TY - JOUR A1 - El-Helou, Sabine M. A1 - Biegner, Anika-Kerstin A1 - Bode, Sebastian A1 - Ehl, Stephan R. A1 - Heeg, Maximilian A1 - Maccari, Maria E. A1 - Ritterbusch, Henrike A1 - Speckmann, Carsten A1 - Rusch, Stephan A1 - Scheible, Raphael A1 - Warnatz, Klaus A1 - Atschekzei, Faranaz A1 - Beider, Renata A1 - Ernst, Diana A1 - Gerschmann, Stev A1 - Jablonka, Alexandra A1 - Mielke, Gudrun A1 - Schmidt, Reinhold E. A1 - Schürmann, Gesine A1 - Sogkas, Georgios A1 - Baumann, Ulrich H. A1 - Klemann, Christian A1 - Viemann, Dorothee A1 - Bernuth, Horst von A1 - Krüger, Renate A1 - Hanitsch, Leif G. A1 - Scheibenbogen, Carmen M. A1 - Wittke, Kirsten A1 - Albert, Michael H. A1 - Eichinger, Anna A1 - Hauck, Fabian A1 - Klein, Christoph A1 - Rack-Hoch, Anita A1 - Sollinger, Franz M. A1 - Avila, Anne A1 - Borte, Michael A1 - Borte, Stephan A1 - Fasshauer, Maria A1 - Hauenherm, Anja A1 - Kellner, Nils A1 - Müller, Anna H. A1 - Ülzen, Anett A1 - Bader, Peter A1 - Bakhtiar, Shahrzad A1 - Lee, Jae-Yun A1 - Heß, Ursula A1 - Schubert, Ralf A1 - Wölke, Sandra A1 - Zielen, Stefan A1 - Ghosh, Sujal A1 - Laws, Hans-Juergen A1 - Neubert, Jennifer A1 - Oommen, Prasad T. A1 - Hönig, Manfred A1 - Schulz, Ansgar A1 - Steinmann, Sandra A1 - Klaus, Schwarz A1 - Dückers, Gregor A1 - Lamers, Beate A1 - Langemeyer, Vanessa A1 - Niehues, Tim A1 - Shai, Sonu A1 - Graf, Dagmar A1 - Müglich, Carmen A1 - Schmalzing, Marc T. A1 - Schwaneck, Eva C. A1 - Tony, Hans-Peter A1 - Dirks, Johannes A1 - Haase, Gabriele A1 - Liese, Johannes G. A1 - Morbach, Henner A1 - Foell, Dirk A1 - Hellige, Antje A1 - Wittkowski, Helmut A1 - Masjosthusmann, Katja A1 - Mohr, Michael A1 - Geberzahn, Linda A1 - Hedrich, Christian M. A1 - Müller, Christiane A1 - Rösen-Wolff, Angela A1 - Roesler, Joachim A1 - Zimmermann, Antje A1 - Behrends, Uta A1 - Rieber, Nikolaus A1 - Schauer, Uwe A1 - Handgretinger, Rupert A1 - Holzer, Ursula A1 - Henes, Jörg A1 - Kanz, Lothar A1 - Boesecke, Christoph A1 - Rockstroh, Jürgen K. A1 - Schwarze-Zander, Carolynne A1 - Wasmuth, Jan-Christian A1 - Dilloo, Dagmar A1 - Hülsmann, Brigitte A1 - Schönberger, Stefan A1 - Schreiber, Stefan A1 - Zeuner, Rainald A1 - Ankermann, Tobias A1 - Bismarck, Philipp von A1 - Huppertz, Hans-Iko A1 - Kaiser-Labusch, Petra A1 - Greil, Johann A1 - Jakoby, Donate A1 - Kulozik, Andreas E. A1 - Metzler, Markus A1 - Naumann-Bartsch, Nora A1 - Sobik, Bettina A1 - Graf, Norbert A1 - Heine, Sabine A1 - Kobbe, Robin A1 - Lehmberg, Kai A1 - Müller, Ingo A1 - Herrmann, Friedrich A1 - Horneff, Gerd A1 - Klein, Ariane A1 - Peitz, Joachim A1 - Schmidt, Nadine A1 - Bielack, Stefan A1 - Groß-Wieltsch, Ute A1 - Classen, Carl F. A1 - Klasen, Jessica A1 - Deutz, Peter A1 - Kamitz, Dirk A1 - Lassy, Lisa A1 - Tenbrock, Klaus A1 - Wagner, Norbert A1 - Bernbeck, Benedikt A1 - Brummel, Bastian A1 - Lara-Villacanas, Eusebia A1 - Münstermann, Esther A1 - Schneider, Dominik T. A1 - Tietsch, Nadine A1 - Westkemper, Marco A1 - Weiß, Michael A1 - Kramm, Christof A1 - Kühnle, Ingrid A1 - Kullmann, Silke A1 - Girschick, Hermann A1 - Specker, Christof A1 - Vinnemeier-Laubenthal, Elisabeth A1 - Haenicke, Henriette A1 - Schulz, Claudia A1 - Schweigerer, Lothar A1 - Müller, Thomas G. A1 - Stiefel, Martina A1 - Belohradsky, Bernd H. A1 - Soetedjo, Veronika A1 - Kindle, Gerhard A1 - Grimbacher, Bodo T1 - The German national registry of primary immunodeficiencies (2012-2017) JF - Frontiers in Immunology N2 - Introduction: The German PID-NET registry was founded in 2009, serving as the first national registry of patients with