TY - JOUR A1 - Dufner, Vera A1 - Kessler, Almuth Friederike A1 - Just, Larissa A1 - Hau, Peter A1 - Bumes, Elisabeth A1 - Pels, Hendrik Johannes A1 - Grauer, Oliver Martin A1 - Wiese, Bettina A1 - Löhr, Mario A1 - Jordan, Karin A1 - Strik, Herwig T1 - The emesis trial: depressive glioma patients are more affected by chemotherapy-induced nausea and vomiting JF - Frontiers in Neurology N2 - Purpose Glioma patients face a limited life expectancy and at the same time, they suffer from afflicting symptoms and undesired effects of tumor treatment. Apart from bone marrow suppression, standard chemotherapy with temozolomide causes nausea, emesis and loss of appetite. In this pilot study, we investigated how chemotherapy-induced nausea and vomiting (CINV) affects the patients' levels of depression and their quality of life. Methods In this prospective observational multicentre study (n = 87), nausea, emesis and loss of appetite were evaluated with an expanded MASCC questionnaire, covering 10 days during the first and the second cycle of chemotherapy. Quality of life was assessed with the EORTC QLQ-C30 and BN 20 questionnaire and levels of depression with the PHQ-9 inventory before and after the first and second cycle of chemotherapy. Results CINV affected a minor part of patients. If present, it reached its maximum at day 3 and decreased to baseline level not before day 8. Levels of depression increased significantly after the first cycle of chemotherapy, but decreased during the further course of treatment. Patients with higher levels of depression were more severely affected by CINV and showed a lower quality of life through all time-points. Conclusion We conclude that symptoms of depression should be perceived in advance and treated in order to avoid more severe side effects of tumor treatment. Additionally, in affected patients, delayed nausea was most prominent, pointing toward an activation of the NK1 receptor. We conclude that long acting antiemetics are necessary totreat temozolomide-induced nausea. KW - glioblastoma KW - chemotherapy KW - depression KW - nausea and emesis KW - quality of life Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262859 SN - 1664-2295 VL - 13 ER - TY - JOUR A1 - Gaab, Christine A1 - Adolph, Jonas E. A1 - Tippelt, Stephan A1 - Mikasch, Ruth A1 - Obrecht, Denise A1 - Mynarek, Martin A1 - Rutkowski, Stefan A1 - Pfister, Stefan M. A1 - Milde, Till A1 - Witt, Olaf A1 - Bison, Brigitte A1 - Warmuth-Metz, Monika A1 - Kortmann, Rolf-Dieter A1 - Dietzsch, Stefan A1 - Pietsch, Torsten A1 - Timmermann, Beate A1 - Sträter, Ronald A1 - Bode, Udo A1 - Faldum, Andreas A1 - Kwiecien, Robert A1 - Fleischhack, Gudrun T1 - Local and systemic therapy of recurrent medulloblastomas in children and adolescents: results of the P-HIT-REZ 2005 Study JF - Cancers N2 - Recurrent medulloblastomas are associated with survival rates <10%. Adequate multimodal therapy is being discussed as having a major impact on survival. In this study, 93 patients with recurrent medulloblastoma treated in the German P-HIT-REZ 2005 Study were analyzed for survival (PFS, OS) dependent on patient, disease, and treatment characteristics. The median age at the first recurrence was 10.1 years (IQR: 6.9–16.1). Median PFS and OS, at first recurrence, were 7.9 months (CI: 5.7–10.0) and 18.5 months (CI: 13.6–23.5), respectively. Early relapses/progressions (<18 months, n = 30/93) found mainly in molecular subgroup 3 were associated with markedly worse median PFS (HR: 2.34) and OS (HR: 3.26) in regression analyses. A significant survival advantage was found for the use of volume-reducing surgery as well as radiotherapy. Intravenous chemotherapy with carboplatin and etoposide (ivCHT, n = 28/93) showed improved PFS and OS data and the best objective response rate (ORR) was 66.7% compared to oral temozolomide (oCHT, n = 47/93) which was 34.8%. Intraventricular (n = 43) as well as high-dose chemotherapy (n = 17) at first relapse was not related to a significant survival benefit. Although the results are limited due to a non-randomized study design, they may serve as a basis for future treatment decisions in order to improve the patients' survival. KW - medulloblastoma KW - refractory KW - recurrent KW - children KW - chemotherapy KW - surgery KW - radiotherapy KW - re-irradiation KW - intraventricular therapy Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-254809 SN - 2072-6694 VL - 14 IS - 3 ER - TY - JOUR A1 - Kandels, Daniela A1 - Pietsch, Torsten A1 - Bison, Brigitte A1 - Warmuth‐Metz, Monika A1 - Thomale, Ulrich‐Wilhelm A1 - Kortmann, Rolf‐Dieter A1 - Timmermann, Beate A1 - Hernáiz Driever, Pablo A1 - Witt, Olaf A1 - Schmidt, René A1 - Gnekow, Astrid K. T1 - Loss of efficacy of subsequent nonsurgical therapy after primary treatment failure in pediatric low‐grade glioma patients—Report from the German SIOP‐LGG 2004 cohort JF - International Journal of Cancer N2 - First‐line treatment of pediatric low‐grade glioma using surgery, radio‐ or chemotherapy fails in a relevant proportion of patients. We analyzed efficacy of subsequent surgical and nonsurgical therapies of the German cohort of the SIOP‐LGG 2004 study (2004‐2012, 1558 registered patients; median age at diagnosis 7.6 years, median observation time 9.2 years, overall survival 98%/96% at 5/10 years, 15% neurofibromatosis type 1 [NF1]). During follow‐up, 1078/1558 patients remained observed without (n = 217), with 1 (n = 707), 2 (n = 124) or 3 to 6 (n = 30) tumor volume reductions; 480/1558 had 1 (n = 332), 2 (n = 80), 3 or more (n = 68) nonsurgical treatment‐lines, accompanied by up to 4 tumor‐reductive surgeries in 215/480; 265/480 patients never underwent any neurosurgical tumor volume reduction (163/265 optic pathway glioma). Patients with progressing tumors after first‐line adjuvant treatment were at increased risk of suffering further progressions. Risk factors were young age (<1 year) at start of treatment, tumor dissemination or progression within 18 months after start of chemotherapy. Progression‐free survival rates declined with subsequent treatment‐lines, yet remaining higher for patients with NF1. In non‐NF1‐associated tumors, vinblastine monotherapy vs platinum‐based chemotherapy was noticeably less effective when used as second‐line treatment. Yet, for the entire cohort, results did not favor a certain sequence of specific treatment options. Rather, all can be aligned as a portfolio of choices which need careful balancing of risks and benefits. Future molecular data may predict long‐term tumor biology. KW - chemotherapy KW - pediatric low‐grade glioma KW - progression KW - radiotherapy KW - surgery Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-216130 VL - 147 IS - 12 SP - 3471 EP - 3489 ER - TY - THES A1 - Laufs, Valeria T1 - Evaluation von ERCC1 als prädiktiver Biomarker bei mit platinbasierter Chemotherapie behandeltem Nebennierenrindenkarzinom T1 - ERCC1 as predictive biomarker to platinum-based chemotherapy in adrenocortical carcinomas N2 - Platinbasierte Chemotherapie ist die effektivste Chemotherapie für das fortgeschrittene Nebennierenrindenkarzinom (ACC). Excision repair cross complementing group 1 (ERCC1) spielt eine entscheidende Rolle bei der Reparatur durch Platin entstandener DNA-Schäden. Zwei Studien die die Rolle von ERCC1 per Immunhistochemie als prädiktiver Marker für das Ansprechen auf platinbasierte Chemotherapie beim ACC untersuchten kamen zu sich widersprechenden Ergebnissen. Beide Studien nutzten den ERCC1-Antikörper Klon 8F1 der sich später als nicht spezifisch herausstellte. Das Ziel der Doktorarbeit war die Evaluation von ERCC1 mit einem neuen hoch spezifischen Antikörper in einer großen Kohorte von Patienten mit ACC. Material und Methoden: 146 Patienten mit verfügbaren FFPE-Schnitten wurden eingeschlossen. Alle Patienten erhielten eine platinbasierte Chemotherapie im Median für 6 Zyklen, nämlich Cisplatin (n=131) oder Carboplatin (n=15), in den meisten Fällen in Kombination mit Etoposid (n=144 , Doxorubicin (n=131) und Mitotane (n=131). Die Immunhistochemische Färbung wurde mit dem neuen Antikörper Klon 4F9 durchgeführt. Der Zusammenhang zwischen ERCC1-Expression und klinischen Parametern, Therapieansprechen, progressionsfreiem Überleben und Gesamtüberleben wurde analysiert. Ergebnisse: Eine hohe ERCC1-Expression wurde in 66% der Tumorproben beobachtet. Während der Chemotherapie zeigte sich bei 43 Pateinten ein Therapieansprechen (29,5%), bei 49 Patienten eine Stabilisierung der Erkrankung (33,6%), bei 8 Patienten ein gemischtes Ansprechen (5,5%) und bei 46 Pateinten ein Krankheitsprogress (31,5%), ohne Zusammenhang zur ERCC1-Expression. Auch zeigte sich kein