Brandt, Gregor A1 - Vissani, Matteo A1 - Pozzi, Nicoló G. A1 - Canessa, Andrea A1 - Brumberg, Joachim A1 - Marotta, Giorgio A1 - Volkmann, Jens A1 - Mazzoni, Alberto A1 - Pezzoli, Gianni A1 - Frigo, Carlo A. A1 - Isaias, Ioannis U. T1 - Gait Initiation in Parkinson’s Disease: Impact of Dopamine Depletion and Initial Stance Condition JF - Frontiers in Bioengineering and Biotechnology N2 - Postural instability, in particular at gait initiation (GI), and resulting falls are a major determinant of poor quality of life in subjects with Parkinson’s disease (PD). Still, the contribution of the basal ganglia and dopamine on the feedforward postural control associated with this motor task is poorly known. In addition, the influence of anthropometric measures (AM) and initial stance condition on GI has never been consistently assessed. The biomechanical resultants of anticipatory postural adjustments contributing to GI [imbalance (IMB), unloading (UNL), and stepping phase) were studied in 26 unmedicated subjects with idiopathic PD and in 27 healthy subjects. A subset of 13 patients was analyzed under standardized medication conditions and the striatal dopaminergic innervation was studied in 22 patients using FP-CIT and SPECT. People with PD showed a significant reduction in center of pressure (CoP) displacement and velocity during the IMB phase, reduced first step length and velocity, and decreased velocity and acceleration of the center of mass (CoM) at toe off of the stance foot. All these measurements correlated with the dopaminergic innervation of the putamen and substantially improved with levodopa. These results were not influenced by anthropometric parameters or by the initial stance condition. In contrast, most of the measurements of the UNL phase were influenced by the foot placement and did not correlate with putaminal dopaminergic innervation. Our results suggest a significant role of dopamine and the putamen particularly in the elaboration of the IMB phase of anticipatory postural adjustments and in the execution of the first step. The basal ganglia circuitry may contribute to defining the optimal referent body configuration for a proper initiation of gait and possibly gait adaptation to the environment. KW - gait initiation KW - Parkinson’s disease KW - basal ganglia KW - dopamine KW - base of support KW - anthropometric measurements Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200801 SN - 2296-4185 VL - 8 ER - TY - JOUR A1 - Palmisano, Chiara A1 - Beccaria, Laura A1 - Haufe, Stefan A1 - Volkmann, Jens A1 - Pezzoli, Gianni A1 - Isaias, Ioannis U. T1 - Gait initiation impairment in patients with Parkinson’s disease and freezing of gait JF - Bioengineering N2 - Freezing of gait (FOG) is a sudden episodic inability to produce effective stepping despite the intention to walk. It typically occurs during gait initiation (GI) or modulation and may lead to falls. We studied the anticipatory postural adjustments (imbalance, unloading, and stepping phase) at GI in 23 patients with Parkinson’s disease (PD) and FOG (PDF), 20 patients with PD and no previous history of FOG (PDNF), and 23 healthy controls (HCs). Patients performed the task when off dopaminergic medications. The center of pressure (CoP) displacement and velocity during imbalance showed significant impairment in both PDNF and PDF, more prominent in the latter patients. Several measurements were specifically impaired in PDF patients, especially the CoP displacement along the anteroposterior axis during unloading. The pattern of segmental center of mass (SCoM) movements did not show differences between groups. The standing postural profile preceding GI did not correlate with outcome measurements. We have shown impaired motor programming at GI in Parkinsonian patients. The more prominent deterioration of unloading in PDF patients might suggest impaired processing and integration of somatosensory information subserving GI. The unaltered temporal movement sequencing of SCoM might indicate some compensatory cerebellar mechanisms triggering time-locked models