TY - THES A1 - Zimmermann [née Papp], Lena T1 - Platelets as modulators of blood-brain barrier disruption and inflammation in the pathophysiology of ischemic stroke T1 - Thrombozyten als Modulatoren der Blut-Hirn-Schrankenstörung und Inflammation in der Pathophysiologie des ischämischen Schlaganfalls N2 - Ischemia-reperfusion injury (I/R injury) is a common complication in ischemic stroke (IS) treatment, which is characterized by a paradoxical perpetuation of tissue damage despite the successful re-establishment of vascular perfusion. This phenomenon is known to be facilitated by the detrimental interplay of platelets and inflammatory cells at the vascular interface. However, the spatio-temporal and molecular mechanisms underlying these cellular interactions and their contribution to infarct progression are still incompletely understood. Therefore, this study intended to clarify the temporal mechanisms of infarct growth after cerebral vessel recanalization. The data presented here could show that infarct progression is driven by early blood-brain-barrier perturbation and is independent of secondary thrombus formation. Since previous studies unravelled the secretion of platelet granules as a molecular mechanism of how platelets contribute to I/R injury, special emphasis was placed on the role of platelet granule secretion in the process of barrier dysfunction. By combining an in vitro approach with a murine IS model, it could be shown that platelet α-granules exerted endothelial-damaging properties, whereas their absence (NBEAL2-deficiency) translated into improved microvascular integrity. Hence, targeting platelet α-granules might serve as a novel treatment option to reduce vascular integrity loss and diminish infarct growth despite recanalization. Recent evidence revealed that pathomechanisms underlying I/R injury are already instrumental during large vessel occlusion. This indicates that penumbral tissue loss under occlusion and I/R injury during reperfusion share an intertwined relationship. In accordance with this notion, human observational data disclosed the presence of a neutrophil dominated immune response and local platelet activation and secretion, by the detection of the main components of platelet α-granules, within the secluded vasculature of IS patients. These initial observations of immune cells and platelets could be further expanded within this thesis by flow cytometric analysis of local ischemic blood samples. Phenotyping of immune cells disclosed a yet unknown shift in the lymphocyte population towards CD4+ T cells and additionally corroborated the concept of an immediate intravascular immune response that is dominated by granulocytes. Furthermore, this thesis provides first-time evidence for the increased appearance of platelet-leukocyte-aggregates within the secluded human vasculature. Thus, interfering with immune cells and/or platelets already under occlusion might serve as a potential strategy to diminish infarct expansion and ameliorate clinical outcome after IS. N2 - Eine häufig auftretende Komplikation in der Behandlung des ischämischen Schlaganfalls ist der Ischämie/Reperfusion Schaden (I/R Schaden), welcher trotz der erfolgreichen Wiederherstellung der zerebralen Durchblutung durch ein paradoxes Fortschreiten des entstandenen Gewebeschadens charakterisiert ist. Dieses Phänomen wird durch das schädigende Zusammenspiel von Thrombozyten und inflammatorischen Zellen am vaskulären Endothel verursacht. Allerdings sind die räumlich-temporalen und molekularen Mechanismen dieser zellulären Interaktionen und deren Beteiligung am Infarktwachstum noch nicht vollständig verstanden. Daraus folgend, beabsichtigte diese Arbeit eben diese temporalen Mechanismen des fortschreitenden Infarktwachstums nach der zerebralen Gefäßwiedereröffnung aufzuklären. Die hier vorgestellten Daten implizieren, dass das anhaltende Fortschreiten des Gewebeschadens durch die Schädigung der Bluthirnschranke verursacht wird und somit unabhängig vom Auftreten sekundär gebildeter Thromben ist. In vorangegangenen Studien konnte die Freisetzung von thrombozytären Granula als molekularer Mechanismus, mit welchem Thrombozyten zum I/R Schaden beitragen, aufgedeckt werden. Basierend auf diesen Studien wurde in dieser Arbeit ein besonderes Augenmerk auf die Sekretion thrombozytärer Granula im Zusammenhang mit der Beeinträchtigung der endothelialen Barriere gelegt. Durch die Kombination eines in vitro Ansatzes mit einem murinen Model des ischämischen Schlaganfalls konnte gezeigt werden, dass α-Granula endothelialen Schaden verursachen, wohingegen deren Absenz (NBEAL2 Defizienz) zu einer verbesserten mikrovaskulären Integrität führte. Aufgrund dessen könnte das Adressieren der α-Granula als eine neuartige Therapieoption zum Erhalt der vaskulären Integrität und zur Verminderung des Infarktwachstums trotz Rekanalisation genutzt werden. Neuste Erkenntnisse enthüllten, dass die dem I/R Schaden zu Grunde liegenden Pathomechanismen bereits während des Verschlusses eines großen hirnversorgenden Gefäßes zu beobachten sind. Dies deutet darauf hin, dass der Verlust von penumbralem Gewebe unter Okklusion und I/R Schädigung während der Reperfusion im engen Zusammenhang stehen. Im Einklang hiermit konnten humane Daten eine Neutrophilen-dominierte Immunantwort und lokale Thrombozyten Aktivierung und deren Sekretion, anhand der Detektion der α-Granula Hauptkomponenten, im verschlossenen Gefäßsystem von ischämischen Schlaganfall Patienten nachweisen. Diese anfänglichen Beobachtungen konnten im Rahmen dieser Arbeit anhand durchflusszytometrischer Untersuchungen von lokal abgenommenen ischämischen Blutproben erweitert werden. Die Phänotypisierung von Immunzellen enthüllte eine bisher unbekannte Verschiebung der Lymphozyten Population hin zu CD4+ T-Zellen und bekräftigte zusätzlich das Konzept einer unmittelbaren intravaskulären Immunantwort, welche durch Granulozyten dominiert wird. Darüber hinaus konnte in dieser Thesis das erste Mal das erhöhte Auftreten von Thrombozyten-Leukozyten-Aggregaten in dem verschlossenen humanen Gefäßsystem nachgewiesen werden. Demzufolge könnte eine Beeinflussung von Immunzellen und/oder Thrombozyten bereits unter Okklusion als potentiell vielversprechende Strategie genutzt werden, um die Ausweitung des Infarktes einzuschränken und klinische Endpunkte nach einem ischämischen Schlaganfall zu verbessern. KW - Schlaganfall KW - Thrombozyt KW - Entzündung KW - Thrombo-inflammation KW - Ischemic stroke KW - Platelets KW - Inflamamtion KW - Immune cells KW - Vascular system Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-302850 ER - TY - THES A1 - Göser, Marlies T1 - "Eignet sich die kritische Flimmerfrequenz zur Diagnose einer minimal hepatischen Enzephalopathie?" T1 - "Is the critical flicker frequency suitable for the diagnosis of minimal hepatic encephalopathy?" N2 - Korrelation und Kontingenzprüfung von Kritischer Flimmerfrequenz als diagnostischem Mittel bei minimal hepatischer Enzephalopathie mit anderen etablierten diagnostischen Mitteln und beschreibenden Parametern. In den Ergebnissen lediglich Korrelation mit Alertness Testung in der Testbatterie. Minimal hepatische Enzephalopathie braucht zur Diagnostik mindestens 2 verschiedene ergänzende diagnostische Verfahren (neuropsychologisch und -physiologisch), um sicher entdeckt werden zu können. Bei nur einem Testverfahren blieben zahlreiche Betroffene unentdeckt. Möglicherweise ist das verschiedenen pathophysiologischen Subgruppen geschuldet. N2 - Correlation and contingency testing of critical flicker frequency as a diagnostic tool in minimal hepatic encephalopathy with other established diagnostic tools and descriptive parameters. In the results only correlation with alertness testing in the test battery. Minimal hepatic encephalopathy requires at least 2 different complementary diagnostic procedures (neuropsychological and -physiological) in order to be reliably detected. With only one test procedure, many affected persons remain undetected. This may be due to different pathophysiological subgroups. KW - Encephalopathia hepatica KW - minimal hepatische Enzephalopathie KW - Kritische Flimmerfrequenz KW - PHES KW - TAP Alertness KW - critical flimmer frequency Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-349363 ER - TY - JOUR A1 - Wiessler, Anna-Lena A1 - Talucci, Ivan A1 - Piro, Inken A1 - Seefried, Sabine A1 - Hörlin, Verena A1 - Baykan, Betül B. A1 - Tüzün, Erdem A1 - Schaefer, Natascha A1 - Maric, Hans M. A1 - Sommer, Claudia A1 - Villmann, Carmen T1 - Glycine receptor β–targeting autoantibodies contribute to the pathology of autoimmune diseases JF - Neurology: Neuroimmunology & Neuroinflammation N2 - Background and Objectives Stiff-person syndrome (SPS) and progressive encephalomyelitis with rigidity and myoclonus (PERM) are rare neurologic disorders of the CNS. Until now, exclusive GlyRα subunit–binding autoantibodies with subsequent changes in function and surface numbers were reported. GlyR autoantibodies have also been described in patients with focal epilepsy. Autoimmune reactivity against the GlyRβ subunits has not yet been shown. Autoantibodies against GlyRα1 target the large extracellular N-terminal domain. This domain shares a high degree of sequence homology with GlyRβ making it not unlikely that GlyRβ-specific autoantibody (aAb) exist and contribute to the disease pathology. Methods In this study, we investigated serum samples from 58 patients for aAb specifically detecting GlyRβ. Studies in microarray format, cell-based assays, and primary spinal cord neurons and spinal cord tissue immunohistochemistry were performed to determine specific GlyRβ binding and define aAb binding to distinct protein regions. Preadsorption approaches of aAbs using living cells and the purified extracellular receptor domain were further used. Finally, functional consequences for inhibitory neurotransmission upon GlyRβ aAb binding were resolved by whole-cell patch-clamp recordings. Results Among 58 samples investigated, cell-based assays, tissue analysis, and preadsorption approaches revealed 2 patients with high specificity for GlyRβ aAb. Quantitative protein cluster analysis demonstrated aAb binding to synaptic GlyRβ colocalized with the scaffold protein gephyrin independent of the presence of GlyRα1. At the functional level, binding of GlyRβ aAb from both patients to its target impair glycine efficacy. Discussion Our study establishes GlyRβ as novel target of aAb in patients with SPS/PERM. In contrast to exclusively GlyRα1-positive sera, which alter glycine potency, aAbs against GlyRβ impair receptor efficacy for the neurotransmitter glycine. Imaging and functional analyses showed that GlyRβ aAbs antagonize inhibitory neurotransmission by affecting receptor function rather than localization. KW - autoantibody (aAb) KW - glycine receptor (GlyR) KW - stiff-person syndrome (SPS) KW - clinical neurology KW - movement disorders KW - progressive encephalitis with rigidity and myoclonus (PERM) Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-349958 VL - 11 IS - 2 ER - TY - JOUR A1 - Breyer, Maximilian A1 - Grüner, Julia A1 - Klein, Alexandra A1 - Finke, Laura A1 - Klug, Katharina A1 - Sauer, Markus A1 - Üçeyler, Nurcan T1 - \(In\) \(vitro\) characterization of cells derived from a patient with the GLA variant c.376A>G (p.S126G) highlights a non-pathogenic role in Fabry disease JF - Molecular Genetics and Metabolism Reports N2 - Highlights • The GLA variant S126G is not associated with Fabry symptoms in the presented case • S126G has no effect on α-GAL A activity or Gb3 levels in this patient • S126G sensory neurons show no electrophysiological abnormalities Abstract Fabry disease (FD) is a life-limiting disorder characterized by intracellular globotriaosylceramide (Gb3) accumulations. The underlying α-galactosidase A (α-GAL A) deficiency is caused by variants in the gene GLA. Variants of unknown significance (VUS) are frequently found in GLA and challenge clinical management. Here, we investigated a 49-year old man with cryptogenic lacunar cerebral stroke and the chance finding of the VUS S126G, who was sent to our center for diagnosis and initiation of a costly and life-long FD-specific treatment. We combined clinical examination with in vitro investigations of dermal fibroblasts (HDF), induced pluripotent stem cells (iPSC), and iPSC-derived sensory neurons. We analyzed α-GAL A activity in iPSC, Gb3 accumulation in all three cell types, and action potential firing in sensory neurons. Neurological examination and small nerve fiber assessment was normal except for reduced distal skin innervation. S126G iPSC showed normal α-GAL A activity compared to controls and no Gb3 deposits were found in all three cell types. Baseline electrophysiological characteristics of S126G neurons showed no difference compared to healthy controls as investigated by patch-clamp recordings. We pioneer multi-level cellular characterization of the VUS S126G using three cell types derived from a patient and provide further evidence for the benign nature of S126G in GLA, which is of great importance in the management of such cases in clinical practice. KW - Fabry disease KW - variants of unknown significance KW - C.376A>G (p.S126G) KW - globotriaosylceramide KW - induced pluripotent stem cells KW - sensory neurons KW - disease model KW - α-Galactosidase A Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-350295 SN - 22144269 VL - 38 ER - TY - JOUR A1 - Jänsch, Sarah A1 - Evdokimov, Dimitar A1 - Egenolf, Nadine A1 - Meyer zu Altenschildesche, Caren A1 - Kreß, Luisa A1 - Üçeyler, Nurcan T1 - Distinguishing fibromyalgia syndrome from small fiber neuropathy: a clinical guide JF - Pain Reports N2 - Introduction: Fibromyalgia syndrome (FMS) and small fiber neuropathy (SFN) are distinct pain conditions that share commonalities and may be challenging as for differential diagnosis. Objective: To comprehensively investigate clinical characteristics of women with FMS and SFN to determine clinically applicable parameters for differentiation. Methods: We retrospectively analyzed medical records of 158 women with FMS and 53 with SFN focusing on pain-specific medical and family history, accompanying symptoms, additional diseases, and treatment. We investigated data obtained using standardized pain, depression, and anxiety questionnaires. We further analyzed test results and findings obtained in standardized small fiber tests. Results: FMS patients were on average ten years younger at symptom onset, described higher pain intensities requiring frequent change of pharmaceutics, and reported generalized pain compared to SFN. Pain in FMS was accompanied by irritable bowel or sleep disturbances, and in SFN by paresthesias, numbness, and impaired glucose metabolism (P < 0.01 each). Family history was informative for chronic pain and affective disorders in FMS (P < 0.001) and for neurological disorders in SFN patients (P < 0.001). Small fiber pathology in terms of skin denervation and/or thermal sensory threshold elevation was present in 110/158 (69.7 %) FMS patients and 39/53 (73.6 %) SFN patients. FMS patients mainly showed proximally reduced skin innervation and higher corneal nerve branch densities (p<0.001) whereas SFN patients were characterized by reduced cold detection and prolonged electrical A-delta conduction latencies (P < 0.05). Conclusions: Our data show that FMS and SFN differ substantially. Detailed pain, drug and family history, investigating blood glucose metabolism, and applying differential small fiber tests may help to improve diagnostic differentiation and targeted therapy. KW - fibromyalgia syndrome KW - small fiber neuropathy KW - clinical phenotype KW - pain pattern KW - differential diagnosis Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-350306 VL - 9 IS - 1 ER - TY - JOUR A1 - Hartmannsberger, Beate A1 - Scriba, Sabrina A1 - Guidolin, Carolina A1 - Becker, Juliane A1 - Mehling, Katharina A1 - Doppler, Kathrin A1 - Sommer, Claudia A1 - Rittner, Heike L. T1 - Transient immune activation without loss of intraepidermal innervation and associated Schwann cells in patients with complex regional pain syndrome JF - Journal of Neuroinflammation N2 - Background Complex regional pain syndrome (CRPS) develops after injury and is characterized by disproportionate pain, oedema, and functional loss. CRPS has clinical signs of neuropathy as well as neurogenic inflammation. Here, we asked whether skin biopsies could be used to differentiate the contribution of these two systems to ultimately guide therapy. To this end, the cutaneous sensory system including nerve fibres and the recently described nociceptive Schwann cells as well as the cutaneous immune system were analysed. Methods We systematically deep-phenotyped CRPS patients and immunolabelled glabrous skin biopsies from the affected ipsilateral and non-affected contralateral finger of 19 acute (< 12 months) and 6 chronic (> 12 months after trauma) CRPS patients as well as 25 sex- and age-matched healthy controls (HC). Murine foot pads harvested one week after sham or chronic constriction injury were immunolabelled to assess intraepidermal Schwann cells. Results Intraepidermal Schwann cells were detected in human skin of the finger—but their density was much lower compared to mice. Acute and chronic CRPS patients suffered from moderate to severe CRPS symptoms and corresponding pain. Most patients had CRPS type I in the warm category. Their cutaneous neuroglial complex was completely unaffected despite sensory plus signs, e.g. allodynia and hyperalgesia. Cutaneous innate sentinel immune cells, e.g. mast cells and Langerhans cells, infiltrated or proliferated ipsilaterally independently of each other—but only in acute CRPS. No additional adaptive immune cells, e.g. T cells and plasma cells, infiltrated the skin. Conclusions Diagnostic skin punch biopsies could be used to diagnose individual pathophysiology in a very heterogenous disease like acute CRPS to guide tailored treatment in the future. Since numbers of inflammatory cells and pain did not necessarily correlate, more in-depth analysis of individual patients is necessary. KW - complex regional pain syndrome KW - IENFD KW - nociceptive Schwann cells KW - mast cells KW - Langerhans cells KW - tissue resident T cells KW - dermal B cells KW - skin punch biopsy KW - chronic constriction nerve injury Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357164 VL - 21 ER - TY - THES A1 - Hörner, Michaela T1 - The role of inflammation in hereditary spastic paraplegia type 11 T1 - Die Rolle von Entzündungsreaktionen bei hereditärer spastischer Paraplegie Typ 11 N2 - Hereditary spastic paraplegias (HSPs) are genetically-determined, neurodegenerative disorders characterized by progressive weakness and spasticity of the lower limbs. Spastic paraplegia type 11 (SPG11) is a complicated form of HSP, which is caused by mutations in the SPG11 gene encoding spatacsin, a protein possibly involved in lysosomal reformation. Based on our previous studies demonstrating that secondary neuroinflammation can be a robust amplifier of various genetically-mediated diseases of both the central and peripheral nervous system, we here test the possibility that neuroinflammation may modify the disease outcome also in a mouse model for SPG11. Spg11-knockout (Spg11-/-) mice develop early walking pattern and behavioral abnormalities, at least partially reflecting motor, and behavioral changes typical for patients. Furthermore, we detected a progressive increase in axonal damage and axonal spheroid formation in the white and grey matter compartments of the central nervous system of Spg11-/- mice. This was accompanied by a concomitant substantial increase of secondary inflammation by cytotoxic CD8+ and CD4+ T-lymphocytes. We here provide evidence that disease-related changes can be ameliorated/delayed by the genetic deletion of the adaptive immune system. Accordingly, we provide evidence that repurposing clinically approved immunomodulators (fingolimod/FTY720 or teriflunomide), that are in use for treatment of multiple sclerosis (MS), also improve disease symptoms in mice, when administered in an early (before neural damage) or late (after/during neural damage) treatment regime. This work provides strong evidence that immunomodulation can be a therapeutic option for the still untreatable SPG11, including its typical neuropsychological features. This poses the question if inflammation is not only a disease amplifier in SPG11 but can act as a unifying factor also for other genetically mediated disorders of the CNS. If true, this may pave the way to therapeutic options in a wide range of still untreatable, primarily genetic, neurological disorders by repurposing approved immunomodulators. N2 - Hereditäre spastische Paraplegien (HSPs) sind genetisch-determinierte, neurodegenerative Erkrankungen, die durch eine progressive Schwäche und Spastizität der unteren Extremitäten charakterisiert sind. Die spastische Paraplegie Typ 11 (SPG11) ist eine komplizierte Form der HSP, die durch eine Mutation des SPG11 Gens hervorgerufen wird. Dieses Gen kodiert Spatacsin, ein Protein, das wahrscheinlich in der lysosomalen Reformation eine Rolle spielt. Frühere Studien unserer Arbeitsgruppe konnten zeigen, dass sekundäre Entzündungsreaktionen verschiedene genetisch-determinierte Krankheiten des zentralen und peripheren Nervensystems verstärken können. Daher haben wir hier untersucht, ob neuroinflammatorische Reaktionen auch in einem Mausmodell für SPG11 den Krankheitsverlauf beeinflussen. Spg11-knockout (Spg11-/-) Mäuse entwickeln frühzeitige Gangveränderungen und Verhaltensauffälligkeiten, welche die Veränderungen der Patienten, zumindest teilweise, abbilden. Außerdem konnten wir eine progressive Zunahme von axonalem Schaden und die Bildung von axonalen Schwellungen in der weißen und grauen Substanz des zentralen Nervensystems von Spg11-/- Mäusen feststellen. Dies wurde von einer deutlichen Zunahme einer sekundären Entzündungsreaktion in der weißen und grauen Substanz durch zytotoxische CD8+ und CD4+ T-Lymphozyten begleitet. Wir zeigen hier, dass diese krankheitsbedingten Veränderungen durch eine genetische Deletion von Teilen des adaptiven Immunsystems verbessert bzw. ihr Auftreten hinausgezögert werden können. Entsprechend zeigen wir, dass eine Behandlung mit klinisch etablierten Immunomodulatoren (Fingolimod/FTY720 oder Teriflunomid), die zu der Behandlung der Multiplen Sklerose (MS) eingesetzt werden, den Krankheitsverlauf positiv beeinflusst, wenn sie in einem frühzeitigen (Gabe vor neuronalem Schaden) oder späten (Gabe nach/während neuronalem Schaden) Behandlungsversuch appliziert werden. Diese Arbeit deutet stark darauf hin, dass Immunomodulation eine Therapiemöglichkeit für die noch nicht behandelbare Krankheit SPG11 sein könnte, inklusive der typischen neuropsychologischen Auffälligkeiten. Das wirft die Frage auf, ob sekundäre Entzündungsreaktionen nicht nur einen krankheitsverstärkenden Effekt in SPG11 haben, sondern als ein vereinender Faktor für andere genetisch determinierte Krankheiten des ZNS fungieren können. Dies könnte den Weg dahin ebnen das Fortschreiten anderer unheilbarer, primär genetisch bedingter, neurologischer Erkrankungen durch eine individuelle Behandlung mit auf dem Markt verfügbaren immunomodulatorischen Medikamenten zu verlangsamen. KW - Entzündung KW - Immunmodulation KW - Hereditary spastic paraplegia KW - Hereditäre spastsiche Paraplegie KW - Approved immunomodulators KW - Nervendegeneration KW - Neurodegenerative Erkrankung KW - Entzündungsreaktion KW - Inflammation Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-303368 ER - TY - THES A1 - Wilhelmi, Kai Alexander T1 - Untersuchung von Veränderungen der myelinisierten Nervenfasern durch Entmarkung in Haut- und Nervenbiopsien von Patienten mit Polyneuropathie T1 - Examination of changes in myelinated nerve fibers due to demyelination in skin and nerve biopsies of patients with polyneuropathy N2 - In dieser Arbeit wurde durch das immunhistochemische Anfärben von nodalen (Natriumkanäle, NF), paranodalen (Caspr, NF) und internodalen (MBP) Proteinen der in Fingerhautbiopsien vorhanden Nervenfasern untersucht, ob eine Veränderung der typischen Verteilungsmuster dieser Proteine, eine demyelinisierende Polyneuropathie anzeigen kann. Dazu wurden am Universitätsklinikum Würzburg prospektiv 93 Polyneuropathie-Patienten und 25 Kontrollpersonen rekrutiert. Bei allen Patienten wurden Hautstanzbiospien am Zeigefinger durchgeführt. Bei 35 Patienten mit schweren oder unklaren Verläufen, wurden konsiliarisch Nervus suralis Biopsien durchgeführt. Aus einem Abschnitt von 27 dieser Biopsien, konnten im Rahmen dieser Arbeit Zupfnervenpräparate angefertigt und analog zu den Hautbiopsien ausgewertet werden. Aus der Routinediagnostik der Klinik flossen weiterhin die Ergebnisse der elektrophysiologischen Routinediagnostik und der Histologiebefund der Nervus suralis Biopsien in die Auswertung ein. Zusammenfassend kamen veränderte Natriumkanalbanden in Fingerhautbiopsien signifikant häufiger bei Patienten mit elektrophysiologisch als demyelinisierend befundeten Polyneuropathien, als bei Patienten mit elektrophysiologisch als axonal befundeten Polyneuropathien vor. Vielfach fanden sich veränderte Natriumkanalbanden inmitten para- und internodal unauffälliger Schnürringe und umgekehrt. Diese Beobachtung stützt die bereits in Vorarbeiten vorgeschlagene und in der aktuellen Leitlinie zur Diagnostik für Polyneuropathien aufgegriffene Entität der Paranodopathien (Uncini, Susuki, & Yuki, 2013). Möglich wäre, dass eine veränderte Verteilung der Natriumkanäle die schnelle Leitfähigkeit beeinträchtigen und somit trotz intakter Bemarkung, elektrophysiologisch das Bild einer demyelinisierenden Neuropathie vermittelt. Ein direkter Zusammenhang zwischen dem Auftreten von doppelten und verlängerten Natriumkanalbanden und einzelnen Messwerten (z.B. Amplituden und Latenzzeiten) fand sich nicht. Auch in den Zupfnervenpräparaten der Nervus suralis Biopsien, konnten o.g. Verteilungsmuster untersucht werden. Deren Vorkommen zeigte sich als unabhängig vom elektrophysiologischen und histologischen Befund, von der Ätiologie der PNP und von den gefundenen Veränderungen in den Hautbiopsien des betreffenden Patienten. N2 - Myelinated nerve fibers in finger skin biopsies and sural nerve biopsies were examined using immunohistochemical staining to detect changes in the typical distribution patterns of nodal (voltage-gated sodium channels, neurofascin 186), paranodal (Caspr, neurofascin 155), and internodal (myelin basic protein) proteins, aiming to identify indicators for demyelinating polyneuropathies. A total of 93 polyneuropathy patients and 25 control subjects were prospectively recruited from the University Hospital Würzburg. Skin punch biopsies were conducted on all patients and control subjects. Additionally, sural nerve biopsies were performed on a consultative basis for 35 patients. Teased nerve fiber preparations were made from a section of 27 of these biopsies and evaluated similarly to the skin biopsies. In summary, altered sodium channel bands in myelinated nerve fibers from finger skin biopsies were significantly more prevalent in patients electrophysiologically diagnosed with demyelinating polyneuropathies. However, there was no significant difference in the means of individual electrophysiological measurements between patients with and without changes in the immunohistochemical stainings. Each of the investigated changes was significantly more common in the polyneuropathy group than in the control group. Further correlations, particularly in the comparison of results from skin and sural nerve biopsies, were not found KW - Polyneuropathie KW - Ranvier-Schnürring KW - Entmarkung KW - Elektrophysiologie KW - Caspr KW - Neurofascin KW - MBP KW - spannungsgesteuerter Natriumkanal Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-360046 ER - TY - JOUR A1 - Steinhardt, Maximilian J. A1 - Cejka, Vladimir A1 - Chen, Mengmeng A1 - Bäuerlein, Sabrina A1 - Schäfer, Julia A1 - Adrah, Ali A1 - Ihne-Schubert, Sandra M. A1 - Papagianni, Aikaterini A1 - Kortüm, K. Martin A1 - Morbach, Caroline A1 - Störk, Stefan T1 - Safety and tolerability of SGLT2 inhibitors in cardiac amyloidosis — a clinical feasibility study JF - Journal of Clinical Medicine N2 - Sodium-glucose transport protein 2 inhibitors (SGLT2i) slow the progression of renal dysfunction and improve the prognosis of patients with heart failure. Amyloidosis constitutes an important subgroup for which evidence is lacking. Amyloidotic fibrils originating from misfolded transthyretin and light chains are the causal agents in ATTR and AL amyloidosis. In these most frequent subtypes, cardiac involvement is the most common organ manifestation. Because cardiac and renal function frequently deteriorate over time, even under best available treatment, SGLT2i emerge as a promising treatment option due to their reno- and cardioprotective properties. We retrospectively analyzed patients with cardiac amyloidosis, who received either dapagliflozin or empagliflozin. Out of 79 patients, 5.1% had urinary tract infections; 2 stopped SGLT2i therapy; and 2.5% died unrelated to the intake of SGLT2i. No genital mycotic infections were observed. As expected, a slight drop in the glomerular filtration rate was noted, while the NYHA functional status, cardiac and hepatic function, as well as the 6 min walk distance remained stable over time. These data provide a rationale for the use of SGLT2i in patients with amyloidosis and concomitant cardiac or renal dysfunction. Prospective randomized data are desired to confirm safety and to prove efficacy in this increasingly important group of patients. KW - heart failure KW - chronic kidney disease KW - amyloidosis KW - SGLT2 inhibitors Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-356024 SN - 2077-0383 VL - 13 IS - 1 ER - TY - THES A1 - Behne, Robert Stefan Friedrich T1 - Development Of A Human iPSC-Derived Cortical Neuron Model Of Adaptor- Protein-Complex-4-Deficiency T1 - Entwicklung eines humanen iPSC-abgeleiteten kortikalen Neuronenmodells der Adaptor-Protein-Komplex-4-Defizienz N2 - Adaptor-protein-4-deficiency (AP-4-deficiency) is an autosomal-recessive childhood- onset form of complicated hereditary spastic paraplegia (HSP) caused by bi-allelic loss- of-function mutations in one of the four subunits of the AP-4-complex. These four conditions are named SPG47 (AP4B1, OMIM #614066), SPG50 (AP4M1, OMIM #612936), SPG51 (AP4E1, OMIM #613744) and SPG52 (AP4S1, OMIM #614067), respectively and all present with global developmental delay, progressive spasticity and seizures. Imaging features include a thinning of the corpus callosum, ventriculomegaly and white matter changes. AP-4 is a highly conserved heterotetrameric complex, which is responsible for polarized sorting of transmembrane cargo including the autophagy- related protein 9 A (ATG9A). Loss of any of the four subunits leads to an instable complex and defective sorting of AP-4-cargo. ATG9A is implicated in autophagosome formation and neurite outgrowth. It is missorted in AP-4-deficient cells and CNS-specific knockout of Atg9a in mice results in a phenotype reminiscent of AP-4-deficiency. However, the AP-4-related cellular phenotypes including ATG9A missorting have not been investigated in human neurons. Thus, the aim of this study is to provide the first human induced pluripotent stem cell- derived (iPSC) cortical neuron model of AP-4-deficiency to explore AP-4-related phenotypes in preparation for a high-content screening. Under the hypothesis that AP-4- deficiency leads to ATG9A missorting, elevated ATG9A levels, impaired autophagy and neurite outgrowth in human iPSC-derived cortical neurons, in vitro biochemical and imaging assays including automated high-content imaging and analysis were applied. First, these phenotypes were investigated in fibroblasts from three patients with compound heterozygous mutations in the AP4B1 gene and their sex-matched parental controls. The same cell lines were used to generate iPSCs and differentiate them into human excitatory cortical neurons. This work shows that ATG9A is accumulating in the trans-Golgi-network in AP-4- deficient human fibroblasts and that ATG9A levels are increased compared to parental controls and wild type cells suggesting a compensatory mechanism. Protein levels of the AP4E1-subunit were used as a surrogate marker for the AP-4-complex and were decreased in AP-4-deficient fibroblasts with co-immunoprecipitation confirming the instability of the complex. Lentiviral re-expression of the AP4B1-subunit rescues this corroborating the fact that a stable AP-4-complex is needed for ATG9A trafficking. Surprisingly, autophagic flux was present in AP-4-deficient fibroblasts under nutrient- rich and starvation conditions. These phenotypic markers were evaluated in iPSC-derived cortical neurons and here, a robust accumulation of ATG9A in the juxtanuclear area was seen together with elevated ATG9A protein levels. Strikingly, assessment of autophagy markers under nutrient-rich conditions showed alterations in AP-4-deficient iPSC- derived cortical neurons indicating dysfunctional autophagosome formation. These findings point towards a neuron-specific impairment of autophagy and need further investigation. Adding to the range of AP-4-related phenotypes, neurite outgrowth and branching are impaired in AP-4-deficient iPSC-derived cortical neurons as early as 24h after plating and together with recent studies point towards a distinct role of ATG9A in neurodevelopment independent of autophagy. Together, this work provides the first patient-derived neuron model of AP-4-deficiency and shows that ATG9A is sorted in an AP-4-dependent manner. It establishes ATG9A- related phenotypes and impaired neurite outgrowth as robust markers for a high-content screening. This disease model holds the promise of providing a platform to further study AP-4-deficiency and to search for novel therapeutic targets. N2 - Die Adaptor-Protein-4-Defizienz (AP-4-Defizienz) ist eine autosomal-rezessiv vererbte, komplizierte Form hereditären spastischen Paraplegien (HSPs), welche durch biallelische Mutationen in einer der vier Untereinheiten des AP-4-Gens verursacht wird. Die vier resultierenden Erkrankungen werden SPG47 (AP4B1, OMIM #614066), SPG50 (AP4M1, OMIM #612936), SPG51 (AP4E1, OMIM #613744) und SPG52 (AP4S1, OMIM #614067) genannt und präsentieren sich mit globaler Entwicklungsverzögerung im frühen Säuglingsalter, progressiver Spastik sowie Krampfanfällen. Radiologische Zeichen beinhalten ein verschmälertes Corpus callosum, Ventrikulomegalie und Veränderungen der weißen Substanz. AP-4 ist ein hoch konservierter, heterotetramerer Proteinkomplex, welcher für die polarisierte Verteilung von Transmembranproteinen einschließlich des „autophagy-related protein 9 A“ (ATG9A) zuständig ist. Eine „lossof- function“ Mutation in einer der vier Untereinheiten führt zur Instabilität des gesamten Komplexes und zur Beeinträchtigung des AP-4-abhängigen Proteintransportes. ATG9A ist notwendig für die Bildung von Autophagosomen und das Neuritenwachstum. In AP- 4-defizienten Zellen ist der ATG9A-Transport beeinträchtigt und ein ZNS-spezifischer Knockout von ATG9A erzeugt in Mäusen einen Phenotyp, der große Überschneidungen mit dem der AP-4-Defizienz aufweist. Bisher sind diese AP-4-abhängigen zellulären Phenotypen nicht in humanen Neuronen untersucht worden. Daher ist die Entwicklung des ersten humanen aus induzierten pluripotenten Stammzellen (iPSC) abgeleiteten kortikalen Neuronenmodells der AP-4-Defizienz und die Identifikation AP-4-abhängiger Phenotypen für die Anwendung in einem Hochdurchsatzscreening das Ziel dieser Arbeit. Unter der Hypothese, dass AP-4- Defizienz in humanen iPSC-abgeleiteten kortikalen Neuronen zu ATG9A Fehltransport, erhöhtem ATG9A Protein, beeinträchtigter Autophagie und vermindertem Neuritenwachstum führt, wurden biochemische und automatisierte, Mikroskopie-basierte in vitro Assays entwickelt. Zunächst wurden primäre humane Fibroblasten von Patienten mit compound-heterozygoten Mutationen im AB4B1-Gen und geschlechtsangepasste, elterliche Kontrollzellen auf die genannten Phenotypen hin untersucht. Dieselben Zelllinien wurden anschließend für die Generierung von iPSCs und die Differenzierung in exzitatorische kortikale Neurone verwendet. 