TY - THES A1 - Kolb-Mäurer, Annette T1 - Interaktion humaner dendritischer Zellen mit Listeria monocytogenes T1 - Interaction of human dendritic cells with Listeria monocytogenes N2 - Dendritische Zellen (DZ) aktivieren naive CD4+ und CD8+ T-Lymphozyten und spielen daher die entscheidende Rolle bei der Auslösung einer Immunantwort gegenüber pathogenen Mikroorganismen. In dieser Arbeit wurde die Interaktion von DZ mit Listeria monocytogenes untersucht. Es konnte gezeigt werden, dass L. monocytogenes effizient in unreife, humane DZ aufgenommen wird. Die Phagozytoserate von L. monocytogenes unter Zugabe von humanem Plasma war wesentlich höher als im Plasma-freien Medium oder Medium mit fötalem Kälberserum (FCS). Die Zugabe von Immunglobulinen führte zu einem konzentrationsabhängigen Anstieg der Phagozytose von L. monocytogenes in humane DZ, der mit der Phagozytoserate bei Zugabe von humanem Plasma vergleichbar war. Plasma von gesunden Spendern enthielt Antikörper gegen das listerielle Oberflächenprotein p60. Durch die Verwendung einer p60 Deletionsmutante konnte gezeigt werden, dass der p60 Antikörper das Haupt-Opsonin für die Aufnahme von L. monocytogenes in Mo-DZ darstellt. Die Aufnahmerate dieser Mutante zeigte nur geringe Differenzen bei An- oder Abwesenheit von humanem Plasma während der Inkubationszeit, was den Schluss zulässt, dass Immunglobuline gegen das Oberflächenprotein p60 von L. monocytogenes und anderen apathogenen Listerien, für die effiziente Phagozytose verantwortlich sind. Nach Aufnahme der Listerien befanden sich die meisten (> 95 Prozent) DZ in Membran-umgrenzten Phagosomen und sehr selten frei im Zytosol. Die Mehrzahl der Listerien wurde im Phagosom der humanen DZ effizient lysiert. L. monocytogenes-infizierte DZ entwickelten sich phänotypisch zu reifen DZ. Die durch Listerien ausgelöste Maturation der DZ ließen sich durch die Zugabe von listerieller Lipoteichonsäure (LTA) nachahmen. Obwohl bekannt ist, dass eine Listerieninfektion in anderen Zellkulturen Zelltod induziert, führte die Infektion humaner DZ lediglich in weniger als 20 Prozent der infizierten DZ zur Nekrose. Apoptotischer Zelltod konnte nicht nachgewiesen werden. Die Interaktion humaner DZ mit L. monocytogenes könnte somit eine Verbreitung der Bakterien im Organismus verhindern. Langfristig gesehen ergeben die in dieser Arbeit gewonnenen Daten zur Interaktion DZ mit L. monocytogenes Erkenntnisse zur Entwicklung neuer DNA-Vakzinierungsstrategien mit L. monocytogenes als DNA-Träger. N2 - Dendritic cells (DC) activate naive CD4+ and CD8+ lymphocytes and are therefore critical for the initiation of an immune response against microorganisms. In this work the interaction between DC and L. monocytogenes was examined. Immature DC show a very efficient uptake of L. monocytogenes. Phagocytosis was much higher in the presence of human plasma than with plasma free media or media with fetal calf serum (FCS). However, the addition of immunoglobulins showed a concentration dependent increase in phagocytosis comparable with the addition of human plasma. Human plama contains antibodies against the listerial surface protein p60. By using a iap-deletion mutant it was shown that antibodies against p60 are the main opsonin for the uptake of L. monocytogenes into DC. Because no difference in the uptake of this deletion mutant in the presence or absence of human plasma was observed; antibodies against p60 appear to be resonsible for the efficient uptake of L. monocytogenes and other apathogenic Listeria strains. A major portion of internalized bacteria is found in membrane-bound phagosomes and rarely free in the cytosol. Most of the bacteria that were taken up by DC were killed very efficiently in the phagosome. Interestingly, infection with L. monocytogenes caused maturation of the immature DC into mature DC. This effect appeared to be largely mediated by listerial lipoteichoic acid. Although L. monocytogenes infection is known to induce death in other cell types, DC were relatively resistant and only 20 per cent of infected DC underwent cell death. Uptake, maturation and resistance to apoptosis suggest that DC are essentiel antigen presenting cell (APC) for L. monocytogenes immunity. Thus these observations into the interaction of L. monocytogenes with human DC provide an important into the pathogenesis of Listeria infection as well as providing a basis for Listeria-based vaccination strategies. KW - Mensch KW - Dendritische Zelle KW - Listeria monocytogenes KW - Dendritische Zelle KW - Listeria monocytogenens KW - Apoptose KW - dendritic cell KW - Listeria monocytogenes KW - apoptosis Y1 - 2001 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-1638 ER - TY - JOUR A1 - Elias, Johannes A1 - Heuschmann, Peter U. A1 - Schmitt, Corinna A1 - Eckhardt, Frithjof A1 - Boehm, Hartmut A1 - Maier, Sebastian A1 - Kolb-Mäurer, Annette A1 - Riedmiller, Hubertus A1 - Müllges, Wolfgang A1 - Weisser, Christoph A1 - Wunder, Christian A1 - Frosch, Matthias A1 - Vogel, Ulrich T1 - Prevalence dependent calibration of a predictive model for nasal carriage of methicillin-resistant Staphylococcus aureus JF - BMC Infectious Diseases N2 - Background Published models predicting nasal colonization with Methicillin-resistant Staphylococcus aureus among hospital admissions predominantly focus on separation of carriers from