of body mechanics in PD. KW - freezing of gait KW - gait initiation KW - Parkinson’s disease KW - posture KW - segmental centers of mass KW - anthropometric measurement KW - base of support Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-297579 SN - 2306-5354 VL - 9 IS - 11 ER - TY - THES A1 - Palmisano, Chiara T1 - Supraspinal Locomotor Network Derangements: A Multimodal Approach T1 - Störungen des Supraspinalen Lokomotorischen Netzwerks: ein Multimodaler Ansatz N2 - Parkinson’s Disease (PD) constitutes a major healthcare burden in Europe. Accounting for aging alone, ~700,000 PD cases are predicted by 2040. This represents an approximately 56% increase in the PD population between 2005 and 2040, with a consequent rise in annual disease‐related medical costs. Gait and balance disorders are a major problem for patients with PD and their caregivers, mainly because to their correlation with falls. Falls occur as a result of a complex interaction of risk factors. Among them, Freezing of Gait (FoG) is a peculiar gait derangement characterized by a sudden and episodic inability to produce effective stepping, causing falls, mobility restrictions, poor quality of life, and increased morbidity and mortality. Between 50–70% of PD patients have FoG and/or falls after a disease duration of 10 years, only partially and inconsistently improved by dopaminergic treatment and Deep Brain Stimulation (DBS). Treatment-induced worsening has been also observed under certain conditions. Effective treatments for gait disturbances in PD are lacking, probably because of the still poor understanding of the supraspinal locomotor network. In my thesis, I wanted to expand our knowledge of the supraspinal locomotor network and in particular the contribution of the basal ganglia to the control of locomotion. I believe this is a key step towards new preventive and personalized therapies for postural and gait problems in patients with PD and related disorders. In addition to patients with PD, my studies also included people affected by Progressive Supranuclear Palsy (PSP). PSP is a rare primary progressive parkinsonism characterized at a very early disease stage by poor balance control and frequent backwards falls, thus providing an in vivo model of dysfunctional locomotor control. I focused my attention on one of the most common motor transitions in daily living, the initiation of gait (GI). GI is an interesting motor task and a relevant paradigm to address balance and gait impairments in patients with movement disorders, as it is associated with FoG and high risk of falls. It combines a preparatory (i.e., the Anticipatory Postural Adjustments [APA]) and execution phase (the stepping) and allows the study of movement scaling and timing as an expression of muscular synergies, which follow precise and online feedback information processing and integration into established feedforward patterns of motor control. By applying a multimodal approach that combines biomechanical assessments and neuroimaging investigations, my work unveiled the fundamental contribution of striatal dopamine to GI in patients with PD. Results in patients with PSP further supported the fundamental role of the striatum in GI execution, revealing correlations between the metabolic intake of the left caudate nucleus with diverse GI measurements. This study also unveiled the interplay of additional brain areas in the motor control of GI, namely the Thalamus, the Supplementary Motor Area (SMA), and the Cingulate cortex. Involvement of cortical areas was also suggested by the analysis of GI in patients with PD and FoG. Indeed, I found major alterations in the preparatory phase of GI in these patients, possibly resulting from FoG-related deficits of the SMA. Alterations of the weight shifting preceding the stepping phase were also particularly important in PD patients with FoG, thus suggesting specific difficulties in the integration of somatosensory information at a cortical level. Of note, all patients with PD showed preserved movement timing of GI, possibly suggesting