90 Diese Arbeit zeigt, dass ATG9A in AP-4-defizienten Fibroblasten im Bereich des Trans- Golgi-Netzwerkes akkumuliert und das ATG9A Proteinlevel erhöht sind, was auf eine kompensatorische Hochregulierung hindeutet. Die Proteinlevel der AP4E1-Untereinheit wurden als Surrogatparameter für einen stabilen AP-4-Komplex genutzt und waren in AP-4-defizienten Fibroblasten vermindert. In der Co-Immunpräzipitation konnte eine Instabilität des AP-4-Komplexes bestätigt werden. Die lentivirale Reexpression der AB4B1-Untereinheit führte zu einer Wiederherstellung des Wildtyp-Phänotyps und zeigt damit, dass ein stabiler AP-4-Komplex für die korrekte Verteilung von ATG9A notwendig ist. Trotz der bekannten Beteiligung von ATG9A an der Bildung von Autophagosomen, zeigte sich eine intakte Autophagosomenbildung und Degradation in AP-4-defizienten Fibroblasten. Die beschriebenen phänotypischen Marker wurden in iPSC-abgeleiteten kortikalen Neuronen evaluiert und auch hier konnten eine juxtanukleäre Akkumulation von ATG9A sowie erhöhte ATG9A Proteinlevel demonstriert werden. Im Gegensatz zu den Fibroblasten, zeigten AP-4-defiziente iPSCabgeleitete kortikale Neurone bereits unter nährstoffreichen Bedingungen eine Konstellation von Autophagiemarkern, die auf eine gestörte Autophagosomenbildung und damit auf eine Neuronen-spezifische Störung von Autophagie hindeuten und der weiteren Untersuchung bedürfen. Zusätzlich fand sich bei AP-4-defizienten kortikalen Neuronen bereits in den ersten 24 Stunden im Inkubator eine Störung des Neuritenwachstums und der -verzweigung, welche in Zusammenschau mit kürzlich erschienenen Arbeiten auf eine zusätzliche Autophagie-unabhängige Funktion von ATG9A hinweisen. Diese Arbeit stellt zusammenfassend die Entwicklung des ersten Patienten-abgeleiteten Neuronenmodells der AP-4-Defizienz dar und zeigt das ATG9A in einer AP-4-abhänigen Weise in der Zelle verteilt wird. Weiterhin etabliert diese Arbeit ATG9A-abhängige zelluläre Phänotypen und gestörtes Neuritenwachstum als robuste phänotypische Marker für ein High-Content Screening. Dieses zelluläre Krankheitsmodell trägt das Potential als Plattform für weitere Studien der AP-4-Defizienz zu dienen und damit neue therapeutische Möglichkeiten aufzudecken. KW - Adaptorproteine KW - hereditary spastic paraplegia KW - iPSC Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-351390 ER - TY - THES A1 - Knorr, Susanne T1 - Pathophysiology of early-onset isolated dystonia in a DYT-TOR1A rat model with trauma-induced dystonia-like movements T1 - Pathophysiologie der früh beginnenden, isolierten Dystonie in einem DYT-TOR1A Rattenmodell mit Trauma-induzierten Dystonie-ähnlichen Bewegungen N2 - Early-onset torsion dystonia (DYT-TOR1A, DYT1) is an inherited hyperkinetic movement disorder caused by a mutation of the TOR1A gene encoding the torsinA protein. DYT-TOR1A is characterized as a network disorder of the central nervous system (CNS), including predominantly the cortico-basal ganglia-thalamo-cortical loop resulting in a severe generalized dystonic phenotype. The pathophysiology of DYTTOR1A is not fully understood. Molecular levels up to large-scale network levels of the CNS are suggested to be affected in the pathophysiology of DYT-TOR1A. The reduced penetrance of 30% - 40% indicates a gene-environmental interaction, hypothesized as “second hit”. The lack of appropriate and phenotypic DYT-TOR1A animal models encouraged us to verify the “second hit” hypothesis through a unilateral peripheral nerve trauma of the sciatic nerve in a transgenic asymptomatic DYT-TOR1A rat model (∆ETorA), overexpressing the human mutated torsinA protein. In a multiscale approach, this animal model was characterized phenotypically and pathophysiologically. Nerve-injured ∆ETorA rats revealed dystonia-like movements (DLM) with a partially generalized phenotype. A physiomarker of human dystonia, describing increased theta oscillation in the globus pallidus internus (GPi), was found in the entopeduncular nucleus (EP), the rodent equivalent to the human GPi, of nerve-injured ∆ETorA rats. Altered oscillation patterns were also observed in the primary motor cortex. Highfrequency stimulation (HFS) of the EP reduced DLM and modulated altered oscillatory activity in the EP and primary motor cortex in nerve-injured ∆ETorA rats. Moreover, the dopaminergic system in ∆ETorA rats demonstrated a significant increased striatal dopamine release and dopamine turnover. Whole transcriptome analysis revealed differentially expressed genes of the circadian clock and the energy metabolism, thereby pointing towards novel, putative pathways in the pathophysiology of DYTTOR1A dystonia. In summary, peripheral nerve trauma can trigger DLM in genetically predisposed asymptomatic ΔETorA rats leading to neurobiological alteration in the central motor network on multiple levels and thereby supporting the “second hit” hypothesis. This novel symptomatic DYT-TOR1A rat model, based on a DYT-TOR1A genetic background, may prove as a valuable chance for DYT-TOR1A dystonia, to further investigate the pathomechanism in more detail and to establish new treatment strategies. N2 - Früh beginnende Torsionsdystonie (DYT-TOR1A, DYT1) ist eine genetisch bedingte hyperkinetische Bewegungsstörung, die aufgrund einer Mutation im TOR1A Gen verursacht wird, welches für das TorsinA-Protein codiert. DYT-TOR1A wird als zentrale Netzwerkstörung bezeichnet und betrifft hauptsächlich die kortiko-striatothalamo-kortikale Funktionsschleife, welches schließlich zu einem schweren generalisierten dystonen Phänotyp führt. Die Pathophysiologie von DYT-TOR1A ist nicht vollständig verstanden, man geht jedoch davon aus, dass Ebenen im Zentralnervensystem von molekularer Basis bis hin zu ganzen Netzwerken betroffen sind. Die reduzierte Penetranz von nur 30% bis 40% deutet auf eine Gen-UmweltInteraktion hin, im Sinne einer „2-Treffer-Hypothese“. Auch das Fehlen eines adäquaten DYT-TOR1A Tiermodelles hat uns dazu veranlasst, die „2-TrefferHypothese“ zu verifizieren, indem eine unilaterale periphere Quetschläsion des Nervus ischiadicus in einem transgenen, asymptomatischen DYT-TOR1A Rattenmodell (∆ETorA) durchgeführt wurde, welches das humane mutierte TorsinA-Protein überexprimiert. Das Tiermodell wurde phänotypisch und pathophysiologisch auf verschiedenen Analysenebenen charakterisiert. ∆ETorA Ratten mit Quetschläsion entwickelten Dystonie-ähnliche Bewegungen (DLM) mit teilweise generalisiertem Phänotyp. Erhöhte Theta-Oszillationen im Globus pallidus internus (GPi) sind bezeichnend für die humane Dystonie, welche auch im Nucleus entopeduncularis (EP), dem Äquivalent zum humanen GPi, von ∆ETorA Ratten mit Quetschläsion nachgewiesen wurden. Veränderte oszillatorische Muster wurden auch im primären Motorkortex gefunden. Hochfrequenz-Stimulation (HFS) des EP konnte das klinische Erscheinungsbild verbessern und hatte zudem auch einen modulatorischen Effekt auf die veränderte oszillatorische Aktivität des EP und des primären Motorcortex von ∆ETorA Ratten mit Quetschläsion. Auch das veränderte dopaminerge System erwies sich als ein pathologisches Merkmal in ∆ETorA Ratten. Es fand sich eine erhöhte striatale Ausschüttung von Dopamin und ein erhöhter Dopaminumsatz. In der Transkriptomanalyse kamen die zirkadiane Uhr und der Energiemetabolismus als weitere potentielle Signalwege in der Pathophysiologie der DYT-TOR1A Dystonie zum Vorschein. Zusammengefasst konnten DLM in genetisch prädisponierten, asymptomatischen ΔETorA Ratten mittels peripheren Nerventraumas ausgelöst werden, welches zu neurobiologischen Veränderungen in verschiedenen Ebenen des zentralen motorischen Netzwerk führte. Somit konnte die „2-Treffer-Hypothese“ bestätigt werden. Dieses neue symptomatische DYT-TOR1A Rattenmodell, fundiert auf der genetischen Grundlage von DYT-TOR1A, kann sich als wertvolle Möglichkeit für die DYT-TOR1A Dystonie erweisen, um Pathomechanismen genauer zu untersuchen und neue Behandlungsstrategien zu entwickeln. KW - Dystonie KW - Trauma KW - Ratte KW - Zentralnervensystem KW - DYT-TOR1A KW - early-onset isolated dystonia KW - gene-environmental interaction KW - peripheral nerve trauma KW - striatum KW - dopamine KW - deep brain stimulation Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-206096 ER - TY - THES A1 - Yuan, Xidi T1 - Aging and inflammation in the peripheral nervous system T1 - Altern und Entzündung im peripheren Nervensystem N2 - Aging is known to be a risk factor for structural abnormalities and functional decline in the nervous system. Characterizing age-related changes is important to identify putative pathways to overcome deleterious effects and improve life quality for the elderly. In this study, the peripheral nervous system of 24-month-old aged C57BL/6 mice has been investigated and compared to 12-month-old adult mice. Aged mice showed pathological alterations in their peripheral nerves similar to nerve biopsies from elderly human individuals, with nerve fibers showing demyelination and axonal damage. Such changes were lacking in nerves of adult 12-month-old mice and adult, non-aged humans. Moreover, neuromuscular junctions of 24-month-old mice showed increased denervation compared to adult mice. These alterations were accompanied by elevated numbers of macrophages in the peripheral nerves of aged mice. The neuroinflammatory conditions were associated with impaired myelin integrity and with a decline of nerve conduction properties and muscle strength in aged mice. To determine the pathological impact of macrophages in the aging mice, macrophage depletion was performed in mice by oral administration of CSF-1R specific kinase (c-FMS) inhibitor PLX5622 (300 mg/kg body weight), which reduced the number of macrophages in the peripheral nerves by 70%. The treated mice showed attenuated demyelination, less muscle denervation and preserved muscle strength. This indicates that macrophage-driven inflammation in the peripheral nerves is partially responsible for the age-related neuropathy in mice. Based on previous observations that systemic inflammation can accelerate disease progression in mouse models of neurodegenerative diseases, it was hypothesized that systemic inflammation can exacerbate the peripheral neuropathy found in aged mice. To investigate this hypothesis, aged C57BL/6 mice were intraperitoneally injected with a single dose of lipopolysaccharide (LPS; 500 μg/kg body weight) to induce systemic inflammation by mimicking bacterial infection, mostly via activation of Toll-like receptors (TLRs). Altered endoneurial macrophage activation, highlighted by Trem2 downregulation, was found in LPS injected aged mice one month after injection. This was accompanied by a so far rarely observed form of axonal perturbation, i.e., the occurrence of “dark axons” characterized by a damaged cytoskeleton and an increased overall electron density of the axoplasm. At the same time, however, LPS injection reduced demyelination and muscle denervation in aged mice. Interestingly, TREM2 deficiency in aged mice led to similar changes to LPS injection. This suggests that LPS injection likely mitigates aging-related demyelination and muscle denervation via Trem2 downregulation. Taken together, this study reveals the role of macrophage-driven inflammation as a pathogenic mediator in age-related peripheral neuropathy, and that targeting macrophages might be an option to mitigate peripheral neuropathies in aging individuals. Furthermore, this study shows that systemic inflammation may be an ambivalent modifier of age-related nerve damage, leading to a distinct type of axonal perturbation, but in addition to functionally counteracting, dampened demyelination and muscle denervation. Translationally, it is plausible to assume that tipping the balance of macrophage polarization to one direction or the other may determine the functional outcome in the aging peripheral nervous system of the elderly. N2 - Es ist bekannt, dass das Altern ein Risikofaktor für strukturelle Veränderungen und Funktionsstörungen des Nervensystems ist. Die Charakterisierung altersbedingter Veränderungen ist wichtig, um mögliche Wege zu identifizieren, um schädliche Auswirkungen zu überwinden und die Lebensqualität älterer Menschen zu verbessern. In dieser Studie wurde das periphere Nervensystem von 24 Monate alten gealterten C57BL/6-Mäusen untersucht und mit 12 Monate alten adulten Mäusen verglichen. Gealterte Mäuse zeigten ähnliche pathologische Veränderungen in ihren peripheren Nerven wie Nervenbiopsien älterer Menschen, wobei die Nervenfasern eine Demyelinisierung und axonale Schädigung zeigten. Bei den Nerven von adulten 12 Monate alten Mäusen und nicht gealterten Menschen fehlten solche Veränderungen. Darüber hinaus wiesen die neuromuskulären Endplatten von 24 Monate alten Mäusen im Vergleich zu adulten Mäusen eine erhöhte Denervation auf. Diese Veränderungen wurden von einer erhöhten Anzahl von Makrophagen in den peripheren Nerven gealterter Mäuse begleitet. Die neuroinflammatorischen Bedingungen waren mit einer Beeinträchtigung der Myelinintegrität, einer Abnahme der Nervenleitungseigenschaften und der Muskelkraft bei gealterten Mäusen verbunden. Um den pathologischen Einfluss von Makrophagen bei alternden Mäusen zu bestimmen, wurde die Makrophagen-Depletion bei Mäusen durch orale Verabreichung des CSF-1R-spezifischen Kinase-Inhibitors (c-FMS) PLX5622 (300 mg/kg Körpergewicht) durchgeführt, welche die Anzahl der Makrophagen in den peripheren Nerven um 70% reduzierte. Die behandelten Mäuse zeigten eine verminderte Demyelinisierung, eine reduzierte Muskeldenervation und einen Erhalt der Muskelkraft. Dies deutet darauf hin, dass die durch Makrophagen verursachte Entzündung in den peripheren Nerven teilweise für die altersbedingte Neuropathie bei Mäusen verantwortlich ist. Auf der Grundlage früherer Beobachtungen, dass systemische Entzündungen das Fortschreiten der Krankheit in Mausmodellen neurodegenerativer Erkrankungen beschleunigen können, wurde die Hypothese aufgestellt, dass systemische Entzündungen die periphere Neuropathie in gealterten Mäusen verschlimmern können. Um diese Hypothese zu untersuchen, wurde gealterten C57BL/6-Mäusen eine Einzeldosis Lipopolysaccharid (LPS; 500 μg/kg Körpergewicht) intraperitonal injiziert, um eine systemische Entzündung durch Nachahmung einer bakteriellen Infektion, meist über die Aktivierung von Toll-like-Rezeptoren (TLRs), zu induzieren. Eine veränderte endoneuriale Makrophagenaktivierung, die durch eine reduzierte Trem2-Expression hervorgehoben wird, konnte bei LPS-injizierten gealterten Mäusen einen Monat nach der Injektion gefunden werden. Dies ging einher mit einer bisher selten beobachteten Form der axonalen Perturbation, d.h. dem Auftreten von "dunklen Axonen", die sich durch ein geschädigtes Zytoskelett und eine erhöhte Gesamtelektronendichte des Axoplasmas auszeichnen. Gleichzeitig verringerte die LPS-Injektion jedoch die Demyelinisierung und Muskeldenervation bei gealterten Mäusen. Interessanterweise führte die TREM2 Defizienz bei gealterten Mäusen zu vergleichbaren Veränderungen wie die LPS-Injektion. Dies deutet darauf hin, dass die LPS-Injektion die alterungsbedingte Demyelinisierung und Muskeldenervierung über die Trem2 Herunterregulation abschwächt. Zusammenfassend zeigt diese Studie die Rolle der Makrophagen-getriebenen Entzündung als pathogener Mediator bei der altersbedingten peripheren Neuropathie. Zusätzlich deuten die Ergebnisse darauf hin, dass die gezielte Behandlung von Makrophagen eine Option zur Linderung peripherer Neuropathien bei alternden Menschen sein könnte. Darüber hinaus zeigt diese Studie, dass die systemische Entzündung ein ambivalenter Modifikator der altersbedingten Nervenschädigung sein kann, der zu einer bestimmten Art von axonaler Perturbation führt, aber zusätzlich zu einer funktionell entgegenwirkenden, weniger schweren Demyelinisierung und Muskeldenervation. Translatorisch ist es plausibel anzunehmen, dass eine Veränderung des Gleichgewichts der Makrophagenpolarisation in die eine oder andere Richtung das funktionelle Ergebnis im alternden peripheren Nervensystem der älteren Menschen bestimmen kann. KW - Maus KW - Peripheres Nervensystem KW - Altern KW - Immunsystem KW - macrophages KW - peripheral nervous system KW - aging KW - neuroinflammation KW - Trem2 KW - systemic inflammation Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-237378 ER - TY - THES A1 - Yin, Jing T1 - Progressive alterations of pro- and antidegeneration markers in the nigrostriatal tract of the AAV1/2-A53T-α synuclein rat model of Parkinson’s disease T1 - Progressive Veränderungen von Pro- und Antidegenerationsmarkern im Nigrostriataltrakt des AAV1/2-A53T-α-Synuclein-Rattenmodells der Parkinson-Krankheit N2 - Neurodegeneration plays an essential role in Parkinson’s disease (PD). Several crucial neuronal pro-and antidegeneration markers were described to be altered in disease models accompanied by neurodegeneration. In the AAV1/2-A53T-aSyn PD rat model progressive time-dependent motor impairment and neurodegeneration in the nigrostriatal tract starting from 2 weeks after PD model induction could be found. Downregulation of Nrf2 in SN and nigrostriatal axon localization, a trend of Tau downregulation in SN and upregulation in axon localization in the AAV1/2-A53T-aSyn PD rat model were observed, indicating potential therapeutic value of these two molecular targets in PD. No alterations of SARM1 and NMNAT2 could be detected, indicating little relevance of these two molecules with our AAV1/2-A53T-aSyn rat model. N2 - Die Neurodegeneration spielt eine wesentliche Rolle bei der Parkinson-Krankheit (PD). Es wurde beschrieben, dass mehrere entscheidende neuronale Pro- und Antidegenerationsmarker in Krankheitsmodellen, die von Neurodegeneration begleitet werden, verändert sind. Im AAV1/2-A53T-aSyn PD-Rattenmodell konnte eine fortschreitende zeitabhängige motorische Beeinträchtigung und Neurodegeneration im Nigrostriataltrakt ab 2 Wochen nach PD-Modellinduktion gefunden werden. Herunterregulierung von Nrf2 in SN und nigrostriataler Axonlokalisierung, ein Trend der Tau-Herunterregulierung in SN und Hochregulierung in Axonlokalisierung im AAV1/2-A53T-aSyn-PD-Rattenmodell wurden beobachtet, was auf einen potenziellen therapeutischen Wert dieser beiden molekularen Ziele bei PD hinweist. Es konnten keine Veränderungen von SARM1 und NMNAT2 nachgewiesen werden, was auf eine geringe Relevanz dieser beiden Moleküle mit unserem AAV1/2-A53T-aSyn-Rattenmodell hinweist. KW - Parkinson's disease KW - Neurodegeneration Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260645 ER - TY - THES A1 - Grohmann, Christoph T1 - Kognitive Leistungsfähigkeit und Lebensqualität bei minimaler hepatischer Enzephalopathie - eine Pilotstudie zum Patient Reported Outcome in der Verlaufsdiagnostik T1 - Cognitive performance and quality of life in minimal hepatic encephalopathy - a pilot study of Patient Reported Outcome in follow-up N2 - Die WHO definiert Gesundheit als völliges körperliches, geistiges und soziales Wohlbefinden. Während diese ganzheitliche Betrachtungsweise seit Menschengedenken nahezu weltweit das Gesundheitswesen prägt, hat die Medizin in Europa mit der naturwissenschaftlichen Erkenntnisrevolution einen Sonderweg eingeschlagen. Hier wird der kranke Organismus in erster Linie als defekter Apparat gesehen, der mit ausgeklügelter Technik zu reparieren ist. Aber auch präziseste Qualitätsarbeit stößt dabei oft an Leistungsgrenzen, weil sie als seelenlos erlebt wird. Daher sehen heute viele Fachgebiete die Notwendigkeit, ihre Behandlungskonzepte zu beseelen und ihre Behandlungserfolge auch anhand der subjektiv von Patienten empfundenen Lebensqualität zu beurteilen. Für die Ermittlung dieses PRO kommen etablierte psychometrische Testverfahren in Frage, die sich auch für routinemäßige Verlaufskontrollen eignen. In der vorliegenden Arbeit wurde am Beispiel der mHE geprüft, welchen Nutzen eine PRO-Bestimmung bei der Verlaufskontrolle haben kann. Dazu wurde eine prospektive Studie mit anfänglich 75 Patienten durchgeführt. Alle hatten eine mHE und waren entweder alkoholbedingt oder aus anderen Gründen schwer leberkrank. An vier Terminen im Abstand von sechs Monaten wurden die kognitive Leistungsfähigkeit und der emotionale Status überprüft. Die Patienten zeigten anfänglich kognitive Einschränkungen, die sich im Verlauf der individuell abgestimmten Behandlung deutlich verbesserten oder ganz verschwanden. Die globale Testung mit dem MoCA ergab eine hochsignifikante Normalisierung im ersten Behandlungsjahr. Die MoCA-Werte am Studienanfang und -ende waren von der Erkrankungsursache unabhängig. Dieser Befund differenzierte sich in den Spezialtests TMT, PHES und NHPT. Hier zeigten die alkoholbedingt Erkrankten durchweg schlechtere Leistungen als die nicht-alkoholbedingt Erkrankten, erholten sich aber in der Regel auch deutlicher. Die seelische Gestimmtheit gemäß BDI-II und die mit dem SF-36 MCS ermittelte psychosoziale Befindlichkeit waren in beiden Patientengruppen von Anfang an vergleichsweise günstig. Dabei hatten die alkoholbedingt Erkrankten die besseren Werte, speziell der BDI-II zeigte bei ihnen nach einem halben Jahr eine zusätzliche und bleibende Stimmungsaufhellung an. Der SF-36 PCS zum Körpererleben zeigte hingegen, dass sich die alkoholbedingt Erkrankten zu Studienbeginn in einer deutlich schlechteren Verfassung befanden. Diese verbesserte sich aber kontinuierlich, sodass nach 1,5 Jahren kein Unterschied mehr zu den nicht-alkoholbedingt Erkrankten bestand. Aus diesen Befunden und dem reichhaltigen Erfahrungsgut zur Alkoholkrankheit wird geschlossen, dass der Genesungsprozess bei alkoholbedingtem Leberversagen viel komplexer ist als bei nicht-alkoholbedingtem Leberversagen. Er könnte wesentlich mehr Zeit erfordern und wird offensichtlich anders erlebt. Dieser Patientengruppe könnten besondere physio- und gesprächstherapeutische Angebote eine große Hilfe sein. Die Arbeit zeigt, dass es möglich ist, mit wenig Aufwand komplementär zu den klinischen Verlaufsbefunden einen informativen PRO-Bericht zu erhalten. Er hilft Angehörigen und medizinischem Personal, die persönlichen Nöte und Hoffnungen der Patienten besser zu verstehen und gegebenenfalls einen Korrekturbedarf im Umgang zu erkennen. Hinzu kam im vorliegenden Fall die Erkenntnis, dass die alkoholbedingt Erkrankten in ihrem Kranksein anders betroffen waren. Die Gründe dafür sind im Nachhinein plausibel, der Sachverhalt als solcher wäre aber ohne diese Spezialuntersuchung wohl nicht erkannt worden. Das Beispiel der PRO-Ermittlung bei der mHE macht den praktischen Wert einer Berücksichtigung des gesamtheitlichen Gesundheitskonzepts der WHO auch in der technikzentrierten „westlichen Medizin“ deutlich. N2 - The WHO defines health as complete physical, mental and social well-being. While this holistic approach has characterized health care almost worldwide since time immemorial, medicine in Europe has taken a special path with the scientific knowledge revolution. Here, the sick organism is seen primarily as a defective apparatus that can be repaired with sophisticated technology. But even the most precise quality work often comes up against performance limits, because it is experienced as soulless. For this reason, many specialties today see the need to soul their treatment concepts and to assess their treatment successes also on the basis of the quality of life subjectively perceived by patients. Established psychometric test procedures can be used to determine this PRO, which are also suitable for routine progress monitoring. In the present study, we used the example of mHE to examine the potential benefits of PRO assessment in follow-up. For this purpose, a prospective study with initially 75 patients was performed. All had mHE and were either alcohol-related or severely liver diseased for other reasons. Cognitive performance and emotional status were assessed at four appointments six months apart. Patients initially showed cognitive impairment, which improved significantly or disappeared completely during the course of individually tailored treatment. Global testing with the MoCA showed highly significant normalization in the first year of treatment. MoCA scores at baseline and end of study were independent of disease cause. This finding was differentiated in the special tests TMT, PHES and NHPT. Here, the alcohol-related ill persons consistently performed worse than the non-alcohol-related ill persons, but generally also recovered more clearly. The mental mood according to the BDI-II and the psychosocial well-being measured with the SF-36 MCS were comparatively favorable in both patient groups from the beginning. The alcohol-related patients had the better values, especially the BDI-II showed an additional and lasting improvement of their mood after half a year. The SF-36 PCS on body experience, on the other hand, showed that the alcohol-dependent patients were in a significantly worse condition at the beginning of the study. However, this improved continuously, so that after 1.5 years there was no longer any difference to the non-alcohol-related sufferers. From these findings and the rich body of experience on alcohol-related disease, it is concluded that the recovery process in alcohol-related liver failure is much more complex than in non-alcohol-related liver failure. It could require much more time and is obviously experienced differently. This group of patients could be greatly helped by special physical and talk therapy services. The work shows that it is possible to obtain an informative PRO report complementary to the clinical course findings with little effort. It helps relatives and medical staff to better understand the personal needs and hopes of patients and, if necessary, to recognize a need for corrective action. In addition, in the present case there was the realization that the alcohol-related patients were affected differently in their being ill. The reasons for this are plausible in retrospect, but the facts as such would probably not have been recognized without this special investigation. The example of the PRO investigation in mHE makes clear the practical value of taking into account the holistic health concept of the WHO even in technology-centered "Western medicine". KW - Patient Reported Outcome KW - Lebensqualität bei mHE KW - Kognition bei mHE KW - Encephalopathia hepatica KW - Hepatische Enzephalopathie Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-305375 ER - TY - THES A1 - Zeumer, Karolina T1 - Die Rolle dendritischer Zellen beim ischämischen Schlaganfall T1 - The role of dendritic cells in ischemic stroke N2 - Ziel dieser Studie war es, zu untersuchen, ob dendritische Zellen eine Rolle beim ischämischen Schlaganfall spielen. Zur Beantwortung dieser Fragestellung wurde ein Mausmodell gewählt, in dem es nach Administration von Diphterietoxin zur selektiven Depletion CD11c positiver Zellen kommt (C.FVB-Tg(Itgax-DTR/EGFP)57Lan/J). Hierbei wird der Diphterietoxinrezeptor unter dem CD11c Promotor (ITGAX) exprimiert. Aufgrund der Wiederherstellung dendritischer Zellen nach ca. 24 Stunden waren wiederholte Applikationen von Diphterietoxin notwendig. Die Zusammensetzung anderer Immunzellen wurde dabei im Wesentlichen nicht geändert. Für eine Schlaganfallinduktion wurde eine tMCAO (transient middle cerebral artery occlusion) durchgeführt. Hierbei wird durch Okklusion der A. cerebri media mittels Verschlussfilament für 30 oder 60 Minuten ein Schlaganfall im Mediastromgebiet induziert. Es wurden unterschiedliche Verschlusszeiten, Zeitpunkte und Depletionsraten untersucht. In keinem der Versuchsansätze kam es zu einer signifikanten Veränderung des Schlaganfallvolumens nach Depletion CD11c positiver Zellen. Mittels quantitativer real-time PCR wurde die Expression unterschiedlicher Zytokine nach tMCAO und CD11c-Depletion untersucht. An Tag 1 nach Schlaganfallinduktion und hoher Depletionsrate ergab sich eine Verminderung der Expression von IL-1β und IL-6, während an Tag 3 und niedriger Depletionsrate die Expression dieser Zytokine nach CD11c-Depletion zunahm. Grund hierfür könnte die Expression dieser Zytokine durch andere Zellen des Immunsystems, wie etwa neutrophile Granulozyten oder Mikroglia/Makrophagen sein, die möglicherweise einer regulatorischen Funktion durch die Interaktion von Dendritischen Zellen und regulatorischen T-Zellen unterliegen. Weitere experimentelle Ansätze sind notwendig, um diese Fragestellung beantworten zu können. TGF-β zeigte durchgehend in allen Versuchsanordnungen eine verminderte Expression nach der Depletion dendritischer Zellen. Es ist naheliegend, dass dieses neuroprotektiv-regulatorische Zytokin direkt einer Produktion durch dendritische Zellen oder von nachfolgend aktivierten T-Zellen unterliegt. In immunhistochemischen Studien konnte des Weiteren keine Änderung des Immigrationsverhaltens von CD11b+ Zellen ins Gehirn gesehen werden. Diese Studie unterliegt jedoch einigen Limitationen. So stellte sich im Laufe der Experimente heraus, dass die wiederholte Applikation von Diphterietoxin zu einer erhöhten Mortalität der Versuchstiere führte. Nach Fertigstellung der Experimente erschien hierzu eine Publikation, welche die wiederholte Administration von DTX und die Entwicklung einer Myokarditis im gewählten Mausmodell in Zusammenhang brachte. N2 - The aim of this study was to investigate whether dendritic cells play a role in ischemic stroke. To address the subject we chose a mouse model in which administration of diphteria toxin induces selective depletion of CD11c positive cells (C.FVB-Tg(Itgax-DTR/EGFP)57Lan/J). In these the diphteria toxin receptor is expressed under the CD11c promotor (ITGAX). Due to reconstitution of dendric cells after 24 hours repeated application of diptheria toxin was necessary. In general, the composition of other immune cells was not affected. To induce ischemic stroke, we performed tMCAO (transient middle cerebral artery occlusion). Here ischemic stroke in the perfusion area of the middle cerebral artery is induced by occlusion of the middle cerebral artery via insertion of a blocking filament for 30 or 60 minutes. Different times of blocking, points in time and depletion rates were examined. None of our experimental setups showed significant changes in stroke volumetry after depletion of CD11c positive cells. By means of quantitative real-time PCR we assessed the expression of different cytokines after tMCAO and CD11c depletion. On day 1 after stroke induction and high depletion rate we found a reduction in IL-1β and IL-6 expression, whereas on day 3 and low depletion rate there was an increase of the expression of these two cytokines. This might be due to expression of these cytokines by other cell types of the immune system like neutrophils or microglia/macrophages which may underly regulatory functions due to interaction with dendritic cells and regulatory T cells. Further experiments will be necessary to address these issues thoroughly. In all our experiments TGF-β expression was reduced after depletion of dendritic cells. It appears likely that this neuroprotective-regulatory cytokine is regulated by the production of dendric cells or activated T cells. In immune-histochemical studies there was no change in the migration of CD11b+ cells into the brain. There are some limitations to this study. During our experiments there was evidence that repeated application of diphteria toxin increases mortality in our test animals. After completion of our studies, it was published that repeated administration of DTX favours the development of myocarditis in the chosen mouse model. KW - Schlaganfall KW - Neuroimmunologie KW - Dendritische Zelle Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-302580 ER - TY - THES A1 - Ostertag, Viktoria Charlotte Caroline T1 - Präventive und therapeutische Behandlung mit einem CSF-1-Rezeptorinhibitor bei verschiedenen Charcot-Marie-Tooth Mausmodellen T1 - Preventive and therapeutic treatment with a CSF-receptor-inhibitor in various Charcot-Marie-Tooth mouse models N2 - Die Charcot-Marie-Tooth-Neuropathie umfasst eine heterogene Gruppe von erblichen unter anderem demyelinisierenden Erkrankungen des peripheren Nervensystems. Trotz ihrer hohen Prävalenz von 1:2.500 gibt es bis dato keine kausalen Therapiemöglichkeiten. Durch den progressiven Krankheitsverlauf wird die Lebensqualität der Patienten stetig gemindert; der fortschreitende Verlust der Muskelkraft und Störungen des Gangbildes sind besonders belastend. Ursächlich für die CMT1-Neuropathie sind unter anderem Mutationen in Genen, die für Moleküle des Myelins von Schwannzellen codieren. Diese Mutationen führen zu einer verminderten Stabilität und Funktion des Myelins und so letzten Endes zu einer Demyelinisierung und axonalen Schädigung der peripheren Nerven. Weitere Studien in CMT1-Mausmodellen zeigten jedoch, dass nicht nur die verringerte Myelinstabilität sondern auch eine durch das Immunsystem vermittelte geringgradige Entzündungsreaktion für die Symptome ursächlich sein könnte. Hier spielen vor allem Makrophagen eine zentrale Rolle. Das Zytokin CSF-1 aktiviert die Makrophagen und verursacht so eine Demyelinisierung der peripheren Nerven. In P0het und Cx32def Mausmodellen konnte nachgewiesen werden, dass eine medikamentöse Inhibition des CSF-1-Rezeptors an Makrophagen zu einem verbesserten Nervphänotypen und einer deutlichen Abmilderung des Krankheitsbildes führte. In dieser Arbeit wurden in P0het und Cx32def Mausmodellen weiterführende Behandlungsstudien mit einem CSF-1-RI durchgeführt, die untersuchen, zu welchem Zeitpunkt innerhalb des Krankheitsverlaufs (therapeutisch oder präventiv) eine erfolgreiche Therapie noch möglich ist und ob bei einem früheren Beginn eine noch bessere Wirkung erzielt werden kann. Abhängig von den verschiedenen Start- und Endpunkten waren unterschiedliche Ergebnisse zu beobachten: Hinsichtlich der klinischen Parameter wie der Greifkraft und der Anzahl an abnormal innervierten Synapsen zeigten die Tiere im präventiven Behandlungszweig in beiden Mausmodellen das beste Ergebnis im Vergleich zu den Kontrolltieren. Diese substantielle Verbesserung ließ sich unabhängig von einem Makrophagen-Reflux sogar noch 6 Monate nach Behandlungsabbruch nachweisen. Bezüglich der endoneuralen Makrophagendepletion war sowohl in den P0het als auch den Cx32def Tieren im präventiven sowie im therapeutischen Behandlungszweig eine signifikante Verbesserung zu beobachten. Diese Ergebnisse heben ein weiteres Mal die Bedeutung der Makrophagen als Teil einer Entzündungsreaktion in der Pathogenese der CMT1-Neuropathie hervor. Des Weiteren konnte die These gefestigt werden, dass eine Inhibition des CSF-1-Rezeptors zu verbesserten histopathologischen sowie funktionellen Parametern führt. Um ein gutes Ansprechen auf die Therapie zu erzielen, müssen ein möglichst früher Therapiebeginn sowie eine nachhaltige Behandlungsdauer gewährleistet sein. N2 - "Macrophage-mediated inflamma3on is a potent driver of disease progression in mouse models of Charcot-Marie-Tooth (CMT) 1 diseases. This leads to the possibility to consider these cells as therapeu3c targets to dampen disease outcome in the so far non-treatable neuropathies. As a pharmacological proof-of-principle study, long-term targe3ng of nerve macrophages with the orally applied CSF-1 receptor specific kinase (c-FMS) inhibitor PLX5622 showed a substan3al allevia3on of the neuropathy in dis3nct CMT1 mouse models. However, regarding transla3onal op3ons, clinically relevant ques3ons emerged regarding treatment onset, dura3on and termina3on. Corrobora3ng previous data, we here show that in a model for CMT1B, peripheral neuropathy was substan3ally alleviated aQer early con3nuous PLX5622 treatment in CMT1B mice, leading to preserved motor func3on. However, late-onset treatment failed to mi3gate histopathological and clinical features, despite a similar reduc3on in the number of macrophages. Surprisingly, in CMT1B mice, termina3ng early PLX5622 treatment at six months was s3ll sufficient to preserve motor func3on at 12 months of age, sugges3ng a long-las3ng, therapeu3c effect of early macrophage deple3on. This novel and unexpected finding may have important transla3onal implica3ons, since we here show that con3nuous macrophage targe3ng appears not to be necessary for disease allevia3on, provided that the treatment starts within an early, cri3cal 3me window.” (Ostertag et al., Experimental Neurology, 2022) KW - Charcot-Marie-Syndrom KW - Neuropathie KW - Charcot-Marie-Tooth KW - CSF-1-Rezeptor-Inhibitor Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-308528 ER - TY - JOUR A1 - Kreß, Luisa A1 - Egenolf, Nadine A1 - Sommer, Claudia A1 - Üçeyler, Nurcan T1 - Cytokine expression profiles in white blood cells of patients with small fiber neuropathy JF - BMC Neuroscience N2 - Background The role of cytokines in the pathophysiology, diagnosis, and prognosis of small fiber neuropathy (SFN) is incompletely understood. We studied expression profiles of selected pro- and anti-inflammatory cytokines in RNA from white blood cells (WBC) of patients with a medical history and a clinical phenotype suggestive for SFN and compared data with healthy controls. Methods We prospectively recruited 52 patients and 21 age- and sex-matched healthy controls. Study participants were characterized in detail and underwent complete neurological examination. Venous blood was drawn for routine and extended laboratory tests, and for WBC isolation. Systemic RNA expression profiles of the pro-inflammatory cytokines interleukin (IL)-1ß, IL-2, IL-8, tumor necrosis factor-alpha (TNF) and the anti-inflammatory cytokines IL-4, IL-10, transforming growth factor beta-1 (TGF) were analyzed. Protein levels of IL-2, IL-8, and TNF were measured in serum of patients and controls. Receiver operating characteristic (ROC)-curve analysis was used to determine the accuracy of IL-2, IL-8, and TNF in differentiating patients and controls. To compare the potential discriminatory efficacy of single versus combined cytokines, equality of different AUCs was tested. Results WBC gene expression of IL-2, IL-8, and TNF was higher in patients compared to healthy controls (IL-2: p = 0.02; IL-8: p = 0.009; TNF: p = 0.03) and discriminated between the groups (area under the curve (AUC) ≥ 0.68 for each cytokine) with highest diagnostic accuracy reached by combining the three cytokines (AUC = 0.81, sensitivity = 70%, specificity = 86%). Subgroup analysis revealed the following differences: IL-8 and TNF gene expression levels were higher in female patients compared to female controls (IL-8: p = 0.01; TNF: p = 0.03). The combination of TNF with IL-2 and TNF with IL-2 and IL-8 discriminated best between the study groups. IL-2 was higher expressed in patients with moderate pain compared to those with severe pain (p = 0.02). Patients with acral pain showed higher IL-10 gene expression compared to patients with generalized pain (p = 0.004). We further found a negative correlation between the relative gene expression of IL-2 and current pain intensity (p = 0.02). Serum protein levels of IL-2, IL-8, and TNF did not differ between patients and controls. Conclusions We identified higher systemic gene expression of IL-2, IL-8, and TNF in SFN patients than in controls, which may be of potential relevance for diagnostics and patient stratification. KW - gene expression KW - small fiber neuropathy KW - cytokines KW - white blood cells Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300619 VL - 24 IS - 1 ER - TY - THES A1 - Wagenhäuser, Laura Maria T1 - Die Auswirkungen der X-Inaktivierung auf den klinischen Phänotyp bei Patientinnen mit Morbus Fabry T1 - The effect of X-chromosomal inactivation in women with Fabry disease N2 - M. Fabry ist eine X-chromosomal vererbte Stoffwechselerkrankung. Die Mutation im α-Galactosidase A Gen führt zur reduzierten Aktivität des Enzyms und zur Akkumulation der Stoffwechselprodukte im gesamten Körper. Von der daraus resultierenden Multiorganerkrankung sind sowohl Männer, als auch Frauen betroffen. Als Grund hierfür steht eine verschobene X-Inaktivierung zur Diskussion. In der vorliegenden Arbeit wurden 104 Frauen rekrutiert und die X-Inaktivierungsmuster in Mundschleimhautepithel, Blut und Hautfibroblasten untersucht. Es wurden umfangreiche klinische und laborchemische Untersuchungen durchgeführt, sodass von jeder Patientin ein klinischer Phänotyp vorlag, der mit Hilfe eines numerischen Scores klassifiziert wurde. Es zeigte sich, dass Blut ein leicht zu asservierendes Biomaterial mit einer hohen Prävalenz an verschobenen X-Inaktivierungsmustern darstellt. Eine signifikante Korrelation mit dem klinischen Phänotyp konnte in keinem der drei untersuchten Gewebe nachgewiesen werden. N2 - Fabry disease is a X-linked lysosomal storage disorder caused by mutations in the α-galactosidase A gene, which leads to deficient activity of the enzyme. The resulting multisystem disease affects men as well as women. As a reason therefor the X-inactivation is discussed. This study recruited 104 women and investigated in X-inactivation patterns from mouth epithelial cells, blood and skin fibroblasts. A clinical and laboratory examination of each women was carried out, so that the clinical phenotype of the women was classified with a numeric score. It was shown that blood is an easy available biomaterial with a high prevalence of skewing in X-inactivation patterns. However no significant correlation was found between X-inactivation patterns and the clinical phenotype in all three investigated biomaterials. KW - Fabry-Krankheit KW - X-Chromosom KW - Fabry KW - X-Inaktivierung KW - skewed Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-311530 ER - TY - THES A1 - Aster, Hans-Christoph T1 - Characterization of subgroups in fibromyalgia syndrome T1 - Charakterisierung von Subgruppen des Fibromyalgie-Syndroms N2 - The present cumulative dissertation summarizes three clinical studies, which examine subgroups of patients within the fibromyalgia syndrome (FMS). FMS entails chronic pain and associated symptoms, and its pathophysiology is incompletely understood (1). Previous studies show that there is a subgroup of patients with FMS with objective histological pathology of the small nerve fibers of the peripheral nervous system (PNS). Another subgroup of FMS patients does not show any signs of pathological changes of the small nerve fibers. The aim of this dissertation was to compare FMS patients with healthy controls, and these two FMS subgroups for differences in the central nervous system (CNS) in order to explore possible interactions between PNS and the CNS. Regarding the CNS, differences of FMS patients with healthy controls have already been found in studies with small sample sizes, but no subgroups have yet been identified. Another aim of this thesis was to test whether the subgroups show a different response to different classes of pain medication. The methods used in this thesis are structural and functional magnetic resonance imaging (MRI), magnetic resonance diffusion imaging and magnetic resonance spectroscopy. For the evaluation of clinical symptoms, we used standardized questionnaires. The subgroups with and without pathologies of the PNS were determined by skin biopsies of the right thigh and lower leg based on the intraepidermal nerve fiber density (IENFD) of the small nerve fibers. 