non-carriers and are frequently evaluated using measures of discrimination. In contrast, accurate estimation of carriage probability, which may inform decisions regarding treatment and infection control, is rarely assessed. Furthermore, no published models adjust for MRSA prevalence. Methods Using logistic regression, a scoring system (values from 0 to 200) predicting nasal carriage of MRSA was created using a derivation cohort of 3091 individuals admitted to a European tertiary referral center between July 2007 and March 2008. The expected positive predictive value of a rapid diagnostic test (GeneOhm, Becton & Dickinson Co.) was modeled using non-linear regression according to score. Models were validated on a second cohort from the same hospital consisting of 2043 patients admitted between August 2008 and January 2012. Our suggested correction score for prevalence was proportional to the log-transformed odds ratio between cohorts. Calibration before and after correction, i.e. accurate classification into arbitrary strata, was assessed with the Hosmer-Lemeshow-Test. Results Treating culture as reference, the rapid diagnostic test had positive predictive values of 64.8% and 54.0% in derivation and internal validation corhorts with prevalences of 2.3% and 1.7%, respectively. In addition to low prevalence, low positive predictive values were due to high proportion (> 66%) of mecA-negative Staphylococcus aureus among false positive results. Age, nursing home residence, admission through the medical emergency department, and ICD-10-GM admission diagnoses starting with “A” or “J” were associated with MRSA carriage and were thus included in the scoring system, which showed good calibration in predicting probability of carriage and the rapid diagnostic test’s expected positive predictive value. Calibration for both probability of carriage and expected positive predictive value in the internal validation cohort was improved by applying the correction score. Conclusions Given a set of patient parameters, the presented models accurately predict a) probability of nasal carriage of MRSA and b) a rapid diagnostic test’s expected positive predictive value. While the former can inform decisions regarding empiric antibiotic treatment and infection control, the latter can influence choice of screening method. KW - Methicillin-resistant staphylococcus aureus KW - Infection control KW - Clinical prediction rule KW - Predictive value of tests KW - False positive reactions KW - Calibration Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-96091 UR - http://www.biomedcentral.com/1471-2334/13/111 ER - TY - JOUR A1 - Kolb-Mäurer, Annette A1 - Goebeler, Matthias A1 - Mäurer, Mathias T1 - Cutaneous adverse events associated with interferon-\(\beta\) treatment of multiple sclerosis JF - International Journal of Molecular Sciences N2 - Interferons are widely used platform therapies as disease-modifying treatment of patients with multiple sclerosis. Although interferons are usually safe and well tolerated, they frequently cause dermatological side effects. Here, we present a multiple sclerosis (MS) patient treated with interferon-\(\beta\) who developed new-onset psoriasis. Both her MS as well as her psoriasis finally responded to treatment with fumarates. This case illustrates that interferons not only cause local but also systemic adverse events of the skin. These systemic side effects might indicate that the Th17/IL-17 axis plays a prominent role in the immunopathogenesis of this individual case and that the autoimmune process might be deteriorated by further administration of interferons. In conclusion, we think that neurologists should be aware of systemic cutaneous side effects and have a closer look on interferon-associated skin lesions. Detection of psoriasiform lesions might indicate that interferons are probably not beneficial in the individual situation. We suggest that skin lesions may serve as biomarkers to allocate MS patients to adequate disease-modifying drugs. KW - autoimmune diseases KW - psoriasis KW - cutaneous adverse events KW - utaneous adverse events KW - interferon-\(\beta\) KW - multiple sclerosis KW - lesions KW - therapy KW - experience KW - skin reactions KW - improvement Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-148451 VL - 16 ER - TY - JOUR A1 - Kolb-Mäurer, Annette A1 - Sunderkötter, Cord A1 - Kukowski, Borries A1 - Meuth, Sven G. T1 - An update on Peginterferon beta-1a Management in Multiple Sclerosis: results from an interdisciplinary Board of German and Austrian Neurologists and dermatologists JF - BMC Neurology N2 - Background: Interferon (IFN) beta drugs have been approved for the treatment of relapsing forms of multiple sclerosis (RMS) for more than 20years and are considered to offer a favourable benefit-risk profile. In July 2014, subcutaneous (SC) peginterferon beta-1a 125g dosed every 2weeks, a pegylated form of interferon beta-1a, was approved by the EMA for the treatment of adult patients with RRMS and in August 2014 by the FDA for RMS. Peginterferon beta-1a shows a prolonged half-life and increased systemic drug exposure resulting in a reduced dosing frequency compared to other available interferon-based products in MS. In the Phase 3 ADVANCE trial peginterferon beta-1a demonstrated significant positive effects on clinical and MRI