primary immunodeficiencies (PID) in Germany. It is part of the European Society for Immunodeficiencies (ESID) registry. The primary purpose of the registry is to gather data on the epidemiology, diagnostic delay, diagnosis, and treatment of PIDs. Methods: Clinical and laboratory data was collected from 2,453 patients from 36 German PID centres in an online registry. Data was analysed with the software Stata® and Excel. Results: The minimum prevalence of PID in Germany is 2.72 per 100,000 inhabitants. Among patients aged 1-25, there was a clear predominance of males. The median age of living patients ranged between 7 and 40 years, depending on the respective PID. Predominantly antibody disorders were the most prevalent group with 57% of all 2,453 PID patients (including 728 CVID patients). A gene defect was identified in 36% of patients. Familial cases were observed in 21% of patients. The age of onset for presenting symptoms ranged from birth to late adulthood (range 0-88 years). Presenting symptoms comprised infections (74%) and immune dysregulation (22%). Ninety-three patients were diagnosed without prior clinical symptoms. Regarding the general and clinical diagnostic delay, no PID had undergone a slight decrease within the last decade. However, both, SCID and hyper IgE-syndrome showed a substantial improvement in shortening the time between onset of symptoms and genetic diagnosis. Regarding treatment, 49% of all patients received immunoglobulin G (IgG) substitution (70%-subcutaneous; 29%-intravenous; 1%-unknown). Three-hundred patients underwent at least one hematopoietic stem cell transplantation (HSCT). Five patients had gene therapy. Conclusion: The German PID-NET registry is a precious tool for physicians, researchers, the pharmaceutical industry, politicians, and ultimately the patients, for whom the outcomes will eventually lead to a more timely diagnosis and better treatment. KW - registry for primary immunodeficiency KW - primary immunodeficiency (PID) KW - German PID-NET registry KW - PID prevalence KW - European Society for Immunodeficiencies (ESID) KW - IgG substitution therapy KW - CVID Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-226629 VL - 10 ER - TY - THES A1 - Müller, Claudia Maria T1 - Studies on the Role of Histone-like Proteins in Gene Regulation in Uropathogenic Escherichia coli Isolate 536 T1 - Untersuchungen zur Rolle von Histon-ähnlichen Proteinen bei der Genregulation im Uropathogenen Escherichia coli Isolat 536 N2 - In this study, the role of histone-like proteins in gene regulation in uropathogenic Escherichia coli isolate 536 was monitored. The histone-like nucleoid structuring protein H-NS is a global regulator in Escherichia coli that has been intensively studied in non-pathogenic strains. No comprehensive study on the role of H-NS and it’s homolog StpA on gene expression in a pathogenic E. coli strain has been carried out so far. Moreover, we identified a third, so far uncharacterized member of the H-NS-like protein family in uropathogenic E. coli isolate 536, which was designated Hlp (H-NS-like protein). Hlp is a 134-amino acid protein, which shares 58 % sequence identity with H-NS. The gene coding for the Hlp protein, hlp, is found in several uropathogenic E. coli variants, but not in non-pathogenic E. coli K-12. In UPEC strains 536 and CFT073, Hlp is encoded on a possibly horizontally acquired 23-kb genomic region inserted into the serU locus. Studies on hlp transcription revealed, that the gene is transcribed monocistronically from a single promoter