preserved and compensatory activity of the cerebellum. Postural abnormalities (i.e., increased trunk and thigh flexion) showed no relationship with GI, ruling out an adaptation of the motor pattern to the altered postural condition. In a group of PD patients implanted with DBS, I further explored the pathophysiological functioning of the locomotor network by analysing the timely activity of the Subthalamic Nucleus (STN) during static and dynamic balance control (i.e., standing and walking). For this study, I used novel DBS devices capable of delivering stimulation and simultaneously recording Local Field Potentials (LFP) of the implanted nucleus months and years after surgery. I showed a gait-related frequency shift in the STN activity of PD patients, possibly conveying cortical (feedforward) and cerebellar (feedback) information to mesencephalic locomotor areas. Based on this result, I identified for each patient a Maximally Informative Frequency (MIF) whose power changes can reliably classify standing and walking conditions. The MIF is a promising input signal for new DBS devices that can monitor LFP power modulations to timely adjust the stimulation delivery based on the ongoing motor task (e.g., gait) performed by the patient (adaptive DBS). Altogether my achievements allowed to define the role of different cortical and subcortical brain areas in locomotor control, paving the way for a better understanding of the pathophysiological dynamics of the supraspinal locomotor network and the development of tailored therapies for gait disturbances and falls prevention in PD and related disorders. N2 - Die Parkinson-Krankheit (PD) stellt in Europa eine große Belastung für das Gesundheitswesen dar. Allein unter Berücksichtigung der Alterung werden bis zum Jahr 2040 etwa 700 000 Fälle von Parkinson prognostiziert. Dies entspricht einer Zunahme der Parkinson-Population um etwa 56 % zwischen 2005 und 2040, was zu einem Anstieg der jährlichen krankheitsbedingten medizinischen Kosten führt. Gang- und Gleichgewichtsstörungen sind ein großes Problem für Morbus-Parkinson-Patienten und ihre Betreuer, vor allem, weil sie mit Stürzen zusammenhängen. Stürze sind das Ergebnis einer komplexen Interaktion von Risikofaktoren. Zu diesen Faktoren gehört das Freezing of Gait (FoG), eine besondere Gangstörung, die durch eine plötzliche und episodische Unfähigkeit gekennzeichnet ist, einen effektiven Schritt zu machen, was zu Stürzen, Mobilitätseinschränkungen, schlechter Lebensqualität und erhöhter Morbidität und Mortalität führt. Zwischen 50 und 70 % der Morbus-Parkinson-Patienten haben nach einer Krankheitsdauer von 10 Jahren FoG und/oder Stürze, die sich durch dopaminerge Behandlung und Tiefe Hirnstimulation (DBS) nur teilweise und uneinheitlich verbessern. Unter bestimmten Bedingungen wurde auch eine behandlungsbedingte Verschlechterung beobachtet. Es gibt keine wirksamen Behandlungen für Gangstörungen bei Morbus Parkinson, was wahrscheinlich auf das noch immer unzureichende Verständnis des supraspinalen lokomotorischen Netzwerks zurückzuführen ist. In meiner Dissertation wollte ich unser Wissen über das supraspinale Bewegungsnetzwerk und insbesondere den Beitrag der Basalganglien zur Steuerung der Fortbewegung erweitern. Ich glaube, dass dies ein wichtiger Schritt auf dem Weg zu neuen präventiven und personalisierten Therapien für Haltungs- und Gangprobleme bei Patienten mit Parkinson und verwandten Erkrankungen ist. Neben Morbus-Parkinson-Patienten wurden in meine Studien auch Menschen mit progressiver supranukleärer Lähmung (PSP) einbezogen. PSP ist ein seltener primär progressiver Parkinsonismus, der in einem sehr frühen Krankheitsstadium durch eine schlechte Gleichgewichtskontrolle und häufige Rückwärtsstürze gekennzeichnet ist und somit ein In-vivo-Modell für eine gestörte Bewegungskontrolle darstellt. Ich habe mich auf einen der häufigsten motorischen Übergänge im täglichen Leben konzentriert, die Initiierung des Gangs (GI). GI ist eine interessante motorische Aufgabe und ein relevantes Paradigma zur Untersuchung von Gleichgewichts- und