1) In the first MRI study, 43 female patients with the diagnosis of FMS and 40 healthy control subjects, matched in age and body mass index, were examined with different MRI sequences. Cortical thickness was investigated by structural T1 imaging, white matter integrity by diffusion tensor imaging and functional connectivity within neuronal networks by functional resting state MRI. Compared to the controls, FMS patients had a lower cortical volume in bilateral frontotemporoparietal regions and the left insula, but a higher cortical volume in the left pericalcarine cortex. Compared to the subgroup without PNS pathology, the subgroup with PNS pathology had lower cortical volume in both pericalcarine cortices. Diffusion tensor imaging revealed an increased fractional anisotropy (FA) of FMS patients in corticospinal pathways such as the corona radiata, but also in regions of the limbic systems such as the fornix and cingulum. Subgroup comparison again revealed lower mean FA values of the posterior thalamic radiation and the posterior limb of the left internal capsule in the subgroup with PNS pathology. In the functional connectivity analysis FMS patients, compared to controls, showed a hypoconnectivity between the right median frontal gyrus and the posterior cerebellum and the right crus cerebellum, respectively. In the subgroup comparisons, the subgroup with PNS pathology showed a hyperconnectivity between both inferior frontal gyri, the right posterior parietal cortex and the right angular gyrus. In summary, these results show that differences in brain morphology and functional connectivity exist between FMS patients with and without PNS pathology. These differences were not associated with symptom duration or severity and, in some cases, have not yet been described in the context of FMS. The differences in brain morphology and connectivity between subgroups could also lead to a differential response to treatment with centrally acting drugs. Further imaging studies with FMS patients should take into account this heterogeneity of FMS patient cohorts. 2) Following the results from the first MRI study, drug therapies of FMS patients and their treatment response were compared between PNS subgroups. As there is no licensed drug for FMS in Europe, the German S3 guideline recommends amitriptyline, duloxetine and pregabalin for temporary use. In order to examine the current drug use in FMS patients in Germany on a cross-sectional basis, 156 patients with FMS were systematically interviewed. The drugs most frequently used to treat pain in FMS were non-steroidal anti-inflammatory drugs (NSAIDs) (28.9%), metamizole (15.4%) and amitriptyline (8.8%). Pain relief assessed by patients on a numerical rating scale from 0-10 averaged 2.2 points for NSAIDs, 2.0 for metamizole and 1.5 for amitriptyline. Drugs that were discontinued for lack of efficacy and not for side effects were acetaminophen (100%), flupirtine (91.7%), selective serotonin reuptake inhibitors (81.8%), NSAIDs (83.7%) and weak opioids (74.1%). Patients were divided into subgroups with and without PNS pathology as determined by skin biopsies. We found no differences in drug use and effect between the subgroups. Taken together, these results show that many FMS patients take medication that is not in accordance with the guidelines. The reduction of symptoms was best achieved with metamizole and NSAIDs. Further longitudinal studies on medication in FMS are necessary to obtain clearer treatment recommendations. 3) Derived from previous pharmacological and imaging studies (with smaller case numbers), there is a hypothesis in the FMS literature that hyperreactivity of the insular cortex may have an impact on FMS. The hyperreactivity seems to be due to an increased concentration of the excitatory neurotransmitter glutamate in the insular cortex of FMS patients. The hypothesis is supported by magnetic resonance spectroscopy studies with small number of cases, as well as results from pharmacological studies with glutamate-inhibiting medication. Studies from animal models have also shown that an artificially induced increase in glutamate in the insular cortex can lead to reduced skin innervation. Therefore, the aim of this study was to compare glutamate and GABA concentrations in the insular cortex of FMS patients with those of healthy controls using magnetic resonance imaging. There was no significant difference of both neurotransmitters between the groups. In addition, there was no correlation between the neurotransmitter concentrations and the severity of clinical symptoms. There were also no differences in neurotransmitter concentrations between the subgroups with and without PNS pathology. In conclusion, our study could not show any evidence of a correlation of glutamate and GABA concentrations with the symptoms of FMS or the pathogenesis of subgroups with PNS pathologies. N2 - Die vorliegende kumulative Dissertation fasst drei klinische Studien zusammen, welche Unterschiede zwischen Patientinnen mit Fibromyalgiesyndrom (FMS) und gesunden Kontrollen, sowie Subgruppen des FMS untersuchen. Das FMS wird als chronisches Schmerzsyndrom mit Begleitsymptomen wie Depressionen, gastrointestinalen Symptomen oder Erschöpfung definiert. Die Pathophysiologie ist noch nicht vollständig geklärt (1). Frühere Studien zeigen, dass es eine Subgruppe von PatientInnen mit FMS gibt, welche objektive, histologische Pathologien der kleinen Nervenfasern des peripheren Nervensystems (PNS) aufweisen. Eine andere Subgruppe von FMS-Patienten zeigt keinerlei Anzeichen für pathologische Veränderungen dieser kleinen Nervenfasern. Ziel dieser Dissertation ist es, diese beiden Subgruppen auf Unterschiede im zentralen Nervensystem (ZNS) hin zu vergleichen, um mögliche Wechselwirkungen zwischen dem PNS und ZNS zu untersuchen. Hinsichtlich des ZNS wurden bereits Unterschiede zwischen FMS-Patienten und gesunden Kontrollpersonen in Studien mit kleineren Fallzahlen festgestellt, jedoch wurden noch keine Subgruppen identifiziert. Ein weiteres Ziel dieser Arbeit war es, zu prüfen, ob die Subgruppen von FMS PatientInnen unterschiedlich auf verschiedene Arten von Schmerzmedikamenten ansprechen. Die in dieser Arbeit verwendeten Methoden sind die strukturelle und funktionelle Magnetresonanztomographie (MRT), die Magnetresonanz-Diffusionsbildgebung und die Magnetresonanzspektroskopie. Für die Bewertung der klinischen Symptome wurden standardisierte Fragebögen verwendet. Die Subgruppen mit und ohne Pathologien des peripheren Nervensystems (PNS) wurden durch Hautbiopsien des rechten Ober- und Unterschenkels anhand der intraepidermalen Nervenfaserdichte der kleinen Nervenfasern bestimmt. 1) In der ersten MRT-Studie wurden 43 Patientinnen mit der Diagnose eines FMS und 40 gesunde Kontrollpersonen, die hinsichtlich Alter und Body-Mass-Index gematcht waren, mit verschiedenen Sequenzen der Magnetresonanztomographie (MRT) untersucht. Das Volumen des Kortex wurde mittels struktureller T1-Bildgebung, die Integrität der weißen Substanz mittels Diffusionstensor-Bildgebung und die funktionelle Konnektivität innerhalb neuronaler Netzwerke mittels einer funktionellen Ruhezustands-MRT untersucht. Im Vergleich zu den Kontrollpersonen hatten FMS-Patientinnen ein geringeres Kortexvolumen der bilateralen frontotemporoparietalen Regionen und der linken Inselrinde, aber ein höheres Kortexvolumen im linken pericalcarinen Kortex. Im Vergleich zu der Untergruppe ohne PNS-Pathologien wies die Untergruppe mit PNS-Pathologien ein geringeres Kortexvolumen in beiden pericalcarinen Kortizes auf. Die Diffusions-Tensor-Bildgebung zeigte eine erhöhte fraktionelle Anisotropie (FA) der FMS PatientInnen in kortikospinalen Bahnen wie der Corona radiata, aber auch in Regionen des limbischen Systems wie dem Fornix und dem Cingulum. Ein Subgruppenvergleich ergab wiederum niedrigere mittlere FA-Werte in der Subgruppe mit PNS-Pathologien bezüglich der hinteren Thalamusausstrahlung und des hinteren Schenkels der linken Capsula interna. In der Analyse der funktionellen Konnektivität zeigten FMS-Patienten im Vergleich zu den Kontrollen eine Hypokonnektivität zwischen dem rechten medianen frontalen Gyrus und dem hinteren Kleinhirn bzw. dem rechten Kleinhirn. In den Subgruppenvergleichen zeigte die Subgruppe mit PNS-Pathologien eine Hyperkonnektivität zwischen beiden inferioren frontalen Gyri, dem rechten posterioren parietalen Kortex und dem rechten Gyrus angularis. Zusammengefasst zeigen diese Ergebnisse, dass zwischen FMS Patienten mit und ohne PNS-Pathologie Unterschiede in der Hirnmorphologie und funktionellen Konnektivität bestehen. Diese Unterschiede waren nicht mit der Dauer oder Ausprägung der Symptome assoziiert und sind teilweise noch nicht im Zusammenhang mit dem FMS beschrieben worden. Die Unterschiede in der Hirnmorphologie und Konnektivität zwischen den Subgruppen könnte auch zu einem unterschiedlichen Ansprechen auf die Behandlung mit zentral wirksamen Medikamenten führen. Weitere bildgebende Studien mit FMS-PatientInnen sollten diese Heterogenität von FMS-Patientenkohorten berücksichtigen. 2) Den Ergebnissen der ersten MRT-Studie folgend wurden die medikamentösen Therapien von FMS-PatientInnen und ihr Ansprechen auf die Behandlung zwischen den PNS-Subgruppen verglichen. Da es in Europa kein zugelassenes Medikament für das FMS gibt, empfiehlt die deutsche S3-Leitlinie Amitriptylin, Duloxetin und Pregabalin zur vorübergehenden Anwendung. Um den aktuellen Medikamenteneinsatz bei FMS-Patienten in Deutschland im Querschnitt zu untersuchen, wurden 156 PatientInnen mit FMS systematisch befragt. Die am häufigsten verwendeten Medikamente zur Schmerzbehandlung bei FMS waren nicht-steroidale Antirheumatika (NSAIDs) (28,9 %), Metamizol (15,4 %) und Amitriptylin (8,8 %). Die von den Patienten auf einer numerischen Bewertungsskala von 0-10 bewertete Schmerzlinderung betrug im Durchschnitt 2,2 Punkte für NSAIDs, 2,0 für Metamizol und 1,5 für Amitriptylin. Medikamente, die wegen mangelnder Wirksamkeit und nicht wegen Nebenwirkungen abgesetzt wurden, waren Paracetamol (100 %), Flupirtin (91,7 %), selektive Serotonin-Wiederaufnahmehemmer (81,8 %), NSAIDs (83,7 %) und schwache Opioide (74,1 %). Die Patienten wurden in Subgruppen mit und ohne PNS-Pathologien eingeteilt, welche, wie schon beschrieben, anhand von Hautbiopsien bestimmt wurden. Wir fanden keine Unterschiede zwischen den Subgruppen in Bezug auf die Medikamenteneinnahme und deren Wirkung. Insgesamt zeigen diese Ergebnisse, dass viele FMS-PatientInnen Medikamente einnehmen, die nicht mit den Leitlinien übereinstimmen. Die Reduzierung der Symptome wurde am besten mit Metamizol und NSAIDs erreicht. Weitere Längsschnittstudien zur Medikation bei FMS wären hilfreich, um breitere Behandlungsempfehlungen zu erhalten. 3) Abgeleitet aus den bisherigen pharmakologischen und bildgebenden Studien (mit kleineren Fallzahlen) besteht in der FMS Literatur die Hypothese, dass eine Hypersensitivität der Inselrinde einen Einfluss auf die FMS-Symptomatik haben könnte. Diese Hypersensitivität könnte durch eine erhöhte Konzentration des erregenden Neurotransmitters Glutamat in der Inselrinde von FMS Patienten bedingt sein. Diese Hypothese wird durch Magnetresonanzspektroskopie-Studien mit kleinen Fallzahlen, sowie Ergebnissen aus pharmakologischen Studien mit Glutamat-hemmender Medikation gestützt. Studien aus dem Tiermodell konnten außerdem zeigen, dass ein künstlich herbeigeführter Anstieg von Glutamat in der Inselrinde zu einer Reduktion der kleinen Nervenfasern im PNS führen kann. Ziel dieser Studie war es deshalb, mittels Magnetresonanztomographie die Glutamat- und GABA Konzentrationen der Inselrinde von FMS Patienten mit denen von gesunden Kontrollen zu vergleichen. Es zeigte sich kein signifikanter Unterschied beider Neurotransmitter zwischen den Gruppen. Es konnte ebenfalls kein Zusammenhang zwischen den Konzentrationen und der Ausprägung der klinischen Symptomatik bewiesen werden. Auch zwischen den Subgruppen mit und ohne PNS Pathologie zeigten sich keine Unterschiede in der Neurotransmitterkonzentration. Zusammenfassend konnte unsere Studie keinen Hinweis auf einen Zusammenhang der Glutamat- und GABA- Konzentrationen in der Inselrinde mit der Symptomatik des FMS oder der Entstehung von Subgruppen mit PNS Pathologien zeigen. KW - Fibromyalgie Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313049 ER - TY - THES A1 - Behnke, Jennifer Kim T1 - Charakterisierung der Krankheitsprogression im genetischen hm\(^2\)α-SYN-39 Mausmodell des Morbus Parkinson T1 - Characterization of disease progression in the genetic hm\(^2\)α-SYN-39 mouse model of Parkinson´s disease N2 - In dieser Arbeit wurde die Krankheitsprogression im Parkinson-Mausmodell hm2α-SYN-39 mit zunehmendem Alter charakterisiert. Die Mäuse wurden in 4 Altersgruppen (2-3, 7-8, 11-12, 16-17 Monate) mit motorischen Verhaltenstests auf einen Parkinson-Phänotyp untersucht. Zudem erfolgten Untersuchungen des dopaminergen Systems zur Detektion von neurochemischen Veränderungen und einer Neurodegeneration im nigrostriatalen Trakt. Weiterhin wurden neuroinflammatorische Prozesse des adaptiven und angeborenen IS in der SN und im Striatum mittels immunhistochemischer Färbungen beurteilt. Ein Parkinson-Phänotyp in diesem Mausmodell zeigte sich nur leicht ausgeprägt, sodass der Rotarod- und Zylinder-Test lediglich den Hinweis auf eine nicht-signifikante Einschränkung der Motorik erbrachte. Dennoch ergab die stereologische Quantifizierung TH- und Nissl-positiver Zellen in der SNpc der hm2α-SYN-39 Mäuse eine altersabhängige, signifikant-progrediente Reduktion der dopaminergen Neurone mit zunehmendem Alter. Eine signifikant niedrigere TH-positive Zellzahl dieser tg Mäuse zeigte sich ab einem Alter von 16-17 Monaten verglichen zu gleichaltrigen wt Tieren. Dagegen war die Neurodegeneration im Striatum etwas weniger ausgeprägt. Die tg Mäuse präsentierten im Alter von 16-17 Monaten eine nicht-signifikante Erniedrigung der dopaminergen Terminalen verglichen zu gleichaltrigen wt Tieren. Ein DA-Mangel im Striatum der tg Mäuse konnte mittels HPLC bestätigt werden. Bis zum Alter von 16-17 Monaten wurde eine signifikante Reduktion der DA-Level von 23,2 % verglichen zu gleichaltrigen wt Mäusen gezeigt. Außerdem erniedrigt waren die striatalen Level von NA und 5-HAT bei tg Mäusen, passend zu den bisherigen Ergebnissen bei Parkinson-Patienten. Immunhistochemische Untersuchungen einer Neuroinflammation im nigrostriatalen Trakt ergaben eine tendenziell erhöhte Infiltration von CD4- und CD8-positiven T-Zellen bei hm2α-SYN-39 Mäusen mit zunehmendem Alter, wobei die Infiltration CD8-positiver Zellen ausgeprägter war als bei CD4-positiven Zellen. Eine noch deutlichere neuroinflammatorische Reaktion zeigte das angeborene IS. Hierbei ergab die immunhistologische Quantifizierung CD11b-positiver mikroglialer Zellen einen hochsignifikanten Anstieg im nigrostriatalen Trakt bei hm2α-SYN-39 Mäusen schon im jungen Alter. Zusammenfassend präsentierte dieses Parkinson-Mausmodell eine langsam-progrediente Parkinson-Pathologie mit begleitender Neuroinflammation im nigrostriatalen Trakt während des Alterns, wobei die Immunantwort der mikroglialen Zellen zu einem früheren Zeitpunkt einsetzte als die T-Zellinfiltration und Neurodegeneration. Dieses Mausmodell bietet zahlreiche Möglichkeiten zur zukünftigen Erforschung der Pathophysiologie beim MP. Generell weist diese Arbeit auf eine bedeutende Rolle neuroinflammatorischer Prozesse in der Krankheitsprogression der Parkinsonerkrankung hin und soll dazu ermutigen Neuroinflammation durchaus intensiver in tg Tiermodellen zu untersuchen. N2 - In this doctoral thesis the progression of disease during ageing has been characterized in the mouse model of Parkinson´s disease hm2α-SYN-39. Mice in 4 age groups (2-3, 7-8, 11-12, 16-17 months of age) were tested for a Parkinson´s phenotype through motor performance analysis. Additionally, investigations of the dopaminergic system were performed to detect neurochemical changes and neurodegeneration in the nigrostriatal tract. Furthermore, neuroinflammatory processes of the adaptive and innate immune system in the SN and striatum were evaluated via immunohistochemical staining. A Parkinson´s phenotype in this mouse model appeared only mildly, revealing a hint of non-significant motor impairment in the Rotarod and Cylinder test. However, stereological quantification of TH- and Nissl-positive cells in the SNpc of hm2α-SYN-39 mice resulted in an age-dependent, significant-progressive reduction of dopaminergic neurons with increased age. A significant lower TH-positive cell count of these tg mice was shown at an age of 16-17 months compared to wt mice of the same age. In contrast, the neurodegeneration in the striatum was less pronounced. At an age of 16-17 months tg mice presented with a non-significant reduction of dopaminergic terminals compared to wt mice of the same age. Loss of DA in the striatum of tg mice has been confirmed via HPLC. A significant reduction of DA-levels of 23,2 % was shown at the age of 16-17 months in comparison to same-aged wt mice. Striatal levels of NA and 5-HT of tg mice were reduced as well, matching previous results of Parkinson´s patients. Immunohistochemical investigations of neuroinflammation in the nigrostriatal tract revealed a tendency of increased infiltration of CD4- and CD8-positive T cells in hm2α-SYN-39 mice with increased age, an infiltration of CD8-positive cells being more distinct though than of CD4-positive cells. The innate IS exposed an even stronger neuroinflammatory response. Immunohistochemical quantification of CD11b-positive microglial cells resulted in a highly significant surge in the nigrostriatal tract of hm2α-SYN-39 mice starting at a young age already. In summary, this mouse model of Parkinson´s disease presented with a slowly progressive Parkinson´s pathology accompanied by neuroinflammation in the nigrostriatal tract during the process of ageing, taking in account that an immune response of microglial cells was setting in earlier than T cell infiltration and neurodegeneration. This mouse model offers various opportunities for exploring Parkinson´s pathophysiology in the future. Generally, this work points to a substantial role of neuroinflammatory responses in the progression of Parkinson´s disease and should encourage to further investigate neuroinflammation in tg animal models. KW - Parkinson-Krankheit KW - Altern KW - Tiermodell KW - Neurodegeneration KW - Neuroinflammation KW - Mausmodell Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-302040 ER - TY - JOUR A1 - Bellut, Maximilian A1 - Bieber, Michael A1 - Kraft, Peter A1 - Weber, Alexander N. R. A1 - Stoll, Guido A1 - Schuhmann, Michael K. T1 - Delayed NLRP3 inflammasome inhibition ameliorates subacute stroke progression in mice JF - Journal of Neuroinflammation N2 - Background Ischemic stroke immediately evokes a strong neuro-inflammatory response within the vascular compartment, which contributes to primary infarct development under vessel occlusion as well as further infarct growth despite recanalization, referred to as ischemia/reperfusion injury. Later, in the subacute phase of stroke (beyond day 1 after recanalization), further inflammatory processes within the brain parenchyma follow. Whether this second wave of parenchymal inflammation contributes to an additional/secondary increase in infarct volumes and bears the potential to be pharmacologically targeted remains elusive. We addressed the role of the NLR-family pyrin domain-containing protein 3 (NLRP3) inflammasome in the subacute phase of ischemic stroke. Methods Focal cerebral ischemia was induced in C57Bl/6 mice by a 30-min transient middle cerebral artery occlusion (tMCAO). Animals were treated with the NLRP3 inhibitor MCC950 therapeutically 24 h after or prophylactically before tMCAO. Stroke outcome, including infarct size and functional deficits as well as the local inflammatory response, was assessed on day 7 after tMCAO. Results Infarct sizes on day 7 after tMCAO decreased about 35% after delayed and about 60% after prophylactic NLRP3 inhibition compared to vehicle. Functionally, pharmacological inhibition of NLRP3 mitigated the local inflammatory response in the ischemic brain as indicated by reduction of infiltrating immune cells and reactive astrogliosis. Conclusions Our results demonstrate that the NLRP3 inflammasome continues to drive neuroinflammation within the subacute stroke phase. NLRP3 inflammasome inhibition leads to a better long-term outcome—even when administered with a delay of 1 day after stroke induction, indicating ongoing inflammation-driven infarct progression. These findings may pave the way for eagerly awaited delayed treatment options in ischemic stroke. KW - ischemic stroke KW - secondary infarct growth KW - neuroinflammation KW - middle cerebral artery occlusion KW - NLRP3 KW - inflammasome Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300599 VL - 20 IS - 1 ER - TY - THES A1 - Stößel, Anna T1 - Auswirkungen zerebellärer Gleichstromstimulation auf das motorische Lernen bei gesunden älteren Probanden T1 - Effects of cerebellar anodal transcranial direct current stimulation on motor learning in healthy older adults N2 - Sowohl neurologische Erkrankungen als auch der natürliche Alterungsprozess gehen regelhaft mit einem Untergang von Neuronen einher und bedingen neurologische Funktionsverluste. Diese mit Hilfe nicht-invasiver Techniken, beispielsweise tDCS, zu reduzieren, stellt ein wichtiges Ziel der neurowissenschaftlichen Forschung dar. Neben Arbeiten, die tDCS-Effekte auf das motorische Lernen bei Stimulation des motorischen Kortex nachweisen konnten, gibt es auch Hinweise für solche Effekte bei Stimulation des Kleinhirns. Allerdings besteht derzeit noch eine hohe Variabilität und damit einhergehend eine schlechte Vergleichbarkeit der Studien bezüglich ihrer Stimulationsbedingungen. Das Ansprechen unterschiedlicher Altersgruppen bleibt unklar. In der vorliegenden Arbeit wurden die Effekte zerebellärer a-tDCS auf das motorische Lernen bei gesunden älteren Probanden untersucht. Im Cross-over-Design wurde zu unterschiedlichen Zeitpunkten (vor bzw. nach der motorischen Aufgabe) stimuliert und im 24-Stunden-Verlauf die Langzeitwirkung evaluiert. Gruppe A erhielt vor einer motorischen Übungsaufgabe eine zerebelläre Stimulation, entweder als a-tDCS oder Scheinstimulation, Gruppe B nach der Übungsaufgabe. Zur Überprüfung der Effekte auf das Sequenzlernen diente der Finger-Tapping-Task. Der Lernerfolg wurde anhand der Genauigkeit, der Sequenzdauer und des Skill-Index gemessen. Die Ergebnisse deuten darauf hin, dass eine zerebelläre a-tDCS vor einer Übungsaufgabe zu einer Verbesserung der Konsolidierung der Fähigkeit, eine Zahlenfolge möglichst schnell und gleichzeitig genau einzutippen, führt, während die Stimulation nach einer Übungsaufgabe das motorische Lernen nicht zu beeinflussen scheint. Insgesamt stützen die Ergebnisse zum Teil die bisherigen Hinweise, dass eine zerebellär applizierte a-tDCS das motorische Lernen verbessern kann. Aufgrund einiger Limitationen, besonders der geringen Gruppengröße, verbleibt dieses Ergebnis jedoch vorläufig und bedarf einer Bestätigung in größeren Probandengruppen. Es bleibt von hohem Interesse, die optimalen Bedingungen für die Anwendung von tDCS am Kleinhirn zu definieren, um motorische Lernprozesse positiv zu beeinflussen. Dies ist die Voraussetzung dafür, zerebelläre tDCS mittelfristig auch zu therapeutischen Zwecken anwenden zu können. N2 - Neurological diseases as well as the natural aging process are regularly accompanied by a loss of neurons resulting into a loss of neurological function. Reducing these impactswith the help of non-invasive techniques, such as transcranial direct current stiumulation (tDCS), is an important goal of neuroscientific research. In addition to studies successfully providing evidence that tDCS is impacting motor learning when stimulating the motor cortex, indication of similar effects exist when stimulating the cerebellum. Unfortunately studies today only provide poor comparability given the underlying inconsistency in stimulation conditions and consequentially yielded results. The response of different age groups remains unclear. The following study explores the effects of cerebellar anodal transranial direct current simulation (a-tDSC) on healthy elderly subjects. Using a crossover design, patience were stimulated at different times (before or after the motor task) and long-term effects were evaluated over a 24-hour period. Group A received cerebellar stimulation prior to a motor exercise in form of an actual a-tDCS or sham stimulation, Group B received treatment after the exercise. The finger tapping task was used to verify the effects on sequence learning. Learning success was measured by accuracy, sequence duration, and skill index. The results indicate that cerebellar a-tDCS prior to the exercise task leads to enhanced consolidation of the ability to type a sequence of numbers quickly and accurately at the same time, whereas stimulation after the exercise task does not seem to affect motor learning. Overall, the results partially support previous evidence that cerebellar applied a-tDCS can improve motor learning. Due to some limitations, in particular the small sample size, results are preliminary and require confirmation across a larger population. Defining the optimal conditions for the application of tDCS to the cerebellum to positively influence motor learning processes remains of high interest. It is the prerequisite to enable application of cerebellar tDCS for therapeutic purposes in the medium term. KW - Motorisches Lernen KW - Kleinhirn KW - transkranielle Gleichstromstimulation (tDCS) KW - finger-tapping task (FTT) KW - zerebelläre Gleichstromstimulation KW - motor learning KW - tDCS Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-317930 ER - TY - THES A1 - Messinger, Julia T1 - Die Effekte von IVIG auf die Antikörperbindung und Komplementablagerung bei Anti-Neurofascin-positiver Nodo-Paranodopathie T1 - The effects of IVIG on antibody binding and complement deposition in anti-neurofascin associated neuropathy N2 - Autoantikörper gegen nodo-paranodale Proteine des Ranvier’schen Schnürrings wie Neurofascin-155 (NF-155), Contactin-1 und Caspr wurden in der Literatur bei Patienten/Patientinnen mit Immunneuropathien beschrieben. Bei zwei bis zehn Prozent der Patienten/Patientinnen mit Immunneuropathien können Autoantikörper gegen Isoformen des Neurofascin detektiert werden. Patienten/Patientinnen mit Autoantikörpern gegen NF-155 weisen gemeinsame klinische Merkmale auf, unter anderem einen schweren Verlauf mit subakutem Beginn, vorwiegend motorischen Defiziten, Tremor und einem schlechten Ansprechen auf eine Therapie mit intravenösen Immunglobulinen (IVIG). Ein Grund für Letzteres könnte sein, dass es sich überwiegend um Autoantikörper der Subklasse IgG4 handelt, die als anti-inflammatorisch gelten und kein Komplement aktivieren. Neben der IgG4-Subklasse können bei manchen Erkrankten auch die proinflammatorischen IgG-Subklassen 1 bis 3 nachgewiesen werden. Bei der Anti-Pan-Neurofascin (155/140/186) Polyneuropathie zeigt sich klinisch häufig ein fulminanter Phänotyp mit IgG3 Prädominanz. Das Ziel dieser Studie war, die Autoantikörper-induzierte Komplementablagerung zu detektieren, sowie die Rolle der IgG Subklasse und die Effekte von IVIG auf Antikörperbindung, Komplementaktivierung und Effektorfunktionen zu untersuchen. Hierzu wurde das Serum von 212 Probanden/-innen mit der Verdachtsdiagnose einer entzündlichen Neuropathie auf Autoantikörper gegen NF-155 mittels ELISA und Bindungsversuchen an Mäusezupfnerven gescreent. Im Fall eines positiven Ergebnisses dienten zellbasierte Bindungsversuche mit NF-155-transfizierten HEK-293- Zellen als Bestätigungstest. Die Effekte unterschiedlicher IVIG Konzentrationen auf die Antikörperbindung und Komplementablagerung wurden in ELISA, Komplementbindungsassays und zellbasierten Verfahren getestet. Außerdem wurde mithilfe von LDH-Zytotoxizitätsmessungen die Komplement-induzierte Zelllyse sowie die Effekte von IVIG untersucht. Klinische Daten wurden retrospektiv ausgewertet. Fünf Patienten/Patientinnen mit hohen Autoantikörpertitern gegen NF-155 und ein Patient mit Anti-Pan-Neurofascin Autoantikörpern konnten in der Studie detektiert werden. Der Patient mit Autoantikörpern gegen alle drei Isoformen des Neurofascins und IgG3-Prädominanz zeigte die deutlichste Komplementablagerung. Bei drei Patienten/Patientinnen, die IgG1, IgG2 und IgG4 aufwiesen, war eine Aktivierung des Komplementsystems zu beobachten, während bei zwei Patienten mit prädominanter IgG4-Antikörpersubklasse keine Komplementablagerung nachweisbar war. Bei Letzteren war eine Therapie mit IVIG in der Vorgeschichte erfolglos, während es bei zwei der Patienten/Patientinnen mit anderen IgG-Subklassen und Komplementbindung unter IVIG Therapie zu einer mäßigen bis deutlichen Symptombesserung in der Akutphase kam. Eine Koinkubation mit IVIG führte in den ELISA basierten und zellbasierten Versuchen zu keinem Effekt auf die Autoantikörperbindung an das Zielantigen, jedoch zu einer deutlichen Reduktion der Antikörper-vermittelten Komplementbindung. Diese Reduktion war sowohl bei Koinkuabtion von IVIG mit dem Komplementfaktor C1q als auch bei Präinkubation von IVIG vor C1q Gabe zu sehen. Bei zwei der Patienten/Patientinnen mit hohen Komplementablagerungen konnte eine erhöhte Zytotoxizität nachgewiesen werden, welche bei Zugabe von IVIG verringert wurde. Schlussfolgernd ist die Autoantikörper-induzierte Komplementablagerung abhängig von der prädominanten IgG Subklasse. IVIG führt zu einer deutlichen, konzentrationsabhängigen Reduktion der Komplementablagerung, sowie möglicher zytotoxischer Effektorfunktionen wie die Zytolyse myelinisierter Schwannzellen oder Nervenaxonen. Darüber hinaus könnte die Subklassenanalyse von Erkrankten das Therapieansprechen auf IVIG vorhersagen und sollte daher eine wichtige Rolle in der Diagnostik der Nodo-Paranodopathie spielen. IVIG sowie andere über das Komplementsystem wirkende Therapeutika können in der Behandlung der schwer betroffenen Patienten/Patientinnen, insbesondere bei Anti-Pan-Neurofascin positiver Neuropathie, in Betracht gezogen werden. N2 - Autoantibodies against nodo-paranodal proteins of the Node of Ranvier like Neurofascin-155 (NF-155), Contactin-1 (CNTN-1) and Contactin-associated-protein-1 (Caspr-1) can be detected in patients with autoimmune polyneuropathies. In 2-10% of patients with inflammatory polyneuropathies autoantibodies against isoforms of the (para)nodal protein neurofascin (NF-140/155/186) can be detected. NF-155-seropositive patients present a severe, motor-predominant phenotype with subacute onset, tremor and poor response to intravenous immunoglobulins (IVIG) which might be due to the predominance of non-complement activating IgG4 antibodies. Anti-pan-NF-associated neuropathy is associated with a fulminant clinical phenotype and IgG3 predominance whereas treatment response has not been thoroughly investigated. In the present study, we aim to measure autoantibody-associated complement activation, the role of IgG subclasses and the effects of IVIG on antibody binding, complement deposition and effector functions. Sera of 212 patients with chronic inflammatory demyelinating polyneuropathy (CIDP), Guillain-Barré syndrome (GBS) or other forms of polyneuropathies were screened for anti-NF autoantibodies and subclasses by binding assays on murine teased fibers and by ELISA. Antibodies were confirmed in seropositive patients by cell-based assay. Complement binding and the effects of different concentrations of IVIG on complement deposition and complement-dependent cell lysis were analyzed via ELISA, cell-based tests and LDH-cytotoxicity assay. Five patients with autoantibodies against NF-155 and one patient with anti-pan-NF autoanibodies were identified in this study. Two patients with predominance of the IgG4 subclass did not show a complement deposition whereas four patients with predominant IgG1 to IgG3 did. Complement binding was associated with the presence of IgG subclass IgG3>IgG1>IgG2>IgG4, corresponding to physiological C1q binding-capacities. IVIG led to a strong reduction of complement deposition in a dose dependent manner. In the cytotoxicity assay patient sera with high amounts of complement deposition showed an increased relative cytotoxicity that can be reduced by high-dose IVIG. We conclude that complement deposition in NF-associated neuropathy is IgG subclass-dependent and IVIG leads to a reduction of complement deposition and its effector functions, such as possible cytolysis of myelinating Schwann cells or neurons. The characterization of autoantibody subclasses as well as IVIG and other options targeting the complement cascade can be considered in the therapeutic regime of severely-affected patients, especially in anti-pan-NF-associated neuropathy. KW - Paranodopathie KW - Neurofascin KW - Komplement KW - Neuropathie KW - Komplementsystem KW - IVIG Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-321109 ER - TY - THES A1 - Spitzel, Marlene T1 - The impact of inflammation, hypoxia, and vasculopathy on pain development in the α-galactosidase A mouse model of Morbus Fabry T1 - Der Einfluss von Inflammation, Hypoxie und Vaskulopathie auf die Schmerzentwicklung des Morbus Fabry-spezifischen α-Galaktosidase A Mausmodells N2 - Fabry disease (FD), an X-linked lysosomal storage disorder, is caused by variants in the gene α-galactosidase A (GLA). As a consequence, the encoded homonymous enzyme GLA is not produced in sufficient amount or does not function properly. Subsequently, globotriaosylceradmide (Gb3), the target substrate of GLA, starts accumulating in several cell types, especially neurons and endothelial cells. FD patients suffer from multiorgan symptoms including cardiomyopathy, nephropathy, stroke, and acral burning pain. It is suggested that the impact of pathological Gb3 accumulation, inflammatory and hypoxic processes, and vasculopathy are contributing to the specific FD pain phenotype. Thus, we investigated the role of inflammation, hypoxia, and vasculopathy on molecular level in dorsal root ganglia (DRG) of the GLA knockout (KO) mouse model. Further, we investigated pain-like characteristics of GLA KO mice at baseline (BS), after capsaicin administration, and after repeated enzyme replacement therapy (ERT) administration for a period of 1.5 years. Acquired data showed disturbances in immune response markers represented by downregulated inflammation-associated genes and lower numbers of CD206+ macrophages in DRG of GLA KO mice. Hypoxic mechanisms were active in DRG of GLA KO mice reflected by increased gene expression of hypoxia- and DNA damage-associated targets, higher numbers of hypoxia-inducible factor 1α-positive (HIF1α+) and carbonic anhydrase 9-positive (CA9+) neurons in DRG of GLA KO mice, and DRG neuronal HIF1α cytosolic-nuclear translocation in GLA KO mice. Vascularization in DRG of GLA KO mice was reduced including lower numbers of blood vessel branches and reduced total blood vessel length. Pain-like behavior of the GLA KO mouse model revealed no mechanical hypersensitivity at BS but age-dependent heat hyposensitivity, which developed also age-matched wild type (WT) mice. Capsaicin administration under isoflurane anesthesia did not elicit the development of nocifensive behavior in GLA KO mice after mechanical or heat stimulation. Repeated ERT administration did not show a clear effect in GLA KO mice in terms of restored heat hyposensitivity to BS paw withdrawal latencies. In summary, we demonstrated the impact of disturbed immune response markers, active hypoxic mechanisms, and reduced vascularization on molecular FD pathophysiology. N2 - Morbus Fabry (M. Fabry oder Fabry disease, FD) ist eine X-chromosomal vererbte, lysosomale Speichererkrankung, die durch Varianten im Gen α-Galaktosidase A (GLA) verursacht wird. Das