signifikanter Zusammenhanf zwischen der ERCC1-Expression und dem progressionsfreien Überleben (Median 6.5 vs. 6 Monate, P=0.33, HR=1.23, 95%CI=0.82-2.0) oder dem Gesamtüberleben. Zusammenfassung: Es besteht kein Zusammenhang zwischen der ERCC1-Expression und der Platinsensitivität beim Nebennierenrindenkarzinom. Somit werden andere Biomarker zur Therapieentscheidung benötigt. N2 - Objective: Platinum-based chemotherapy (PBC) is the most effective cytotoxic treatment for advanced adrenocortical carcinoma (ACC). Excision repair cross complementing group 1 (ERCC1) plays a critical role in the repair of platinum-induced DNA damage. Two studies investigating the role of ERCC1 immunostaining as a predictive marker for the response to PBC in ACC had reported conflicting results. Both studies used the ERCC1-antibody clone 8F1 that later turned out to be not specific. The aim of this study was to evaluate the predictive role of ERCC1 with the new specific antibody in a larger series of ACC. Design and methods: 146 ACC patients with available FFPE slides were investigated. All patients underwent PBC (median cycles=6), including cisplatin (n=131) or carboplatin (n=15), in most cases combined with etoposide (n=144), doxorubicin (n=131) and mitotane (n=131). Immunostaining was performed with the novel ERCC1-antibody clone 4F9. The relationship between ERCC1 expression and clinico-pathological parameters, as well as best objective response to therapy and progression-free survival (PFS) during PBC was evaluated. Results: High ERCC1 expression was observed in 66% of ACC samples. During PBC, 43 patients experienced objective response (29.5%), 49 stable disease (33.6%), 8 mixed response (5.5%) and 46 progressive disease (31,5%) without any relationship with the ERCC1 immunostaining. No significant correlation was also found between ERCC1 expression and progression-free survival (median 6.5 vs 6 months, P=0.33, HR=1.23, 95%CI=0.82-2.0). Conclusion: ERCC1 expression is not directly associated with sensitivity to PBC in ACC. Thus, other predictive biomarkers are required to support treatment decisions in patients with ACC. KW - ERCC1 Chemotherapie Nebennierenrindenkarzinom KW - ERCC1 KW - chemotherapy KW - Chemotherapie KW - Platin KW - Nebennierenrindenkarzinom KW - platinum KW - adrenocortical carcinoma Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-180230 ER - TY - JOUR A1 - Bartmann, Catharina A1 - Janaki Raman, Sudha R. A1 - Flöter, Jessica A1 - Schulze, Almut A1 - Bahlke, Katrin A1 - Willingstorfer, Jana A1 - Strunz, Maria A1 - Wöckel, Achim A1 - Klement, Rainer J. A1 - Kapp, Michaela A1 - Djuzenova, Cholpon S. A1 - Otto, Christoph A1 - Kämmerer, Ulrike T1 - Beta-hydroxybutyrate (3-OHB) can influence the energetic phenotype of breast cancer cells, but does not impact their proliferation and the response to chemotherapy or radiation JF - Cancer & Metabolism N2 - Background: Ketogenic diets (KDs) or short-term fasting are popular trends amongst supportive approaches for cancer patients. Beta-hydroxybutyrate (3-OHB) is the main physiological ketone body, whose concentration can reach plasma levels of 2–6 mM during KDs or fasting. The impact of 3-OHB on the biology of tumor cells described so far is contradictory. Therefore, we investigated the effect of a physiological concentration of 3 mM 3-OHB on metabolism, proliferation, and viability of breast cancer (BC) cells in vitro. Methods: Seven different human BC cell lines (BT20, BT474, HBL100, MCF-7, MDA-MB 231, MDA-MB 468, and T47D) were cultured in medium with 5 mM glucose in the presence of 3 mM 3-OHB at mild hypoxia (5% oxygen) or normoxia (21% oxygen). Metabolic profiling was performed by quantification of the turnover of glucose, lactate, and 3-OHB and by Seahorse metabolic flux analysis. Expression of key enzymes of ketolysis as well as the main monocarboxylic acid transporter MCT2 and the glucose-transporter GLUT1 was analyzed by RT-qPCR and Western blotting. The effect of 3-OHB on short- and long-term cell proliferation as well as chemo- and radiosensitivity were also analyzed. Results: 3-OHB significantly changed the oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) in BT20 cells resulting in a more oxidative energetic phenotype. MCF-7 and MDA-MB 468 cells had increased ECAR only in response to 3-OHB, while the other three cell types remained uninfluenced. All cells expressed MCT2 and GLUT1, thus being able to uptake the metabolites. The consumption of 3-OHB was not strongly linked to mRNA overexpression of key enzymes of ketolysis and did not correlate with lactate production and glucose consumption. Neither 3-OHB nor acetoacetate did interfere with proliferation. Further, 3-OHB incubation did not modify the response of the tested BC cell lines to chemotherapy or radiation. Conclusions: We found that a physiological level of 3-OHB can change the energetic profile of some BC cell lines. However, 3-OHB failed to influence different biologic processes in these cells, e.g., cell proliferation and the response to common breast cancer chemotherapy and radiotherapy. Thus, we have no evidence that 3-OHB generally influences the biology of breast cancer cells in vitro. KW - ketogenic diet KW - β-Hydroxybutyrate KW - ketone bodies KW - breast cancer KW - seahorse KW - metabolic profile KW - chemotherapy KW - ionizing radiation Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175607 VL - 6 IS - 8 ER - TY - JOUR A1 - Memmel, Simon A1 - Sisario, Dmitri A1 - Zöller, Caren A1 - Fiedler, Vanessa A1 - Katzer, Astrid A1 - Heiden, Robin A1 - Becker, Nicholas A1 - Eing, Lorenz A1 - Ferreira, Fábio L.R. A1 - Zimmermann, Heiko A1 - Sauer, Markus A1 - Flentje, Michael A1 - Sukhorukov, Vladimir L. A1 - Djuzenova, Cholpon S. T1 - Migration pattern, actin cytoskeleton organization and response to PI3K-, mTOR-, and Hsp90-inhibition of glioblastoma cells with different invasive capacities JF - Oncotarget N2 - High invasiveness and resistance to chemo- and radiotherapy of glioblastoma multiforme (GBM) make it the most lethal brain tumor. Therefore, new treatment strategies for preventing migration and invasion of GBM cells are needed. Using two different migration assays, Western blotting, conventional and super-resolution (dSTORM) fluorescence microscopy we examine the effects of the dual PI3K/mTOR-inhibitor PI-103 alone and in combination with the Hsp90 inhibitor NVP-AUY922 and/or irradiation on the migration, expression of marker proteins, focal adhesions and F-actin cytoskeleton in two GBM cell lines (DK-MG and SNB19) markedly differing in their invasive capacity. Both lines were found to be strikingly different in morphology and migration behavior. The less invasive DK-MG cells maintained a polarized morphology and migrated in a directionally persistent manner, whereas the highly invasive SNB19 cells showed a multipolar morphology and migrated randomly. Interestingly, a single dose of 2 Gy accelerated wound closure in both cell lines without affecting their migration measured by single-cell tracking. PI-103 inhibited migration of DK-MG (p53 wt, PTEN wt) but not of SNB19 (p53 mut, PTEN mut) cells probably due to aberrant reactivation of the PI3K pathway in SNB19 cells treated with PI-103. In contrast, NVP-AUY922 exerted strong anti-migratory effects in both cell lines. Inhibition of cell migration was associated with massive morphological changes and reorganization of the actin cytoskeleton. Our results showed a cell line-specific response to PI3K/mTOR inhibition in terms of GBM cell motility. We conclude that anti-migratory agents warrant further preclinical investigation as potential therapeutics for treatment of GBM. KW - chemotherapy KW - glioblastoma multiforme KW - migration KW - treatment Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-170719 VL - 8 IS - 28 ER - TY - JOUR A1 - Wiegering, Armin A1 - Matthes, Niels A1 - Mühling, Bettina A1 - Koospal, Monika A1 - Quenzer, Anne A1 - Peter, Stephanie A1 - Germer, Christoph-Thomas A1 - Linnebacher, Michael A1 - Otto, Christoph T1 - Reactivating p53 and Inducing Tumor Apoptosis (RITA) Enhances the Response of RITA-Sensitive Colorectal Cancer Cells to Chemotherapeutic Agents 5-Fluorouracil and Oxaliplatin JF - Neoplasia N2 - Colorectal carcinoma (CRC) is the most common cancer of the gastrointestinal tract with frequently dysregulated intracellular signaling pathways, including p53 signaling. The mainstay of chemotherapy treatment of CRC is 5-fluorouracil (5FU) and oxaliplatin. The two anticancer drugs mediate their therapeutic effect via DNA damage-triggered signaling. The small molecule reactivating p53 and inducing tumor apoptosis (RITA) is