and that expression is repressed by H-NS. Purified Hlp protein was binding to its own and to the hns promoter, thereby mediating negative auto- and crossregulation. Furthermore, Hlp and H-NS were directly interacting, resulting in the formation of stable heteromers. Complementation studies with hns mutant strains in a K-12 background revealed that the Hlp protein had in vivo activity, being able to complement the lack of H-NS in terms of motility, growth, and repression of the proU, bgl, and clyA genes. When analyzing the role of the histone-like proteins in expression of virulence-associated genes by using DNA arrays and classical phenotypic assays, most of the observed effects were mediated by the H-NS protein alone. Expression profiling revealed that transcript level of more than 500 genes was affected by an hns mutation, resulting in increased expression of alpha-hemolysin, fimbriae and iron-uptake systems, as well as genes involved in stress adaptation. Furthermore, several other putative virulence factors were found to be part of the H-NS regulon. On the other hand, no effect of StpA alone was observed. An hns stpA double mutant, however, exhibited a distinct gene expression pattern that differed in great parts from that of the hns single mutant. This suggests a direct interaction between the two homologs and the existence of distinct regulons of H-NS and an H-NS/StpA heteromeric complex. Although the H-NS protein has – either as homomer or in complex with StpA – a marked impact on gene expression in pathogenic E. coli strains, its effect on urovirulence is ambiguous. At a high infection dose, hns mutants accelerate lethality in murine UTI and sepsis models relative to the wild type, probably due to increased production of alpha-hemolysin. At lower infectious dose, however, mutants lacking H-NS are attenuated through their impaired growth rate, which can only partially be compensated by the higher expression of numerous virulence factors. As seen with StpA, an hlp single mutant did not exhibit a notable phenotype under standard growth conditions. A severe growth defect of hns hlp double mutants at low temperatures, however, suggests a biological relevance of H-NS/Hlp heteromers under certain circumstances. Furthermore, these mutants expressed more capsular polysaccharide and curli fimbriae, thereby indicating a distinct role of H-NS and Hlp in regulation of these surface structures. The H-NS paralogs Hlp and StpA also modulated H-NS-mediated regulation of fimbrial adhesins, and are oppositely required for normal growth at low or high temperatures, respectively. Finally, expression levels of the three histone-like proteins H-NS, StpA and Hlp itself varied with different temperatures, thereby suggesting a flexible composition of the nucleoid-associated protein pool. Hence, we propose that the biological role of Hlp and StpA does not rely on a distinct function of the single protein, but rather on their interaction with the global regulator H-NS. N2 - In dieser Studie wurde die Rolle von Histon-ähnlichen Proteinen bei der Genregulation im uropathogenen Escherichia coli (UPEC) Isolat 536 untersucht. Das Histon-ähnliche Protein H-NS (engl. histone-like nucleoid structuring protein) ist ein globaler Regulator in E. coli, der in apathogenen Stämmen eingehend untersucht worden ist. Im Gegensatz dazu liegen noch keine umfassenden Studien zur Rolle von H-NS und des homologen Proteins StpA in einem pathogenen E. coli Stamm vor. Zudem konnten wir ein drittes, bis jetzt noch nicht charakterisiertes