outcome measures versus placebo after one year. Furthermore, in the ATTAIN extension study, sustained efficacy with long-term treatment for nearly 6years was shown. Main text In July 2016, an interdisciplinary panel of German and Austrian experts convened to discuss the management of side effects associated with peginterferon beta-1a and other interferon beta-based treatments in MS in daily practice. The panel was composed of experts from university hospitals and private clinics comprised of neurologists, dermatologists, and an MS nurse. In this paper we report recommendations regarding best practices for adverse event management, focussing on peginterferon beta-1a. Injection site reactions (ISRs) and influenza-like illness are the most common adverse effects of interferon beta therapies and can present a burden for MS patients leading to non-adherence and discontinuation of therapy. Peginterferon beta-1a shows improved pharmacological properties. In clinical trials, the adverse event (AE) profile of peginterferon beta-1a was similar to other interferon beta formulations. The most common AEs were mild to moderate ISRs, influenza-like illness, pyrexia, and headache. Current information on the underlying cause of skin reactions associated with SC interferon treatment, and the management strategies for these AEs are limited. In pivotal trials, ISRs were mainly characterized and classified by neurologists, while dermatologists were only rarely consulted. Conclusions This report addresses expert recommendations on the management of most relevant adverse effects related to peginterferon beta-1a and other interferon betas, based on literature and interdisciplinary experience. KW - multiple sclerosis KW - peginterferon bet-1a KW - interferon beta KW - flu-like symptoms KW - injection site reactions KW - management Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-224646 VL - 19 ER - TY - JOUR A1 - Strobel, Katharina A1 - Sickenberger, Christina A1 - Schoen, Christoph A1 - Kneitz, Hermann A1 - Kolb-Mäurer, Annette A1 - Goebeler, Matthias T1 - Diagnosis and therapy of Mycobacterium marinum: a single-center 21-year retrospective analysis JF - Journal der Deutschen Dermatologischen Gesellschaft N2 - Background and Objectives In Europe, infections with Mycobacterium (M.) marinum are rare. We conducted a retrospective single-center study to assess the clinical spectrum of M. marinum infection and its diagnosis, treatment and outcome under real-world conditions. Patients and Methods Eighteen patients presenting with M. marinum infections between 1998 and 2018 were identified in the data warehouse of the University Hospital Würzburg and considered for detailed analysis. Results Twelve patients reported aquatic exposure. In 16/18 cases the upper extremities were affected. No invasive infections were detected. Mean time to diagnosis was 15 weeks. Histology revealed granulomatous inflammation in 14 patients while mycobacterial cultures were positive for M. marinum in 16 cases. Most patients received antibiotic monotherapy (14/18) while combination therapy was administered in four cases. Treatment (with a median duration of 10 weeks) was successful in 13 patients. Five patients were lost to follow-up. Conclusions Our retrospective analysis of M. marinum infections at a German tertiary referral center revealed a considerable diagnostic delay and the relevance of microbiological culture, PCR and histology for diagnosis. Monotherapy with clarithromycin (rather than doxycycline) appeared as a reasonable treatment option while immunosuppressed or -compromised patients and those with extended disease received combination therapy. KW - Mycobacterium marinum KW - diagnosis KW - therapy Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318428 VL - 20 IS - 9 SP - 1211 EP - 1218 ER - TY - JOUR A1 - Rak, Katrin A1 - Hamm, Henning A1 - Kerstan, Andreas A1 - Kolb-Mäurer, Annette A1 - Goebeler, Matthias T1 - Severe and prolonged liver damage in pityriasis rubra pilaris treated with acitretin: a case report JF - SN Comprehensive Clinical Medicine N2 - Acitretin is a systemic retinoid that is used in dermatology for treatment of various inflammatory and especially hyperkeratotic diseases. Elevation of liver enzymes may occur occasionally but normally resolves spontaneously, at the latest after termination of acitretin. However, it can very rarely develop into a life-threatening adverse event including drug-induced liver injury (DILI). A 45-year-old man with classical pityriasis rubra pilaris, a frequently severe, inflammatory skin disease, was started on acitretin. After a seemingly harmless elevation of transaminases, a few weeks after initiation of acitretin, the patient experienced a dramatic course of liver injury with hepatic jaundice though acitretin was stopped immediately. Eventually, laboratory values recovered upon high-dose oral prednisolone therapy. Prescribing physicians should keep in mind that acitretin might induce severe liver injury. Even after termination of acitretin laboratory values should be monitored for a while in order to recognize symptomless but harmful drug-induced liver injury in time. KW - acitretin KW - pityriasis rubra pilaris KW - drug-induced liver injury (DILI) KW - adverse event Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-323982 VL - 4 IS - 1 ER -