described as an activator of wild-type and reactivator of mutant p53 function, resulting in elevated levels of p53 protein, cell growth arrest, and cell death. Additionally, it has been shown that RITA can induce DNA damage signaling. It is expected that the therapeutic benefits of 5FU and oxaliplatin can be increased by enhancing DNA damage signaling pathways. Therefore, we highlighted the antiproliferative response of RITA alone and in combination with 5FU or oxaliplatin in human CRC cells. A panel of long-term established CRC cell lines (n = 9) including p53 wild-type, p53 mutant, and p53 null and primary patient-derived, low-passage cell lines (n = 5) with different p53 protein status were used for this study. A substantial number of CRC cells with pronounced sensitivity to RITA (IC\(_{50}\)< 3.0 μmol/l) were identified within established (4/9) and primary patient-derived (2/5) CRC cell lines harboring wild-type or mutant p53 protein. Sensitivity to RITA appeared independent of p53 status and was associated with an increase in antiproliferative response to 5FU and oxaliplatin, a transcriptional increase of p53 targets p21 and NOXA, and a decrease in MYC mRNA. The effect of RITA as an inducer of DNA damage was shown by a strong elevation of phosphorylated histone variant H2A.X, which was restricted to RITA-sensitive cells. Our data underline the primary effect of RITA, inducing DNA damage, and demonstrate the differential antiproliferative effect of RITA to CRC cells independent of p53 protein status. We found a substantial number of RITA-sensitive CRC cells within both panels of established CRC cell lines and primary patient-derived CRC cell lines (6/14) that provide a rationale for combining RITA with 5FU or oxaliplatin to enhance the antiproliferative response to both chemotherapeutic agents. KW - colorectal carcinoma KW - reactivating p53 and inducing tumor apoptosis (RITA) KW - chemotherapy KW - 5-fluorouracil KW - oxaliplatin Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-171067 VL - 19 IS - 4 ER - TY - JOUR A1 - Lichthardt, Sven A1 - Kerscher, Alexander A1 - Dietz, Ulrich A. A1 - Jurowich, Christian A1 - Kunzmann, Volker A1 - von Rahden, Burkhard H. A. A1 - Germer, Christoph-Thomas A1 - Wiegering, Armin T1 - Original article: role of adjuvant chemotherapy in a perioperative chemotherapy regimen for gastric cancer JF - BMC Cancer N2 - Background Multimodal treatment strategies – perioperative chemotherapy (CTx) and radical surgery – are currently accepted as treatment standard for locally advanced gastric cancer. However, the role of adjuvant postoperative CTx (postCTx) in addition to neoadjuvant preoperative CTx (preCTx) in this setting remains controversial. Methods Between 4/2006 and 12/2013, 116 patients with locally advanced gastric cancer were treated with preCTx. 72 patients (62 %), in whom complete tumor resection (R0, subtotal/total gastrectomy with D2-lymphadenectomy) was achieved, were divided into two groups, one of which receiving adjuvant therapy (n = 52) and one without (n = 20). These groups were analyzed with regard to survival and exclusion criteria for adjuvant therapy. Results Postoperative complications, as well as their severity grade, did not correlate with fewer postCTx cycles administered (p = n.s.). Long-term survival was shorter in patients receiving postCTx in comparison to patients without postCTx, but did not show statistical significance. In per protocol analysis by excluding two patients with perioperative death, a shorter 3-year survival rate was observed in patients receiving postCTx compared to patients without postCTx (3-year survival: 71.2 % postCTx group vs. 90.0 % non-postCTx group; p = 0.038). Conclusion These results appear contradicting to the anticipated outcome. While speculative, they question the value of post-CTx. Prospectively randomized studies are needed to elucidate the role of postCTx. KW - gastric cancer KW - chemotherapy KW - neoadjuvant KW - multimodal KW - complication KW - adjuvant KW - risk factor KW - survival Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-147743 VL - 16 IS - 650 ER - TY - JOUR A1 - Chiorean, E. G. A1 - Von Hoff, D. D. A1 - Reni, M. A1 - Arena, F. P. A1 - Infante, J. R. A1 - Bathini, V. G. A1 - Wood, T. E. A1 - Mainwaring, P. N. A1 - Muldoon, R. T. A1 - Clingan, P. R. A1 - Kunzmann, V. A1 - Ramanathan, R. K. A1 - Tabernero, J. A1 - Goldstein, D. A1 - McGovern, D. A1 - Lu, B. A1 - Ko, A. T1 - CA19-9 decrease at 8 weeks as a predictor of overall survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic cancer JF - Annals of Oncology N2 - Background A phase I/II study and subsequent phase III study (MPACT) reported significant correlations between CA19-9 decreases and prolonged overall survival (OS) with nab-paclitaxel plus gemcitabine (nab-P + Gem) treatment for metastatic pancreatic cancer (MPC). CA19-9 changes at week 8 and potential associations with efficacy were investigated as part of an exploratory analysis in the MPACT trial. Patients and methods Untreated patients with MPC (N = 861) received nab-P + Gem or Gem alone. CA19-9 was evaluated at baseline and every 8 weeks. Results Patients with baseline and week-8 CA19-9 measurements were analyzed (nab-P + Gem: 252; Gem: 202). In an analysis pooling the treatments, patients with any CA19-9 decline (80%) versus those without (20%) had improved OS (median 11.1 versus 8.0 months; P = 0.005). In the nab-P + Gem arm, patients with (n = 206) versus without (n = 46) any CA19-9 decrease at week 8 had a confirmed overall response rate (ORR) of 40% versus 13%, and a median OS of 13.2 versus 8.3 months (P = 0.001), respectively. In the Gem-alone arm, patients with (n = 159) versus without (n = 43) CA19-9 decrease at week 8 had a confirmed ORR of 15% versus 5%, and a median OS of 9.4 versus 7.1 months (P = 0.404), respectively. In the nab-P + Gem and Gem-alone arms, by week 8, 16% (40/252) and 6% (13/202) of patients, respectively, had an unconfirmed radiologic response (median OS 13.7 and 14.7 months, respectively), and 79% and 84% of patients, respectively, had stable disease (SD) (median OS 11.1 and 9 months, respectively). Patients with SD and any CA19-9 decrease (158/199 and 133/170) had a median OS of 13.2 and 9.4 months, respectively. Conclusion This analysis demonstrated that, in patients with MPC, any CA19-9 decrease at week 8 can be an early marker for chemotherapy efficacy, including in those patients with SD. CA19-9 decrease identified more patients with survival benefit than radiologic response by week 8. KW - CA19-9 KW - pancreatic cancer KW - chemotherapy KW - nab-paclitaxel KW - MPACT Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-189659 VL - 27 IS - 4 ER - TY - JOUR A1 - Worku, Netsanet A1 - Stich, August A1 - Daugschies, Arwid A1 - Wenzel, Iris A1 - Kurz, Randy A1 - Thieme, Rene A1 - Kurz, Susanne A1 - Birkenmeier, Gerd T1 - Ethyl Pyruvate Emerges as a Safe and Fast Acting Agent against Trypanosoma brucei by Targeting Pyruvate Kinase Activity JF - PLoS ONE N2 - Background Human African Trypanosomiasis (HAT) also called sleeping sickness is an infectious disease in humans caused by an extracellular protozoan parasite. The disease, if left untreated, results in 100% mortality. Currently available drugs are full of severe drawbacks and fail to escape the fast development of trypanosoma resistance. Due to similarities in cell metabolism between cancerous tumors and trypanosoma cells, some of the current registered drugs against HAT have also been tested in cancer chemotherapy. Here we demonstrate for the first time that the simple ester, ethyl pyruvate, comprises such properties. Results The current study covers the efficacy and corresponding target evaluation of ethyl pyruvate on T. brucei cell lines using a combination of biochemical techniques including cell proliferation assays, enzyme kinetics, phasecontrast microscopic video imaging and ex vivo toxicity tests. We have shown that ethyl pyruvate effectively kills trypanosomes most probably by net ATP depletion through inhibition of pyruvate kinase (Ki = 3.0\(\pm\)0.29 mM). The potential of ethyl pyruvate as a trypanocidal compound is also strengthened by its fast acting property, killing cells within three hours post exposure. This has been demonstrated using video imaging of live cells as well as concentration and time dependency experiments. Most importantly, ethyl pyruvate produces minimal side effects in human red cells and is known to easily cross the blood-brain-barrier. This makes it a promising candidate for effective treatment of the two clinical stages of sleeping sickness. Trypanosome drug-resistance tests indicate