Mitglied der Familie von H-NS-ähnlichen Protein im uropathogenen E. coli Isolat 536 identifizieren, das Hlp benannt wurde (für H-NS-like protein). Hlp ist ein aus 134 Aminosäuren bestehendes Protein, dessen Sequenz zu 58 % identisch mit der des H-NS Proteins ist. Das Gen, das für das Hlp Protein kodiert, hlp, konnte in zahlreichen uropathogenen und Fäkalisolaten nachgewiesen werden, jedoch nicht im apathogenen E. coli K-12. In den UPEC Isolaten 536 und CFT073 ist das hlp Gen auf einer 23-kb großen genomischen Insel lokalisiert, die in den serU Lokus inseriert ist und möglicherweise über horizontalen Gentransfer erworben wurde. Untersuchungen zur Transkription des hlp Gens ergaben, dass das Gen monocistronisch von einem einzigen Promotor transkribiert, und dessen Expression durch H-NS reprimiert wird. Rekombinantes Hlp Protein war befähigt, sowohl an seinen eigenen, als auch an den hns Promotor zu binden, was zu negativer Auto- und Kreuzregulation führte. Zudem konnte gezeigt werden, dass Hlp und H-NS direkt miteinander interagieren, was zu stabilen Heteromeren führte. Komplementierungsstudien in hns Mutanten einiger K-12 Stämme ergaben, dass das Hlp Protein über in vivo Aktivität verfügt, was es befähigte, die Abwesenheit von H-NS bei zahlreichen Phänotypen wie z.B. Motilität, Wachstum, und Repression der proU, bgl und clyA Gene zu komplementieren. Die Rolle der Histon-ähnlichen Proteine bei der Expression von Virulenz-assoziierten Genen wurde mittels DNA Array Technologie, sowie klassischen phänotypischen Tests analysiert. Dabei wurden die meisten der beobachteten Effekte einzig durch das H-NS Protein bedingt. Die Expressionsstudien ergaben, dass über 500 Gene von einer hns Mutation beeinflusst wurden, was eine verstärkte Expression des alpha-Hämolysins, mehrerer Fimbrien und Eisenaufnahmesysteme sowie von Genen, die in Stress-Antworten involviert sind, bedingte. Des Weiteren konnten zahlreiche putative Virulenzfaktoren dem H-NS-Regulon zugeordnet werden. Andererseits konnten keine Effekt durch StpA beobachtet werden. Eine hns stpA Doppelmutante wies jedoch ein eindeutiges Expressionsmuster auf, das in großen Teilen von dem der hns Einzelmutante abwich. Dies legt nahe, dass beide Proteine direkt miteinander interagieren, was das Auftreten von unterschiedlichen Regulons zur Folge hat, die entweder durch H-NS oder einem heteromeren H-NS/StpA Komplex beeinflusst werden. Obwohl das H-NS Protein – entweder als Homomer oder als Komplex mit StpA – einen sehr starken Einfluss auf die Genexpression pathogener E. coli Stämme nimmt, bleiben dessen Effekte auf die tatsächliche Virulenz im Urogenitaltrakt unklar. In einem experimentellen Mausmodell der aufsteigenden Harnwegsinfektion bewirken hns Mutanten, in hoher Dosis verabreicht, eine rasch eintretende Lethalität, was vermutlich der verstärkten Produktion von alpha-Hämolysin zuzuschreiben ist. In verringerter Dosis verabreicht, sind diese Mutanten durch ihre langsameren Wachstumsraten jedoch attenuiert, was nur teilweise durch die vestärkte Expression zahlreicher Virulenzfaktoren kompensiert werden kann. Wie schon bei StpA beobachtet, besitzt eine hlp Mutante keinen offensichtlichen Phänotyp, zumindest unter Standard-Wachstumsbedingungen. Jedoch macht sich in hns hlp Doppelmutanten ein starker Wachstumsdefekt bei erniedrigten Temperaturen bemerkbar, was eine biologische Relevanz von H-NS/Hlp Heteromeren unter bestimmten Bedingungen nahe legt. Des Weiteren exprimierten diese Mutanten erhöhte Mengen an Kapsel-Polysacchariden und Curli-Adhesin, was