durch GLA kodierte gleichnamige Enzym GLA kann somit nicht in ausreichender Menge produziert werden oder erhält nicht die volle Funktionalität. Als Folge akkumuliert das Glykosphingolipid Globotriaosylceramid (Gb3), welches das Zielsubstrat von GLA ist und durch dieses Enzym normalerweise abgebaut wird. Gb3 Akkumulationen sind in verschiedenen Zelltypen zu finden, jedoch bevorzugt in Neurone und Endothelzellen. FD-Patienten leiden unter Symptome, die verschiedene Organe betreffen, insbesondere Kardiomyopathien, Nephropathien, Schlaganfälle, und brennende Schmerzen in den Extremitäten. Es wird vermutet, dass neben dem pathologischen Einfluss der Gb3 Ablagerungen auch inflammatorische und hypoxische Prozesse und Vaskulopathien zum spezifischen FD-Schmerzphänotyps beitragen. Daher wurde die Rolle der Inflammation, Hypoxie und Vaskulopathie auf molekularer Ebene in Spinalganglien (dorsal root ganglion, DRG) eines FD-spezifischen GLA knockout (KO) Mausmodells untersucht. Des Weiteren wurde der Schmerz-ähnliche Phänotyp in GLA KO Mäusen unter nativen Bedingungen, nach Capsaicingabe und unter Enzymersatztherapie (enzyme replacement therapy, ERT) während einer Dauer von 1,5 Jahren untersucht. Unsere erhobenen Daten zeigten eine Beeinträchtigung von Faktoren der Immunantwort, die sich durch herunterregulierter Genexpression Inflammations-assoziierter Gene und einer geringeren Anzahl an CD206+ Makrophagen in DRG von GLA KO Mäusen nachweisen ließ. Zu aktiven Hypoxiemechanismen trugen eine hochregulierte Genexpression Hypoxie- und DNA-Schäden-assoziierter Gene, eine höhere Anzahl an hypoxia-inducible factor 1α-positiver (HIF1α+) und carbonic anhydrase 9-positiver (CA9+) Neurone in DRG von GLA KO Mäusen, und die DRG neuronale HIF1α Translokation zwischen Zytosol und Nukleus bei. Die Vaskularisierung der DRG in GLA KO Mäusen war reduziert zusätzlich zu der geringeren Anzahl an Blutgefäßverzweigungen und einer Reduzierung der gesamten Blutgefäßlänge. Die Untersuchungen des nativen Schmerz-ähnlichen Verhaltens der GLA KO Mäuse zeigte keine Entwicklung mechanischer Hypersensitivität, während sich eine Hitzehyposensitivität mit steigendem Alter der Tiere entwickelte, die sich auch in altersangepassten Wildtyp (WT) Mäusen zeigte. Eine Capsaicingabe unter Isoflurannarkose zeigte keine erhöhte Sensitivität der GLA KO Mäuse nach mechanischer oder Hitzestimulation. Wiederholte ERT-Gaben zeigten keine Verbesserung der Hitzehyposensitivität auf ein natives Niveau der Pfotenrückzuglatenz. Wir konnten den Einfluss beeinträchtigter Faktoren der Immunantwort, aktiver Hypoxieprozesse und reduzierter Vaskularisierung in DRG von GLA KO Mäusen auf die molekulare FD-Pathophysiologie zeigen. KW - Fabry disease KW - GLA KO mouse model KW - molecular mechanism KW - Fabry-Krankheit KW - Morbus Fabry Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-345794 ER - TY - JOUR A1 - Wohnrade, Camilla A1 - Velling, Ann-Kathrin A1 - Mix, Lucas A1 - Wurster, Claudia D. A1 - Cordts, Isabell A1 - Stolte, Benjamin A1 - Zeller, Daniel A1 - Uzelac, Zeljko A1 - Platen, Sophia A1 - Hagenacker, Tim A1 - Deschauer, Marcus A1 - Lingor, Paul A1 - Ludolph, Albert C. A1 - Lulé, Dorothée A1 - Petri, Susanne A1 - Osmanovic, Alma A1 - Schreiber-Katz, Olivia T1 - Health-related quality of life in spinal muscular atrophy patients and their caregivers — a prospective, cross-sectional, multi-center analysis JF - Brain Sciences N2 - Spinal muscular atrophy (SMA) is a disabling disease that affects not only the patient’s health-related quality of life (HRQoL), but also causes a high caregiver burden (CGB). The aim of this study was to evaluate HRQoL, CGB, and their predictors in SMA. In two prospective, cross-sectional, and multi-center studies, SMA patients (n = 39) and SMA patient/caregiver couples (n = 49) filled in the EuroQoL Five Dimension Five Level Scale (EQ-5D-5L) and the Short Form Health Survey 36 (SF-36). Caregivers (CGs) additionally answered the Zarit Burden Interview (ZBI) and the Hospital Anxiety and Depression Scale (HADS). Patients were clustered into two groups with either low or high HRQoL (EQ-5D-5L index value <0.259 or >0.679). The latter group was mostly composed of ambulatory type III patients with higher motor/functional scores. More severely affected patients reported low physical functioning but good mental health and vitality. The CGB (mean ZBI = 22/88) correlated negatively with patients’ motor/functional scores and age. Higher CGB was associated with a lower HRQoL, higher depression and anxiety, and more health impairments of the CGs. We conclude that patient and CG well-being levels interact closely, which highlights the need to consider the health of both parties while evaluating novel treatments. KW - caregiver KW - caregiver burden KW - mental health KW - quality of life KW - spinal muscular atrophy KW - patient reported outcome measures Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-305048 SN - 2076-3425 VL - 13 IS - 1 ER - TY - THES A1 - Steeg, Felix Leonard T1 - Kinematische und histomorphologische Charakterisierung des DYT1 Knock-in Mausmodells mit Trauma-induzierter Dystonie T1 - Kinematic and histomorphological characterization of the DYT1 knock-in mouse model with trauma-induced dystonia N2 - Die dem Formenkreis der Dystonien zugrundeliegenden, pathophysiologischen Grundlagen sind bislang nicht abschließend geklärt. Für die DYT-TOR1A Dystonie ist bekannt, dass eine 3-bp Deletion eines GAG-Codons im TOR1A-Gen auf Chromosom 9 einen Funktionsverlust des Proteins TorsinA bewirkt. Dieser Funktionsverlust wird als auslösender Faktor für die Entstehung der DYT-TOR1A Dystonie angenommen. Nichtsdestotrotz entwickeln lediglich circa 30% der Mutationsträger eine dystone Bewegungsstörung. Als Grund dafür wird eine Two-hit Hypothese diskutiert, die zusätzlich zur genetischen Prädisposition einen Umweltfaktor wie ein peripheres Trauma für die Entstehung von Symptomen postuliert. Durch eine standardisierte Quetschläsion des N. ischiadicus konnte mit dieser Arbeit bei DYT1KI Mäusen, die die ∆GAG-Mutation im endogenen Genom tragen, ein dystoner Phänotyp hervorgerufen werden. Mit den Aufzeichnungen der Mäuse im TST wurde ein neuronales Netzwerk mittels der Software „DeepLabCut“ trainiert, sodass die Dystonie-ähnlichen Bewegungen automatisiert erfasst und ausgewertet werden konnten. Das Netzwerk trägt dazu bei, dem vorwiegend klinischen Syndrom der Dystonie eine objektive kinematische Charakterisierung zu bieten und kann auf andere TSTs anderer Nagermodelle übertragen werden. Ferner wurde überprüft, ob die beobachteten Bewegungen durch Unterschiede in der Regeneration nach der Nervenquetschung zustande kamen. Elektroneurographien zeigten jedoch diesbezüglich keine Unterschiede zwischen wt und DYT1KI Tieren. Darüber hinaus sind mikromorphologische Prozesse im zentralen und peripheren Nervensystem Gegenstand dieser Studie. Einerseits konnten wir mittels Immunzellfärbungen von T-, B-Zellen, Makrophagen und Mikroglia feststellen, dass sowohl zentral als auch peripher kein Anhalt darauf besteht, dass die beim DYT1KI Mausmodell entstandenen Dystonie-ähnlichen Bewegungen auf einer Dysfunktion oder Aktivierung des Immunsystems, wie es bei anderen neurologischen Erkrankungen bereits nachgewiesen wurde, eine Rolle spielt. Andererseits konnte anhand stereologischer Messungen gezeigt werden, dass bei den naiven DYT1KI Tieren im Vergleich zu wt Tieren dopaminerge Neurone der SN in der Anzahl verringert und im Volumen vergrößert sind, was auf einen Endophänotypen hinweist. Bei den symptomatischen, nervengequetschten DYT1KI Mäusen zeigte sich wiederum eine weitere, signifikante Zunahme der Hypertrophie der dopaminergen Neurone als Hinweis auf eine unmittelbar mit dem dystonen Phänotypen in Zusammenhang stehende Veränderung. Zusammenfassend konnte ein symptomatisches Mausmodell von hoher translationaler Bedeutung etabliert werden, in dem sich Hinweise für eine dopaminerge Dysregulation ergaben und welches für weitere Studien, insbesondere therapeutischer Art, eingesetzt werden könnte. N2 - The pathophysiological principles underlying the types of dystonia have not yet been conclusively clarified. For DYT-TOR1A dystonia, it is known that a 3-bp deletion of a GAG codon in the TOR1A gene on chromosome 9 causes a loss of function of the protein TorsinA. This loss of function is believed to be a triggering factor for the development of DYT-TOR1A dystonia. Nevertheless, only around 30% of mutation carriers develop a dystonic movement disorder. The reason for this is believed to be a two-hit hypothesis, which postulates an environmental factor such as a peripheral trauma for the development of symptoms in addition to the genetic predisposition. In this work, we were able to induce a dystonic phenotype in DYT1KI mice that carry the ∆GAG mutation in their endogenous genome by a standardized crush lesion of the sciatic nerve. With recordings of the mice in the TST, a deep neural network was trained using the software “DeepLabCut” so that the dystonia-like movements could be automatically recorded and evaluated. The network contributes to providing an objective kinematic characterization of the predominantly clinical syndrome of dystonia and can be transferred to other TSTs from other rodent models. It was also checked whether the observed movements were caused by differences in regeneration after the nerve crush. However, electroneurography showed no differences between wt and DYT1KI animals in this regard. In addition, micromorphological processes in the central and peripheral nervous system are subject of this study. On the one hand, using immune cell staining of T cells, B cells, macrophages and microglia, we were able to determine that there is no evidence, both centrally and peripherally, that the dystonia-like movements developed in the DYT1KI mouse model are due to a dysfunction or activation of the immune system, as it has already been proven to play a role in other neurologic diseases. On the other hand, stereological measurements showed that dopaminergic neurons in the SN were reduced in number and increased in volume in naive DYT1KI animals compared to wt animals, indicating an endophenotype. In the symptomatic, nerve-crushed DYT1KI mice, there was again a further, significant increase in the hypertrophy of the dopaminergic neurons, indicating a change directly related to the dystonic phenotype. In summary, a symptomatic mouse model of high translational importance was established, in which there was evidence of dopaminergic dysregulation and which could be used for further studies, particularly of a therapeutic nature. KW - Dystonie Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-345805 ER - TY - JOUR A1 - Haarmann, Axel A1 - Vollmuth, Christoph A1 - Kollikowski, Alexander M. A1 - Heuschmann, Peter U. A1 - Pham, Mirko A1 - Stoll, Guido A1 - Neugebauer, Hermann A1 - Schuhmann, Michael K. T1 - Vasoactive soluble endoglin: a novel biomarker indicative of reperfusion after cerebral large-vessel occlusion JF - Cells N2 - Now that mechanical thrombectomy has substantially improved outcomes after large-vessel occlusion stroke in up to every second patient, futile reperfusion wherein successful recanalization is not followed by a favorable outcome is moving into focus. Unfortunately, blood-based biomarkers, which identify critical stages of hemodynamically compromised yet reperfused tissue, are lacking. We recently reported that hypoxia induces the expression of endoglin, a TGF-β co-receptor, in human brain endothelium in vitro. Subsequent reoxygenation resulted in shedding. Our cell model suggests that soluble endoglin compromises the brain endothelial barrier function. To evaluate soluble endoglin as a potential biomarker of reperfusion (-injury) we analyzed its concentration in 148 blood samples of patients with acute stroke due to large-vessel occlusion. In line with our in vitro data, systemic soluble endoglin concentrations were significantly higher in patients with successful recanalization, whereas hypoxia alone did not induce local endoglin shedding, as analyzed by intra-arterial samples from hypoxic vasculature. In patients with reperfusion, higher concentrations of soluble endoglin additionally indicated larger infarct volumes at admission. In summary, we give translational evidence that the sequence of hypoxia and subsequent reoxygenation triggers the release of vasoactive soluble endoglin in large-vessel occlusion stroke and can serve as a biomarker for severe ischemia with ensuing recanalization/reperfusion. KW - endoglin KW - brain endothelium KW - stroke KW - shedding KW - mechanical thrombectomy KW - hypoxia KW - reperfusion injury KW - biomarker Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304995 SN - 2073-4409 VL - 12 IS - 2 ER - TY - JOUR A1 - Haufe, Stefan A1 - Isaias, Ioannis U. A1 - Pellegrini, Franziska A1 - Palmisano, Chiara T1 - Gait event prediction using surface electromyography in parkinsonian patients JF - Bioengineering N2 - Gait disturbances are common manifestations of Parkinson’s disease (PD), with unmet therapeutic needs. Inertial measurement units (IMUs) are capable of monitoring gait, but they lack neurophysiological information that may be crucial for studying gait disturbances in these patients. Here, we present a machine learning approach to approximate IMU angular velocity profiles and subsequently gait events using electromyographic (EMG) channels during overground walking in patients with PD. We recorded six parkinsonian patients while they walked for at least three minutes. Patient-agnostic regression models were trained on temporally embedded EMG time series of different combinations of up to five leg muscles bilaterally (i.e., tibialis anterior, soleus, gastrocnemius medialis, gastrocnemius lateralis, and vastus lateralis). Gait events could be detected with high temporal precision (median displacement of <50 ms), low numbers of missed events (<2%), and next to no false-positive event detections (<0.1%). Swing and stance phases could thus be determined with high fidelity (median F1-score of ~0.9). Interestingly, the best performance was obtained using as few as two EMG probes placed on the left and right vastus lateralis. Our results demonstrate the practical utility of the proposed EMG-based system for gait event prediction, which allows the simultaneous acquisition of an electromyographic signal to be performed. This gait analysis approach has the potential to make additional measurement devices such as IMUs and force plates less essential, thereby reducing financial and preparation overheads and discomfort factors in gait studies. KW - electromyography KW - inertial measurement units KW - gait-phase prediction KW - machine learning KW - Parkinson’s disease Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304380 SN - 2306-5354 VL - 10 IS - 2 ER - TY - JOUR A1 - Silwedel, Christine A1 - Hütten, Matthias C. A1 - Speer, Christian P. A1 - Härtel, Christoph A1 - Haarmann, Axel A1 - Henrich, Birgit A1 - Tijssen, Maud P. M. A1 - Alnakhli, Abdullah Ahmed A1 - Spiller, Owen B. A1 - Schlegel, Nicolas A1 - Seidenspinner, Silvia A1 - Kramer, Boris W. A1 - Glaser, Kirsten T1 - Ureaplasma-driven neonatal neuroinflammation: novel insights from an ovine model JF - Cellular and Molecular Neurobiology N2 - Ureaplasma species (spp.) are considered commensals of the adult genitourinary tract, but have been associated with chorioamnionitis, preterm birth, and invasive infections in neonates, including meningitis. Data on mechanisms involved in Ureaplasma-driven neuroinflammation are scarce. The present study addressed brain inflammatory responses in preterm lambs exposed to Ureaplasma parvum (UP) in utero. 7 days after intra-amniotic injection of UP (n = 10) or saline (n = 11), lambs were surgically delivered at gestational day 128–129. Expression of inflammatory markers was assessed in different brain regions using qRT-PCR and in cerebrospinal fluid (CSF) by multiplex immunoassay. CSF was analyzed for UP presence using ureB-based real-time PCR, and MRI scans documented cerebral white matter area and cortical folding. Cerebral tissue levels of atypical chemokine receptor (ACKR) 3, caspases 1-like, 2, 7, and C–X–C chemokine receptor (CXCR) 4 mRNA, as well as CSF interleukin-8 protein concentrations were significantly increased in UP-exposed lambs. UP presence in CSF was confirmed in one animal. Cortical folding and white matter area did not differ among groups. The present study confirms a role of caspases and the transmembrane receptors ACKR3 and CXCR4 in Ureaplasma-driven neuroinflammation. Enhanced caspase 1-like, 2, and 7 expression may reflect cell death. Increased ACKR3 and CXCR4 expression has been associated with inflammatory central nervous system (CNS) diseases and impaired blood–brain barrier function. According to these data and previous in vitro findings from our group, we speculate that Ureaplasma-induced caspase and receptor responses affect CNS barrier properties and thus facilitate neuroinflammation. KW - Ureaplasma parvum KW - CNS integrity KW - neonatal meningitis KW - preterm birth KW - immaturity KW - animal model Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324285 VL - 43 IS - 2 ER - TY - JOUR A1 - Friedrich, Maximilian U. A1 - Schneider, Erich A1 - Buerklein, Miriam A1 - Taeger, Johannes A1 - Hartig, Johannes A1 - Volkmann, Jens A1 - Peach, Robert A1 - Zeller, Daniel T1 - Smartphone video nystagmography using convolutional neural networks: ConVNG JF - Journal of Neurology N2 - Background Eye movement abnormalities are commonplace in neurological disorders. However, unaided eye movement assessments lack granularity. Although videooculography (VOG) improves diagnostic accuracy, resource intensiveness precludes its broad use. To bridge this care gap, we here validate a framework for smartphone video-based nystagmography capitalizing on recent computer vision advances. Methods A convolutional neural network was fine-tuned for pupil tracking using > 550 annotated frames: ConVNG. In a cross-sectional approach, slow-phase velocity of optokinetic nystagmus was calculated in 10 subjects using ConVNG and VOG. Equivalence of accuracy and precision was assessed using the “two one-sample t-test” (TOST) and Bayesian interval-null approaches. ConVNG was systematically compared to OpenFace and MediaPipe as computer vision (CV) benchmarks for gaze estimation. Results ConVNG tracking accuracy reached 9–15% of an average pupil diameter. In a fully independent clinical video dataset, ConVNG robustly detected pupil keypoints (median prediction confidence 0.85). SPV measurement accuracy was equivalent to VOG (TOST p < 0.017; Bayes factors (BF) > 24). ConVNG, but not MediaPipe, achieved equivalence to VOG in all SPV calculations. Median precision was 0.30°/s for ConVNG, 0.7°/s for MediaPipe and 0.12°/s for VOG. ConVNG precision was significantly higher than MediaPipe in vertical planes, but both algorithms’ precision was inferior to VOG. Conclusions ConVNG enables offline smartphone video nystagmography with an accuracy comparable to VOG and significantly higher precision than MediaPipe, a benchmark computer vision application for gaze estimation. This serves as a blueprint for highly accessible tools with potential to accelerate progress toward precise and personalized Medicine. KW - digital medicine KW - nystagmus KW - eye movement disorders KW - videooculography KW - computer vision KW - telemedicine KW - precision medicine Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324526 VL - 270 IS - 5 ER - TY - JOUR A1 - McFleder, Rhonda L. A1 - Makhotkina, Anastasiia A1 - Groh, Janos A1 - Keber, Ursula A1 - Imdahl, Fabian A1 - Peña Mosca, Josefina A1 - Peteranderl, Alina A1 - Wu, Jingjing A1 - Tabuchi, Sawako A1 - Hoffmann, Jan A1 - Karl, Ann-Kathrin A1 - Pagenstecher, Axel A1 - Vogel, Jörg A1 - Beilhack, Andreas A1 - Koprich, James B. A1 - Brotchie, Jonathan M. A1 - Saliba, Antoine-Emmanuel A1 - Volkmann, Jens A1 - Ip, Chi Wang T1 - Brain-to-gut trafficking of alpha-synuclein by CD11c\(^+\) cells in a mouse model of Parkinson’s disease JF - Nature Communications N2 - Inflammation in the brain and gut is a critical component of several neurological diseases, such as Parkinson’s disease (PD). One trigger of the immune system in PD is aggregation of the pre-synaptic protein, α-synuclein (αSyn). Understanding the mechanism of propagation of αSyn aggregates is essential to developing disease-modifying therapeutics. Using a brain-first mouse model of PD, we demonstrate αSyn trafficking from the brain to the ileum of male mice. Immunohistochemistry revealed that the ileal αSyn aggregations are contained within CD11c+ cells. Using single-cell RNA sequencing, we demonstrate that ileal CD11c\(^+\) cells are microglia-like and the same subtype of cells is activated in the brain and ileum of PD mice. Moreover, by utilizing mice expressing the photo-convertible protein, Dendra2, we show that CD11c\(^+\) cells traffic from the brain to the ileum. Together these data provide a mechanism of αSyn trafficking between the brain and gut. KW - antigen-presenting cells KW - neuroimmunology KW - Parkinson's disease Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357696 VL - 14 ER - TY - JOUR A1 - Griebel, Matthias A1 - Segebarth, Dennis A1 - Stein, Nikolai A1 - Schukraft, Nina A1 - Tovote, Philip A1 - Blum, Robert A1 - Flath, Christoph M. T1 - Deep learning-enabled segmentation of ambiguous bioimages with deepflash2 JF - Nature Communications N2 - Bioimages frequently exhibit low signal-to-noise ratios due to experimental conditions, specimen characteristics, and imaging trade-offs. Reliable segmentation of such ambiguous images is difficult and laborious. Here we introduce deepflash2, a deep learning-enabled segmentation tool for bioimage analysis. The tool addresses typical challenges that may arise during the training, evaluation, and application of deep learning models on ambiguous data. The tool’s training and evaluation pipeline uses multiple expert annotations and deep model ensembles to achieve accurate results. The application pipeline supports various use-cases for expert annotations and includes a quality assurance mechanism in the form of uncertainty measures. Benchmarked against other tools, deepflash2 offers both high predictive accuracy and efficient computational resource usage. The tool is built upon established deep learning libraries and enables sharing of trained model ensembles with the research community. deepflash2 aims to simplify the integration of deep learning into bioimage analysis projects while improving accuracy and reliability. KW - machine learning KW - microscopy KW - quality control KW - software Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357286 VL - 14 ER - TY - JOUR A1 - Ip, Chi Wang A1 - Wischhusen, Jörg T1 - Versatile guardians: regenerative regulatory T cells in Parkinson’s disease rodent models JF - Signal Transduction and Targeted Therapy N2 - No abstract available. KW - diseases of the nervous system KW - neuroimmunology KW - neurological disorders Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357674 VL - 8 ER - TY - JOUR A1 - García-Fernández, Patricia A1 - Reinhold, Colette A1 - Üçeyler, Nurcan A1 - Sommer, Claudia T1 - Local inflammatory mediators involved in neuropathic pain JF - International Journal of Molecular Sciences N2 - Polyneuropathy (PNP) is a term to describe diseases of the peripheral nervous system, 50% of which present with neuropathic pain. In some types of PNP, pain is restricted to the skin distally in the leg, suggesting a local regulatory process leading to pain. In this study, we proposed a pro-inflammatory pathway mediated by NF-κB that might be involved in the development of pain in patients with painful PNP. To test this hypothesis, we have collected nerve and skin samples from patients with different etiologies and levels of pain. We performed RT-qPCR to analyze the gene expression of the proposed inflammatory pathway components in sural nerve and in distal and proximal skin samples. In sural nerve, we showed a correlation of TLR4 and TNFα to neuropathic pain, and an upregulation of TNFα in patients with severe pain. Patients with an inflammatory PNP also presented a lower expression of TRPV1 and SIRT1. In distal skin, we found a reduced expression of TLR4 and miR-146-5p, in comparison to proximal skin. Our findings thus support our hypothesis of local inflammatory processes involved in pain in PNP, and further show disturbed anti-inflammatory pathways involving TRPV1 and SIRT1 in inflammatory PNP. KW - polyneuropathy KW - pain KW - inflammation KW - NF-κB KW - TNFα Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313613 SN - 1422-0067 VL - 24 IS - 9 ER - TY - JOUR A1 - Kuzkina, A. A1 - Rößle, J. A1 - Seger, A. A1 - Panzer, C. A1 - Kohl, A. A1 - Maltese, V. A1 - Musacchio, T. A1 - Blaschke, S. J. A1 - Tamgüney, G. A1 - Kaulitz, S. A1 - Rak, K. A1 - Scherzad, A. A1 - Zimmermann, P. H. A1 - Klussmann, J. P. A1 - Hackenberg, S. A1 - Volkmann, J. A1 - Sommer, C. A1 - Sommerauer, M. A1 - Doppler, K. T1 - Combining skin and olfactory α-synuclein seed amplification assays (SAA)—towards biomarker-driven phenotyping in synucleinopathies JF - npj Parkinson’s Disease N2 - Seed amplification assays (SAA) are becoming commonly used in synucleinopathies to detect α-synuclein aggregates. Studies in Parkinson’s disease (PD) and isolated REM-sleep behavior disorder (iRBD) have shown a considerably lower sensitivity in the olfactory epithelium than in CSF or skin. To get an insight into α-synuclein (α-syn) distribution within the nervous system and reasons for low sensitivity, we compared SAA assessment of nasal brushings and skin biopsies in PD (n = 27) and iRBD patients (n = 18) and unaffected controls (n = 30). α-syn misfolding was overall found less commonly in the olfactory epithelium than in the skin, which could be partially explained by the nasal brushing matrix exerting an inhibitory effect on aggregation. Importantly, the α-syn distribution was not uniform: there was a higher deposition of misfolded α-syn across all sampled tissues in the iRBD cohort compared to PD (supporting the notion of RBD as a marker of a more malignant subtype of synucleinopathy) and in a subgroup of PD patients, misfolded α-syn was detectable only in the olfactory epithelium, suggestive of the recently proposed brain-first PD subtype. Assaying α-syn of diverse origins, such as olfactory (part of the central nervous system) and skin (peripheral nervous system), could increase diagnostic accuracy and allow better stratification of patients. KW - diagnostic markers KW - Parkinson's disease Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357687 SN - 2373-8057 VL - 9 ER - TY - JOUR A1 - Odorfer, Thorsten M. A1 - Yabe, Marie A1 - Hiew, Shawn A1 - Volkmann, Jens A1 - Zeller, Daniel T1 - Topological differences and confounders of mental rotation in cervical dystonia and blepharospasm JF - Scientific Reports N2 - Mental rotation (mR) bases on imagination of actual movements. It remains unclear whether there is a specific pattern of mR impairment in focal dystonia. We aimed to investigate mR in patients with cervical dystonia (CD) and blepharospasm (BS) and to assess potential confounders. 23 CD patients and 23 healthy controls (HC) as well as 21 BS and 19 hemifacial spasm (HS) patients were matched for sex, age, and education level. Handedness, finger dexterity, general reaction time, and cognitive status were assessed. Disease severity was evaluated by clinical scales. During mR, photographs of body parts (head, hand, or foot) and a non-corporal object (car) were displayed at different angles rotated within their plane. Subjects were asked to judge laterality of the presented image by keystroke. Both speed and correctness were evaluated. Compared to HC, CD and HS patients performed worse in mR of hands, whereas BS group showed comparable performance. There was a significant association of prolonged mR reaction time (RT) with reduced MoCA scores and with increased RT in an unspecific reaction speed task. After exclusion of cognitively impaired patients, increased RT in the mR of hands was confined to CD group, but not HS. While the question of whether specific patterns of mR impairment reliably define a dystonic endophenotype remains elusive, our findings point to mR as a useful tool, when used carefully with control measures and tasks, which may be capable of identifying specific deficits that distinguish between subtypes of dystonia. KW - neurology KW - neuroscience Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357713 VL - 13 ER - TY - JOUR A1 - Groh, Janos A1 - Abdelwahab, Tassnim A1 - Kattimani, Yogita A1 - Hörner, Michaela A1 - Loserth, Silke A1 - Gudi, Viktoria A1 - Adalbert, Robert A1 - Imdahl, Fabian A1 - Saliba, Antoine-Emmanuel A1 - Coleman, Michael A1 - Stangel, Martin A1 - Simons, Mikael A1 - Martini, Rudolf T1 - Microglia-mediated demyelination protects against CD8\(^+\) T cell-driven axon degeneration in mice carrying PLP defects JF - Nature Communications N2 - Axon degeneration and functional decline in myelin diseases are often attributed to loss of myelin but their relation is not fully understood. Perturbed myelinating glia can instigate chronic neuroinflammation and contribute to demyelination and axonal damage. Here we study mice with distinct defects in the proteolipid protein 1 gene that develop axonal damage which is driven by cytotoxic T cells targeting myelinating oligodendrocytes. We show that persistent ensheathment with perturbed myelin poses a risk for axon degeneration, neuron loss, and behavioral decline. We demonstrate that CD8\(^+\) T cell-driven axonal damage is less likely to progress towards degeneration when axons are efficiently demyelinated by activated microglia. Mechanistically, we show that cytotoxic T cell effector molecules induce cytoskeletal alterations within myelinating glia and aberrant actomyosin constriction of axons at paranodal domains. Our study identifies detrimental axon-glia-immune interactions which promote neurodegeneration and possible therapeutic targets for disorders associated with myelin defects and neuroinflammation. KW - diseases of the nervous system KW - myelin biology and repair KW - neuroimmunology Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357641 VL - 14 ER - TY - JOUR A1 - Gunkel, Sarah A1 - Schötzau, Andreas A1 - Fluri, Felix T1 - Burden of cerebral small vessel disease and changes of diastolic blood pressure affect clinical outcome after acute ischemic stroke JF - Scientific Reports N2 - Elevated and low blood pressure (BP) may lead to poor functional outcome after ischemic stroke, which is conflicting. Hence, there must be another factor—such as cerebral small vessel disease (cSVD) -interacting with BP and thus, affecting outcome. Here, we investigate the relationship between BP and cSVD regarding outcome after stroke. Data of 423/503 stroke patients were prospectively analyzed. Diastolic (DBP) and systolic BP (SBP) were collected on hospital admission (BP\(_{ad}\)) and over the first 72 h (BP\(_{72h}\)). cSVD-burden was determined on MR-scans. Good functional outcome was defined as a modified Rankin Scale score ≤ 2 at hospital discharge and 12 months thereafter. cSVD was a predictor of poor outcome (OR 2.8; p < 0.001). SBPad, DBP\(_{ad}\) and SBP\(_{72h}\) were not significantly associated with outcome at any time. A significant relationship was found between DBP\(_{72h}\), (p < 0.01), cSVD (p = 0.013) and outcome at discharge. At 12 months, we found a relationship between outcome and DBP\(_{72h}\) (p = 0.018) and a statistical tendency regarding cSVD (p = 0.08). Changes in DBP72h were significantly related with outcome. There was a U-shaped relationship between DBP\(_{72h}\) and outcome at discharge. Our results suggest an individualized stroke care by either lowering or elevating DBP depending on cSVD-burden in order to influence functional outcome. KW - cerebrovascular disorders KW - neurological disorders KW - stroke KW - white matter disease Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357669 VL - 13 ER - TY - JOUR A1 - Ding, Hao A1 - Seusing, Nelly A1 - Nasseroleslami, Bahman A1 - Anwar, Abdul Rauf A1 - Strauss, Sebastian A1 - Lotze, Martin A1 - Grothe, Matthias A1 - Groppa, Sergiu A1 - Muthuraman, Muthuraman T1 - The role of ipsilateral motor network in upper limb movement JF - Frontiers in Physiology N2 - The execution of voluntary movements is primarily governed by the cerebral hemisphere contralateral to the moving limb. Previous research indicates that the ipsilateral motor network, comprising the primary motor cortex (M1), supplementary motor area (SMA), and premotor cortex (PM), plays a crucial role in the planning and execution of limb movements. However, the precise functions of this network and its interplay in different task contexts have yet to be fully understood. Twenty healthy right-handed participants (10 females, mean age 26.1 ± 4.6 years) underwent functional MRI scans while performing biceps brachii representations such as bilateral, unilateral flexion, and bilateral flexion-extension. Ipsilateral motor evoked potentials (iMEPs) were obtained from the identical set of participants in a prior study using transcranial magnetic stimulation (TMS) targeting M1 while employing the same motor tasks. The voxel time series was extracted based on the region of interest (M1, SMA, ventral PM and dorsal PM). Directed functinal connectivity was derived from the extracted time series using time-resolved partial directed coherence. We found increased connectivity from left-PMv to both sides M1, as well as right-PMv to both sides SMA, in unilateral flexion compared to bilateral flexion. Connectivity from left M1 to left-PMv, and left-SMA to right-PMd, also increased in both unilateral flexion and bilateral flexion-extension compared to bilateral flexion. However, connectivity between PMv and right-M1 to left-PMd decreased during bilateral flexion-extension compared to unilateral flexion. Additionally, during bilateral flexion-extension, the connectivity from right-M1 to right-SMA had a negative relationship with the area ratio of iMEP in the dominant side. Our results provide corroborating evidence for prior research suggesting that the ipsilateral motor network is implicated in the voluntary movements and underscores its involvement in cognitive processes such as movement planning and coordination. Moreover, ipsilateral connectivity from M1 to SMA on the dominant side can modulate the degree of ipsilateral M1 activation during bilateral antagonistic contraction. KW - ipsilateral motor network KW - upper limb KW - ipsilateral motor evoked potential KW - voluntary movement KW - bilateral motor network Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-321805 SN - 1664-042X VL - 14 ER - TY - JOUR A1 - Schuhmann, Michael K. A1 - Langhauser, Friederike A1 - Zimmermann, Lena A1 - Bellut, Maximilian A1 - Kleinschnitz, Christoph A1 - Fluri, Felix T1 - Dimethyl fumarate attenuates lymphocyte infiltration and reduces infarct size in experimental stroke JF - International journal of molecular sciences N2 - Ischemic stroke is associated with exacerbated tissue damage caused by the activation of immune cells and the initiation of other inflammatory processes. Dimethyl fumarate (DMF) is known to modulate the immune response, activate antioxidative pathways, and improve the blood–brain barrier (BBB) after stroke. However, the specific impact of DMF on immune cells after cerebral ischemia remains unclear. In our study, male mice underwent transient middle cerebral artery occlusion (tMCAO) for 30 min and received oral DMF (15 mg/kg) or a vehicle immediately after tMCAO, followed by twice-daily administrations for 7 days. Infarct volume was assessed on T2-weighted magnetic resonance images on days 1 and 7 after tMCAO. Brain-infiltrating immune cells (lymphocytes, monocytes) and microglia were quantified using fluorescence-activated cell sorting. DMF treatment significantly reduced infarct volumes and brain edema. On day 1 after tMCAO, DMF-treated mice showed reduced lymphocyte infiltration compared to controls, which was not observed on day 7. Monocyte and microglial cell counts did not differ between groups on either day. In the acute phase of stroke, DMF administration attenuated lymphocyte infiltration, probably due to its stabilizing effect on the BBB. This highlights the potential of DMF as a therapeutic candidate for mitigating immune cell-driven damage in stroke. KW - experimental stroke KW - transient middle cerebral artery occlusion model KW - dimethyl fumarate KW - cerebral inflammation Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357731 VL - 24 IS - 21 ER - TY - JOUR A1 - Pozzi, Nicoló Gabriele A1 - Bolzoni, Francesco A1 - Biella, Gabriele Eliseo Mario A1 - Pezzoli, Gianni A1 - Ip, Chi Wang A1 - Volkmann, Jens A1 - Cavallari, Paolo A1 - Asan, Esther A1 - Isaias, Ioannis Ugo T1 - Brain noradrenergic innervation supports the development of Parkinson’s tremor: a study in a reserpinized rat model JF - Cells N2 - The pathophysiology of tremor in Parkinson’s disease (PD) is evolving towards a complex alteration to monoaminergic innervation, and increasing evidence suggests a key role of the locus coeruleus noradrenergic system (LC-NA). However, the difficulties in imaging LC-NA in patients challenge its direct investigation. To this end, we studied the development of tremor in a reserpinized rat model of PD, with or without a selective lesioning of LC-NA innervation with the neurotoxin DSP-4. Eight male rats (Sprague Dawley) received DSP-4 (50 mg/kg) two weeks prior to reserpine injection (10 mg/kg) (DR-group), while seven male animals received only reserpine treatment (R-group). Tremor, rigidity, hypokinesia, postural flexion and postural immobility were scored before and after 20, 40, 60, 80, 120 and 180 min of reserpine injection. Tremor was assessed visually and with accelerometers. The injection of DSP-4 induced a severe reduction in LC-NA terminal axons (DR-group: 0.024 ± 0.01 vs. R-group: 0.27 ± 0.04 axons/um\(^2\), p < 0.001) and was associated with significantly less tremor, as compared to the R-group (peak tremor score, DR-group: 0.5 ± 0.8 vs. R-group: 1.6 ± 0.5; p < 0.01). Kinematic measurement confirmed the clinical data (tremor consistency (% of tremor during 180 s recording), DR-group: 37.9 ± 35.8 vs. R-group: 69.3 ± 29.6; p < 0.05). Akinetic–rigid symptoms did not differ between the DR- and