irreversible cell death and a low incidence of resistance development under experimental conditions. Conclusion Our results present ethyl pyruvate as a safe and fast acting trypanocidal compound and show that it inhibits the enzyme pyruvate kinase. Competitive inhibition of this enzyme was found to cause ATP depletion and cell death. Due to its ability to easily cross the blood-brain-barrier, ethyl pyruvate could be considered as new candidate agent to treat the hemo-lymphatic as well as neurological stages of sleeping sickness. KW - human african trypanosomiasis KW - glycolysis KW - transport KW - protein KW - cruzi KW - chemotherapy KW - metabolism KW - in vitro KW - drugs KW - sleeping sickness Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-150002 VL - 10 IS - 9 ER - TY - JOUR A1 - Cardani, Diego A1 - Sardi, Claudia A1 - La Ferla, Barbara A1 - D'Orazio, Guiseppe A1 - Sommariva, Michele A1 - Marcucci, Fabrizio A1 - Olivero, Daniela A1 - Tagliabue, Elda A1 - Koepsell, Hermann A1 - Nicotra, Francesco A1 - Balsari, Andrea A1 - Rumio, Christiano T1 - Sodium glucose cotransporter 1 ligand BLF501 as a novel tool for management of gastrointestinal mucositis JF - Molecular Cancer N2 - Background: Recent studies demonstrated that engagement of sodium glucose transporter 1 (SGLT-1) by orally administered D-glucose protects the intestinal mucosa from lipopolysaccharide (LPS)-induced injury. We tested whether SGLT-1 engagement might protect the intestinal mucosa from doxorubicin (DXR)- and 5-fluorouracil (5-FU)-induced injury in animal models mimicking acute or chronic mucositis. Methods: Mice were treated intraperitoneally with DXR, alone or in combination with 5-FU, and orally with BLF501, a glucose-derived synthetic compound with high affinity for SGLT-1. Intestinal mucosal epithelium integrity was assessed by histological analysis, cellular proliferation assays, real-time PCR gene expression assays and Western blot assays. Student's t-test (paired two-tailed) and X-2 analyses were used for comparisons between groups. Differences were considered significant at p < 0.05. Results: BLF501 administration in mice treated with DXR and/or 5-FU decreased the injuries to the mucosa in terms of epithelial integrity and cellular proliferative ability. Co-treatment with BLF501 led to a normal expression and distribution of both zonula occludens-1 (ZO-1) and beta-catenin, which were underexpressed after treatment with either chemotherapeutic agent alone. BLF501 administration also restored normal expression of caspase-3 and ezrin/radixin/moesin (ERM), which were overexpressed after treatment with DXR and 5-FU. In SGLT1-/- mice, BLF501 had no detectable effects. BLF501 administration in wild-type mice with growing A431 tumors did not modify antitumor activity of DXR. Conclusions: BLF501-induced protection of the intestinal mucosa is a promising novel therapeutic approach to reducing the severity of chemotherapy-induced mucositis. KW - apoptosis KW - prevention KW - doxorubicin KW - cancer KW - gastrointestinal mucositis KW - SGLT-1 KW - synthetic D-glucose analogy KW - chemotherapy KW - inflammation KW - clinical practice guidelines KW - intestinal mucositis KW - epithelial cells KW - oral mucositis KW - gene-expression Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-117352 SN - 1476-4598 VL - 13 IS - 23 ER - TY - JOUR A1 - Brehm, Klaus A1 - Koziol, Uriel T1 - On the importance of targeting parasite stem cells in anti-echinococcosis drug development T1 - De l’importance de cibler les cellules souches du parasite dans la recherche de nouveaux médicaments contre les échinococcoses JF - Parasite N2 - The life-threatening diseases alveolar and cystic echinococcoses are caused by larvae of the tapeworms Echinococcus multilocularis and E. granulosus, respectively. In both cases, intermediate hosts, such as humans, are infected by oral uptake of oncosphere larvae, followed by asexual multiplication and almost unrestricted growth of the metacestode within host organs. Besides surgery, echinococcosis treatment relies on benzimidazole-based chemotherapy, directed against parasite beta-tubulin. However, since beta-tubulins are highly similar between cestodes and humans, benzimidazoles can only be applied at parasitostatic doses and are associated with adverse side effects. Mostly aiming at identifying alternative drug targets, the nuclear genome sequences of E. multilocularis and E. granulosus have recently been characterized, revealing a large number of druggable targets that are expressed by the metacestode. Furthermore, recent cell biological investigations have demonstrated that E. multilocularis employs pluripotent stem cells, called germinative cells, which are the only parasite cells capable of proliferation and which give rise to all differentiated cells. Hence, the germinative cells are the crucial cell type mediating proliferation of E. multilocularis, and most likely also E. granulosus, within host organs and should also be responsible for parasite recurrence upon discontinuation of chemotherapy. Interestingly, recent investigations have also indicated that germinative cells might be less sensitive to chemotherapy because they express a beta-tubulin isoform with limited affinity to benzimidazoles. In this article, we briefly review the recent findings concerning Echinococcus genomics and stem cell research and propose that future research into anti-echinococcosis drugs should also focus on the parasite’s stem cell population. N2 - Les échinococcoses alvéolaire et kystique, deux maladies potentiellement mortelles, sont respectivement causées par les larves des vers plats Echinococcus multilocularis et E. granulosus. Dans les deux cas, les hôtes intermédiaires, comme l’homme, s’infectent par l’ingestion des oncosphères, suivie de la multiplication asexuée et la croissance presque illimitée du métacestode dans les organes de l’hôte. À côté de la chirurgie, le traitement des échinococcoses repose sur une chimiothérapie par les benzimidazoles, dont l’action est dirigée contre la bêta-tubuline du parasite. Cependant, comme les bêta-tubulines sont extrêmement similaires chez les cestodes et les humains, les benzimidazoles ne peuvent être utilisés qu’à des posologies parasitostatiques et sont associés à des effets secondaires indésirables. Avec l’objectif principal d’identifier des cibles pour des médicaments alternatifs, le génome nucléaire d’E. multilocularis et d’E. granulosus a été récemment séquencé, et de nombreuses cibles potentielles pour des médicaments sont exprimées par le métacestode. De plus, des études récentes de biologie cellulaire ont montré qu’E. multilocularis dispose de cellules souches multipotentes, appelées cellules germinales, qui sont les seules cellules parasitaires capables de prolifération et à l’origine de toutes les cellules différenciées. Ces cellules germinales représentent donc un type cellulaire crucial pour la prolifération d’E. multilocularis, et très vraisemblablement aussi d’E. granulosus, dans les organes de l’hôte, et vraisemblablement responsables des récurrences parasitaires à l’arrêt de la chimiothérapie. Des études récentes ont aussi indiqué que les cellules germinales pourraient être moins sensibles à la chimiothérapie car elles expriment un isoforme de la bêta-tubuline à affinité limitée vis-à-vis des benzimidazoles. Dans cet article, nous faisons une courte revue des découvertes récentes concernant la génomique d’Echinococcus et la recherche sur les cellules souches. Nous proposons que les recherches futures sur de nouveaux médicaments contre les échinococcoses se focalisent sur la population des cellules souches du parasite. KW - genome KW - chemotherapy KW - benzimidazole KW - stem cells KW - germinative cells KW - beta-tubulin Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-118030 SN - 1252-607X VL - 21 ER - TY - JOUR A1 - Koch, Oliver A1 - Cappel, Daniel A1 - Nocker, Monika A1 - Jäger, Timo A1 - Flohé, Leopold A1 - Sotriffer, Christoph A. A1 - Selzer, Paul M. T1 - Molecular Dynamics Reveal Binding Mode of Glutathionylspermidine by Trypanothione Synthetase JF - PLoS ONE N2 - The trypanothione synthetase (TryS) catalyses the two-step biosynthesis of trypanothione from spermidine and glutathione and is an attractive new drug target for the development of trypanocidal and antileishmanial drugs, especially since the structural information of TryS from Leishmania major has become available. Unfortunately, the TryS structure was solved without any of the substrates and lacks loop regions that are mechanistically important. This contribution describes docking and molecular dynamics simulations that led to