als Indiz für eine besondere Rolle für H NS und Hlp bei der Regulation dieser Oberflächenstrukturen dienen kann. Zudem hatten beide H-NS-Paraloge Hlp und StpA einen modulierenden Effekt bei der H-NS-vermittelten Regulation weiterer Fimbrien-Adhesine und waren in gegenläufigen Maßen für normales Wachstum bei erhöhten bzw. erniedrigten Temperaturen notwendig. Zuletzt variierte das Expressionsniveau der drei Histon-ähnlichen Proteine H-NS, StpA und Hlp bei unterschiedlichen Temperaturen, was auf eine flexible Zusammensetzung verfügbarer Nucleoid-assoziierter Proteine hindeutet. Dies alles impliziert, dass die biologische Relevanz von Hlp, und StpA gleichermaßen, nicht auf gesonderten Funktionen des einzelnen Proteins beruht, sondern vielmehr auf deren Interaktionen mit dem globalen Regulatorprotein H-NS. KW - Escherichia coli KW - Pathogenität KW - Histone-like proteins KW - Genregulation KW - Histon-ähnliche Proteine KW - H-NS KW - StpA KW - Genregulation KW - UPECs KW - Histone-like proteins KW - H-NS KW - StpA KW - Gene regulation KW - UPECs Y1 - 2005 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-17617 ER - TY - JOUR A1 - Hanitsch, Leif A1 - Baumann, Ulrich A1 - Boztug, Kaan A1 - Burkhard‐Meier, Ulrike A1 - Fasshauer, Maria A1 - Habermehl, Pirmin A1 - Hauck, Fabian A1 - Klock, Gerd A1 - Liese, Johannes A1 - Meyer, Oliver A1 - Müller, Rainer A1 - Pachlopnik‐Schmid, Jana A1 - Pfeiffer‐Kascha, Dorothea A1 - Warnatz, Klaus A1 - Wehr, Claudia A1 - Wittke, Kirsten A1 - Niehues, Tim A1 - von Bernuth, Horst T1 - Treatment and management of primary antibody deficiency: German interdisciplinary evidence‐based consensus guideline JF - European Journal of Immunology N2 - This evidence‐based clinical guideline provides consensus‐recommendations for the treatment and care of patients with primary antibody deficiencies (PADs). The guideline group comprised 20 clinical and scientific expert associations of the German, Swiss, and Austrian healthcare system and representatives of patients. Recommendations were based on results of a systematic literature search, data extraction, and evaluation of methodology and study quality in combination with the clinical expertise of the respective representatives. Consensus‐based recommendations were determined via nominal group technique. PADs are the largest clinically relevant group of primary immunodeficiencies. Most patients with PADs present with increased susceptibility to infections, however immune dysregulation, autoimmunity, and cancer affect a significant number of patients and may precede infections. This guideline therefore covers interdisciplinary clinical and therapeutic aspects of infectious (e.g., antibiotic prophylaxis, management of bronchiectasis) and non‐infectious manifestations (e.g., management of granulomatous disease, immune cytopenia). PADs are grouped into disease entities with definitive, probable, possible, or unlikely benefit of IgG‐replacement therapy. Summary and consensus‐recommendations are provided for treatment indication, dosing, routes of administration, and adverse events of IgG‐replacement therapy. Special aspects of concomitant impaired T‐cell function are highlighted as well as clinical data on selected monogenetic inborn errors of immunity formerly classified into PADs (APDS, CTLA‐4‐, and LRBA‐deficiency). KW - autoimmunity KW - CVID KW - hypogammaglobulinemia KW - immunoglobulins KW - primary antibody deficiency Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-225731 VL - 50 IS - 10 SP - 1432 EP - 1446 ER -