R-groups. Our results provide preliminary causal evidence for a critical role of LC-NA innervation in the development of PD tremor and foster the development of targeted therapies for PD patients. KW - Parkinson’s disease KW - tremor KW - locus coeruleus KW - noradrenaline KW - reserpinized rat model Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357721 SN - 2073-4409 VL - 12 IS - 21 ER - TY - JOUR A1 - Del Vecchio, Jasmin A1 - Hanafi, Ibrahem A1 - Pozzi, Nicoló Gabriele A1 - Capetian, Philipp A1 - Isaias, Ioannis U. A1 - Haufe, Stefan A1 - Palmisano, Chiara T1 - Pallidal recordings in chronically implanted dystonic patients: mitigation of tremor-related artifacts JF - Bioengineering N2 - Low-frequency oscillatory patterns of pallidal local field potentials (LFPs) have been proposed as a physiomarker for dystonia and hold the promise for personalized adaptive deep brain stimulation. Head tremor, a low-frequency involuntary rhythmic movement typical of cervical dystonia, may cause movement artifacts in LFP signals, compromising the reliability of low-frequency oscillations as biomarkers for adaptive neurostimulation. We investigated chronic pallidal LFPs with the Percept\(^{TM}\) PC (Medtronic PLC) device in eight subjects with dystonia (five with head tremors). We applied a multiple regression approach to pallidal LFPs in patients with head tremors using kinematic information measured with an inertial measurement unit (IMU) and an electromyographic signal (EMG). With IMU regression, we found tremor contamination in all subjects, whereas EMG regression identified it in only three out of five. IMU regression was also superior to EMG regression in removing tremor-related artifacts and resulted in a significant power reduction, especially in the theta-alpha band. Pallido-muscular coherence was affected by a head tremor and disappeared after IMU regression. Our results show that the Percept PC can record low-frequency oscillations but also reveal spectral contamination due to movement artifacts. IMU regression can identify such artifact contamination and be a suitable tool for its removal. KW - dystonia KW - tremor KW - local field potentials KW - globus pallidus KW - deep brain stimulation Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313498 SN - 2306-5354 VL - 10 IS - 4 ER - TY - JOUR A1 - Binder, Tobias A1 - Lange, Florian A1 - Pozzi, Nicolò A1 - Musacchio, Thomas A1 - Daniels, Christine A1 - Odorfer, Thorsten A1 - Fricke, Patrick A1 - Matthies, Cordula A1 - Volkmann, Jens A1 - Capetian, Philipp T1 - Feasibility of local field potential-guided programming for deep brain stimulation in Parkinson’s disease: a comparison with clinical and neuro-imaging guided approaches in a randomized, controlled pilot trial JF - Brain Stimulation N2 - Highlights • Beta-Guided programming is an innovative approach that may streamline the programming process for PD patients with STN DBS. • While preliminary findings from our study suggest that Beta Titration may potentially mitigate STN overstimulation and enhance symptom control, • Our results demonstrate that beta-guided programming significantly reduces programming time, suggesting it could be efficiently integrated into routine clinical practice using a commercially available patient programmer. Background Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson's disease (PD). Clinical outcomes after DBS can be limited by poor programming, which remains a clinically driven, lengthy and iterative process. Electrophysiological recordings in PD patients undergoing STN-DBS have shown an association between STN spectral power in the beta frequency band (beta power) and the severity of clinical symptoms. New commercially-available DBS devices now enable the recording of STN beta oscillations in chronically-implanted PD patients, thereby allowing investigation into the use of beta power as a biomarker for DBS programming. Objective To determine the potential advantages of beta-guided DBS programming over clinically and image-guided programming in terms of clinical efficacy and programming time. Methods We conducted a randomized, blinded, three-arm, crossover clinical trial in eight Parkinson's patients with STN-DBS who were evaluated three months after DBS surgery. We compared clinical efficacy and time required for each DBS programming paradigm, as well as DBS parameters and total energy delivered between the three strategies (beta-, clinically- and image-guided). Results All three programming methods showed similar clinical efficacy, but the time needed for programming was significantly shorter for beta- and image-guided programming compared to clinically-guided programming (p < 0.001). Conclusion Beta-guided programming may be a useful and more efficient approach to DBS programming in Parkinson's patients with STN-DBS. It takes significantly less time to program than traditional clinically-based programming, while providing similar symptom control. In addition, it is readily available within the clinical DBS programmer, making it a valuable tool for improving current clinical practice. KW - beta power KW - deep brain stimulation KW - local field potentials KW - Parkinson's disease KW - DBS programming KW - DBS biomarkers Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-350280 VL - 16 IS - 5 ER - TY - JOUR A1 - Göpfert, Dennis A1 - Traub, Jan A1 - Sell, Roxane A1 - Homola, György A. A1 - Vogt, Marius A1 - Pham, Mirko A1 - Frantz, Stefan A1 - Störk, Stefan A1 - Stoll, Guido A1 - Frey, Anna T1 - Profiles of cognitive impairment in chronic heart failure—A cluster analytic approach JF - Frontiers in Human Neuroscience N2 - Background Cognitive impairment is a major comorbidity in patients with chronic heart failure (HF) with a wide range of phenotypes. In this study, we aimed to identify and compare different clusters of cognitive deficits. Methods The prospective cohort study “Cognition.Matters-HF” recruited 147 chronic HF patients (aged 64.5 ± 10.8 years; 16.2% female) of any etiology. All patients underwent extensive neuropsychological testing. We performed a hierarchical cluster analysis of the cognitive domains, such as intensity of attention, visual/verbal memory, and executive function. Generated clusters were compared exploratively with respect to the results of cardiological, neurological, and neuroradiological examinations without correction for multiple testing. Results Dendrogram and the scree plot suggested three distinct cognitive profiles: In the first cluster, 42 patients (28.6%) performed without any deficits in all domains. Exclusively, the intensity of attention deficits was seen in the second cluster, including 55 patients (37.4%). A third cluster with 50 patients (34.0%) was characterized by deficits in all cognitive domains. Age (p = 0.163) and typical clinical markers of chronic HF, such as ejection fraction (p = 0.222), 6-min walking test distance (p = 0.138), NT-proBNP (p = 0.364), and New York Heart Association class (p = 0.868) did not differ between clusters. However, we observed that women (p = 0.012) and patients with previous cardiac valve surgery (p = 0.005) prevailed in the “global deficits” cluster and the “no deficits” group had a lower prevalence of underlying arterial hypertension (p = 0.029). Total brain volume (p = 0.017) was smaller in the global deficit cluster, and serum levels of glial fibrillary acidic protein were increased (p = 0.048). Conclusion Apart from cognitively healthy and globally impaired HF patients, we identified a group with deficits only in the intensity of attention. Women and patients with previous cardiac valve surgery are at risk for global cognitive impairment when suffering HF and could benefit from special multimodal treatment addressing the psychosocial condition. KW - chronic heart failure KW - cluster analysis KW - cognitive impairment KW - intensity of attention KW - glial fibrillary acidic protein Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313429 VL - 17 ER - TY - JOUR A1 - Hecker, Katharina A1 - Grüner, Julia A1 - Hartmannsberger, Beate A1 - Appeltshauser, Luise A1 - Villmann, Carmen A1 - Sommer, Claudia A1 - Doppler, Kathrin T1 - Different binding and pathogenic effect of neurofascin and contactin–1 autoantibodies in autoimmune nodopathies JF - Frontiers in Immunology N2 - Introduction IgG4 autoantibodies against paranodal proteins are known to induce acute-onset and often severe sensorimotor autoimmune neuropathies. How autoantibodies reach their antigens at the paranode in spite of the myelin barrier is still unclear. Methods We performed in vitro incubation experiments with patient sera on unfixed and unpermeabilized nerve fibers and in vivo intraneural and intrathecal passive transfer of patient IgG to rats, to explore the access of IgG autoantibodies directed against neurofascin-155 and contactin-1 to the paranodes and their pathogenic effect. Results We found that in vitro incubation resulted in weak paranodal binding of anti-contactin-1 autoantibodies whereas anti-neurofascin-155 autoantibodies bound to the nodes more than to the paranodes. After short-term intraneural injection, no nodal or paranodal binding was detectable when using anti-neurofascin-155 antibodies. After repeated intrathecal injections, nodal more than paranodal binding could be detected in animals treated with anti-neurofascin-155, accompanied by sensorimotor neuropathy. In contrast, no paranodal binding was visible in rats intrathecally injected with anti-contactin-1 antibodies, and animals remained unaffected. Conclusion These data support the notion of different pathogenic mechanisms of anti-neurofascin-155 and anti-contactin-1 autoantibodies and different accessibility of paranodal and nodal structures. KW - autoimmune nodopathy KW - IgG4 KW - neurofascin KW - contactin KW - node of ranvier KW - inflammatory neuropathy KW - passive transfer Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-320395 VL - 14 ER - TY - JOUR A1 - Lehrieder, Dominik A1 - Zapantis, Nikolaos A1 - Pham, Mirko A1 - Schuhmann, Michael Klaus A1 - Haarmann, Axel T1 - Treating seronegative neuromyelitis optica spectrum disorder with inebilizumab: a case report JF - Frontiers in Neurology N2 - Background Neuromyelitis optica spectrum disorder (NMOSD) is a devastating inflammatory disease of the central nervous system that is often severely disabling from the outset. The lack of pathognomonic aquaporin 4 (AQP4) antibodies in seronegative NMOSD not only hinders early diagnosis, but also limits therapeutic options, in contrast to AQP4 antibody-positive NMOSD, where the therapeutic landscape has recently evolved massively. Case presentation We report a 56-year-old woman with bilateral optic neuritis and longitudinally extensive myelitis as the index events of a seronegative NMOSD, who was successfully treated with inebilizumab. Conclusion Treatment with inebilizumab may be considered in aggressive seronegative NMOSD. Whether broader CD19-directed B cell depletion is more effective than treatment with rituximab remains elusive. KW - NMOSD KW - inebilizumab KW - AQP4 KW - longitudinally extensive transverse myelitis KW - optic neuritis KW - case report KW - CD19 KW - seronegative Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-354031 VL - 14 ER - TY - JOUR A1 - Rauschenberger, Vera A1 - Piro, Inken A1 - Kasaragod, Vikram Babu A1 - Hörlin, Verena A1 - Eckes, Anna-Lena A1 - Kluck, Christoph J. A1 - Schindelin, Hermann A1 - Meinck, Hans-Michael A1 - Wickel, Jonathan A1 - Geis, Christian A1 - Tüzün, Erdem A1 - Doppler, Kathrin A1 - Sommer, Claudia A1 - Villmann, Carmen T1 - Glycine receptor autoantibody binding to the extracellular domain is independent from receptor glycosylation JF - Frontiers in Molecular Neuroscience N2 - Glycine receptor (GlyR) autoantibodies are associated with stiff-person syndrome and the life-threatening progressive encephalomyelitis with rigidity and myoclonus in children and adults. Patient histories show variability in symptoms and responses to therapeutic treatments. A better understanding of the autoantibody pathology is required to develop improved therapeutic strategies. So far, the underlying molecular pathomechanisms include enhanced receptor internalization and direct receptor blocking altering GlyR function. A common epitope of autoantibodies against the GlyRα1 has been previously defined to residues 1A-33G at the N-terminus of the mature GlyR extracellular domain. However, if other autoantibody binding sites exist or additional GlyR residues are involved in autoantibody binding is yet unknown. The present study investigates the importance of receptor glycosylation for binding of anti-GlyR autoantibodies. The glycine receptor α1 harbors only one glycosylation site at the amino acid residue asparagine 38 localized in close vicinity to the identified common autoantibody epitope. First, non-glycosylated GlyRs were characterized using protein biochemical approaches as well as electrophysiological recordings and molecular modeling. Molecular modeling of non-glycosylated GlyRα1 did not show major structural alterations. Moreover, non-glycosylation of the GlyRα1N38Q did not prevent the receptor from surface expression. At the functional level, the non-glycosylated GlyR demonstrated reduced glycine potency, but patient GlyR autoantibodies still bound to the surface-expressed non-glycosylated receptor protein in living cells. Efficient adsorption of GlyR autoantibodies from patient samples was possible by binding to native glycosylated and non-glycosylated GlyRα1 expressed in living not fixed transfected HEK293 cells. Binding of patient-derived GlyR autoantibodies to the non-glycosylated GlyRα1 offered the possibility to use purified non-glycosylated GlyR extracellular domain constructs coated on ELISA plates and use them as a fast screening readout for the presence of GlyR autoantibodies in patient serum samples. Following successful adsorption of patient autoantibodies by GlyR ECDs, binding to primary motoneurons and transfected cells was absent. Our results indicate that the glycine receptor autoantibody binding is independent of the receptor’s glycosylation state. Purified non-glycosylated receptor domains harbouring the autoantibody epitope thus provide, an additional reliable experimental tool besides binding to native receptors in cell-based assays for detection of autoantibody presence in patient sera. KW - glycine receptor KW - autoantibodies KW - glycosylation KW - extracellular domain KW - adsorption Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304206 VL - 16 ER - TY - JOUR A1 - Andreska, Thomas A1 - Lüningschrör, Patrick A1 - Wolf, Daniel A1 - McFleder, Rhonda L. A1 - Ayon-Olivas, Maurilyn A1 - Rattka, Marta A1 - Drechsler, Christine A1 - Perschin, Veronika A1 - Blum, Robert A1 - Aufmkolk, Sarah A1 - Granado, Noelia A1 - Moratalla, Rosario A1 - Sauer, Markus A1 - Monoranu, Camelia A1 - Volkmann, Jens A1 - Ip, Chi Wang A1 - Stigloher, Christian A1 - Sendtner, Michael T1 - DRD1 signaling modulates TrkB turnover and BDNF sensitivity in direct pathway striatal medium spiny neurons JF - Cell Reports N2 - Highlights • Dopamine receptor-1 activation induces TrkB cell-surface expression in striatal neurons • Dopaminergic deficits cause TrkB accumulation and clustering in the ER • TrkB clusters colocalize with cargo receptor SORCS-2 in direct pathway striatal neurons • Intracellular TrkB clusters fail to fuse with lysosomes after dopamine depletion Summary Disturbed motor control is a hallmark of Parkinson’s disease (PD). Cortico-striatal synapses play a central role in motor learning and adaption, and brain-derived neurotrophic factor (BDNF) from cortico-striatal afferents modulates their plasticity via TrkB in striatal medium spiny projection neurons (SPNs). We studied the role of dopamine in modulating the sensitivity of direct pathway SPNs (dSPNs) to BDNF in cultures of fluorescence-activated cell sorting (FACS)-enriched D1-expressing SPNs and 6-hydroxydopamine (6-OHDA)-treated rats. DRD1 activation causes enhanced TrkB translocation to the cell surface and increased sensitivity for BDNF. In contrast, dopamine depletion in cultured dSPN neurons, 6-OHDA-treated rats, and postmortem brain of patients with PD reduces BDNF responsiveness and causes formation of intracellular TrkB clusters. These clusters associate with sortilin related VPS10 domain containing receptor 2 (SORCS-2) in multivesicular-like structures, which apparently protects them from lysosomal degradation. Thus, impaired TrkB processing might contribute to disturbed motor function in PD. KW - motor learning KW - cortico-striatal synapse KW - basal ganglia KW - direct pathway KW - DRD1 KW - dSPN KW - BDNF KW - TrkB KW - synaptic plasticity KW - GPCR Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-349932 VL - 42 IS - 6 ER - TY - JOUR A1 - Grotemeyer, Alexander A1 - Fischer, Judith F. A1 - Koprich, James B. A1 - Brotchie, Jonathan M. A1 - Blum, Robert A1 - Volkmann, Jens A1 - Ip, Chi Wang T1 - Inflammasome inhibition protects dopaminergic neurons from α-synuclein pathology in a model of progressive Parkinson’s disease JF - Journal of Neuroinflammation N2 - Neuroinflammation has been suggested as a pathogenetic mechanism contributing to Parkinson’s disease (PD). However, anti-inflammatory treatment strategies have not yet been established as a therapeutic option for PD patients. We have used a human α-synuclein mouse model of progressive PD to examine the anti-inflammatory and neuroprotective effects of inflammasome inhibition on dopaminergic (DA) neurons in the substantia nigra (SN). As the NLRP3 (NOD-, LRR- and pyrin domain-containing 3)-inflammasome is a core interface for both adaptive and innate inflammation and is also highly druggable, we investigated the implications of its inhibition. Repeat administration of MCC950, an inhibitor of NLRP3, in a PD model with ongoing pathology reduced CD4\(^+\) and CD8\(^+\) T cell infiltration into the SN. Furthermore, the anti-inflammasome treatment mitigated microglial activation and modified the aggregation of α-synuclein protein in DA neurons. MCC950-treated mice showed significantly less neurodegeneration of DA neurons and a reduction in PD-related motor behavior. In summary, early inflammasome inhibition can reduce neuroinflammation and prevent DA cell death in an α-synuclein mouse model for progressive PD. KW - neurodegeneration KW - movement disorder KW - neuroinflammation KW - Parkinson’s disease KW - inflammasome KW - dopaminergic cells KW - NLRP3 KW - MCC950 KW - microglia KW - T cells Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357652 VL - 20 ER - TY - JOUR A1 - García-Fernández, Patricia A1 - Höfflin, Klemens A1 - Rausch, Antonia A1 - Strommer, Katharina A1 - Neumann, Astrid A1 - Cebulla, Nadine A1 - Reinhold, Ann-Kristin A1 - Rittner, Heike A1 - Üçeyler, Nurcan A1 - Sommer, Claudia T1 - Systemic inflammatory markers in patients with polyneuropathies JF - Frontiers in Immunology N2 - Introduction In patients with peripheral neuropathies (PNP), neuropathic pain is present in 50% of the cases, independent of the etiology. The pathophysiology of pain is poorly understood, and inflammatory processes have been found to be involved in neuro-degeneration, -regeneration and pain. While previous studies have found a local upregulation of inflammatory mediators in patients with PNP, there is a high variability described in the cytokines present systemically in sera and cerebrospinal fluid (CSF). We hypothesized that the development of PNP and neuropathic pain is associated with enhanced systemic inflammation. Methods To test our hypothesis, we performed a comprehensive analysis of the protein, lipid and gene expression of different pro- and anti-inflammatory markers in blood and CSF from patients with PNP and controls. Results While we found differences between PNP and controls in specific cytokines or lipids, such as CCL2 or oleoylcarnitine, PNP patients and controls did not present major differences in systemic inflammatory markers in general. IL-10 and CCL2 levels were related to measures of axonal damage and neuropathic pain. Lastly, we describe a strong interaction between inflammation and neurodegeneration at the nerve roots in a specific subgroup of PNP patients with blood-CSF barrier dysfunction. Conclusion In patients with PNP systemic inflammatory, markers in blood or CSF do not differ from controls in general, but specific cytokines or lipids do. Our findings further highlight the importance of CSF analysis in patients with peripheral neuropathies. KW - cytokines KW - polyneuropathy KW - cerebrospinal fluid KW - neurofilament light chain KW - blood CSF barrier Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304217 VL - 14 ER - TY - JOUR A1 - Odorfer, Thorsten M. A1 - Volkmann, Jens T1 - Deep brain stimulation for focal or segmental craniocervical dystonia in patients who have failed botulinum neurotoxin therapy - a narrative review of the literature JF - Toxins N2 - (1) Background: The first-line treatment for patients with focal or segmental dystonia with a craniocervical distribution is still the intramuscular injection of botulinum neurotoxin (BoNT). However, some patients experience primary or secondary treatment failure from this potential immunogenic therapy. Deep brain stimulation (DBS) may then be used as a backup strategy in this situation. (2) Methods: Here, we reviewed the current study literature to answer a specific question regarding the efficacy and safety of the use of DBS, particularly for cervical dystonia (CD) and Meige syndrome (MS) in patients with documented treatment failure under BoNT. (3) Results: There are only two studies with the highest level of evidence in this area. Despite this clear limitation, in the context of the narrowly defined research question of this paper, it is possible to report 161 patients with CD or MS who were included in studies that were able to show a statistically significant reduction in dystonic symptoms using DBS. Safety and tolerability data appeared adequate. However, much of the information is based on retrospective observations. (4) Conclusions: The evidence base in this area is in need of further scientific investigation. Most importantly, more randomized, controlled and double-blind trials are needed, possibly including a head-to-head comparison of DBS and BoNT. KW - cervical dystonia KW - Meige syndrome KW - deep brain stimulation KW - internal globus pallidus KW - subthalamic nucleus KW - botulinum neurotoxin KW - medication therapy failure KW - symptom control KW - safety and tolerability Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357707 SN - 2072-6651 VL - 15 IS - 10 ER - TY - JOUR A1 - Hiew, Shawn A1 - Eibeck, Leila A1 - Nguemeni, Carine A1 - Zeller, Daniel T1 - The influence of age and physical activity on locomotor adaptation JF - Brain Sciences N2 - Background: Aging increases individual susceptibility to falls and injuries, suggesting poorer adaptation of balance responses to perturbation during locomotion, which can be measured with the locomotor adaptation task (LAT). However, it is unclear how aging and lifestyle factors affect these responses during walking. Hence, the present study investigates the relationship between balance and lifestyle factors during the LAT in healthy individuals across the adult lifespan using a correlational design. Methods: Thirty participants aged 20–78 years performed an LAT on a split-belt treadmill (SBT). We evaluated the magnitude and rate of adaptation and deadaptation during the LAT. Participants reported their lifelong physical and cognitive activity. Results: Age positively correlated with gait-line length asymmetry at the late post-adaptation phase (p = 0.007). These age-related effects were mediated by recent physical activity levels (p = 0.040). Conclusion: Our results confirm that locomotor adaptive responses are preserved in aging, but the ability to deadapt newly learnt balance responses is compromised with age. Physical activity mediates these age-related effects. Therefore, gait symmetry post-adaptation could effectively measure the risk of falling, and maintaining physical activity could protect against declines in balance. KW - locomotor adaptation KW - walking KW - physical activity KW - exercise KW - aging KW - balance Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-362478 SN - 2076-3425 VL - 13 IS - 9 ER - TY - THES A1 - Leinweber, Jonas T1 - Untersuchung zur pathophysiologischen Rolle und therapeutischen Relevanz der neuen Inhibitoren der plasmatischen Blutgerinnung Agaphelin und Ixolaris im experimentellen Schlaganfallmodell der Maus T1 - Characterization of the pathophysiological role and therapeutic relevance of the new inhibitors of plasmatic blood coagulation Agaphelin and Ixolaris in the model of ischemic stroke in mice N2 - Beim ischämischen Schlaganfall führt ein thrombotischer Verschluss von gehirnversorgenden Arterien zu einer akuten Durchblutungsstörung, mit der Folge von neurologischen Defiziten. Primäres Therapieziel ist es, diese Blutgerinnsel aufzulösen, um die Sauerstoffversorgung des Gehirns wiederherzustellen und den ischämischen Hirnschaden zu begrenzen. Dazu stehen die intravenösen Thrombolyse mit rt-PA (rekombinanter Gewebe-Plasminogen-Aktivator) sowie die endovaskuläre mechanische Thrombektomie zur Verfügung. Häufig kann ein Schlaganfall, trotz erfolgreicher Rekanalisation der Gefäße, zu einer weiteren Größenzunahme des Infarktes und neurologischen Defiziten bei den Patienten führen. Diese Größenzunahme beruht zum einen auf einem sich entwickelnden Hirnödem und zum anderen auf entzündlichen Prozessen. Zahlreiche Hinweise deuten darauf hin, dass der Schlaganfall ein Zusammenspiel aus thrombotischen und entzündlichen Ereignissen ist, ein Phänomen, das als Thromboinflammation bezeichnet wird. Aufgrund der begrenzten Behandlungsmöglichkeiten ist die Entwicklung neuer Therapieansätze für den ischämischen Schlaganfall besonders wichtig. Agaphelin und Ixolaris sind Proteine aus den Speicheldrüsen von Hämatophagen, für welche in früheren Studien eine starke antithrombotische Wirkung bei gleichzeitig geringem Blutungsrisiko nachgewiesen wurde. Diese möglichen antithrombotischen Effekte wurden in dieser Studie im Hinblick auf ihre Wirksamkeit und Sicherheit im Mausmodell der zerebralen Ischämie untersucht. Die Behandlung der Mäuse mit Agaphelin 1 Stunde nach transienter Okklusion der Arteria cerebri media (tMCAO) führte zu kleineren Schlaganfallvolumina und geringeren neurologischen Defiziten an Tag 1 nach dem Schlaganfall. Die Mortalität der Mäuse war bis Tag 7 deutlich gesunken. Aus klinischer Sicht ist ebenfalls relevant, dass der starke antithrombotische Effekt von Agaphelin im Mausmodell nicht mit einem erhöhten Risiko für intrazerebrale Blutungen einherging. Diesem protektiven Effekt von Agaphelin lagen eine verminderte intrazerebrale Thrombusbildung, eine abgeschwächte Entzündungsantwort und eine Stabilisierung der Blut-Hirn-Schranke sowie eine Reduzierung der Apoptose zugrunde. Nach der Gabe von Ixolaris 1 Stunde nach tMCAO waren zwar signifikant geringere Infarktgrößen messbar, diese führten allerdings nicht zu einer Verbesserung der neurologischen Defizite. Zudem verursachte die Gabe von Ixolaris schon 24 Stunden nach tMCAO erhebliche intrazerebrale Blutungen und auch die Mortalität der Mäuse war zu diesem Zeitpunkt bereits erhöht. Aufgrund dieser massiven Nebenwirkungen scheint Ixolaris kein geeigneter Kandidat für eine humane Anwendung zu sein. Bei Agaphelin hingegen könnte es sich um einen vielversprechenden Kandidaten für die Behandlung des ischämischen Schlaganfalls handeln. Vor einer möglichen Testung von Agaphelin in klinischen Studien, sind weitere translationale Untersuchungen notwendig, um ein noch präziseres Verständnis für die Wirksamkeit und Sicherheit von Agaphelin zu gewinnen. Insgesamt stellt die Hemmung thromboinflammatorischer Prozesse, ohne eine Erhöhung der Blutungskomplikationen, eine vielversprechende Option zur Behandlung des ischämischen Schlaganfalls dar. N2 - Thrombotic occlusion of cerebral vessels is an important process in pathogenesis of ischemic stroke resulting in lack of blood supply of the brain and neurological deficits. In order to restore the oxygenation of the brain and to limit brain injury, recanalization of the occluded vessels is the therapeutic main goal of stroke treatment. So far, the only proven pharmacological intervention for thrombolysis is the recombinant tissue-type plasminogen activator. For recanalization of larger arteries endovascular thrombectomy was established as a mechanic intervention. Nevertheless, despite successful recanalization ischemic brain damage and neurological deficits evolve. Increased size of infarct lesions develop due to brain edema and inflammatory processes. Moreover, there is evidence that inflammation and thrombosis are linked, which has led to the concept of thromboinflammation. Due to the limited treatment strategies in stroke management, the development of new therapeutic approaches for ischemic stroke is particularly important. Recent studies have shown that the hematophagous salivary gland proteins Agaphelin and Ixolaris exhibit multiple antithrombotic effects without promoting a risk of bleeding. To investigate the potentially safe antithrombotic effects, Agaphelin and Ixolaris were tested in a mouse model of transient middle cerebral artery occlusion (tMCAO). Treatment of mice with Agaphelin 1 hour after tMCAO resulted in smaller infarct volumes and an improved neurological function on day one after stroke. Up to seven days after stroke the mortality rate was significantly reduced. This protective effect was due to reduced local thrombus formation, a reduced inflammatory response and less severe blood-brain-barrier damage as well as reduced apoptosis. Moreover, it is important to mention, that the strong protective effect of Agaphelin was not linked to an increased risk of intracerebral bleeding. Treatment of mice with Ixolaris one hour after tMCAO leads to significantly smaller infarct sizes. However, neurologic deficits did not improve after treatment with Ixolaris. Furthermore, risk of intracerebral bleeding and mortality rates were significantly increased 24 hours after treatment with Ixolaris. Due to these severe side effects, Ixolaris does not seem to be an appropriate candidate for human therapy. Nevertheless, Agaphelin appears to be a promising component for ischemic stroke treatment, but further translational studies should be performed before testing Agaphelin in clinical stroke trials. Overall, the inhibition of thromboinflammatory effects without increased bleeding reflects a promising option for successful ischemic stroke treatment. KW - Schlaganfall KW - antithrombotic KW - inflammation KW - stroke KW - Agaphelin KW - Ixolaris KW - Thromboinflammation KW - Experimenteller Schlaganfall Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-252921 ER - TY - THES A1 - Nakchbandi, Luis T1 - Adaptives motorisches Lernen und seine Konsolidierung bei Multipler Sklerose T1 - Adaptive motor learning and its consolidation in Multiple Scerosis N2 - Der Verlauf der Multiplen Sklerose ist heterogener Natur; die Fähigkeit zu einem intakten adaptiven motorischen Lernen und einer intakten Konsolidierung könnten einen milden Krankheitsverlauf begünstigen. In der vorliegenden Arbeit wurden das adaptive motorische Lernen und seine Konsolidierung bei MS-Patienten im Vergleich zu neurologisch gesunden Kontrollprobanden untersucht; außerdem wurde das Verhältnis dieser Formen des Lernens zu klinischen und apparativen Parametern des Krankheitsprogresses untersucht. Dazu führten 20 MS-Patienten und 20 Kontrollprobanden eine visuoadaptive Lernaufgabe durch. Hierzu sollten mittels Computerbildschirm und Computermaus geradlinige Zielbewegungen zwischen einem Startpunkt und einem Zielpunkt wechselnder Lokalisation durchgeführt werden, wobei in einem Rotationsmodus eine externe Ablenkung der Zielbewegung im Uhrzeigersinn eingeführt wurde, welche auszugleichen war. Die Übungssitzung wurde nach 24 Stunden und nach 72 Stunden wiederholt. Analysiert wurden die Richtungsfehler der Zielbewegungen, die Adaptationsrate an die Ablenkung und die Retention der erlernten Adaptation bis zur Folgesitzung. Motorische Einschränkung wurde durch den EDSS-Score und den 9-Loch-Stecktest quantifiziert, zentralnervöse Läsionslast wurde mittels cMRT und MEP ermittelt. Die Adaptation und Lernfähigkeit innerhalb einer Übungssitzung waren in der Patienten- und der Kontrollgruppe vergleichbar; jedoch zeigte sich eine signifikant verminderte Retentionsrate in der Patientengruppe an den Folgeuntersuchungstagen im Vergleich zur Kontrollgruppe. In den Korrelationsanalysen und Subgruppenvergleichen innerhalb der Patientengruppe nach Stratifizierung aufgrund von EDSS-Score, 9-Lochstecktest und zentralnervöser Läsionslast im MRT konnte kein eindeutiger Zusammenhang zwischen klinischer Beeinträchtigung bzw. zentralnervöser Läsionslast auf der einen Seite und Adaptation bzw. Konsolidierung auf der anderen Seite identifiziert werden. Jedoch zeigte sich in der Patientengruppe für den ersten Nachuntersuchungstag eine signifikant höhere Retentionsrate in der Subgruppe mit geringerer Leistung im 9-Lochsteck-Test. Insgesamt deuten die vorliegenden Daten auf eine erhaltene Fähigkeit zu adaptivem motorischen Lernen und somit auf eine erhaltene rasch einsetzende Neuroplastizität bei leicht bis mittelgradig betroffenen MS-Patienten hin; jedoch sprechen die Daten für eine eingeschränkte Konsolidierungsfähigkeit. Zentralnervöse Läsionslast scheint Motoradaptation und Konsolidierung nicht zu verhindern. Das genaue Verhältnis der Motoradapation und Konsolidierung zum klinischen Funktionserhalt konnte nicht genauer aufgeklärt werden. Um die genaue Beziehung zwischen Motoradaptation und Konsolidierung und klinischer Beeinträchtigung bzw. ZNS-Läsionen zu eruieren, bedarf es weiterer Studien. N2 - Multiple Sclerosis is a heterogenous disease. The intact ability of motor adaptation and consolidation could contribute to a favorable clinical course of the disease. We aimed to evaluate the adaptive motor learning and its consolidation in people with multiple sclerosis compared to neurologically healthy individuals. Further we analyzed its relationship to clinical and paraclinical parameters of disease course. Therefore 20 people with MS and 20 healthy individuals performed a visuoadaptive motor task. Participants sat in front of a computer screen and performed straight movements from a central starting point towards targets of varying positions with a computer mouse. Later a perturbation was introduced rotating the movement 30° clockwise. The aim was to compensate for the perturbation. The training session was repeated after 24 hours and after 72 hours. We measured the directional error, the rate of adaptation to the perturbation and the rate of retention on the following sessions. Motor impairments were estimated by the EDSS-Score and the 9-Hole-Peg-Test, CNS lesions were evaluated with cranial MRI and MEP. The adaptive learning within the training sessions was comparable in the MS group and the control group. However, the retention rate after 24 hours and after 72 hours was significantly lower in the MS group compared to the control group. The correlation analyses and the subgroup analyses after stratifying the MS group by EDSS-Score, 9-Hole-Peg-Test and CNS lesion load showed no consistent relation between motor adaptation and consolidation on the one hand and clinical impairments and CNS lesion load on the other hand. However, the retention rate after 24 hours was significantly higher in the MS-subgroup with more impaired hand function measured by the 9-Hole-Peg-Test. Our data indicate a preserved motor adaptation and therefore a preserved rapid-onset plasticity in people with MS with mild to moderate disease course. However, the data suggest an impaired consolidation in people with MS. CNS lesions seem not to prevent adaptive learning and consolidation. The exact relationship between motor learning and consolidation on the one hand and preservation of motor function on the other hand could not be unraveled. There are more studies needed to evaluate the relationship between motor adaptation/consolidation and clinical impairment and CNS lesion load. KW - Multiple Sklerose KW - Konsolidierung KW - motorisches Lernen KW - Neuronale Plastizität KW - Visuomotorisches Lernen KW - Motoradaptation KW - visuomotorisches Lernen KW - Motorkonsolidierung KW - Neuroplastizität KW - multiple sclerosis KW - consolidation KW - visuoadaptive motor task KW - neuronal plasticity KW - motor learning Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-252465 ER - TY - JOUR A1 - Vogt, Marius L. A1 - Kollikowski, Alexander M. A1 - Weidner, Franziska A1 - Strinitz, Marc A1 - Feick, Jörn A1 - Essig, Fabian A1 - Neugebauer, Herrmann A1 - Haeusler, Karl Georg A1 - Pham, Mirko A1 - Maerz, Alexander T1 - Safety and Effectiveness of the New Generation APERIO® Hybrid Stent-retriever Device in Large Vessel Occlusion Stroke JF - Clinical Neuroradiology N2 - Background It is unknown whether technological advancement of stent-retriever devices influences typical observational indicators of safety or effectiveness. Methods Observational retrospective study of APERIO® (AP) vs. new generation APERIO® Hybrid (APH) (Acandis®, Pforzheim, Germany) stent-retriever device (01/2019–09/2020) for mechanical thrombectomy (MT) in large vessel occlusion (LVO) stroke. Primary effectiveness endpoint was successful recanalization eTICI (expanded Thrombolysis In Cerebral Ischemia) ≥ 2b67, primary safety endpoint was occurrence of hemorrhagic complications after MT. Secondary outcome measures were time from groin puncture to first pass and successful reperfusion, and the total number of passes needed to achieve the final recanalization result. Results A total of 298 patients with LVO stroke who were treated by MT matched the inclusion criteria: 148 patients (49.7%) treated with AP vs. 150 patients (50.3%) treated with new generation APH. Successful recanalization was not statistically different between both groups: 75.7% for AP vs. 79.3% for APH; p = 0.450. Postinterventional hemorrhagic complications and particularly subarachnoid hemorrhage as the entity possibly associated with stent-retriever device type was significantly less frequent in the group treated with the APH: 29.7% for AP and 16.0% for APH; p = 0.005; however, rates of symptomatic hemorrhage with clinical deterioration