further insights into trypanothione biosynthesis and, in particular, explains the binding modes of substrates for the second catalytic step. The structural model essentially confirm previously proposed binding sites for glutathione, ATP and two \(Mg^{2+}\) ions, which appear identical for both catalytic steps. The analysis of an unsolved loop region near the proposed spermidine binding site revealed a new pocket that was demonstrated to bind glutathionylspermidine in an inverted orientation. For the second step of trypanothione synthesis glutathionylspermidine is bound in a way that preferentially allows \(N^1\)-glutathionylation of \(N^8\)-glutathionylspermidine, classifying \(N^8\)-glutathionylspermidine as the favoured substrate. By inhibitor docking, the binding site for \(N^8\)-glutathionylspermidine was characterised as druggable. KW - purification KW - crithidia fasciulata KW - trypanosoma cruzi KW - RESP model KW - biosynthesis KW - chemotherapy KW - metabolism KW - brucei KW - system KW - leishmaniasis Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-131070 VL - 8 IS - 2 ER - TY - JOUR A1 - Sturm, Julia B. A1 - Hess, Michael A1 - Weibel, Stephanie A1 - Chen, Nanhei G. A1 - Yu, Yong A. A1 - Zhang, Quian A1 - Donat, Ulrike A1 - Reiss, Cora A1 - Gambaryan, Stepan A1 - Krohne, Georg A1 - Stritzker, Jochen A1 - Szalay, Aladar A. T1 - Functional hyper-IL-6 from vaccinia virus-colonized tumors triggers platelet formation and helps to alleviate toxicity of mitomycin C enhanced virus therapy N2 - Background: Combination of oncolytic vaccinia virus therapy with conventional chemotherapy has shown promise for tumor therapy. However, side effects of chemotherapy including thrombocytopenia, still remain problematic. Methods: Here, we describe a novel approach to optimize combination therapy of oncolytic virus and chemotherapy utilizing virus-encoding hyper-IL-6, GLV-1h90, to reduce chemotherapy-associated side effects. Results: We showed that the hyper-IL-6 cytokine was successfully produced by GLV-1h90 and was functional both in cell culture as well as in tumor-bearing animals, in which the cytokine-producing vaccinia virus strain was well tolerated. When combined with the chemotherapeutic mitomycin C, the anti-tumor effect of the oncolytic virotherapy was significantly enhanced. Moreover, hyper-IL-6 expression greatly reduced the time interval during which the mice suffered from chemotherapy-induced thrombocytopenia. Conclusion: Therefore, future clinical application would benefit from careful investigation of additional cytokine treatment to reduce chemotherapy-induced side effects. KW - Biologie KW - vaccinia virus KW - cancer KW - cytokine KW - hyper-IL-6 KW - oncolysis KW - chemotherapy Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-75224 ER - TY - JOUR A1 - Tessmer, Ingrid A1 - Melikishvili, Manana A1 - Fried, Michael G. T1 - Cooperative cluster formation, DNA bending and base-flipping by O\(^6\)-alkylguanine-DNA alkyltransferase JF - Nucleic Acids Research N2 - O\(^6\)-Alkylguanine-DNA alkyltransferase (AGT) repairs mutagenic O\(^6\)-alkylguanine and O\(^4\)-alkylthymine adducts in DNA, protecting the genome and also contributing to the resistance of tumors to chemotherapeutic alkylating agents. AGT binds DNA cooperatively, and cooperative interactions are likely to be important in lesion search and repair. We examined morphologies of complexes on long, unmodified DNAs, using analytical ultracentrifugation and atomic force microscopy. AGT formed clusters of 11 proteins. Longer clusters, predicted by the McGhee-von Hippel model, were not seen even at high [protein]. Interestingly, torsional stress due to DNA unwinding has the potential to limit cluster size to the observed range. DNA at cluster sites showed bend angles (similar to 0, similar to 30 and similar to 60 degrees) that are consistent with models in which each protein induces a bend of similar to 30 degrees. Distributions of complexes along the DNA are incompatible with sequence specificity but suggest modest preference for DNA ends. These properties tell us about environments in which AGT may function. Small cooperative clusters and the ability to accommodate a range of DNA bends allow function where DNA topology is constrained, such as near DNA-replication complexes. The low sequence specificity allows efficient and unbiased lesion search across the entire genome. KW - inactivation KW - nucleotide excision-repair KW - atomic-force microscopy KW - noncooperative binding KW - restricition enzymes KW - complex stability KW - stranded DNAs KW - protein KW - chemotherapy KW - AGT Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-133949 VL - 40 IS - 17 ER - TY - THES A1 - Wierlemann, Alexander T1 - Entwicklung eines rechnergestützten Therapiemanagementsystems für die medizinische Onkologie T1 - Developement of a computer-basesd therapy-management system for medical oncology N2 - Durch die Einführung eines neuen fallpauschalierten Abrechnungssystems (Diangnosis related groups, DRG) sowie zahlreiche neue Maßnahmen der Qualitätssicherung wächst der Anteil administrativer Tätigkeiten für die klinisch tätigen Ärztinnen und Ärzte. Diese Entwicklung hat nicht zuletzt auch Auswirkungen auf die zeitlichen Ressourcen, die für die ärztlichen Kernaufgaben zur Verfügung stehen. In Bereichen mit intensiver klinischer Forschung steigen darüberhinaus auch die Anforderungen an die forschungsbegleitende Dokumentation. Eine effiziente Unterstützung bei der Kalkulation, Planung und Durchführung von Therapien durch Informationstechnologische (IT-) Systeme kann eine sinnvolle Entlastung der Ärzte darstellen. Es wurde ein einsatzfähiger Prototyp entwickelt, prgrammiert und implementiert. Anschließend wurde das Ergebnis mit potentiellen Anwendern der Software evaluiert. N2 - With the introduction of diagnoses related groups (DRG) and with other task for quality control, the part of adminitrative task in medical work rises every day. This development has an impact on the timely resources that are available for medical core issues. In departments with intense clinical research, the requirements for research-relatet documentation are rising. An effectiv support in calculation, planing and performing of therapies by modern information technology can bei a vital factor for clincial works. A ready-to-use prototyp of a computer-aided chemotherapy-system has been develepoed, programmed and implemented. Afterwards, the results were evalueted by possible users of this system. KW - Computergestützte Medizin KW - Chemotherapie KW - Onkologie KW - Computer-aided therapy KW - chemotherapy KW - oncology Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-37366 ER - TY - THES A1 - Schramm, Stefanie T1 - Überleben und Lebensqualität sprechen für ein konservatives Therapiekonzept bei Patienten mit Magenlymphomen : Ergebnisse einer prospektiven randomisierten Studie T1 - Outcome & quality of live favour a conservative treatment of patients with gastric lymphoma : results of a prospective randomised study N2 - Gastrointestinale Lymphome des MALT sind heute als eigenständige Entität anerkannt. Sie zeichnen sich durch morphologische, molekularbiologische, ätiopathogenetische und biologische Besonderheiten aus, die sie von den nodalen Lymphomen abgrenzen lassen. Im Rahmen der Würzburger Multicenterstudie „Gastrointestinale Lymphome II“ soll die Frage geklärt werden, ob in den lokalisierten Stadien I und II primärer Magenlymphome unter Berücksichtigung der posttherapeutischen Lebensqualität der operativen oder einer primär konservativen Therapie (Chemo- oder Radiotherapie) Vorzug gegeben werden soll. Von 1998 bis 2002 wurden dazu 49 Patienten mit neu diagnostiziertem niedrig- (n=19) oder hochmalignen (n=30) NHL des Magens in die Studie eingeschlossen. Nach zentraler Randomisierung wurden die Patienten mit low grade NHL der Operation (n=10) oder der Radiotherapie (n=9) zugeteilt. Die Patienten mit high grade NHL erhielten Operation plus Chemotherapie (n=16) oder alleinige Chemotherapie (n=14). Das mediane follow up betrug 74 Monate. Sowohl das operative als auch das konservative Vorgehen zeigten bei beiden Lymphomhistologien überaus hohe Remissionsraten in den Stadien EI und EII (CR um 90%). Unterschiede zwischen den Behandlungsmethoden konnten, evtl. auch bedingt durch die kleinen Gruppengrößen, nicht nachgewiesen werden. Insgesamt verstarben sechs Patienten, die sich in etwa gleichmäßig auf die Gruppen verteilten. Die Auswertung der Fragebögen zur Lebensqualität ergab gemäß SF-36 durchaus hohe Werte zur posttherapeutischen Lebensqualität. Eine Differenzierung der Patienten nach Behandlungsmethode oder Malignitätsgrad (low, high grade) war nicht möglich. Der Lebensqualitätsindex nach Troidl ließ einen prä-post-therapeutischen Vergleich zu: Betrachtet man die Kombination von Therapie und Malignitätsgrad, so fallen konservativ therapierte Patienten (unabhängig vom Malignitätsgrad) durch deutlich ansteigende Lebensqualität auf. Es lässt sich festhalten, dass bei primär gastrointestinalen Lymphomen sowohl mit operativem als auch konservativem Vorgehen hohe Remissionsraten erzielt werden können. Jedoch sind im Hinblick auf Organerhalt und die höhere post-therapeutische Lebensqualität die primäre Radio- und/oder Chemotherapie dem operativen Vorgehen vorzuziehen. N2 - Primary gastric MALT lymphomas have come to be considered as a separate tumor entity with specific histological and biological features. As part of the multicenter study „Gastrointestinale Lymphome II“ the question should be solved whether gastric MALT lymphomas in localized stage I and II should undergo either primary surgical or conservative (radio- or chemotherapy) treatment taking into consideration the post-therapeutic quality of life. From 1998 to 2002 49 patients with newly diagnosed low (n=19) and high grade (n=30) gastric lymphoma were enrolled in the multicenter study. After central randomisation patients with low grade NHL were referred to operation (n=10) or radiotherapy (n=9). Patients with high grade NHL underwent gastric surgery plus chemotherapy (n=16) or primary chemotherapy (n=14). The median follow up-time amounted to 74 months. Both surgical and conservative treatment showed very high remission rates in stage I and II (CR about 90%) for either lymphoma histology. Differences between the two therapy strategies could not be detected, possibly due to the small size of the groups. A total of six patients deceased, about evenly distributed among the both groups. The evaluation of the SF-36 qualitiy of life questionnaires proved quite a high post-therapeutic quality of life. It was not possible to differentiate between the patients with respect to either treatment or grade (low, high grade). According to the Troidl index the pre-post quality of life could be compared. Looking at the combination of therapy and grade conservatively treated patients (regardless of the grade) showed a considerably increasing quality of life. To sum up, it can be said that in primary gastric MALT lymphoma high remission rates can be achieved with both surgery and conservative therapy. But with regard to organ preservation and higher post-therapeutic quality of life primary radio- and/or chemotherapy should be preferred to surgical treatment. KW - Non-Hodgkin-Lymphom KW - B-Zell-Lymphom KW - Lymphom KW - Malignes Lymphom KW - Lebensqualität KW - Strahlentherapie KW - Chemotherapie KW - Überleben KW - MALT KW - Lymphom KW - Lebensqualität KW - Überleben KW - Rezidiv KW - Radiotherapie KW - Chemotherapie KW - lymphoma KW - MALT KW - radiotherapy KW - chemotherapy KW - quality of life KW - outcome Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-30698 ER - TY - THES A1 - Gelmedin, Verena Magdalena T1 - Targeting flatworm signaling cascades for the development of novel anthelminthic drugs T1 - Signalkaskaden von Plattwürmern als Angriffspunkte zur Entwicklung neuer Antihelminthika N2 - Echinococcus multilocularis verursacht die Alveoläre Echinokokkose (AE), eine lebendsbedrohliche Krankheit mit limitierten chemotherapeutischen Möglichkeiten. Die jetzige Anti-AE Chemotherapie basiert auf einer einzigen Wirkstoffklasse, den Benzimidazolen. Obwohl Benzimidazole in vitro parasitozid wirken, wirken sie in vivo bei AE-Behandlung lediglich parasitostatisch und rufen schwere Nebenwirkungen hervor. In Fällen operabler Läsionen erfordert die Resektion des Parasitengewebes über einen längeren Zeitraum eine chemotherapeutische Unterstützung. Damit sind die jetzigen Behandlungsmöglichkeiten inadäquat und benötigen Alternativen. In der vorliegenden Arbeit wurden die Signalwege von Plattwürmern analysiert, um potentielle Targets für neue therapeutische Ansätze zu identifizieren. Dabei konzentrierte ich mich unter Anwendung von molekularbiologischer, biochemischer und zellbiologischer Methoden auf Faktoren, die an Entwicklung und Proliferation von E. multilocularis beteiligt sind. Darunter waren die drei MAP kinases des Parasiten EmMPK1, ein Erk1/2-Ortholog, EmMPK2, ein p38-Ortholog und EmMPK3, ein Erk7/8-Ortholog. Des Weiteren identifizierte und charakterisierte ich EmMKK2, ein MEK1/2-Ortholog des Parasiten, welches zusammen mit den bekannten Kinasen EmRaf und EmMPK1 ein Erk1/2-ähnliches MAPK Modul bildet. Ich konnte zudem verschiedene Einflüsse von Wirtswachstumsfaktoren wie EGF (epidermal growth factor) und Insulin auf die Signalmechanismen des Parasiten und das Larvenwachstum zeigen, darunter die Phosphorylierung von Elp, ein Ezrin-Radixin-Moesin ähnliches Protein, die Aktivierung von EmMPK1 und EmMPK3 und eine gesteigerte mitotische Aktivität der Echinokokkenzellen. Zusätzlich wurden verschiedene Substanzen auf ihre letale Wirkung auf den Parasiten untersucht, darunter befanden sich (1.) generelle Inhibitoren von Tyrosinkinasen (PP2, Leflunamid), (2.) gegen die Aktivität von Rezeptor-Tyrosin-Kinasen gerichtete Präparate, (3.) ursprünglich anti-neoplastische Wirkstoffe wie Miltefosin und Perifosin, (4.) Inhibitoren von Serin/ Threonin-Kinasen, die die Erk1/2 MAPK Kaskade blockieren und (5.) Inhibitoren der p38 MAPK. In diesen Untersuchungen hat sich EmMPK2 aus den folgenden Gründen als vielversprechendes Target erwiesen. Aminosäuresequenz-Analysen offenbarten einige Unterschiede zu menschlichen p38 MAP Kinasen, welche sehr wahrscheinlich die beobachtete gesteigerte basale Aktivität des rekombinanten EmMPK2 verursachen, verglichen mit der Aktivität humaner p38 MAPK-α. Zusätzlich suggerieren die prominente Autophosphorylierungsaktivität von rekombinantem EmMPK2 und das Ausbleiben einer Interaktion mit den Echinococcus MKKs einen unterschiedlichen Regulierungsmechanismus im Vergleich zu den humanen Proteinen. Die Aktivität von EmMPK2 konnte sowohl in vitro als auch in kultivierten Metazestodenvesikeln durch die Behandlung mit SB202190 und ML3403, zwei ATP kompetitiven Pyridinylimidazolinhibitoren der p38 MAPK, in Konzentrations-abhängiger Weise inhibiert werden. Zudem verursachten beide Substanzen, insbesondere ML3403 die Inaktivierung von Parasitenvesikeln bei Konzentrationen, die kultivierte Säugerzellen nicht beeinträchtigten. Ebenso verhinderte die Anwesenheit von ML3403 die Generation von neuen Vesikeln während der Kultivierung von Echinococcus Primärzellen. Das Targeting von Mitgliedern des EGF-Signalwegs, insbesondere der Erk1/2-ähnlichen MAPK Kaskade mit Raf- und MEK- Inhibitoren verhinderte die Phosphorylierung von EmMPK1 in in vitro kultivierten Metazestoden. Obwohl das Parasitenwachstum unter diesen Konditionen verhindert wurde, blieb die strukturelle Integrität der Metazestodenvesikeln während der Langzeitkultivierung in Anwesenheit der MAPK Kaskade-Inhibitoren erhalten. Ähnliche Effekte wurden beobachtet nach Behandlung mit den anderen zuvor aufgeführten Inhibitoren. Zusammenfassend lässt sich festhalten, dass verschiedene Targets identifiziert werden konnten, die hoch sensibel auf die Anwesenheit der inhibitorischen Substanzen reagierten, aber nicht zum Absterben des Parasiten führten, mit Ausnahme der Pyridinylimidazolen. Die vorliegenden Daten zeigen, dass EmMPK2 ein Überlebendsignal vermittelnden Faktor darstellt und dessen Inhibierung zur Behandlung der AE benutzt werden könnte. Dabei erwiesen sich p38 MAPK Inhibitoren der Pyridinylimidazolklasse als potentielle neue Substanzklasse gegen Echinokokken. N2 - Echinococcus multilocularis is the causative agent of alveolar echinococcosis (AE), a life-threatening disease with limited options of chemotherapeutic treatment. Anti-AE chemotherapy is currently based on a single class of drugs, the benzimidazoles. Although acting parasitocidic in vitro, benzimidazoles are merely parasitostatic during in vivo treatment of AE and cause severe site effects. In the case of operable lesions, the resection of parasite tissue needs to be supported by a prolonged chemotherapy. Thus, the current treatment options for AE are inadequate and require alternatives. In the present work, the flatworm signaling pathways were analyzed to establish potential targets for novel therapeutic approaches. I focused on factors that are involved in development and proliferation of E. multilocularis using molecular, biochemical and cell biological methods. Among the analysed factors were three MAP kinases of the parasite, EmMPK1, an Erk-1/2 orthologue, EmMPK2, a p38 orthologue and