Gangstörungen bei Patienten mit Bewegungsstörungen, da sie mit FoG und einem hohen Sturzrisiko verbunden ist. Sie kombiniert eine Vorbereitungsphase (d. h. die antizipatorischen posturalen Anpassungen [APA]) und eine Ausführungsphase (den Schritt) und ermöglicht die Untersuchung der Bewegungsskalierung und des Timings als Ausdruck muskulärer Synergien, die einer präzisen und online erfolgenden Verarbeitung von Feedback-Informationen und der Integration in etablierte Feedforward-Muster der motorischen Kontrolle folgen. Durch Anwendung eines multimodalen Ansatzes, der biomechanische Bewertungen und bildgebende Untersuchungen kombiniert, hat meine Arbeit den grundlegenden Einfluss des striatalen Dopamins auf GI bei Patienten mit Parkinson enthüllt. Die Ergebnisse bei Patienten mit PSP untermauerten die grundlegende Rolle des Striatums bei der Ausführung von GI, indem sie Korrelationen zwischen der metabolischen Aufnahme des linken Nucleus caudatus und verschiedenen GI-Parametern aufzeigten. Diese Studie enthüllte auch das Zusammenspiel weiterer Hirnareale bei der motorischen Kontrolle von GI, nämlich des Thalamus, der Supplementary Motor Area (SMA) und des Cingulum-Kortex. Die Beteiligung kortikaler Areale wurde auch durch die Analyse der GI bei Patienten mit Parkinson und FoG nahegelegt. In der Tat fand ich bei diesen Patienten erhebliche Veränderungen in der Vorbereitungsphase des GI, die möglicherweise auf FoG-bedingte Defizite der SMA zurückzuführen sind. Veränderungen der Gewichtsverlagerung, die der Schrittphase vorausgeht, waren bei Morbus-Parkinson-Patienten mit FoG ebenfalls besonders ausgeprägt, was auf spezifische Schwierigkeiten bei der Integration somatosensorischer Informationen auf kortikaler Ebene schließen lässt. Bemerkenswert ist, dass alle Morbus-Parkinson-Patienten ein gut erhaltenes Bewegungs-Timing von GI aufwiesen, was möglicherweise auf eine ebenfalls gut erhaltene und kompensatorische Aktivität des Kleinhirns hindeutet. Haltungsanomalien (d. h. verstärkte Rumpf- und Oberschenkelflexion) standen in keinem Zusammenhang mit GI, was eine Anpassung des motorischen Musters an die veränderten Haltungsbedingungen ausschließt. Bei einer Gruppe von Morbus-Parkinson-Patienten, denen eine DBS implantiert wurde, untersuchte ich die pathophysiologische Funktionsweise des lokomotorischen Netzwerks weiter, indem ich die rechtzeitige Aktivität des subthalamischen Nucleus (STN) während der statischen und dynamischen Gleichgewichtskontrolle (d. h. Stehen und Gehen) analysierte. Für diese Studie habe ich neuartige DBS-Geräte verwendet, die in der Lage sind, Stimulationen abzugeben und gleichzeitig lokale Feldpotentiale (LFP) des implantierten Nucleus Monate und Jahre nach der Operation aufzuzeichnen. Ich konnte eine gehbezogene Frequenzverschiebung in der STN-Aktivität von Morbus-Parkinson-Patienten nachweisen, die möglicherweise kortikale (feedforward) und zerebelläre (feedback) Informationen an mesenzephale Bewegungsbereiche weiterleitet. Auf der Grundlage dieses Ergebnisses habe ich für jeden Patienten eine maximal informative Frequenz (MIF) identifiziert, deren Leistungsänderungen eine zuverlässige Klassifizierung von Steh- und Gehzuständen ermöglichen. Die MIF ist ein vielversprechendes Eingangssignal für neue DBS-Geräte, die LFP-Leistungsmodulationen überwachen können, um die Stimulationsabgabe zeitnah an die laufende motorische Aufgabe (z. B. Gehen) des Patienten anzupassen (adaptive DBS). Insgesamt ist es mir gelungen, die Rolle verschiedener kortikaler und subkortikaler Hirnareale bei der Bewegungskontrolle zu definieren. Dies ebnet den Weg für ein besseres Verständnis der pathophysiologischen Dynamik des supraspinalen Bewegungsnetzwerks und die Entwicklung maßgeschneiderter Therapien für Gangstörungen und Sturzprävention bei Morbus Parkinson und verwandten Erkrankungen. KW - locomotor network KW - gait initiation KW - deep brain stimulation KW - gait analysis KW - movement disorders KW - neural biomarkers KW - parkinson's disease Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266442 ER -