and in domo mortality were not statistically different. Neither the median number of stent-retriever passages needed to achieve final recanalization, time from groin puncture to first pass, time from groin puncture to final recanalization nor the number of cases in which successful recanalization could only be achieved by using a different stent-retriever as bail-out device differed between both groups. Conclusion In the specific example of the APERIO® stent-retriever device, we observed that further technological developments of the new generation device were not associated with disadvantages with respect to typical observational indicators of safety or effectiveness. KW - APERIO Hybrid KW - mechanical thrombectomy KW - stent-retriever device KW - stroke KW - APERIO Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-264817 VL - 32 IS - 1 ER - TY - THES A1 - Lintner, Hannes T1 - Die Wertigkeit des Liquorbiomarkers CXCL-13 in der Diagnostik der Neuroborreliose und anderer neuroinflammatorischer Erkrankungen T1 - Sensitivity and specificity of cerebrospinal fluid CXCL13 for diagnosing Lyme neuroborreliosis : A study on 1410 patients and review of the literature N2 - Zu den häufigsten Symptomen der Neuroborreliose zählen Meningopolyradikulitis, lymphozytäre Meningitis und eine Beteiligung von Hirnnerven. Die Diagnosestellung erfolgt anhand klinischer Symptomatik, Liquoranalyse und Antikörperuntersuchungen von Liquor und Serum. Besonders in der Frühphase der Infektion gestaltet sich die Diagnosesicherung aufgrund der noch fehlenden Antikörperreaktion jedoch oftmals sehr schwierig. Die Ergebnisse mehrerer Studien legen nahe, dass CXCL-13 einen wertvollen Beitrag leisten könnte, um diese diagnostische Lücke zu schließen. Ziel der Studie war es, die Wertigkeit des Liquorbiomarkers CXCL-13 in der Diagnostik der Neuroborreliose und anderer neuroinflammatorischer Erkrankungen anhand eines großen unselektierten Kollektivs zu ermitteln, einen cut-off Wert für die Verwendung im klinischen Alltag zu definieren und die Ergebnisse mit der bestehenden Literatur zu vergleichen. Dafür wurden am Klinikum Wels-Grieskirchen über einen Zeitraum von 3 Jahren alle Patienten analysiert, bei denen im Rahmen einer Liquorpunktion die CXCL-13 Konzentration bestimmt wurde. Die Patienten wurden anhand der Hauptdiagnose bei Entlassung in 12 Diagnosegruppen aufgeteilt, für die Einteilung der Neuroborreliose Patienten wurden die Diagnoseleitlinien der DGN herangezogen. Alle Liquorproben wurden routinemäßig auf Zellzahl, Gesamteiweiß und Laktat untersucht, die CXCL-13 Konzentration wurde anhand eines enzyme-linked immunsorbent assay (CXCL-13 ELISA, Euroimmun) bestimmt. Unter den 1410 augewerteten Patienten fanden sich 29 Fälle mit gesicherter Neuroborreliose sowie 9 Fälle mit wahrscheinlicher/möglicher Neuroborreliose. Beide Neuroborreliosegruppen zeigten eine deutlich erhöhte mediane CXCL-13 Konzentration (554pg/ml bzw. 649pg/ml), in der Gruppe der bakteriellen und Pilzinfektionen (n=6) fand sich ebenfalls ein deutlich erhöhter Median von 410pg/ml. Alle anderen Gruppen wiesen signifikant niedrigere CXCL-13 Konzentrationen auf (p<0,001), lediglich bei sechs Patienten aus der Gruppe der soliden Tumore, darunter ein kutanes Lymphom und fünf hirneigene Tumore, wurden Werte über 500pg/ml gefunden. Anhand einer ROC-Kurve wurde der ideale cut-off für die Diagnose der gesicherten Neuroborreliose errechnet. Dieser lag bei 55,5pg/ml mit einer Sensitivität von 96,6% (95% KI 80,4-99,8%) und einer Spezifität von 94,9% (95% KI 93,5-95,9%). Bei 28 der 29 gesicherten Neuroborreliosefälle konnte ein positiver Antikörperindex nachgewiesen werden, dies entspricht einer Sensitivität von 96,6%. Der direkte Erregernachweis mittels PCR wurde bei neun Patienten durchgeführt, er war lediglich in zwei Fällen positiv, die Sensitivität lag bei 22,2%. Bei den Patienten mit wahrscheinlicher Neuroborreliose (n=5) war eine Bestimmung des Antikörper-Index nicht möglich, da entweder nur im Serum oder im Liquor borrelienspezifische Antikörper vorlagen. Alle Patienten zeigten eine typische klinische Symptomatik, eine lymphozytäre Pleozytose und deutlich erhöhte CXCL-13 Konzentrationen. Es erfolgte eine antibiotische Therapie mit Ceftriaxon, worauf die Symptomatik rasch rückläufig war. Die Ergebnisse der Studie bestätigen die hohe Wertigkeit von CXCL-13 für die Diagnose der Neuroborreliose und belegen die Übertragbarkeit der bisherigen Funde auf ein unselektiertes Patientenkollektiv. Die CXCL-13 Bestimmung ist dem direkten Erregernachweis deutlich überlegen, dieser ist aufgrund der niedrigen Sensitivität lediglich als Bestätigungstest geeignet. Im Vergleich zum borrelienspezifischen Antikörper-Index ist CXCL-13 als in etwa ebenbürtig anzusehen. Besonders in der Frühphase der Infektion bietet die CXCL-13 Bestimmung aufgrund der Latenzzeit bis zur Nachweisbarkeit von Antikörpern jedoch einen deutlichen Vorteil. Zusätzlich fällt die CXCL-13 Konzentration nach erfolgter Therapie rasch wieder ab, wodurch es sich auch als Verlaufsparameter eignet. Ein positiver Antikörper-Index kann über viele Jahre persistieren, weshalb eine Unterscheidung zwischen akuter und abgelaufener Infektion unmöglich ist. Am sinnvollsten erscheint eine Kombination von CXCL-13 und Antikörper-Index, in Verbindung mit der klinischen Präsentation ergibt sich so eine sehr hohe diagnostische Sicherheit in allen Stadien der Erkrankung. N2 - Introduction: The B-cell chemoattractant CXCL13 has been suggested as a cerebrospinal fluid (CSF) biomarker for Lyme neuroborreliosis (LNB). Our aim was to substantiate the value of CXCL13 in a large unselected cohort and determine a practical cut-off value to diagnose LNB. Methods: We retrospectively studied clinical and CSF data of consecutive patients who underwent CSF CXCL13 testing over a period of three years (February 2015 to January 2018) at our academic teaching hospital. Patients were classified into 12 groups according to their final diagnosis. To diagnose LNB (definite or probable/possible), definitions of the respective guideline of the German Neurological Society were applied. Results: Of 1410 patients, 29 were diagnosed with definite LNB and 9 with probable/possible LNB. Median CXCL13 levels were highly elevated in both LNB groups (exceeding the test limit of 500 pg/mL) and the group with bacterial/fungal CNS infections (410 pg/mL; n= 6), while the other nine disease groups had markedly lower median CXCL13 levels (p < 0.001). For definite LNB, the best CXCL13 test cut-off was 55.5 pg/mL with a sensitivity of 96.6% (95% confidence interval, CI, 80.4%-99.8%) and a specificity of 94.9% (95% CI 93.5%- 95.9%). All patients diagnosed with LNB showed improvement of clinical symptoms after antibiotic treatment. Conclusion: In this large monocentric cohort, CSF CXCL13 was found to be a highly sensitive and useful marker for LNB. A review of the literature on the sensitivity and specificity of CSF CXCL13 in the differential of LNB is provided. KW - Borreliose KW - Neuroborreliose Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260471 ER - TY - THES A1 - Schanz, Stefan T1 - Rehabilitation des Schlaganfalls – Evaluation eines interdisziplinären Behandlungskonzepts auf einer spezialisierten Station T1 - Stroke rehabilitation – evaluation of an interdisciplinary treatment concept on a specialized ward N2 - Die Rehabilitation von Schlaganfallpatienten erfordert ein interdisziplinäres Vorgehen. Dies ist im klinischen Alltag oft nur schwer umsetzbar. Im Jahr 2011 wurde daher im Neurologischen Rehabilitationszentrum Quellenhof in Bad Wildbad ein spezielles Behandlungskonzept für Schlaganfallpatienten entwickelt. Mit dieser Studie sollte die Wirksamkeit dieses neuen Konzepts untersucht werden. Dabei wurde die Behandlung im Schlaganfallkonzept mit der bisher üblichen Behandlung verglichen. Zielparameter waren der Barthel-Index und die modifizierte Rankin-Skala bei Aufnahme und bei Entlassung. Die Ergebnisse zeigen, dass sowohl die bisherige Behandlung als auch die Behandlung im Schlaganfallkonzept effektiv sind. Im Schlaganfallkonzept konnte jedoch ein größerer Zugewinn an alltagsrelevanten Fähigkeiten erzielt werden; zudem berichteten Pflegekräfte und Therapeuten eine verbesserte Zusammenarbeit. Somit steigert das Schlaganfallkonzept nicht nur die Alltagskompetenz der Patienten, sondern auch den Wissenstransfer zwischen den Berufsgruppen und die Interdisziplinarität. N2 - Rehabilitation of patients with stroke requires an interdisciplinary approach that is difficult to implement in everyday clinical life. Therefore, in 2011 the Neurological Rehabilitation Center Quellenhof in Bad Wildbad established a unique therapy concept. This study investigated the efficacy of this newly developed concept by comparing it to usual treatment. Main outcome parameters were the Barthel-Index and the modified Rankin-Scale at admission and discharge. The results show that the therapy in the usual treatment group as well as in the newly developed concept group is effective. However, therapy in the newly developed concept group leads to more progress in the activities of daily living of patients and also improved knowledge and cooperation within the rehabilitation team. KW - Schlaganfall KW - Rehabilitation KW - Barthel-Index modifizierte Rankin-Skala KW - stroke KW - rehabilitation KW - Barthel-Index modified Rankin-Scale Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260011 ER - TY - THES A1 - Bohr, Arne T1 - Über den Einfluss einer kontinuierlichen tiefen Hirnstimulation des pedunkulopontinen tegmentalen Nucleus auf motorische Defizite in einem Ratten-Schlaganfallmodell T1 - Deep Brain Stimulation for Stroke: Continuous Stimulation of the Pedunculopontine Tegmental Nucleus has no Impact on Skilled Walking in Rats After Photothrombotic Stroke N2 - Bei einem ischämischen Schlaganfall bestehen neben dem Verlust von neuronalen Zellen auch dysfunktionale Signale, die sich pathologisch auf die tieferen motorischen Zentren des zentralen Nervensystems auswirken können. Mittels tiefer Hirnstimulation kann die Weiterleitung pathologischer Signale im Bereich des neuronalen Netzwerks unterbrochen werden. In dieser Arbeit wurde ein Tiermodell verwendet, in welchem bei insgesamt 18 Ratten ein photothrombotischer Schlaganfall des rechten sensomotorischen Kortex induziert wurde. Nachdem bei jedem Tier eine Mikroelektrode in den Bereich des pedunkulopontinen tegmentalen Nucleus implantiert worden war, wurde eine kontinuierliche tiefe Hirnstimulation über 10 Tage durchgeführt. Die Gegenüberstellung der Fall- und Kontrollgruppe im Beam-Walking- und Ladder-Rung-Walking-Test ergab hierbei keine Verbesserung der motorischen Defizite durch die Intervention. Das Ergebnis lässt sich vor dem Hintergrund neuerer Erkenntnisse einordnen, nach welchen der pedunkulopontine tegmentale Nucleus nicht für die Bewegungsinitiierung verantwortlich ist. N2 - Abstract: Background: Gait impairment after stroke is considered as a loss of cerebral function but is also the result of dysfunctional cerebral signals travelling to the spinal motor centres. A therapeutic option to restore disturbed cerebral network activity is deep brain stimulation (DBS). Methods: A promising target for neuromodulation might be the pedunculopontine tegmental nucleus (PPTg), which contributes to the initiation and control of gait. To test this hypothesis, we trained eighteen rats to cross a horizontal ladder and a wooden beam before inflicting a photothrombosis in the right sensorimotor cortex and implanting a stimulating electrode in the ipsilateral PPTg. Results: Continuous high-frequency DBS (130 Hz; amplitude 55 ± 5 μA) of rats for 10 days yielded no significant improvement of skilled walking when examined with the ladder rung walking test and beam walking test compared to sham-stimulation. Conclusion: In contrast to DBS of the cuneiform nucleus, PPTg-stimulation improves neither control of gait nor balance after stroke. KW - Schlaganfall KW - Hirnstimulation KW - Tiefe Hirnstimulation KW - Ischämischer Schlaganfall KW - Ladder-Rung-Walking-Test KW - Beam-Walking-Test KW - Photothrombotic Stroke KW - Deep Brain Stimulation KW - Mesencephal Locomotor Region KW - Mesenzephale Lokomotor Region KW - Pedunculopontiner tegmentaler Nukleus Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-271876 PB - Current Neurovascular Research ER - TY - THES A1 - Hochheimer, Vanessa Christine T1 - Of cells and enzymes: How dermal fibroblasts can impact pain in Fabry Disease and Why looking at the 3D-structure of α-Galactosidase A may be worthwhile for clinical management of Fabry patients T1 - Über Zellen und Enzyme: Wie Hautfibroblasten Schmerz bei Morbus Fabry beeinflussen können und Warum sich die Betrachtung der 3D-Struktur der α-Galaktosidase A für die klinische Versorgung von Fabry Patienten lohnt N2 - Fabry Disease (FD) is a genetic lysosomal storage disorder based on mutations in the gene encoding α-Galactosidase A (α-GalA) leading to accumulation of globotriaosylceramide (Gb3). Missense mutations induce an amino acid exchange (AAE) in the α-GalA. Pain is a predominant symptom in FD and the pathophysiology is unclear. Skin punch biopsies were obtained from 40 adult FD patients and ten healthy controls and dermal fibroblast cultures were generated for cell culture experiments to investigate Gb3 load, gene and protein expression patterns and ion channel activity. The 3D-structure of α-GalA was downloaded into Pymol Graphics System and the AAE was depicted and located in order to investigate the correlation between the AAE location type in the α-GalA and the clinical FD phenotype. FD dermal fibroblasts showed high Gb3 load depending on treatment interval and expressed Kca1.1 channels. Activity was reduced in FD cells at baseline, but increased over-proportionately upon Gb3-cleavage by enzyme replacement therapy. Gene and protein expression of Kca1.1 was increased in FD cells. FD dermal fibroblasts showed higher gene expression of Notch1 and several cytokines. Further, it was shown that three different AAE location types can be differentiated: mutations in the active site (‘active site’), those buried in the core of α-GalA (‘buried’) and those at another location, mostly on the protein surface (‘other’). FD patients carrying active site or buried mutations showed a severe clinical phenotype with multi-organ manifestation and early disease onset. Patients with other mutations were less severely affected with oligo-organ manifestation sparing the nervous system and later disease onset. These results show that dermal fibroblasts may be involved in FD-associated pain and that stratification of FD patients carrying missense mutations by AAE location type may be an advantageous parameter that can help in the management of FD patients. N2 - M. Fabry ist eine genetisch bedingte lysosomale Speichererkrankung aufgrund von Mutationen im Gen der α-Galaktosidase A (α-GalA) mit Ablagerung von Globotriaosylceramid (Gb3). Missense-Mutationen führen zum Austausch einer Aminosäure (ASA) in der α-GalA. Schmerz ist ein häufiges Symptom, dessen Pathophysiologie unklar ist. Bei 40 Patient*innen mit M. Fabry sowie zehn Kontrollprobanden wurde eine Hautstanzbiopsie durchgeführt und zur Kultivierung von dermalen Fibroblasten verwendet, um den Gb3-Gehalt, Gen- und Proteinexpressionsmuster und Ionenkanalaktivität zu untersuchen. Zudem wurde die 3D-Struktur der α-GalA in Pymol Graphics System geladen und der Ort des ASA dargestellt, um den Zusammenhang zwischen dem ASA in der α-GalA und dem klinischen Phänotypen zu untersuchen. Es zeigte sich, dass Fabry-Fibroblasten erhöhte Gb3-Ablagerungen beinhalten, abhängig von der Zeit zwischen Enzymersatztherapie (ERT) und Biospieentnahme, sowie Kca1.1 Kanäle, deren Funktion in Patientenzellen unter Normalbedingungen reduziert war, der jedoch eine überproportionale Aktivitätszunahme nach Gb3-Abbau mittels ERT zeigte. Die Gen- und Proteinexpression des Kanals war in Fabry-Zellen erhöht. Fabry-Zellen wiesen eine erhöhte Genexpression von Notch1 sowie mehrerer Zytokine auf. Zudem zeigte sich, dass es drei verschiedene ASA Gruppen gab: Mutationen im aktiven Zentrum („active site“), in der Tiefe des Enzyms („buried“) und an anderen Orten, meist an der Oberfläche („other“). Patient*innen mit active site- oder buried-Mutationen zeigten einen schweren Phänotypen mit Multi-Organbeteiligung und frühem Krankheitsbeginn. Patient*innen mit other-Mutationen zeigten eine Beteiligung von wenigen Organen ohne Nervensystem und späteren Krankheitsbeginn. Es zeigt sich, dass dermale Fibroblasten zu Schmerz bei M. Fabry beitragen können und die Einteilung von Patient*innen mit M. Fabry-Missense Mutationen anhand des Ortes des ASA ein lohnender Parameter bei der Betreuung der Patient*innen sein kann. KW - Fabry-Krankheit KW - Hautzelle KW - Schmerz KW - Fabry KW - Fibroblasten KW - 3D-Struktur KW - Fabry disease KW - Pain KW - Fibroblasts KW - 3D structure Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-296607 ER - TY - JOUR A1 - Aster, H-C A1 - Evdokimov, D. A1 - Braun, A. A1 - Üçeyler, N. A1 - Sommer, C. T1 - Analgesic Medication in Fibromyalgia Patients: A Cross-Sectional Study JF - Pain Research and Management N2 - There is no approved drug for fibromyalgia syndrome (FMS) in Europe. In the German S3 guideline, amitriptyline, duloxetine, and pregabalin are recommended for temporary use. The aim of this study was to cross-sectionally investigate the current practice of medication in FMS patients in Germany. We systematically interviewed 156 patients with FMS, while they were participating in a larger study. The patients had been stratified into subgroups with and without a decrease in intraepidermal nerve fiber density. The drugs most commonly used to treat FMS pain were nonsteroidal anti-inflammatory drugs (NSAIDs) (41.0% of all patients), metamizole (22.4%), and amitriptyline (12.8%). The most frequent analgesic treatment regimen was “on demand” (53.9%), during pain attacks, while 35.1% of the drugs were administered daily and the remaining in other regimens. Median pain relief as self-rated by the patients on a numerical rating scale (0–10) was 2 points for NSAIDS, 2 for metamizole, and 1 for amitriptyline. Drugs that were discontinued due to lack of efficacy rather than side effects were acetaminophen, flupirtine, and selective serotonin reuptake inhibitors. Reduction in pain severity was best achieved by NSAIDs and metamizole. Our hypothesis that a decrease in intraepidermal nerve fiber density might represent a neuropathic subtype of FMS, which would be associated with better effectiveness of drugs targeting neuropathic pain, could not be confirmed in this cohort. Many FMS patients take “on-demand” medication that is not in line with current guidelines. More randomized clinical trials are needed to assess drug effects in FMS subgroups. KW - Fibromyalgia KW - analgesic medication KW - study Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300578 VL - 2022 ER - TY - JOUR A1 - Lorenz, Delia A1 - Musacchio, Thomas A1 - Kunstmann, Erdmute A1 - Grauer, Eva A1 - Pluta, Natalie A1 - Stock, Annika A1 - Speer, Christian P. A1 - Hebestreit, Helge T1 - A case report of Sanfilippo syndrome - the long way to diagnosis JF - BMC Neurology N2 - Background Mucopolysaccharidosis type III (Sanfilippo syndrome) is a lysosomal storage disorder, caused by a deficiency in the heparan-N-sulfatase enzyme involved in the catabolism of the glycosaminoglycan heparan sulfate. It is characterized by early nonspecific neuropsychiatric symptoms, followed by progressive neurocognitive impairment in combination with only mild somatic features. In this patient group with a broad clinical spectrum a significant genotype-phenotype correlation with some mutations leading to a slower progressive, attenuated course has been demonstrated. Case presentation Our patient had complications in the neonatal period and was diagnosed with Mucopolysaccharidosis IIIa only at the age of 28 years. He was compound heterozygous for the variants p.R245H and p.S298P, the latter having been shown to lead to a significantly milder phenotype. Conclusions The diagnostic delay is even more prolonged in this patient population with comorbidities and a slowly progressive course of the disease. KW - Mucopolysaccharidosis IIIa KW - diagnostic delay KW - genotype-phenotype correlation KW - p.S298P KW - p.R245H Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300465 VL - 22 IS - 1 ER - TY - JOUR A1 - Klein, Dennis A1 - Groh, Janos A1 - Yuan, Xidi A1 - Berve, Kristina A1 - Stassart, Ruth A1 - Fledrich, Robert A1 - Martini, Rudolf T1 - Early targeting of endoneurial macrophages alleviates the neuropathy and affects abnormal Schwann cell differentiation in a mouse model of Charcot-Marie-Tooth 1A JF - Glia N2 - We have previously shown that targeting endoneurial macrophages with the orally applied CSF-1 receptor specific kinase (c-FMS) inhibitor PLX5622 from the age of 3 months onwards led to a substantial alleviation of the neuropathy in mouse models of Charcot-Marie-Tooth (CMT) 1X and 1B disease, which are genetically-mediated nerve disorders not treatable in humans. The same approach failed in a model of CMT1A (PMP22-overexpressing mice, line C61), representing the most frequent form of CMT. This was unexpected since previous studies identified macrophages contributing to disease severity in the same CMT1A model. Here we re-approached the possibility of alleviating the neuropathy in a model of CMT1A by targeting macrophages at earlier time points. As a proof-of-principle experiment, we genetically inactivated colony-stimulating factor-1 (CSF-1) in CMT1A mice, which resulted in lower endoneurial macrophage numbers and alleviated the neuropathy. Based on these observations, we pharmacologically ablated macrophages in newborn CMT1A mice by feeding their lactating mothers with chow containing PLX5622, followed by treatment of the respective progenies after weaning until the age of 6 months. We found that peripheral neuropathy was substantially alleviated after early postnatal treatment, leading to preserved motor function in CMT1A mice. Moreover, macrophage depletion affected the altered Schwann cell differentiation phenotype. These findings underscore the targetable role of macrophage-mediated inflammation in peripheral nerves of inherited neuropathies, but also emphasize the need for an early treatment start confined to a narrow therapeutic time window in CMT1A models and potentially in respective patients. KW - colony stimulating factor 1 KW - Schwann cell differentiation KW - neuroinflammation KW - macrophage KW - inherited peripheral neuropathy Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318714 VL - 70 IS - 6 SP - 1100 EP - 1116 ER - TY - JOUR A1 - Özdağ Acarlı, Ayşe Nur A1 - Klein, Thomas A1 - Egenolf, Nadine A1 - Sommer, Claudia A1 - Üçeyler, Nurcan T1 - Subepidermal Schwann cell counts correlate with skin innervation - an exploratory study JF - Muscle & Nerve N2 - Introduction/Aims Schwann cell clusters have been described at the murine dermis-epidermis border. We quantified dermal Schwann cells in the skin of patients with small-fiber neuropathy (SFN) compared with healthy controls to correlate with the clinical phenotype. Methods Skin punch biopsies from the lower legs of 28 patients with SFN (11 men, 17 women; median age, 54 [range, 19-73] years) and 9 healthy controls (five men, four women, median age, 34 [range, 25-69] years) were immunoreacted for S100 calcium-binding protein B as a Schwann cell marker, protein-gene product 9.5 as a pan-neuronal marker, and CD207 as a Langerhans cell marker. Intraepidermal nerve fiber density (IENFD) and subepidermal Schwann cell counts were determined. Results Skin samples of patients with SFN showed lower IENFD (P < .05), fewer Schwann cells per millimeter (P < .01), and fewer Schwann cell clusters per millimeter (P < .05) than controls. When comparing SFN patients with reduced (n = 13; median age, 53 [range, 19-73] years) and normal distal (n = 15, median age, 54 [range, 43-68] years) IENFD, the number of solitary Schwann cells per millimeter (p < .01) and subepidermal nerve fibers associated with Schwann cell branches (P < .05) were lower in patients with reduced IENFD. All three parameters correlated positively with distal IENFD (P < .05 to P < .01), whereas no correlation was found between Schwann cell counts and clinical pain characteristics. Discussion Our data raise questions about the mechanisms underlying the interdependence of dermal Schwann cells and skin innervation in SFN. The temporal course and functional impact of Schwann cell presence and kinetics need further investigation. KW - intraepidermal nerve fiber density KW - small-fiber neuropathy KW - skin punch biopsy KW - Schwann cell KW - neuropathic pain KW - innervation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318726 VL - 65 IS - 4 SP - 471 EP - 479 ER - TY - JOUR A1 - Schreglmann, Sebastian R. A1 - Burke, Derek A1 - Batla, Amit A1 - Kresojevic, Nikola A1 - Wood, Nicholas A1 - Heales, Simon A1 - Bhatia, Kailash P. T1 - Cerebellar and Midbrain Lysosomal Enzyme Deficiency in Isolated Dystonia JF - Movement Disorders KW - dystonia KW - lysosomal enzyme KW - diagnostics Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318743 VL - 37 IS - 4 SP - 875 EP - 877 ER - TY - JOUR A1 - Schreglmann, Sebastian R. A1 - Bhatia, Kailash P. T1 - HOPS-Associated Neurological Disorders: Lysosomal Dysfunction as an Emerging Concept Underlying Dystonia JF - Movement Disorders Clinical Practice KW - dystonia KW - homotypic fusion and protein sorting KW - lysosomal dysfunction Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318736 VL - 9 IS - 4 SP - 452 EP - 453 ER - TY - JOUR A1 - Friedrich, Maximilian U. A1 - Eldebakey, Hazem A1 - Roothans, Jonas A1 - Capetian, Philipp A1 - Zwergal, Andreas A1 - Volkmann, Jens A1 - Reich, Martin T1 - Current-dependent ocular tilt reaction in deep brain stimulation of the subthalamic nucleus: Evidence for an incerto-interstitial pathway? JF - European Journal of Neurology N2 - Background and purpose The aim was to characterize a combined vestibular, ocular motor and postural syndrome induced by deep brain stimulation (DBS) of the subthalamic nucleus in a patient with Parkinson's disease. Methods In a systematic DBS programming session, eye, head and trunk position in roll and pitch plane were documented as a function of stimulation amplitude and field direction. Repeat ocular coherence tomography was used to estimate ocular torsion. The interstitial nucleus of Cajal (INC), zona incerta (ZI) and ascending vestibular fibre tracts were segmented on magnetic resonance imaging using both individual and normative structural connectomic data. Thresholded symptom-associated volumes of tissue activated (VTA) were calculated based on documented stimulation parameters. Results Ipsilateral ocular tilt reaction and body lateropulsion as well as contralateral torsional nystagmus were elicited by the right electrode in a current-dependent manner and subsided after DBS deactivation. With increasing currents, binocular tonic upgaze and body retropulsion were observed. Symptoms were consistent with an irritative effect on the INC. Symptom-associated VTA was found to overlap with the dorsal ZI and the ipsilateral vestibulothalamic tract, while lying rather distant to the INC proper. A ZI-to-INC ‘incerto-interstitial’ tract with contact to the medial-uppermost portion of the VTA could be traced. Conclusion Unilateral stimulation of INC-related circuitry induces an ipsilateral vestibular, ocular motor and postural roll-plane syndrome, which converts into a pitch-plane syndrome when functional activation expands bilaterally. In this case, tractography points to an incerto-interstitial pathway, a tract previously only characterized in non-human primates. Directional current steering proved useful in managing this rare side effect. KW - deep brain stimulation KW - vestibular KW - movement disorders Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318700 VL - 29 IS - 5 SP - 1545 EP - 1549 ER - TY - JOUR A1 - Sommer, Claudia T1 - Natural course of Guillain-Barré syndrome JF - European Journal of Neurology KW - Guillain-Barré syndrome KW - intravenous immunoglobulin KW - immunomodulation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318757 VL - 29 IS - 10 SP - 2881 EP - 2882 ER - TY - JOUR A1 - Badr, Mohammad A1 - McFleder, Rhonda L. A1 - Wu, Jingjing A1 - Knorr, Susanne A1 - Koprich, James B. A1 - Hünig, Thomas A1 - Brotchie, Jonathan M. A1 - Volkmann, Jens A1 - Lutz, Manfred B. A1 - Ip, Chi Wang T1 - Expansion of regulatory T cells by CD28 superagonistic antibodies attenuates neurodegeneration in A53T-α-synuclein Parkinson’s disease mice JF - Journal of Neuroinflammation N2 - Background Regulatory CD4\(^+\)CD25\(^+\)FoxP3\(^+\) T cells (Treg) are a subgroup of T lymphocytes involved in maintaining immune balance. Disturbance of Treg number and impaired suppressive function of Treg correlate with Parkinson’s disease severity. Superagonistic anti-CD28 monoclonal antibodies (CD28SA) activate Treg and cause their expansion to create an anti-inflammatory environment. Methods Using the AAV1/2-A53T-α-synuclein Parkinson’s disease mouse model that overexpresses the pathogenic human A53T-α-synuclein (hαSyn) variant in dopaminergic neurons of the substantia nigra, we assessed the neuroprotective and disease-modifying efficacy of a single intraperitoneal dose of CD28SA given at an early disease stage. Results CD28SA led to Treg expansion 3 days after delivery in hαSyn Parkinson’s disease mice. At this timepoint, an early pro-inflammation was observed in vehicle-treated hαSyn Parkinson’s disease mice with elevated percentages of CD8\(^+\)CD69\(^+\) T cells in brain and increased levels of interleukin-2 (IL-2) in the cervical lymph nodes and spleen. These immune responses were suppressed in CD28SA-treated hαSyn Parkinson’s disease mice. Early treatment with CD28SA attenuated dopaminergic neurodegeneration in the SN of hαSyn Parkinson’s disease mice accompanied with reduced brain numbers of activated CD4\(^+\), CD8\(^+\) T cells and CD11b\(^+\) microglia observed at the late disease-stage 10 weeks after AAV injection. In contrast, a later treatment 4 weeks after AAV delivery failed to reduce dopaminergic neurodegeneration. Conclusions Our data indicate that immune modulation by Treg expansion at a timepoint of overt inflammation is effective for treatment of hαSyn Parkinson’s disease mice and suggest that the concept of early immune therapy could pose a disease-modifying option for Parkinson’s disease patients. KW - Parkinson’s disease KW - neuroinflammation KW - T cells KW - regulatory T cells KW - neuroprotection Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300580 VL - 19 ER - TY - JOUR A1 - Traub, Jan A1 - Otto, Markus A1 - Sell, Roxane A1 - Göpfert, Dennis A1 - Homola, György A1 - Steinacker, Petra A1 - Oeckl, Patrick A1 - Morbach, Caroline A1 - Frantz, Stefan A1 - Pham, Mirko A1 - Störk, Stefan A1 - Stoll, Guido A1 - Frey, Anna T1 - Serum phosphorylated tau protein 181 and neurofilament light chain in cognitively impaired heart failure patients JF - Alzheimer's Research & Therapy N2 - Background Chronic heart failure (HF) is known to increase the risk of developing Alzheimer’s dementia significantly. Thus, detecting and preventing mild cognitive impairment, which is common in patients with HF, is of great importance. Serum biomarkers are increasingly used in neurological disorders for diagnostics, monitoring, and prognostication of disease course. It remains unclear if neuronal biomarkers may help detect cognitive impairment in this high-risk population. Also, the influence of chronic HF and concomitant renal dysfunction on these biomarkers is not well understood. Methods Within the monocentric Cognition.Matters-HF study, we quantified the serum levels of phosphorylated tau protein 181 (pTau) and neurofilament light chain (NfL) of 146 extensively phenotyped chronic heart failure patients (aged 32 to 85 years; 15.1% women) using ultrasensitive bead-based single-molecule immunoassays. The clinical work-up included advanced cognitive testing and cerebral magnetic resonance imaging (MRI). Results Serum concentrations of NfL ranged from 5.4 to 215.0 pg/ml (median 26.4 pg/ml) and of pTau from 0.51 to 9.22 pg/ml (median 1.57 pg/ml). We detected mild cognitive impairment (i.e., T-score < 40 in at least one cognitive domain) in 60% of heart failure patients. pTau (p = 0.014), but not NfL, was elevated in this group. Both NfL (ρ = − 0.21; p = 0.013) and pTau (ρ = − 0.25; p = 0.002) related to the cognitive domain visual/verbal memory, as well as white matter hyperintensity volume and cerebral and hippocampal atrophy. In multivariable analysis, both biomarkers were independently influenced by age (T = 4.6 for pTau; T = 5.9 for NfL) and glomerular filtration rate (T = − 2.4 for pTau; T = − 3.4 for NfL). Markers of chronic heart failure, left atrial volume index (T = 4.6) and NT-proBNP (T = 2.8), were further cardiological determinants of pTau and NfL, respectively. In addition, pTau was also strongly affected by serum creatine kinase levels (T = 6.5) and ferritin (T = − 3.1). Conclusions pTau and NfL serum levels are strongly influenced by age-dependent renal and cardiac dysfunction. These findings point towards the need for longitudinal examinations and consideration of frequent comorbidities when using neuronal serum biomarkers. KW - Alzheimer’s dementia KW - heart failure KW - cognitive impairment KW - neurofilament light chain KW - phosphorylated tau protein KW - renal function KW - age Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300515 VL - 14 ER - TY - THES A1 - Hemprich, Antonia T1 - Detektion von Autoantikörpern gegen Cortactin und Agrin im Serum von Patient*innen mit Myasthenia gravis T1 - Detection of autoantibodies against cortactin and agrin in the serum of myasthenia gravis patients N2 - Myasthenia gravis ist eine Autoimmunerkrankung, die durch Störung der Erregungsübertragung an der neuromuskulären Endplatte zu einer Schwäche der Muskulatur führt. In dieser Arbeit wird die Rolle von Cortactin und Agrin als potentielle neue Antigene von Autoantikörpern bei Myasthenia gravis untersucht. Die detektierten Antikörper werden charakterisiert und die klinischen Merkmale der Patient*innen ausgewertet. N2 - Myasthenia gravis is an autoimmune disease that leads to muscle weakness through an impaired signal transmission at the neuromuscular junction. This publication examines the role of cortactin and agrin as new potential antigens of autoantibodies in myasthenia gravis. The detected antibodies are characterized and the clinical features of the patients are evaluated. KW - Myasthenia gravis KW - Agrin KW - Autoantikörper KW - autoantibodies KW - Cortactin KW - Cgrin KW - agrin Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-286920 ER - TY - THES A1 - Özkent, Helena T1 - Untersuchung der Beteiligung der kleinen Nervenfasern bei Patient/-innen mit Antikörper-assoziierten Neuropathien T1 - Investigation of the involvement of small nerve fibers in patients with antibody-associated neuropathies N2 - In der vorliegenden Studie wurden QST, QSART, Hautbiopsien und Fragebögen genutzt, um die Beteiligung kleiner Nervenfasern bei verschiedenen Formen der Immunneuropathien zu untersuchen. Wir konnten hierbei eine signifikante Beeinträchtigung der thermischen Reizleitung bei CIDP- und MADSAM-Patient/-innen nachweisen sowie eine signifikant reduzierte Schweißproduktion am distalen Unterschenkel bei MADSAM-Patient/-innen. Diese Ergebnisse belegen in allen drei Untergruppen der immunvermittelten Neuropathien eine Beteiligung kleiner auch unmyelinisierter Nervenfasertypen. MADSAM- und CIDP-Patient/-innen wiesen in der QST ein ähnliches Schädigungsmuster auf. Dagegen unterschieden sie sich signifikant in der QSART. Diese Ergebnisse können als weiterer Hinweis auf unterschiedliche zugrundeliegende Pathomechanismen verstanden werden. MMN-Patient/-innen wiesen insgesamt die geringste Small-Fiber-Beteiligung in den quantitativen Testungen auf. Auch lagen bei MMN-Patient/-innen durchschnittlich die geringsten Schmerz-Scores und autonomen Symptome vor. Es zeigten sich wenig signifikante Unterschiede zwischen seropositiven und seronegativen Neuropathie-Patient/-innen. Diese jedoch bestätigten unsere Hypothese einer etwas geringeren Small-Fiber-Beteiligung bei seropositiven Patient/-innen. Bei der Vielzahl an unterschiedlichen Pathomechanismen innerhalb der immunvermittelten Neuropathien erscheinen weitere Subklassifizierungen für eine optimale Diagnosestellung und Therapie unabdingbar. Diese Arbeit konnte mit den oben genannten Untersuchungen einen weiteren Beitrag zur Identifikation von klinischen und quantitativen Unterschieden innerhalb dieser großen Erkrankungsgruppe leisten. Künftige, größere Studien dieser Art können möglicherweise hier nur als Tendenzen gesehene Erkenntnisse belegen und sollten durch zusätzliche Informationen wie Korrelation zu Krankheitsdauer, Therapie, Laborchemie und elektrophysiologischen Untersuchen weitere interessante Erkenntnisse liefern. N2 - In the present study QST, QSART, skin biopsies and questionnaires were used to examine the involvement of small nerve fibers in different forms of immune-mediated neuropathies. Here, we demonstrated significant impairment of thermal conduction in CIDP and MADSAM patients and a significantly reduced sweat production at the distal lower leg in MADSAM patients. These results demonstrate an involvement of small unmyelinated nerve fibers in all three subgroups of immune-mediated neuropathies. MADSAM and CIDP patients showed a similar pattern of damage in QST. In contrast, they differed significantly in QSART. These results can be understood as further evidence of different underlying pathomechanisms. MMN patients had the lowest overall small-fiber involvement in our quantitative tests and suffered from less pain and autonomic symptoms compared to CIDP and MADSAM. There were few significant differences between seropositive and seronegative neuropathy patients. However, these confirmed our hypothesis of slightly lower small-fiber involvement in seropositive patients. Given the large number of different pathomechanisms within immune-mediated neuropathies, further subclassifications seem essential for optimal diagnosis and therapy. With these results this work could contribute further aspects to the identification of clinical and quantitative differences within immune-mediated