EmMPK3, an Erk7/8 orthologue. Further, I identified and characterized EmMKK2, a MEK1/2 orthologue of the parasite, which, together with the known kinases EmRaf and EmMPK1, forms an Erk1/2-like MAPK module. Moreover, I was able to demonstrate several influences of host growth factors such as EGF (epidermal growth factor) and insulin on worm signaling mechanisms and larval growth, including the phosphorylation of Elp, an ezrin-radixin-moesin like protein, EmMPK1, EmMPK3 and increased mitotic activity of Echinococcus cells. In addition, several substances were examined for their efficacy against the parasite including (i) general tyrosine kinase inhibitors (PP2, leflunamide), (ii) compounds designed to inhibit the activity of receptor tyrosine kinases, (iii) anti-neoplastic agents (miltefosine, perifosine), (iv) serine/threonine kinase inhibitors that have been designed to block the Erk1/2 MAPK cascade and (v) inhibitors of p38 MAPKs. In these studies, EmMPK2 proved to be a promising drug target for the following reasons. Amino acid sequence analysis disclosed several differences to human p38 MAPKs, which is likely to be the reason for the observed enhanced basal activity of recombinant EmMPK2 towards myelin basic protein in comparison to human recombinant p38 MAPK-α. In addition, the prominent auto-phosphorylation activity of the recombinant EmMPK2 protein together with the absence of an interaction with the Echinococcus MKKs suggest a different mechanism of regulation compared to the human enzyme. EmMPK2 activity could be effectively inhibited in vitro and in cultivated metacestode vesicles by treatment with SB202190 and ML3403, two ATP-competitive pyridinyl imidazole inhibitors of p38 MAPKs, in a concentration-dependent manner. Moreover, both compounds, in particular ML3403, caused parasite vesicle inactivation at concentrations which did not affect cultured mammalian cells. Likewise, during the cultivation of Echinococcus primary cells, the presence of ML3403 prevented the generation of new vesicles. Targeting members of the EGF signaling pathway, particulary of the Erk1/2-like MAPK cascade, with Raf and MEK inhibitors prevented the phosphorylation of EmMPK1 in metacestodes cultivated in vitro. However, although parasite growth was prevented under these conditions, the structural integrity of the metacestode vesicles maintained during long-term cultivation in the presence of the MAPK cascade inhibitors. Similar results were obtained when studying the effects of other drugs mentioned above. Taken together, several targets could be identified that reacted with high sensitivity to the presence of inhibitory substances, but did not cause the parasite’s death with one exception, the pyridinyl imidazoles. Based on the presented data, I suggest pyridinyl imidazoles as a novel class of anti-Echinococcus drugs and imply EmMPK2 as survival signal mediating factor, the inhibition of which could be used for the treatment of AE. KW - Fuchsbandwurm KW - Signaltransduktion KW - MAP-Kinase KW - Eingeweidewürmer KW - Proliferation KW - Zelldifferenzierung KW - Inhibitor KW - Entwicklung KW - Heilmittel KW - Fox tapeworm KW - signaltransduction KW - MAP kinase KW - chemotherapy KW - development Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-33334 ER - TY - THES A1 - Klingelhöffer, Christoph T1 - Untersuchung zur Lebensqualität nach neoadjuvanter Chemotherapie und Radiatio bei fortgeschrittenen Larynx- und Hypopharynxkarzinomen T1 - Evaluation of life quality in patients with progressed Carcinoma of the Larynx and the Hypopharynx following preoperative chemotherapy and radiation N2 - Diese Studie stellt die Lebensqualität und den Gesundheitszustand von Patienten mit einem fortgeschrittenen Larynx- oder Hypopharynxkarzinom nach neoadjuvanter Chemotherapie und Radiatio dar. Hierbei wird auf verschiedene Teilbereiche der Auswirkungen dieser Erkrankung eingegangen, die individuell den Grad der Lebensqualität beeinflussen. Die Werte geben die durchschnittliche Meinung des Patientenkollektivs wieder und können somit nur gemeinsame Tendenzen hervorbringen. Die Patienten gaben an, nur eine geringe Minderung ihrer Lebensqualität durch die Erkrankung festzustellen. Über 60% des Patientenkollektivs schätzten ihre Lebensqualität bzw. ihren Gesundheitszustand als sehr gut oder nur wenig beeinträchtigt ein. Das Patientenkollektiv bestätigt durch seinen hohen Nikotin- und Alkoholkonsumenten-anteil die Risikofaktoren für diese Erkrankung. Leider konnte der Großteil der Patienten nicht dazu bewegt werden, das Alkoholgenussverhalten zu überdenken und es deutlich zu reduzieren. Die Notwendigkeit, den Nikotinkonsum einzuschränken, wurde eher akzeptiert. Im Hinblick auf die alternative operative Entfernung des Primärtumors und damit des Kehlkopfes, war die erneute Entscheidung für die konservative Therapie für die meisten Patienten eindeutig. Auch die Aufklärung wurde in der Regel positiv bewertet. Der hohe Stellenwert einer erhaltenen Kommunikationsfähigkeit ist für die Patienten der ausschlaggebende Punkt, sich wieder für diese Therapie zu entscheiden. Das Symptom der Xerostomie bereitet den Patienten die größten Schwierigkeiten. Die Auswirkung auf andere Bereiche wie verminderte Gleitfähigkeit der Speisen, schlechterer Prothesensitz und verstärkte Zerkleinerung der Speisen sind hier zu berücksichtigen. Eine erhöhte psychische Belastung ist die Folge, die auch das Sozialleben der Patienten beeinflusst. Dies zeigte sich vor allem in der Frage nach Genuss von Essen in der Gesellschaft. 44 % vermieden es, in der Öffentlichkeit zu essen oder schränkten es zumindest stark ein. Häufiger traten Veränderungen der Stimme auf. Sie waren vor allem durch Heiserkeit bedingt. Die Betroffenen wurden jedoch dadurch nur im geringen Maße gestört. Einschränkungen in der Kopf- und Armbewegung stellen sich aufgrund der nichtoperativen Therapie als geringfügiges Problem dar. Dies trägt dazu bei, dass nur wenige Einschränkungen im Bereich Mobilität bzw. Arbeitsfähigkeit zu verzeichnen waren. Eine geringere Abhängigkeit von den Angehörigen ist die Folge, was die Selbstständigkeit der Patienten erhält und gleichzeitig psychische Belastungen abbaut. Andere Symptome wie Schmerzen, Kieferklemme, Entzündungen im Mund- und Rachenraum kommen aufgrund der bereits durchschnittlich längeren Genesungsphase nur selten vor. N2 - This study represents the quality of life and the state of health of patients with a advanced Larynx or Hypopharynxcarcinoma after neoadjuvant chemotherapy and Radiatio. Here with different subranges of the effects of this illness one deals, those individually the degrees of the quality of life affect. The values show the average opinion of the patient collective and can thus only common tendencies out bring. The patients indicated, to determine only a small reduction of their quality of life by the illness. Over 60% of the patient collective estimated their quality of life and/or their state of health as very good or only few impairs. The patient collective confirms the factors of risk for this illness by its high nicotine and consumption of alcohol duck portion. Unfortunately the majority of the patients could not be induced to it, to consider the consumption of alcohol behavior and reduce it clearly. The necessity, to limit the nicotine consumption, rather one accepted. Regarding the alternative operational removal of the primary tumor and thus the larynx, the renewed decision for the conservative therapy for most patients was clear. Also the clearing-up was usually positively evaluated. The high value of a received able to communicateness is for the patients the decisive point, to decide again for this therapy. The symptom of the Xerostomie causes the largest difficulties to the patients. The effect on other ranges as decreased gliding ability of the meals, worse prosthesis seat and intensified cutting up of the meals are to be considered here. A increased psychological load is the result, also the social life of the patients affects. This showed up particularly in the question about benefit of meals in the society. 44% avoided it, in the public to eat or limited it at least strongly. Restrictions in the head and arm movement present themselves due to the not-operational therapy as slight problem. This contributes to it, that only few restrictions within the range mobility and/or. Ability to work to register were. A smaller dependence on the members is the result, which receives the Selbstständigkeit of the patients and diminishes at the same time psychological loads. Other symptoms such as pain, Kieferklemme, Inflammations in the mouth and throat area occur due to the already on the average longer recovery phase only rarely. KW - Lebensqualität KW - Chemotherapie KW - Radiatio KW - Larynxkarzinom KW - Hypopharynxkarzinom KW - lifequality KW - chemotherapy KW - radiotherapy KW - larynxcarcinoma KW - hypopharynxcarcinoma Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-20134 ER - TY - THES A1 - Kuhn, Jochen T1 - Das Medulloblastom bei Erwachsenen : Prognostische Faktoren und histologische Besonderheiten einer seltenen Tumorentität : Vergleich einer adjuvanten mit einer neoadjuvanten Chemotherapie T1 - The Medulloblastoma in Adults. Prognostic factors of a rare tumorentity: Comparison of an adjuvant with a neoadjuvant chemotherapy N2 - In dieser retrospektiven multizentrischen Analyse wurde bei 46 Beobachtungspatienten mit Medulloblastom im Alter von 16 bis 51 Jahren bei einem Median von 20,5 Jahren die Wirksamkeit und Verträglichkeit einer neoadjuvanten Chemotherapie, bestehend aus Procarbacin, Ifosfamid, Etoposid, Methotrexat, Cisplatin und Cytarabin mit einer Erhaltungschemotherapie mit Vincristin, CCNU und Cisplatin verglichen. Die progressionsfreie 4-Jahresüberlebensrate war bei der Erhaltungstherapie mit 86 % tendenziell, jedoch nicht signifikant höher als bei der Sandwichtherapie mit 61 %. Die 4-Jahres-Gesamtüberlebensrate aller 46 Patienten lag bei 85 % und das 4-Jahres-PFS aller Patienten bei 72 %. Unter Erhaltungschemotherapie kam es häufiger zu relevanten Nebenwirkungen, so dass die Zytostatikadosis verringert oder die Chemotherapie abgebrochen werden musste. Bei der Erhaltungstherapie war dies bei 10 von 19 Patienten der Fall, bei neoadjuvanter Therapie bei 5 von 24 Patienten. Der Allgemeinzustand beurteilt mittels Karnofsky-Index mindestens ein Jahr nach Ende der Therapie war im Erhaltungstherapiearm signifikant schlechter als im Sandwichtherapiearm (p= 0,001). Im Vergleich zum Sandwichtherapiearm waren deutlich mehr Patienten, die eine Erhaltungstherapie erhalten hatten (5 von 15 vs. 0 von 14), nach über einem Jahr nach Ende der Therapie immer noch arbeitsunfähig. Bei der histologischen Untersuchung trat die desmoplastische Variante gegenüber der klassischen häufiger auf und war häufiger lateral im Kleinhirn lokalisiert als in vergleichbaren Studien bei Kindern. Folgende Faktoren wurden untersucht: Alter, Geschlecht, histologischer Typ, mediale oder laterale Tumorlokalisation, Resektionsgrad, Metastasierungsstadium, Vorhanden-sein eines Liquorshunts, geringere Bestrahlungsdosis sowie adjuvante oder neoadjuvante Chemotherapie. Abhängig vom Metastasierungsstadium zeigte sich ein starker Trend zu einer schlechteren Überlebenswahrscheinlichkeit (M2/3 Stadium 45 % 4-J-PFS vs. 78 % bei M0/1). Aufgrund der niedrigen Fallzahlen konnte aber in den Analysen kein Signifikanzniveau erreicht werden. KW - Medulloblastom KW - Erwachsene KW - Chemotherapie KW - Prognostische Faktoren KW - medulloblastoma KW - adults KW - chemotherapy KW - prognostic factors Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-21060 ER - TY - THES A1 - Milnik, Alexander T1 - Depressivität bei Patienten mit akuter Leukämie oder hochmalignem Non-Hodgkin-Lymphom T1 - Depression of patients with acute leukemia or high malignant non Hodgkin lymphoma N2 - In der vorliegenden Längsschnittuntersuchung wurde die depressive Symptomatik von 40 Patienten mit akuter Leukämie oder hochmalignem Non-Hodgkin-Lymphom innerhalb der ersten sechs Monaten nach Diagnosestellung untersucht. Alle Patienten erhielten eine Chemotherapie. Die vorliegende Untersuchung erstreckte sich über insgesamt fünf Befragungen: T 1 = ein bis drei Tage nach Diagnosestellung, T 2 = in der Aplasiephase des ersten Chemotherapiezyklus, T 3 = zu Beginn des dritten Chemotherapiezyklus, T 4 = in der Aplasiephase des dritten Chemotherapiezyklus, T 5 = sechs Monate nach Diagnosestellung. Die Einschätzung der depressiven Symptomatik erfolgte mit Hilfe der extrahierten Subskala „Depressivität“ aus der deutschen Version der revidierten Symptom-Checkliste 90 (SCL-90-R) von Derogatis. Des Weiteren wurden die körperlichen Beschwerden der Probanden mit einem eigens für die vorliegende Studie konzipierten Instrument zu jedem Messzeitpunkt erfasst. Zusätzlich erfolgte zu den einzelnen Erhebungen eine Evaluation der Prognose der Erkrankung im Rahmen eines vom Arzt auszufüllenden Fragebogens. Die Resultate unserer Studie zeigten eine hochsignifikante Zunahme der Depressivität vom Erstinterview (T 1) zum zweiten Erhebungszeitpunkt (T 2), im Durchschnitt 11 Tage später in der Phase der Aplasie des ersten Chemotherapiezyklus. Das Ausmaß der Depressivität war zu Beginn des dritten Chemotherapiezyklus (T 3), durchschnittlich drei Monate nach Erstdiagnose, gegenüber dem zweiten Messzeitpunkt (T 2) unverändert. Der Ausprägungsgrad der Depressivität zu T 3 unterschied sich zudem weder von dem Level der depressiven Symptomatik in der entsprechenden Isolationsphase (T 4) noch von dem Ausmaß der Depressivität sechs Monate nach Diagnosestellung (T 5). Auch frühere Arbeiten beschrieben eine signifikante Zunahme der Depressivität nach Diagnosestellung. Die Erhebungsintervalle lagen dabei ein bis drei Monate auseinander. Im Gegensatz zu anderen Studien wurden in unserer Untersuchung mitunter sehr kurze Zeitabschnitte (ca. ein bis zwei Wochen) zwischen zwei Erhebungszeitpunkten gewählt. Hierdurch konnten wir erstmalig eine hochsignifikante Zunahme der Depressivität bereits innerhalb weniger Tage nach Diagnosestellung feststellen. Medizinische, soziodemographische und somatische Faktoren zeigten nur wenige Zusammenhänge mit der depressiven Symptomatik unserer Patienten. Die Ergebnisse zur Veränderung der Depressivität im Verlauf können nicht auf der Basis der hier erfassten medizinischen und somatischen Faktoren oder durch rein aplasiespezifische Umstände erklärt werden. Die Veränderung des Ausmaßes der Depressivität wird eher als Folge einer Modulation des Coping- und Abwehrverhaltens während des Krankheits- und Behandlungsverlaufes mit konsekutiver Änderung des emotionalen Befindens interpretiert. N2 - In this prospective study we investigated the depressive symptoms of 40 patients with newly diagnosed acute leukemia or non Hodgkin lymphoma during the first six months after making the diagnosis. All patients were treated with chemotherapy. We interviewed the patients five times: T 1 = during the first three days after making the diagnosis, T 2 = during the time of aplasia of the first chemotherapy, T 3 = the beginning of the third chemotherapy, T 4 = during the time of aplasia of the third chemotherapie, T 5 = six months after making the diagnosis. The depressive symptoms were assessed with the scale „depression“ , extracted from Derogatis revised symptom-checklist 90 (SCL-90-R). Furthermore we assessed the somatic complaints of the patients and the physicians prognosis about the seriousness of patients disease with two especially designed questionnaires. The results of the study showed a high significant increase of the depression from the first interview (T 1) to the second (T 2), on average 11 days later during the aplasia of the first chemotherapy. There was no difference between the level of depression at the beginning of the third chemotherapy (T 3) and the second interview (T 2). The level of depression at T 3 differed neither from the level of depression at T 4, during the aplasia of the third chemotherapy, nor from the level of depression six months after making the diagnosis (T 5). Former prospective studies also described a significant increase of depression after making a diagnosis of cancer. The time between two interviews covered here one up to three months. In contrast to other studies we partially chose very short intervalls (about one or two weeks) between two interviews. By this we were able to show for the first time a high significant increase of depression already during the first days after making the diagnosis. The investigated medical, sociodemographic or somatic variables were not much related to depressive symptoms of our patients. The results of change of the level of depression during the six months after making the diagnosis can neither be based on the investigated medical and somatic variables nor on the specific situation of the aplasia. We interpret the difference of the level of depression over the time as a consequence of the modulation of the coping mechanisms during the course of the disease and treatment leading to a change of patients emotional health. KW - Depression KW - Depressivität KW - Leukämie KW - Lymphom KW - Chemotherapie KW - depression KW - leukemia KW - lymphoma KW - chemotherapy Y1 - 2002 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-4875 ER -