neuropathies. Future larger studies of this type may be able to substantiate findings - seen here only as trends - and should provide further interesting insights through additional information such as correlation to disease duration, therapy, laboratory chemistry and electrophysiological studies. KW - Polyneuropathie KW - Nervenfaser KW - Neuropathie KW - Quantitativ Sensorische Testung KW - QSART KW - Hautbiopsie KW - small nerve fibers Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-269293 ER - TY - THES A1 - Karch, Katharina T1 - Mapping and Neutralization of Antibodies against Neurofascin, Contactin 1, Contactin associated protein 1 and Cortactin T1 - Kartierung und Neutralisation von Antikörpern gegen Neurofascin, Contactin 1, Contactin assoziiertes Protein 1 und Cortactin N2 - Immune-mediated polyneuropathies like chronic inflammatory demyelinating polyradiculoneuropathy or Guillain-Barré syndrome are rare diseases of the peripheral nervous system. A subgroup of patients harbors autoantibodies against nodal or paranodal antigens, associated with a distinct phenotype and treatment response. In a part of patients with pathologic paranodal or nodal immunoreactivity the autoantigens remain difficult or impossible to determine owing to limitations of the used detection approach - usually ELISAs (enzyme-linked-immunosorbent-assays) - and incomplete knowledge of the possible autoantigens. Due to their high-throughput, low sample consumption and high sensitivity as well as the possibility to display many putative nodal and paranodal autoantigens simultaneously, peptide microarray-based approaches are prime candidates for the discovery of novel autoantigens, point-of-care diagnostics and, in addition, monitoring of pathologic autoimmune response. Current applications of peptide microarrays are however limited by high false-positive rates and the associated need for detailed follow-up studies and validation. Here, robust peptide microarray-based detection of antibodies and the efficient validation of binding signals by on-chip neutralization is demonstrated. First, autoantigens were displayed as overlapping peptide libraries in microarray format. Copies of the biochips were used for the fine mapping of antibody epitopes. Next, binding signals were validated by antibody neutralization in solution. Since neutralizing peptides are obtained in the process of microarray fabrications, neither throughput nor costs are significantly altered. Similar in-situ validation approaches could contribute to future autoantibody characterization and detection methods as well as to therapeutic research. Areas of application could be expanded to any autoimmune-mediated neurological disease as a long-term vision. N2 - Immunvermittelte Polyneuropathien wie die chronisch-inflammatorische demyelinisierende Polyradikuloneuropathie oder das Guillain-Barré-Syndrom sind seltene Erkrankungen des peripheren Nervensystems. Bei einem Teil dieser Patienten lassen sich Autoantikörper gegen nodale oder paranodale Antigene nachweisen, was mit einem bestimmten Phänotyp und Therapienansprechen assoziiert ist. Aufgrund der Einschränkungen verwendeter Detektionsansätze – üblicherweise ELISAs (Enzyme-linked Immunosorbent Assays) – sowie der unvollständigen Kenntnis potenzieller Autoantigene bleibt es bisher zum Teil schwierig bis unmöglich bei nachgewiesener pathologischer paranodaler bzw. nodaler Immunreaktivität die entsprechenden Autoantigene zu identifizieren. Die hohe Durchsatzleistung, der geringe Verbrauch an Probenmaterial, die hohe Sensitivität sowie die Möglichkeit zahlreiche mutmaßliche nodale und paranodale Autoantigene zeitgleich darzustellen machen Peptid-Microarray-basierte Ansätze zu wesentlichen Kandidaten für die Entdeckung neuer Autoantigene, für Point-of-Care-Diagnostik und darüber hinaus für das Monitoring pathologischer Autoimmunantworten. Durch die hohe Rate falsch positiver Ergebnisse sowie die damit verbundene Notwendigkeit detaillierter Folgestudien und Validierungen sind die gegenwärtigen Anwendungen von Peptid-Microarrays jedoch limitiert. In dieser Arbeit wird eine robuste, Peptid-Microarray-basierte Detektion von Antikörpern sowie eine effiziente Validierung der Bindungssignale mittels On-chip Neutralisation demonstriert. Zuerst wurden die Autoantigene als überlappende Peptidbüchereien im Microarray-Format dargestellt. Kopien der Biochips wurden für die Feinkartierung der Antikörper-Epitope verwendet. Mittels Antikörperneutralisation in Lösung wurden die Bindungssignale anschließend validiert. Da die neutralisierenden Peptide im Microarray- Herstellungsprozess gewonnen werden, ergeben sich weder beim Durchsatz noch bei den Kosten signifikante Änderungen. Vergleichbare In-situ-Validierungsansätze könnten zu künftigen Autoantikörper Charakterisierungen, Detektionsmethoden sowie zu therapeutischen Forschungsansätzen beitragen. Als langfristige Vision könnten die Anwendungsgebiete auf jede beliebige autoimmun-vermittelte neurologische Krankheit ausgeweitet werden. KW - Microarray KW - Antikörper KW - Autoantigen KW - Epitop KW - Neutralisation KW - antibody KW - autoantigen KW - epitope KW - neutralization KW - fine-mapping KW - Neurofascin KW - Contactin 1 KW - Caspr1 KW - Cortactin Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-280223 ER - TY - THES A1 - Karus, Christine T1 - Untersuchung der Architektur von Proteinstrukturen des Ranvier-Schnürrings mittels der super-hochauflösenden Mikroskopiemethode dSTORM T1 - Investigation of the architecture of protein structures of the Node of Ranvier using the super-high resolution microscopy method dSTORM N2 - Ranvier-Schnürringe spielen eine entscheidende Rolle bei der schnellen Weiterleitung von elektrischen Impulsen in Nervenzellen. Bei bestimmten neurologischen Erkrankungen, den Neuropathien, kann es zu Störungen in der ultrastrukturellen Organisation verschiedener Schnürring-Proteine kommen (Doppler et al., 2018, Doppler et al., 2016). Eine detailliertere Kenntnis der genauen Anordnung dieser Schnürring-Proteine und eventueller Abweichungen von dieser Anordnung im Krankheitsfall, könnte der Schlüssel zu einer vereinfachten Diagnostik von bestimmten Neuropathie- Formen sein. Ziel meiner Arbeit war es daher, die Untersuchung der ultrastrukturellen Architektur der (para-)nodalen Adhäsionsproteine Neurofascin-155 und Caspr1 unter Verwendung der super-hochauflösenden Mikroskopiemethode dSTORM (direct Stochastic Optical Reconstruction Microscopy) an murinen Zupfnervenpräparaten zu etablieren. Nach erster Optimierung der Probenpräparation für die 2-Farben-dSTORM sowie der korrelationsbasierten Bildanalyse, konnte ich mittels modellbasierter Simulation die zugrundeliegende Molekülorganisation identifizieren und mit Hilfe der Ergebnisse aus früheren Untersuchungen validieren. In einem translationalen Ansatz habe ich anschließend humane Zupfnervenpräparate von 14 Probanden mit unterschiedlichen Formen einer Neuropathie mikroskopiert und ausgewertet, um die Anwendbarkeit dieses Ansatzes in der Diagnostik zu testen. Obgleich keine signifikanten Unterschiede zwischen physiologischem und pathologischem neurologischem Gewebe hinsichtlich Neurofascin-155 und Caspr1 festgestellt werden konnten, scheint der Ansatz grundsätzlich dennoch vielversprechend zu sein, bedarf jedoch noch weiteren Anstrengungen hinsichtlich Probenpräparation, Auswertungs- und Versuchsprotokollen und einer größeren Anzahl an humanen Biopsien mit homogenerem Krankheitsbild. N2 - Nodes of Ranvier play a critical role in the rapid transmission of electrical impulses in neurons. In certain neurological diseases, the neuropathies, there may be disturbances in the ultrastructural organization of various nodal and paranodal proteins (Doppler et al., 2018, Doppler et al., 2016). A more detailed knowledge of the exact arrangement of these nodal and paranodal proteins and possible deviations from this arrangement in disease, could be the key to a simplified diagnosis of certain neuropathy forms. Therefore, the aim of my work was to establish the investigation of the ultrastructural architecture of the (para-)nodal adhesion proteins Neurofascin-155 and Caspr1 using the super-high resolution microscopy method dSTORM (direct Stochastic Optical Reconstruction Microscopy) on murine teased fibers. After initial optimization of sample preparation for 2-color dSTORM as well as correlation-based image analysis, I was able to identify the underlying molecular organization using model-based simulation and validate it using results from previous studies. In a translational approach, I then microscoped and evaluated human teased fibers from 14 subjects with different forms of neuropathy to test the applicability of this approach in diagnostics. Although no significant differences were found between physiological and pathological neurological tissue with respect to Neurofascin-155 and Caspr1, the approach still seems promising in principle, but requires further efforts with respect to sample preparation, evaluation and experimental protocols, and a larger number of human biopsies with more homogeneous disease patterns. KW - dSTORM KW - Ranvier-Schnürring Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-274568 N1 - die Dissertation ist ein Kooperationsprojekt dieser beiden Fakultäten ER - TY - THES A1 - Meyer zu Altenschildesche, Caren T1 - Genetische Variationen bei Patienten mit idiopathischer Small fiber Neuropathie T1 - Genetic variations in patients with idiopathic small fibre neuropathy N2 - Die Literatur beschreibt unter Patienten mit idiopathischer Small fiber Neuro-pathie (SFN) einen Anteil von etwa ein Fünftel bis Drittel mit Variationen unkla-rer pathogenetischer Relevanz in Schmerz-assoziierten Genen. Dies bestätig-te sich im Rahmen unserer klinischen Studie: Über die Zeit von Mai 2015 bis Januar 2020 konnten bei 13 von 66 (21%) eingeschlossenen Patienten mit klinischem Verdacht auf SFN genetische Variationen in Schmerz-assoziierten Genen detektiert werden. Solche Veränderungen können über Gain- oder Loss-of-Function-Mechanismen die Funktion codierter nozizeptiver Signalpro-teine modulieren und so potentiell zur SFN-Symptomatik führen. Im Rahmen der Studie erfolgte neben der genetischen Diagnostik eine umfangreiche Un-tersuchung der Teilnehmer. In der Diagnostik stachen die potentiell geneti-schen SFN-Patienten nicht heraus und auch klinisch fielen nur dezente Unter-schiede zu den übrigen Patienten auf: Wir zeigten, dass die Betroffenen häufi-ger von äußeren Einflussfaktoren getriggerte Schmerzattacken erleiden und eine tendenziell weitläufigere Symptommanifestation aufwiesen. Dies ähnelt der Klinik anderer hereditärer neuropathischer Schmerzsyndrome wie der pa-roxysmalen extremen Schmerzstörung (PEPD) oder den familiären episodi-schen Schmerzsyndromen (FEPS). Die potentiell genetische Grundlage führte bei unseren Patienten zu einer stärkeren Limitation im täglichen und berufli-chen Alltag und minderte die Lebensqualität der Betroffenen deutlich. Mögli-che Ursache hierfür war auch die herausfordernde Therapie der Patienten mit Genvariationen: Für den gleichen Behandlungserfolg mussten die Patienten mit potentiell genetischer SFN deutlich mehr Wirkstoffe einnehmen und über-haupt versuchen. Obwohl nur minimale klinische Hinweise eine potentiell ge-netische Genese andeuten, sollten diese frühzeitig durch eine strukturierte Anamnese erkannt werden. Die Sammlung von Daten zu betroffenen Familien kann die pathogenetische Relevanz der Variationen erhärten. Auch wird im Feld der genetischen Schmerzforschung rasant an zielgerichteten Analgetika gearbeitet, die fehlregulierte Rezeptoren blockieren sollen. Damit könnte Be-troffenen künftig gezielt geholfen werden. Wir empfehlen auf Grundlage unse-rer Studie bei Vorliegen genannter hinweisender Charakteristika eine geneti-sche Testung und Beratung zusätzlich zur weiteren ätiologischen Diagnostik. Das zu untersuchende Panel sollte möglichst viele Schmerz-assoziierte Gene umfassen – vorrangig die Gene codierend für die spannungsabhängigen Nat-riumkanäle SCN9A, -10A und 11A und die TRP-Kanalproteine TRPA1, TRPV1 und -3. N2 - In literature, eyery fifth to third patient with idiopathic small fiber neuropathy (SFN) shows a variation of unclear pathogenetic relevance in a pain-associated gene. This was confirmed in our clinical study: Over the time period from May 2015 to January 2020, genetic variations in pain-associated genes were detected in 13 of 66 (21%) patients with symptoms suspicious for SFN. Those genetical changes can modulate the function of encoded nociceptive signaling proteins via gain- or loss-of-function mechanisms and potentially lead to SFN symptoms. In addition to genetic diagnostics, the study included a full assessment of the participants. In terms of diagnostics, the potentially genetic SFN patients did not stand out, and there were only subtle differences regarding the clinical picture: We showed that patients with genetic SFN more frequently suffered from triggered pain attacks and a more extensive symptom distribution . This is similar to other hereditary neuropathic pain syndromes such as the paroxysmal extreme pain disorder (PEPD) or familial episodic pain syndromes (FEPS). The potentially genetic background led to a higher limitation in our patients' daily and professional life and significantly reduced their quality of life. Additionally, this could base on the challenging therapy of the patients with gene variations: For the same treatment success, patients with potentially genetic SFN had to take and try more analgetic drugs than patients with idiopathic SFN. Although only minimal clinical characteristics indicate a potential genetic etiology, they should be recognized early with a complete anamnesis. The collection of data from affected families can substantiate the pathogenetic relevance of the variations. In pain research, they work rapidly on targeted analgetics that are intended to block dysregulated receptors. In this way, those affected could be helped in a targeted manner in the future. Based on our study, we recommend genetic testing in addition to further etiological diagnostics especially if the clinical characteristics are present. The panel to be examined should include as many pain-associated genes as possible - primarily the genes coding for the voltage-dependent sodium channels SCN9A, -10A and 11A and the TRP channel proteins TRPA1, TRPV1 and -3. KW - Neuropathie KW - Kleinfaserneuropathie Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-282742 ER - TY - THES A1 - Karina, Karina T1 - Beschreibung der Maßnahmen zur Beschleunigung und Verbesserung der Notfallversorgung von Patienten mit akutem Schlaganfall in einer ländlichen Neurologischen Klinik und sequentielle Messung relevanter Qualitätsindikatoren T1 - Report of measures taken to accelerate and improve emergency care for patients with acute stroke in a rural neurological hospital and sequential measurement of relevant quality indicators N2 - Die hohe Mortalität und hohe Rate an Langzeitbehinderungen nach einem erlittenen Schlaganfall verdeutlichen die Relevanz bestmöglicher Akutversorgung bei Schlaganfallpatienten. Daher ist es unentbehrlich, dass die Akuttherapie bei Schlaganfall stets überprüft und bei Bedarf optimiert wird. Der Großteil der Studien, die sich mit Verbesserungsmaßnahmen in der akuten Schlaganfallversorgung befassen, wird in großen städtischen Krankenhäusern bzw. Universitätsklinika durchgeführt. Studien zu diesem Sachverhalt, die in ländlichen Kliniken durchgeführt wurden, sind noch begrenzt vorhanden. Mit dieser Studie evaluieren wir, ob sich durch die Implementierung neuer Optimierungsmaßnahmen Verbesserungen in den relevanten Qualitätsindikatoren ergeben. Die Ergebnisse sind daher von besonderer Bedeutung, da es für nicht-universitäre Kliniken nur eine begrenzte Anzahl an Studien gibt, die sich mit dieser Thematik beschäftigen. N2 - The high mortality and high rate of long-term disabilities after a stroke illustrate the relevance of the best possible acute care for stroke patients. Therefore, it is essential that the acute therapy for stroke is constantly reviewed and enhanced if necessary. The majority of studies dealing with improvement measures in acute stroke care are carried out in large city hospitals or university hospitals. Studies on this issue conducted in rural clinics are still limited. With this study, we evaluate whether the initiation of some new optimization measures results in improvements in the relevant quality indicators. As a consequence, the results are particularly significant, as there are only a limited number of studies dealing with this topic for non-university hospitals. KW - Verbesserung KW - Improvement KW - stroke care KW - Schlaganfall KW - Ländliche Klinik KW - rural clinics Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-291749 ER - TY - JOUR A1 - Montellano, Felipe A. A1 - Kluter, Elisabeth J. A1 - Rücker, Viktoria A1 - Ungethüm, Kathrin A1 - Mackenrodt, Daniel A1 - Wiedmann, Silke A1 - Dege, Tassilo A1 - Quilitzsch, Anika A1 - Morbach, Caroline A1 - Frantz, Stefan A1 - Störk, Stefan A1 - Haeusler, Karl Georg A1 - Kleinschnitz, Christoph A1 - Heuschmann, Peter U. T1 - Cardiac dysfunction and high-sensitive C-reactive protein are associated with troponin T elevation in ischemic stroke: insights from the SICFAIL study JF - BMC Neurology N2 - Background Troponin elevation is common in ischemic stroke (IS) patients. The pathomechanisms involved are incompletely understood and comprise coronary and non-coronary causes, e.g. autonomic dysfunction. We investigated determinants of troponin elevation in acute IS patients including markers of autonomic dysfunction, assessed by heart rate variability (HRV) time domain variables. Methods Data were collected within the Stroke Induced Cardiac FAILure (SICFAIL) cohort study. IS patients admitted to the Department of Neurology, Würzburg University Hospital, underwent baseline investigation including cardiac history, physical examination, echocardiography, and blood sampling. Four HRV time domain variables were calculated in patients undergoing electrocardiographic Holter monitoring. Multivariable logistic regression with corresponding odds ratios (OR) and 95% confidence intervals (CI) was used to investigate the determinants of high-sensitive troponin T (hs-TnT) levels ≥14 ng/L. Results We report results from 543 IS patients recruited between 01/2014–02/2017. Of those, 203 (37%) had hs-TnT ≥14 ng/L, which was independently associated with older age (OR per year 1.05; 95% CI 1.02–1.08), male sex (OR 2.65; 95% CI 1.54–4.58), decreasing estimated glomerular filtration rate (OR per 10 mL/min/1.73 m2 0.71; 95% CI 0.61–0.84), systolic dysfunction (OR 2.79; 95% CI 1.22–6.37), diastolic dysfunction (OR 2.29; 95% CI 1.29–4.02), atrial fibrillation (OR 2.30; 95% CI 1.25–4.23), and increasing levels of C-reactive protein (OR 1.48 per log unit; 95% CI 1.22–1.79). We did not identify an independent association of troponin elevation with the investigated HRV variables. Conclusion Cardiac dysfunction and elevated C-reactive protein, but not a reduced HRV as surrogate of autonomic dysfunction, were associated with increased hs-TnT levels in IS patients independent of established cardiovascular risk factors. KW - echocardiography KW - ischemic stroke KW - troponin KW - heart failure KW - biomarkers Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300119 VL - 22 IS - 1 ER - TY - JOUR A1 - Aster, Hans-Christoph A1 - Evdokimov, Dimitar A1 - Braun, Alexandra A1 - Üçeyler, Nurcan A1 - Kampf, Thomas A1 - Pham, Mirko A1 - Homola, György A. A1 - Sommer, Claudia T1 - CNS imaging characteristics in fibromyalgia patients with and without peripheral nerve involvement JF - Scientific Reports N2 - We tested the hypothesis that reduced skin innervation in fibromyalgia syndrome is associated with specific CNS changes. This prospective case–control study included 43 women diagnosed with fibromyalgia syndrome and 40 healthy controls. We further compared the fibromyalgia subgroups with reduced (n = 21) and normal (n = 22) skin innervation. Brains were analysed for cortical volume, for white matter integrity, and for functional connectivity. Compared to controls, cortical thickness was decreased in regions of the frontal, temporal and parietal cortex in the fibromyalgia group as a whole, and decreased in the bilateral pericalcarine cortices in the fibromyalgia subgroup with reduced skin innervation. Diffusion tensor imaging revealed a significant increase in fractional anisotropy in the corona radiata, the corpus callosum, cingulum and fornix in patients with fibromyalgia compared to healthy controls and decreased FA in parts of the internal capsule and thalamic radiation in the subgroup with reduced skin innervation. Using resting-state fMRI, the fibromyalgia group as a whole showed functional hypoconnectivity between the right midfrontal gyrus and the posterior cerebellum and the right crus cerebellum, respectively. The subgroup with reduced skin innervation showed hyperconnectivity between the inferior frontal gyrus, the angular gyrus and the posterior parietal gyrus. Our results suggest that the subgroup of fibromyalgia patients with pronounced pathology in the peripheral nervous system shows alterations in morphology, structural and functional connectivity also at the level of the encephalon. We propose considering these subgroups when conducting clinical trials. KW - fibromyalgia syndrome KW - CNS imaging KW - peripheral nerve involvement Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300562 VL - 12 IS - 1 ER - TY - JOUR A1 - Bieniussa, Linda A1 - Kahraman, Baran A1 - Skornicka, Johannes A1 - Schulte, Annemarie A1 - Voelker, Johannes A1 - Jablonka, Sibylle A1 - Hagen, Rudolf A1 - Rak, Kristen T1 - Pegylated insulin-like growth factor 1 attenuates hair cell loss and promotes presynaptic maintenance of medial olivocochlear cholinergic fibers in the cochlea of the progressive motor neuropathy mouse JF - Frontiers in Neurology N2 - The progressive motor neuropathy (PMN) mouse is a model of an inherited motor neuropathy disease with progressive neurodegeneration. Axon degeneration associates with homozygous mutations of the TBCE gene encoding the tubulin chaperone E protein. TBCE is responsible for the correct dimerization of alpha and beta-tubulin. Strikingly, the PMN mouse also develops a progressive hearing loss after normal hearing onset, characterized by degeneration of the auditory nerve and outer hair cell (OHC) loss. However, the development of this neuronal and cochlear pathology is not fully understood yet. Previous studies with pegylated insulin-like growth factor 1 (peg-IGF-1) treatment in this mouse model have been shown to expand lifespan, weight, muscle strength, and motor coordination. Accordingly, peg-IGF-1 was evaluated for an otoprotective effect. We investigated the effect of peg-IGF-1 on the auditory system by treatment starting at postnatal day 15 (p15). Histological analysis revealed positive effects on OHC synapses of medial olivocochlear (MOC) neuronal fibers and a short-term attenuation of OHC loss. Peg-IGF-1 was able to conditionally restore the disorganization of OHC synapses and maintain the provision of cholinergic acetyltransferase in presynapses. To assess auditory function, frequency-specific auditory brainstem responses and distortion product otoacoustic emissions were recorded in animals on p21 and p28. However, despite the positive effect on MOC fibers and OHC, no restoration of hearing could be achieved. The present work demonstrates that the synaptic pathology of efferent MOC fibers in PMN mice represents a particular form of “efferent auditory neuropathy.” Peg-IGF-1 showed an otoprotective effect by preventing the degeneration of OHCs and efferent synapses. However, enhanced efforts are needed to optimize the treatment to obtain detectable improvements in hearing performances. KW - cochlea KW - microtubules KW - MOC fibers KW - hearing loss KW - pegylated insulin-like growth factor 1 KW - outer hair cell (OHC) KW - motor neuropathy Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-276669 SN - 1664-2295 VL - 13 ER - TY - JOUR A1 - Bellut, Maximilian A1 - Papp, Lena A1 - Bieber, Michael A1 - Kraft, Peter A1 - Stoll, Guido A1 - Schuhmann, Michael K. T1 - NLPR3 inflammasome inhibition alleviates hypoxic endothelial cell death in-vitro and protects blood-brain barrier integrity in murine stroke JF - Cell Death & Disease N2 - In ischemic stroke (IS) impairment of the blood-brain barrier (BBB) has an important role in the secondary deterioration of neurological function. BBB disruption is associated with ischemia-induced inflammation, brain edema formation, and hemorrhagic infarct transformation, but the underlying mechanisms are incompletely understood. Dysfunction of endothelial cells (EC) may play a central role in this process. Although neuronal NLR-family pyrin domain-containing protein 3 (NLRP3) inflammasome upregulation is an established trigger of inflammation in IS, the contribution of its expression in EC is unclear. We here used brain EC, exposed them to oxygen and glucose deprivation (OGD) in vitro, and analyzed their survival depending on inflammasome inhibition with the NLRP3-specific drug MCC950. During OGD, EC death could significantly be reduced when targeting NLRP3, concomitant with diminished endothelial NLRP3 expression. Furthermore, MCC950 led to reduced levels of Caspase 1 (p20) and activated Gasdermin D as markers for pyroptosis. Moreover, inflammasome inhibition reduced the secretion of pro-inflammatory chemokines, cytokines, and matrix metalloproteinase-9 (MMP9) in EC. In a translational approach, IS was induced in C57Bl/6 mice by 60 mins transient middle cerebral artery occlusion and 23 hours of reperfusion. Stroke volume, functional outcome, the BBB integrity, and-in good agreement with the in vitro results-MMP9 secretion as well as EC survival improved significantly in MCC950-treated mice. In conclusion, our results establish the NLRP3 inflammasome as a critical pathogenic effector of stroke-induced BBB disruption by activating inflammatory signaling cascades and pyroptosis in brain EC. KW - inflammasome KW - preclinical research KW - stroke Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265693 VL - 13 ER - TY - JOUR A1 - Reinhold, Ann Kristin A1 - Krug, Susanne M. A1 - Salvador, Ellaine A1 - Sauer, Reine S. A1 - Karl-Schöller, Franziska A1 - Malcangio, Marzia A1 - Sommer, Claudia A1 - Rittner, Heike L. T1 - MicroRNA-21-5p functions via RECK/MMP9 as a proalgesic regulator of the blood nerve barrier in nerve injury JF - Annals of the New York Academy of Sciences N2 - Both nerve injury and complex regional pain syndrome (CRPS) can result in chronic pain. In traumatic neuropathy, the blood nerve barrier (BNB) shielding the nerve is impaired—partly due to dysregulated microRNAs (miRNAs). Upregulation of microRNA-21-5p (miR-21) has previously been documented in neuropathic pain, predominantly due to its proinflammatory features. However, little is known about other functions. Here, we characterized miR-21 in neuropathic pain and its impact on the BNB in a human-murine back translational approach. MiR-21 expression was elevated in plasma of patients with CRPS as well as in nerves of mice after transient and persistent nerve injury. Mice presented with BNB leakage, as well as loss of claudin-1 in both injured and spared nerves. Moreover, the putative miR-21 target RECK was decreased and downstream Mmp9 upregulated, as was Tgfb. In vitro experiments in human epithelial cells confirmed a downregulation of CLDN1 by miR-21 mimics via inhibition of the RECK/MMP9 pathway but not TGFB. Perineurial miR-21 mimic application in mice elicited mechanical hypersensitivity, while local inhibition of miR-21 after nerve injury reversed it. In summary, the data support a novel role for miR-21, independent of prior inflammation, in elicitation of pain and impairment of the BNB via RECK/MMP9. KW - claudin-1 KW - RECK KW - MMP9 KW - CRPS KW - microRNA KW - neuropathic pain KW - blood nerve barrier Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318226 VL - 1515 IS - 1 SP - 184 EP - 195 ER - TY - JOUR A1 - Kollikowski, Alexander M. A1 - Pham, Mirko A1 - März, Alexander G. A1 - Papp, Lena A1 - Nieswandt, Bernhard A1 - Stoll, Guido A1 - Schuhmann, Michael K. T1 - Platelet Activation and Chemokine Release Are Related to Local Neutrophil-Dominant Inflammation During Hyperacute Human Stroke JF - Translational Stroke Research N2 - Experimental evidence has emerged that local platelet activation contributes to inflammation and infarct formation in acute ischemic stroke (AIS) which awaits confirmation in human studies. We conducted a prospective observational study on 258 consecutive patients undergoing mechanical thrombectomy (MT) due to large-vessel-occlusion stroke of the anterior circulation (08/2018-05/2020). Intraprocedural microcatheter aspiration of 1 ml of local (occlusion condition) and systemic arterial blood samples (self-control) was performed according to a prespecified protocol. The samples were analyzed for differential leukocyte counts, platelet counts, and plasma levels of the platelet-derived neutrophil-activating chemokine C-X-C-motif ligand (CXCL) 4 (PF-4), the neutrophil attractant CXCL7 (NAP-2), and myeloperoxidase (MPO). The clinical-biological relevance of these variables was corroborated by specific associations with molecular-cellular, structural-radiological, hemodynamic, and clinical-functional parameters. Seventy consecutive patients fulfilling all predefined criteria entered analysis. Mean local CXCL4 (+ 39%: 571 vs 410 ng/ml, P = .0095) and CXCL7 (+ 9%: 693 vs 636 ng/ml, P = .013) concentrations were higher compared with self-controls. Local platelet counts were lower (- 10%: 347,582 vs 383,284/µl, P = .0052), whereas neutrophil counts were elevated (+ 10%: 6022 vs 5485/µl, P = 0.0027). Correlation analyses revealed associations between local platelet and neutrophil counts (r = 0.27, P = .034), and between CXCL7 and MPO (r = 0.24, P = .048). Local CXCL4 was associated with the angiographic degree of reperfusion following recanalization (r =  - 0.2523, P = .0479). Functional outcome at discharge correlated with local MPO concentrations (r = 0.3832, P = .0014) and platelet counts (r = 0.288, P = .0181). This study provides human evidence of cerebral platelet activation and platelet-neutrophil interactions during AIS and points to the relevance of per-ischemic thrombo-inflammatory mechanisms to impaired reperfusion and worse functional outcome following recanalization. KW - chemokines KW - CXCL4 KW - PF4 KW - CXCL7 KW - NAP-2 KW - ischemic stroke Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-270194 SN - 1868-601X VL - 13 IS - 3 ER - TY - JOUR A1 - Schanbacher, Constanze A1 - Bieber, Michael A1 - Reinders, Yvonne A1 - Cherpokova, Deya A1 - Teichert, Christina A1 - Nieswandt, Bernhard A1 - Sickmann, Albert A1 - Kleinschnitz, Christoph A1 - Langhauser, Friederike A1 - Lorenz, Kristina T1 - ERK1/2 activity is critical for the outcome of ischemic stroke JF - International Journal of Molecular Sciences N2 - Ischemic disorders are the leading cause of death worldwide. The extracellular signal-regulated kinases 1 and 2 (ERK1/2) are thought to affect the outcome of ischemic stroke. However, it is under debate whether activation or inhibition of ERK1/2 is beneficial. In this study, we report that the ubiquitous overexpression of wild-type ERK2 in mice (ERK2\(^{wt}\)) is detrimental after transient occlusion of the middle cerebral artery (tMCAO), as it led to a massive increase in infarct volume and neurological deficits by increasing blood–brain barrier (BBB) leakiness, inflammation, and the number of apoptotic neurons. To compare ERK1/2 activation and inhibition side-by-side, we also used mice with ubiquitous overexpression of the Raf-kinase inhibitor protein (RKIP\(^{wt}\)) and its phosphorylation-deficient mutant RKIP\(^{S153A}\), known inhibitors of the ERK1/2 signaling cascade. RKIP\(^{wt}\) and RKIP\(^{S153A}\) attenuated ischemia-induced damages, in particular via anti-inflammatory signaling. Taken together, our data suggest that stimulation of the Raf/MEK/ERK1/2-cascade is severely detrimental and its inhibition is rather protective. Thus, a tight control of the ERK1/2 signaling is essential for the outcome in response to ischemic stroke. KW - ERK1/2 KW - tMCAO KW - ischemic stroke KW - RKIP Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-283991 SN - 1422-0067 VL - 23 IS - 2 ER - TY - JOUR A1 - Schmidbauer, Moritz L. A1 - Ferse, Caroline A1 - Salih, Farid A1 - Klingner, Carsten A1 - Musleh, Rita A1 - Kunst, Stefan A1 - Wittstock, Matthias A1 - Neumann, Bernhard A1 - Schebesch, Karl-Michael A1 - Bösel, Julian A1 - Godau, Jana A1 - Lochner, Piergiorgio A1 - Adam, Elisabeth H. A1 - Jahnke, Kolja A1 - Knier, Benjamin A1 - Schirotzek, Ingo A1 - Müllges, Wolfgang A1 - Notz, Quirin A1 - Dengl, Markus A1 - Güldner, Andreas A1 - Onur, Oezguer A. A1 - Garcia Borrega, Jorge A1 - Dimitriadis, Konstantinos A1 - Günther, Albrecht T1 - COVID-19 and intracranial hemorrhage: a multicenter case series, systematic review and pooled analysis JF - Journal of Clinical Medicine N2 - Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) profoundly impacts hemostasis and microvasculature. In the light of the dilemma between thromboembolic and hemorrhagic complications, in the present paper, we systematically investigate the prevalence, mortality, radiological subtypes, and clinical characteristics of intracranial hemorrhage (ICH) in coronavirus disease (COVID-19) patients. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review of the literature by screening the PubMed database and included patients diagnosed with COVID-19 and concomitant ICH. We performed a pooled analysis, including a prospectively collected cohort of critically ill COVID-19 patients with ICH, as part of the PANDEMIC registry (Pooled Analysis of Neurologic Disorders Manifesting in Intensive Care of COVID-19). Results: Our literature review revealed a total of 217 citations. After the selection process, 79 studies and a total of 477 patients were included. The median age was 58.8 years. A total of 23.3% of patients experienced the critical stage of COVID-19, 62.7% of patients were on anticoagulation and 27.5% of the patients received ECMO. The prevalence of ICH was at 0.85% and the mortality at 52.18%, respectively. Conclusion: ICH in COVID-19 patients is rare, but it has a very poor prognosis. Different subtypes of ICH seen in COVID-19, support the assumption of heterogeneous and multifaceted pathomechanisms contributing to ICH in COVID-19. Further clinical and pathophysiological investigations are warranted to resolve the conflict between thromboembolic and hemorrhagic complications in the future. KW - COVID-19 KW - intracranial hemorrhage KW - prognosis KW - anticoagulation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-255236 SN - 2077-0383 VL - 11 IS - 3 ER - TY - THES A1 - Palmisano, Chiara T1 - Supraspinal Locomotor Network Derangements: A Multimodal Approach T1 - Störungen des Supraspinalen Lokomotorischen Netzwerks: ein Multimodaler Ansatz N2 - Parkinson’s Disease (PD) constitutes a major healthcare burden in Europe. Accounting for aging alone, ~700,000 PD cases are predicted by 2040. This represents an approximately 56% increase in the PD population between 2005 and 2040, with a consequent rise in annual disease‐related medical costs. Gait and balance disorders are a major problem for patients with PD and their caregivers, mainly because to their correlation with falls. Falls occur as a result of a complex interaction of risk factors. Among them, Freezing of Gait (FoG) is a peculiar gait derangement characterized by a sudden and episodic inability to produce effective stepping, causing falls, mobility restrictions, poor quality of life, and increased morbidity and mortality. Between 50–70% of PD patients have FoG and/or falls after a disease duration of 10 years, only partially and inconsistently improved by dopaminergic treatment and Deep Brain Stimulation (DBS). Treatment-induced worsening has been also observed under certain conditions. Effective treatments for gait disturbances in PD are lacking, probably because of the still poor understanding of the supraspinal locomotor network. In my thesis, I wanted to expand our knowledge of the supraspinal locomotor network and in particular the contribution of the basal ganglia to the control of locomotion. I believe this is a key step towards new preventive and personalized therapies for postural and gait problems in patients with PD and related disorders. In addition to patients with PD, my studies also included people affected by Progressive Supranuclear Palsy (PSP). PSP is a rare primary progressive parkinsonism characterized at a very early disease stage by poor balance control and frequent backwards falls, thus providing an in vivo model of dysfunctional locomotor control. I focused my attention on one of the most common motor transitions in daily living, the initiation of gait (GI). GI is an interesting motor task and a relevant paradigm to address balance and gait impairments in patients with movement disorders, as it is associated with FoG and high risk of falls. It combines a preparatory (i.e., the Anticipatory Postural Adjustments [APA]) and execution phase (the stepping) and allows the study of movement scaling and timing as an expression of muscular synergies, which follow precise and online feedback information processing and integration into established feedforward patterns of motor control. By applying a multimodal approach that combines biomechanical assessments and neuroimaging investigations, my work unveiled the fundamental contribution of striatal dopamine to GI in patients with PD. Results in patients with PSP further supported the fundamental role of the striatum in GI execution, revealing correlations between the metabolic intake of the left caudate nucleus with diverse GI measurements. This study also unveiled the interplay of additional brain areas in the motor control of GI, namely the Thalamus, the Supplementary Motor Area (SMA), and the Cingulate cortex. Involvement of cortical areas was also suggested by the analysis of GI in patients with PD and FoG. Indeed, I found major alterations in the preparatory phase of GI in these patients, possibly resulting from FoG-related deficits of the SMA. Alterations of the weight shifting preceding the stepping phase were also particularly important in PD patients with FoG, thus suggesting specific difficulties in the integration of somatosensory information at a cortical level. Of note, all patients with PD showed preserved movement timing of GI, possibly suggesting preserved and compensatory activity of the cerebellum. Postural abnormalities (i.e., increased trunk and thigh flexion) showed no relationship with GI, ruling out an adaptation of the motor pattern to the altered postural condition. In a group of PD patients implanted with DBS, I further explored the pathophysiological functioning of the locomotor network by analysing the timely activity of the Subthalamic Nucleus (STN) during static and dynamic balance control (i.e., standing and walking). For this study, I used novel DBS devices capable of delivering stimulation and simultaneously recording Local Field Potentials (LFP) of the implanted nucleus months and years after surgery. I showed a gait-related frequency shift in the STN activity of PD patients, possibly conveying cortical (feedforward) and cerebellar (feedback) information to mesencephalic locomotor areas. Based on this result, I identified for each patient a Maximally Informative Frequency (MIF) whose power changes can reliably classify standing and walking conditions. The MIF is a promising input signal for new DBS devices that can monitor LFP power modulations to timely adjust the stimulation delivery based on the ongoing motor task (e.g., gait) performed by the patient (adaptive DBS). Altogether my achievements allowed to define the role of different cortical and subcortical brain areas in locomotor control, paving the way for a better understanding of the pathophysiological dynamics of the supraspinal locomotor network and the development of tailored therapies for gait disturbances and falls prevention in PD and related disorders. N2 - Die Parkinson-Krankheit (PD) stellt in Europa eine große Belastung für das Gesundheitswesen dar. Allein unter Berücksichtigung der Alterung werden bis zum Jahr 2040 etwa 700 000 Fälle von Parkinson prognostiziert. Dies entspricht einer Zunahme der Parkinson-Population um etwa 56 % zwischen 2005 und 2040, was zu einem Anstieg der jährlichen krankheitsbedingten medizinischen Kosten führt. Gang- und Gleichgewichtsstörungen sind ein großes Problem für Morbus-Parkinson-Patienten und ihre Betreuer, vor allem, weil sie mit Stürzen zusammenhängen. Stürze sind das Ergebnis einer komplexen Interaktion von Risikofaktoren. Zu diesen Faktoren gehört das Freezing of Gait (FoG), eine besondere Gangstörung, die durch eine plötzliche und episodische Unfähigkeit gekennzeichnet ist, einen effektiven Schritt zu machen, was zu Stürzen, Mobilitätseinschränkungen, schlechter Lebensqualität und erhöhter Morbidität und Mortalität führt. Zwischen 50 und 70 % der Morbus-Parkinson-Patienten haben nach einer Krankheitsdauer von 10 Jahren FoG und/oder Stürze, die sich durch dopaminerge Behandlung und Tiefe Hirnstimulation (DBS) nur teilweise und uneinheitlich verbessern. Unter bestimmten Bedingungen wurde auch eine behandlungsbedingte Verschlechterung beobachtet. Es gibt keine wirksamen Behandlungen für Gangstörungen bei Morbus Parkinson, was wahrscheinlich auf das noch immer unzureichende Verständnis des supraspinalen lokomotorischen Netzwerks zurückzuführen ist. In meiner Dissertation wollte ich unser Wissen über das supraspinale Bewegungsnetzwerk und insbesondere den Beitrag der Basalganglien zur Steuerung der Fortbewegung erweitern. Ich glaube, dass dies ein wichtiger Schritt auf dem Weg zu neuen präventiven und personalisierten Therapien für Haltungs- und Gangprobleme bei Patienten mit Parkinson und verwandten Erkrankungen ist. Neben Morbus-Parkinson-Patienten wurden in meine Studien auch Menschen mit progressiver supranukleärer Lähmung (PSP) einbezogen. PSP ist ein seltener primär progressiver Parkinsonismus, der in einem sehr frühen Krankheitsstadium durch eine schlechte Gleichgewichtskontrolle und häufige Rückwärtsstürze gekennzeichnet ist und somit ein In-vivo-Modell für eine gestörte Bewegungskontrolle darstellt. Ich habe mich auf einen der häufigsten motorischen Übergänge im täglichen Leben konzentriert, die Initiierung des Gangs (GI). GI ist eine interessante motorische Aufgabe und ein relevantes Paradigma zur Untersuchung von Gleichgewichts- und Gangstörungen bei Patienten mit Bewegungsstörungen, da sie mit FoG und einem hohen Sturzrisiko verbunden ist. Sie kombiniert eine Vorbereitungsphase (d. h. die antizipatorischen posturalen Anpassungen [APA]) und eine Ausführungsphase (den Schritt) und ermöglicht die Untersuchung der Bewegungsskalierung und des Timings als Ausdruck muskulärer Synergien, die einer präzisen und online erfolgenden Verarbeitung von Feedback-Informationen und der Integration in etablierte Feedforward-Muster der motorischen Kontrolle folgen. Durch Anwendung eines multimodalen Ansatzes, der biomechanische Bewertungen und bildgebende Untersuchungen kombiniert, hat meine Arbeit den grundlegenden Einfluss des striatalen Dopamins auf GI bei Patienten mit Parkinson enthüllt. Die Ergebnisse bei Patienten mit PSP untermauerten die grundlegende Rolle des Striatums bei der Ausführung von GI, indem sie Korrelationen zwischen der metabolischen Aufnahme des linken Nucleus caudatus und verschiedenen GI-Parametern aufzeigten. Diese Studie enthüllte auch das Zusammenspiel weiterer Hirnareale bei der motorischen Kontrolle von GI, nämlich des Thalamus, der Supplementary Motor Area (SMA) und des Cingulum-Kortex. Die Beteiligung kortikaler Areale wurde auch durch die Analyse der GI bei Patienten mit Parkinson und FoG nahegelegt. In der Tat fand ich bei diesen Patienten erhebliche Veränderungen in der Vorbereitungsphase des GI, die möglicherweise auf FoG-bedingte Defizite der SMA zurückzuführen sind. Veränderungen der Gewichtsverlagerung, die der Schrittphase vorausgeht, waren bei Morbus-Parkinson-Patienten mit FoG ebenfalls besonders ausgeprägt, was auf spezifische Schwierigkeiten bei der Integration somatosensorischer Informationen auf kortikaler Ebene schließen lässt. Bemerkenswert ist, dass alle Morbus-Parkinson-Patienten ein gut erhaltenes Bewegungs-Timing von GI aufwiesen, was möglicherweise auf eine ebenfalls gut erhaltene und kompensatorische Aktivität des Kleinhirns hindeutet. Haltungsanomalien (d. h. verstärkte Rumpf- und Oberschenkelflexion) standen in keinem Zusammenhang mit GI, was eine Anpassung des motorischen Musters an die veränderten Haltungsbedingungen ausschließt. Bei einer Gruppe von Morbus-Parkinson-Patienten, denen eine DBS implantiert wurde, untersuchte ich die pathophysiologische Funktionsweise des lokomotorischen Netzwerks weiter, indem ich die rechtzeitige Aktivität des subthalamischen Nucleus (STN) während der statischen und dynamischen Gleichgewichtskontrolle (d. h. Stehen und Gehen) analysierte. Für diese Studie habe ich neuartige DBS-Geräte verwendet, die in der Lage sind, Stimulationen abzugeben und gleichzeitig lokale Feldpotentiale (LFP) des implantierten Nucleus Monate und Jahre nach der Operation aufzuzeichnen. Ich konnte eine gehbezogene Frequenzverschiebung in der STN-Aktivität von Morbus-Parkinson-Patienten nachweisen, die möglicherweise kortikale (feedforward) und zerebelläre (feedback) Informationen an mesenzephale Bewegungsbereiche weiterleitet. Auf der Grundlage dieses Ergebnisses habe ich für jeden Patienten eine maximal informative Frequenz (MIF) identifiziert, deren Leistungsänderungen eine zuverlässige Klassifizierung von Steh- und Gehzuständen ermöglichen. Die MIF ist ein vielversprechendes Eingangssignal für neue DBS-Geräte, die LFP-Leistungsmodulationen überwachen können, um die Stimulationsabgabe zeitnah an die laufende motorische Aufgabe (z. B. Gehen) des Patienten anzupassen (adaptive DBS). Insgesamt ist es mir gelungen, die Rolle verschiedener kortikaler und subkortikaler Hirnareale bei der Bewegungskontrolle zu definieren. Dies ebnet den Weg für ein besseres Verständnis der pathophysiologischen Dynamik des supraspinalen Bewegungsnetzwerks und die Entwicklung maßgeschneiderter Therapien für Gangstörungen und Sturzprävention bei Morbus Parkinson und verwandten Erkrankungen. KW - locomotor network KW - gait initiation KW - deep brain stimulation KW - gait analysis KW - movement disorders KW - neural biomarkers KW - parkinson's disease Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266442 ER - TY - JOUR A1 - Pozzi, Nicoló G. A1 - Palmisano, Chiara A1 - Reich, Martin M. A1 - Capetian, Philip A1 - Pacchetti, Claudio A1 - Volkmann, Jens A1 - Isaias, Ioannis U. T1 - Troubleshooting gait disturbances in Parkinson’s disease with deep brain stimulation JF - Frontiers in Human Neuroscience N2 - Deep brain stimulation (DBS) of the subthalamic nucleus or the globus pallidus is an established treatment for Parkinson’s disease (PD) that yields a marked and lasting improvement of motor symptoms. Yet, DBS benefit on gait disturbances in PD is still debated and can be a source of dissatisfaction and poor quality of life. Gait disturbances in PD encompass a variety of clinical manifestations and rely on different pathophysiological bases. While gait disturbances arising years after DBS surgery can be related to disease progression, early impairment of gait may be secondary to treatable causes and benefits from DBS reprogramming. In this review, we tackle the issue of gait disturbances in PD patients with DBS by discussing their neurophysiological basis, providing a detailed clinical characterization, and proposing a pragmatic programming approach to support their management. KW - Parkinson’s disease KW - freezing of gait (FOG) KW - deep brain stimulation (DBS) KW - subthalamic nucleus (STN) KW - globus pallidus pars interna (GPi) KW - pedunculopontine nucleus (PPN) Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-274007 SN - 1662-5161 VL - 16 ER - TY - JOUR A1 - Wagenhäuser, Laura A1 - Rickert, Vanessa A1 - Sommer, Claudia A1 - Wanner, Christoph A1 - Nordbeck, Peter A1 - Rost, Simone A1 - Üçeyler, Nurcan T1 - X-chromosomal inactivation patterns in women with Fabry disease JF - Molecular Genetics & Genomic Medicine N2 - Background Although Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in the α-galactosidase A gene (GLA), women may develop severe symptoms. We investigated X-chromosomal inactivation patterns (XCI) as a potential determinant of symptom severity in FD women. Patients and Methods We included 95 women with mutations in GLA (n = 18 with variants of unknown pathogenicity) and 50 related men, and collected mouth epithelial cells, venous blood, and skin fibroblasts for XCI analysis using the methylation status of the androgen receptor gene. The mutated X-chromosome was identified by comparison of samples from relatives. Patients underwent genotype categorization and deep clinical phenotyping of symptom severity. Results 43/95 (45%) women carried mutations categorized as classic. The XCI pattern was skewed (i.e., ≥75:25% distribution) in 6/87 (7%) mouth epithelial cell samples, 31/88 (35%) blood samples, and 9/27 (33%) skin fibroblast samples. Clinical phenotype, α-galactosidase A (GAL) activity, and lyso-Gb3 levels did not show intergroup differences when stratified for X-chromosomal skewing and activity status of the mutated X-chromosome. Conclusions X-inactivation patterns alone do not reliably reflect the clinical phenotype of women with FD when investigated in biomaterial not directly affected by FD. However, while XCI patterns may vary between tissues, blood frequently shows skewing of XCI patterns. KW - Fabry disease KW - Fabry genotype KW - Fabry phenotype KW - female Fabry patients KW - X-chromosomal inactivation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312795 VL - 10 IS - 9 ER - TY - JOUR A1 - Spitzel, Marlene A1 - Wagner, Elise A1 - Breyer, Maximilian A1 - Henniger, Dorothea A1 - Bayin, Mehtap A1 - Hofmann, Lukas A1 - Mauceri, Daniela A1 - Sommer, Claudia A1 - Üçeyler, Nurcan T1 - Dysregulation of immune response mediators and pain-related ion channels is associated with pain-like behavior in the GLA KO mouse model of Fabry disease JF - Cells N2 - Fabry disease (FD) is a rare life-threatening disorder caused by deficiency of the alpha-galactosidase A (GLA) enzyme with a characteristic pain phenotype. Impaired GLA production or function leads to the accumulation of the cell membrane compound globotriaosylceramide (Gb3) in the neurons of the dorsal root ganglia (DRG) of FD patients. Applying immunohistochemistry (IHC) and quantitative real-time polymerase chain reaction (qRT PCR) analysis on DRG tissue of the GLA knockout (KO) mouse model of FD, we address the question of how Gb3 accumulation may contribute to FD pain and focus on the immune system and pain-associated ion channel gene expression. We show a higher Gb3 load in the DRG of young (<6 months) (p < 0.01) and old (≥12 months) (p < 0.001) GLA KO mice compared to old wildtype (WT) littermates, and an overall suppressed immune response in the DRG of old GLA KO mice, represented by a reduced number of CD206\(^+\) macrophages (p < 0.01) and lower gene expression levels of the inflammation-associated targets interleukin(IL)1b (p < 0.05), IL10 (p < 0.001), glial fibrillary acidic protein (GFAP) (p < 0.05), and leucine rich alpha-2-glycoprotein 1 (LRG1) (p < 0.01) in the DRG of old GLA KO mice compared to old WT. Dysregulation of immune-related genes may be linked to lower gene expression levels of the pain-associated ion channels calcium-activated potassium channel 3.1 (KCa3.1) and transient receptor potential ankyrin 1 channel (TRPA1). Ion channel expression might further be disturbed by impaired sphingolipid recruitment mediated via the lipid raft marker flotillin-1 (FLOT1). This impairment is represented by an increased number of FLOT1\(^+\) DRG neurons with a membranous expression pattern in old GLA KO mice compared to young GLA KO, young WT, and old WT mice (p < 0.001 each). Further, we provide evidence for aberrant behavior of GLA KO mice, which might be linked to dysregulated ion channel gene expression levels and disturbed FLOT1 distribution patterns. Behavioral testing revealed mechanical hypersensitivity in young (p < 0.01) and old (p < 0.001) GLA KO mice compared to WT, heat hypersensitivity in young GLA KO mice (p < 0.001) compared to WT, age-dependent heat hyposensitivity in old GLA KO mice (p < 0.001) compared to young GLA KO mice, and cold hyposensitivity in young (p < 0.001) and old (p < 0.001) GLA KO mice compared to WT, which well reflects the clinical phenotype observed in FD patients. KW - Fabry disease KW - globotriaosylceramide KW - inflammation KW - macrophages KW - cytokines KW - ion channels KW - flotillin-1 lipid rafts KW - pain-associated behavior KW - mouse model Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-275186 SN - 2073-4409 VL - 11 IS - 11 ER - TY - JOUR A1 - Krämer, Stefanie D. A1 - Schuhmann, Michael K. A1 - Volkmann, Jens A1 - Fluri, Felix T1 - Deep brain stimulation in the subthalamic nucleus can improve skilled Forelimb movements and retune dynamics of striatal networks in a rat stroke model JF - International Journal of Molecular Sciences N2 - Recovery of upper limb (UL) impairment after stroke is limited in stroke survivors. Since stroke can be considered as a network disorder, neuromodulation may be an approach to improve UL motor dysfunction. Here, we evaluated the effect of high-frequency stimulation (HFS) of the subthalamic nucleus (STN) in rats on forelimb grasping using the single-pellet reaching (SPR) test after stroke and determined costimulated brain regions during STN-HFS using 2-[\(^{18}\)F]Fluoro-2-deoxyglucose-([\(^{18}\)F]FDG)-positron emission tomography (PET). After a 4-week training of SPR, photothrombotic stroke was induced in the sensorimotor cortex of the dominant hemisphere. Thereafter, an electrode was implanted in the STN ipsilateral to the infarction, followed by a continuous STN-HFS or sham stimulation for 7 days. On postinterventional day 2 and 7, an SPR test was performed during STN-HFS. Success rate of grasping was compared between these two time points. [\(^{18}\)F]FDG-PET was conducted on day 2 and 3 after stroke, without and with STN-HFS, respectively. STN-HFS resulted in a significant improvement of SPR compared to sham stimulation. During STN-HFS, a significantly higher [\(^{18}\)F]FDG-uptake was observed in the corticosubthalamic/pallidosubthalamic circuit, particularly ipsilateral to the stimulated side. Additionally, STN-HFS led to an increased glucose metabolism within the brainstem. These data demonstrate that STN-HFS supports rehabilitation of skilled forelimb movements, probably by retuning dysfunctional motor centers within the cerebral network. KW - photothrombosis KW - experimental stroke KW - subthalamic nucleus KW - invasive electric stimulation KW - skilled forelimb movements KW - neuronal network KW - [18F]FDG positron emission tomography Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312828 VL - 23 IS - 24 ER - TY - THES A1 - Hähnel, Luzia Maria T1 - Evaluation von Beta-2-Mikroglobulin, Laktat und Angiotensin-Converting Enzyme im Liquor als Biomarker der Multiplen Sklerose T1 - Evaluation of beta-2-microglobulin, lactate and angiotensin-converting enzyme in CSF as biomarkers in multiple sclerosis N2 - This study investigates the suitability of beta-2-microglobulin (β2-microglobulin), lactate and angiotensin-converting enzyme (ACE) as biomarkers, given the good availability of these parameters in routine diagnostics but lack of data in this regard. For this purpose, 6,310 CSF samples obtained at the Neurological Clinic of the University Hospital of Würzburg were analyzed. Closer analysis was carried out of 276 cases with non-inflammatory neurological diseases (NIND; control group) and 438 MS cases not taking an immunotherapy treatment (study group). In the MS cases, the form of progression of the disease and the disease activity (clinical relapses, progression index) were recorded. A clear correlation could be seen between age and CSF levels of β2-microglobulin, lactate and ACE in both the MS and control groups, whereby a correction was required for the subsequent comparison studies; this could also at least partly explain the contradictory data obtained in other studies to date. The MS cases showed elevated β2-microglobulin and lactate levels and decreased ACE levels in CSF compared to the controls. In both groups, there was a positive correlation between β2-microglobulin and ACE levels. In the separate analysis of the forms of progression of MS, cases with clinically-isolated syndrome (CIS) and relapsing-remitting MS (RRMS) revealed elevated β2-microglobulin levels, whilst cases with secondary-progressive or primary-progressive MS (SPMS or PPMS) did not. Lactate levels were only increased in cases of CIS. Cases with a relapsing course showed reduced ACE levels. The disease activity could not reliably be mapped by the parameters. Lactate levels tended to be elevated during a relapse, but this result was no longer significant after correction. Lactate levels also showed a positive correlation with the progression index. Our findings in this study provide evidence that the examined analysis parameters cannot be used in isolation to assess progression, disease activity and duration of disease. However, the significant differences between relapsing and chronic-progressive courses support the hypothesis of different underlying mechanisms of pathogenesis, and could serve as a starting basis for further studies. N2 - In der vorliegenden Arbeit wurde die Eignung der im Rahmen der Routinediagnostik verfügbaren, aber unzu¬reichend charakterisierten Analyten Beta-2-Mikroglobulin (β2-Mikroglobulin), Laktat und Angiotensin-Converting Enzyme (ACE) als Biomarker untersucht. Dazu wurden 6.310 an der Neurologischen Klinik des Universitätsklinikums Würzburg gewonnene Liquorproben analysiert. Näher analysiert wurden 276 Fälle mit nicht entzünd¬lichen neurologischen Erkrankungen (NIND; Kontrollgruppe) und 438 nicht immuntherapeutisch behandelte MS-Fälle (Untersuchugsgruppe). Bei den MS-Fällen wurde die Verlaufs¬form und Krankheitsaktivität (klinische Schübe, Progressionsindex) dokumentiert. Es zeigte sich eine deutliche Altersabhängigkeit der Liquorspiegel von β2-Mikroglobulin, Laktat und ACE in der MS- und Kontrollgruppe, was für die sich anschließenden weiteren Vergleichsuntersuchungen eine Korrektur erforderte und zumindest teilweise die wider¬sprüchliche Datenlage bisheriger Studien erklären könnte. MS-Fälle zeigten im Liquor im Vergleich zu Kontrollen erhöhte β2-Mikroglobulin- und Laktat- sowie er¬niedrigte ACE-Spiegel. In beiden Gruppen korrelierten die β2-Mikroglobulin- und ACE-Spiegel positiv miteinander. Bei der getrennten Analyse der MS-Verlaufsformen zeigten Fälle mit klinisch isoliertem Syndrom (CIS) und schubförmig remittierender MS (RRMS) erhöhte β2-Mikroglobulin-Spiegel, Fälle mit sekundär bzw. primär pro¬gredienter MS (SPMS bzw. PPMS) dagegen nicht. Die Laktat-Spiegel waren lediglich bei CIS-Fällen erhöht. Fälle mit schubförmigen Verläufen zeigten reduzierte ACE-Spiegel. Die Krankheitsaktivität wurde durch die Parameter nicht zuverlässig abgebildet. Die Laktat-Spiegel waren tendenziell bei einem Schub erhöht, das Ergebnis war nach Korrektur aber nicht mehr signifikant. Die Laktat-Spiegel korrelierten zudem positiv mit dem Progressionsindex. Die vorliegenden Befunde belegen, dass die untersuchten Analyten alleine nicht in der Lage sind, die Verlaufsform, Krankheitsaktivität und -dauer zu beurteilen. Die deutlichen Unterschiede zwischen schubförmigen und chronisch progredienten Verläufen unterstützen jedoch die Hypothese unterschiedlicher zugrundeliegender Pathomechanismen und könnten als Ausgangspunkt für weitere Untersuchungen dienen. KW - Multiple Sklerose KW - Biomarker KW - Liquor cerebrospinalis KW - Mikroglobulin KW - ACE KW - Laktat Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258503 ER - TY - THES A1 - Seager, Anna T1 - Die urämische Neuropathie - ein Vitamin-B\(_{12}\)-Mangel? T1 - Uremic Neuropathy - a Vitamin B\(_{12}\) Deficiency? N2 - Eine Vielzahl von Patienten mit fortgeschrittener, beziehungsweise dialysepflichtiger Niereninsuffizienz entwickeln eine Polyneuropathie. Die Pathogenese der urämischen Neuropathie (UN) ist nicht geklärt, sodass auf der Suche nach dem Pathomechanismus auch ein Vitamin-B12-Mangel diskutiert werden muss, da dieser ähnliche Symptome wie die UN hervorrufen kann. Ziel dieser Studie war es, den Zusammenhang zwischen den Parametern des Vitamin-B12-Stoffwechsels und der UN darzustellen. In einer prospektiven Studie mit insgesamt 54 teilnehmenden Patienten wurden diese vor und nach einer Vitamin-B12-Substitution laborchemisch untersucht. Zudem erhielten die Patienten neben einer klinischen Untersuchung eine elektroneurographische Diagnostik des N. suralis und des N. tibialis, sowie eine QST-Untersuchung. N2 - Uremic neuropathy (UN) is the most common neurological disorder in end-stage renal disease. The pathophysiology of uremic neuropathy is complex and is not yet fully understood. Vitamin B12 deficiency can cause severe neurological disorders and symptoms are similar to UN. To investigate whether UN is due to Vitamin B12 deficiency, we conducted a study measuring Vitamin B12 Biomarkers on 54 dialysis patients before and after administering Vitamin B12. In addition a full neurological clinical exam, as well as electroneurography and QST were conducted before and after Vitamin B12 supplementation. KW - Urämie KW - Polyneuropathie KW - Chronische Niereninsuffizienz KW - Vitamin-B12-Mangel KW - Dialyse KW - Methylmalonsäure Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-291094 ER - TY - THES A1 - Brunder, Anna-Michelle T1 - Nodale und paranodale Autoantikörper bei inflammatorischen Polyneuropathien: Nachweis, Charakterisierung und Assoziation zu klinischen Verlaufsformen T1 - Nodal and paranodal autoantibodies in chronic inflammatoric polyneuropathies: Detection, characterization and assoziation with clinical course N2 - In den letzten Jahren gewann das Konzept der Paranodopathien als eigene Krankheitsentität der inflammatorischen Polyneuropathien zunehmend an Bedeutung. Die Forschung konzentrierte sich dabei überwiegend auf die chronisch inflammatorische Polyradikuloneuropathie (CIDP). In dieser Arbeit werden (para-)nodale Antikörper gegen Neurofascin-155, panNeurofascin, Contactin-1 und Caspr-1 in einer großen Kohorte von Patienten mit Guillain-Barré-Syndrom (GBS) und CIDP nachgewiesen. Patienten mit Anti-panNeurofascin-Antikörpern zeigten besonders schwere Verlaufsformen. Patienten mit anderen (para-)nodalen Antikörpern zeigten je nach IgG-Subklasse der Antikörper spezifische klinische Merkmale und ein unterschiedliches Ansprechen auf die Therapie. Die Arbeit zeigt, dass die Bestimmung (para-)nodaler Antikörper bei Patienten mit GBS und CIDP im klinischen Alltag zur Einordung der Prognose und Therapieplanung sinnvoll sein kann. N2 - In the last years the concept of paranodopathy as an own disease entity has gained more relevance. So far, most studies focused on chronic inflammatory polyneuropathy (CIDP). In this study, autoantibodies against neurofascin-155, pan-neurofascin, contactin-1, and capsr-1 in a cohort of Guillain-Barré-syndrome (GBS) and CIDP were detected. All patients with anti-pan-neurofascin-antibodies suffered from a very severe course of disease. Patients with other (para-)nodal autoantibodies showed common clinical features and therapeutic response depending on the autoantibody and their IgG-subclasses. This study shows that (para-)nodal autoantibodies should be determined in GBS and CIDP to estimate clinical course and therapeutic response. KW - Polyneuropathie KW - Guillain-Barré-Syndrom KW - Autoantikörper KW - Neurofascin KW - Contactin KW - Caspr KW - (Para-)nodale Autoantikörper Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-282185 ER - TY - THES A1 - Leinfelder, Teresa T1 - Untersuchung von Trainingseffekten bei der Verwendung einer auditorischen P300-basierten EEG Gehirn-Computer Schnittstelle mittels fMRI Analyse T1 - Investigation of training effects of a P300-based EEG brain-computer interface using fMRI analysis N2 - In dieser Dissertation untersuchten wir die neuronalen Korrelate des Training-Effektes einer auditorischen P300 Gehirn-Computer Schnittstelle mittels fMRI Analyse in einem prä-post Design mit zehn gesunden Testpersonen. Wir wiesen in drei Trainings-sitzungen einen Trainingseffekt in der EEG-Analyse der P300 Welle nach und fanden entsprechende Kontraste in einer prä-post Analyse von fMRI Daten, wobei in allen fünf Sitzungen das gleiche Paradigma verwendet wurde. In der fMRI Analyse fanden wir fol-gende Ergebnisse: in einem Target-/ Nichttarget Kontrast zeigte sich verstärkte Aktivie-rung in Generatorregionen der P300 Welle (temporale und inferiore frontale Regionen) und interessanterweise auch in motorassoziierten Arealen, was höhere kognitiver Pro-zesse wie Aufmerksamkeitslenkung und Arbeitsspeicher widerspiegeln könnte. Der Kon-trast des Trainingseffektes zeigte nach dem Training einen stärkeren Rebound Effekt im Sinne einer verstärkten Aktivierung in Generatorregionen der P300 Welle, was eine ver-besserte Erkennung und Prozessierung von Target-Stimuli reflektieren könnte. Eine Ab-nahme von Aktivierung in frontalen Arealen in diesem Kontrast könnte durch effizientere Abläufe kognitiver Prozesse und des Arbeitsgedächtnis erklärt werden. N2 - In this dissertation we investigated the neuronal correlates of the training effect of an auditory P300-based brain-computer interface using fMRI analysis in a prae-post de-sign in a group of ten healthy probands. We showed a training effect during three training sessions with EEG analysis of the P300 wave and found corresponding contrasts in a prae-post analysis of fMRI data, while using the same paradigma in all sessions. In the fMRI analysis we found the following results: in a target / nontarget contrast we found enhancement of activation in generator regions of the P300 wave such as temporal and inferior frontal areas and interestingly also in motor associated areas which could reflect higher cognitive processes such as attention and working memory. In the contrast of the effects of training we found a stronger rebound effect as a correlate of stronger activation after training in generator regions of P300, possibly reflecting better discrimination and processing of stimuli. The decrease of activation in frontal areas in this contrast could be explained by increased efficiency of cognitive processing and working memory through training. KW - Gehirn-Computer-Schnittstelle KW - Neurofeedback KW - Ereigniskorreliertes Potenzial KW - Funktionelle Kernspintomografie KW - auditorisches Neurofeedback Training KW - P300 Welle KW - EEG KW - BCI KW - ALS KW - auditory KW - fMRI Analyse KW - prä-post Design Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-290683 ER - TY - THES A1 - Stengel, Helena Maria T1 - Paranodale und nodale Autoantikörper: Charakterisierung der Anti-Neurofascin-Autoantikörper-assoziierten Neuropathie und Untersuchung des Effektes von Anti-Contactin-1-Autoantikörpern im Zellkulturmodell T1 - Paranodal and nodal autoantibodies: Characterization of the anti-neurofascin autoantibody-associated neuropathy and examination of the effect of anti-contactin-1 autoantibodies in a cell culture model N2 - Die (Para-)nodopathie ist neben der primär axonalen und der primär demyelinisierenden Polyneuropathie eine neue Krankheitsentität, die sich durch eine Schädigung der Funktion des Ranvierschen Schnürringes auszeichnet. Die Forschung zu (para-)nodalen Autoantikörpern fokussierte sich bislang hauptsächlich auf Neurofascin-155- und Contactin-1-Autoantikörper der Subklasse IgG4. In dieser Studie wurden die Seren von insgesamt 264 PatientInnen mit CIDP, GBS oder anderen Formen von Polyneuropathien mittels Bindungsassays an murinen Ischiadicuszupfnerven und gegebenenfalls ELISA auf (para-)nodale Autoantikörper gescrennt. Positive Autoantikörperbefunde wurden bei IgG-Autoantikörpern mittels Bindungsassays an transfizierten HEK-293-Zellen und bei IgM-Autoantikörpern mittels Western Blot bestätigt. ELISA Untersuchungen dienten zur näheren Spezifizierung. Weiterhin wurde die zeitabhängige Wirkung von Contactin-1-Autoantikörpern im Zellkulturmodell untersucht. Die im folgenden dargestellten Ergebnisse zeigen, dass die (Para-)nodopathie nicht auf die bisher am häufigsten beschriebene Erkrankung mit IgG4-Autoantikörpern beschränkt werden sollte. Bei dem extrem schwer betroffenen IgG-Patient 1 konnte ein Pan-Neurofascin-IgG3-Autoantikörper nachgewiesen werden. Als charakteristische Symptome für diese Autoantikörper konnten in Übereinstimmung mit weiteren Fallberichten Tetraplegie, Beatmungspflichtigkeit sowie eine schwere Hirnnervenbeteiligung bis zur Locked-In-Symptomatik identifiziert werden. Diese Patienten heben sich deutlich von den PatientInnen mit den bisher hauptsächlich beschriebenen Neurofascin-155-IgG4-Autoantikörpern ab, die wie IgG-Patient 2 charakteristischerweise in jungem Alter an einer CIDP mit Tremor ohne Besserung unter IVIG-Therapie leiden. Es wurden fünf PatientInnen mit Neurofascin-155-IgM-Autoantikörpern identifiziert, die eine akut beginnende Erkrankung mit Tetraparese, Tremor und neuropathischen Schmerzen zeigten. Ob sich dieser Phänotyp als charakteristisch für eine Neurofascin-155-IgM-(Para-)nodopathie bestätigt, sollte in weiteren Studien untersucht werden. Im murinen Zellkulturmodell an cerebellären Neuronen und Spinalganglienneuronen zeigte sich nach Inkubation mit Contactin-1-IgG-Patientenantikörpern eine zeitabhängige, rasch reversible Verminderung der Contactin-1-Protein-Expression in immunhistochemischen Färbungen sowie Western Blots, die durch eine Internalisierung des Contactin-1-Proteins erklärbar wäre. Der Angriff von Autoantikörpern an Spinalganglienneuronen und cerebellären Neurone sollte in weitere pathophysiologische Überlegungen miteinbezogen werden, da hierdurch typische Symptome der (Para-)nodopathie wie eine sensible Ataxie oder ein cerebellärer Tremor erklärt werden könnten. N2 - (Para-)nodopathy is besides primary axonal and primary demyelinating polyneuropathy a new disease entity characterized by damage to the function of the node of ranvier. Research on (para)nodal autoantibodies has up to now mainly focused on neurofascin-155 and contactin-1 autoantibodies of IgG4 subclass. In this study sera from 264 patients with CIDP, GBS, or other forms of polyneuropathies were screened for the presence of (para-)nodal autoantibodies by binding assays on murine sciatic nerve and ELISA. Positive autoantibody findings were confirmed by binding assays on transfected HEK-293 cells for IgG autoantibodies and by western blot for IgM autoantibodies. ELISA assays were used for further specification. Furthermore the time-dependent effect of contactin-1 autoantibodies was investigated in a cell culture model. The results, presented in the following, show that (para-)nodopathy should not be limited to the up to now most commonly described disease with IgG4 autoantibodies. In the extremely severely affected IgG patient 1 pan-neurofascin IgG3 autoantibodies were detected. In accordance with other case reports tetraplegia, the need for artificial ventilation and severe cranial nerve involvement up to locked-in syndrome could be identified as characteristic symptoms for these autoantibodies. These patients clearly differ from the patients with neurofascin-155 IgG4 autoantibodies, which have been mainly described so far and who, like IgG patient 2, characteristically suffer from CIDP with tremor, have a younger age of onset and do not show improvement under IVIG therapy. Five patients with neurofascin-155 IgM autoantibodies were identified, who showed acute onset disease with tetraparesis, tremor, and neuropathic pain. Whether this phenotype is confirmed to be characteristic of neurofascin-155 IgM (para-)nodopathy should be investigated in further studies. In the murine cell culture model of cerebellar granule neurons and dorsal root ganglion neurons, incubation with contactin-1 IgG patient antibodies showed a time-dependent, rapidly reversible decrease in contactin-1 protein expression in immunohistochemical staining as well as western blots, which could be explained by internalization of contactin-1 protein. The effect of autoantibodies on dorsal root ganglion neurons and cerebellar granule neurons should be considered in further pathophysiological considerations, as this could explain typical symptoms of (para-)nodopathy such as sensory ataxia or cerebellar tremor. KW - Ranvier-Schnürring KW - Polyneuropathie KW - Guillain-Barré-Syndrom KW - Autoantikörper KW - Zellkultur KW - Paranodale und nodale Autoantikörper KW - Anti-Neurofascin-Autoantikörper-assoziierten Neuropathie KW - Pan-Neurofascin-IgG3 KW - Neurofascin-155-IgG4-(Para-)nodopathie KW - Neurofascin-155-IgM KW - Effekte von Contactin-1-IgG-Patientenantikörpern im Zellkulturmodell Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-254662 ER - TY - JOUR A1 - Üçeyler, Nurcan A1 - Schließer, Mira A1 - Evdokimov, Dimitar A1 - Radziwon, Jakub A1 - Feulner, Betty A1 - Unterecker, Stefan A1 - Rimmele, Florian A1 - Walter, Uwe T1 - Reduced midbrain raphe echogenicity in patients with fibromyalgia syndrome JF - PloS One N2 - Objectives The pathogenesis of fibromyalgia syndrome (FMS) is unclear. Transcranial ultrasonography revealed anechoic alteration of midbrain raphe in depression and anxiety disorders, suggesting affection of the central serotonergic system. Here, we assessed midbrain raphe echogenicity in FMS. Methods Sixty-six patients underwent transcranial sonography, of whom 53 were patients with FMS (27 women, 26 men), 13 patients with major depression and physical pain (all women), and 14 healthy controls (11 women, 3 men). Raphe echogenicity was graded visually as normal or hypoechogenic, and quantified by digitized image analysis, each by investigators blinded to the clinical diagnosis. Results Quantitative midbrain raphe echogenicity was lower in patients with FMS compared to healthy controls (p<0.05), but not different from that of patients with depression and accompanying physical pain. Pain and FMS symptom burden did not correlate with midbrain raphe echogenicity as well as the presence and severity of depressive symptoms. Conclusion We found reduced echogenicity of the midbrain raphe area in patients with FMS and in patients with depression and physical pain, independent of the presence or severity of pain, FMS, and depressive symptoms. Further exploration of this sonographic finding is necessary before this objective technique may enter diagnostic algorithms in FMS and depression. KW - midbrain KW - fibromyalgia KW - depression KW - pain KW - ultrasound imaging KW - neuropathic pain KW - diagnostic medicine KW - migraine Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300639 VL - 17 IS - 11 ER - TY - JOUR A1 - Karikari, Akua A. A1 - McFleder, Rhonda L. A1 - Ribechini, Eliana A1 - Blum, Robert A1 - Bruttel, Valentin A1 - Knorr, Susanne A1 - Gehmeyr, Mona A1 - Volkmann, Jens A1 - Brotchie, Jonathan M. A1 - Ahsan, Fadhil A1 - Haack, Beatrice A1 - Monoranu, Camelia-Maria A1 - Keber, Ursula A1 - Yeghiazaryan, Rima A1 - Pagenstecher, Axel A1 - Heckel, Tobias A1 - Bischler, Thorsten A1 - Wischhusen, Jörg A1 - Koprich, James B. A1 - Lutz, Manfred B. A1 - Ip, Chi Wang T1 - Neurodegeneration by α-synuclein-specific T cells in AAV-A53T-α-synuclein Parkinson’s disease mice JF - Brain, Behavior, and Immunity N2 - Background Antigen-specific neuroinflammation and neurodegeneration are characteristic for neuroimmunological diseases. In Parkinson’s disease (PD) pathogenesis, α-synuclein is a known culprit. Evidence for α-synuclein-specific T cell responses was recently obtained in PD. Still, a causative link between these α-synuclein responses and dopaminergic neurodegeneration had been lacking. We thus addressed the functional relevance of α-synuclein-specific immune responses in PD in a mouse model. Methods We utilized a mouse model of PD in which an Adeno-associated Vector 1/2 serotype (AAV1/2) expressing human mutated A53T-α-Synuclein was stereotactically injected into the substantia nigra (SN) of either wildtype C57BL/6 or Recombination-activating gene 1 (RAG1)\(^{-/-}\) mice. Brain, spleen, and lymph node tissues from different time points following injection were then analyzed via FACS, cytokine bead assay, immunohistochemistry and RNA-sequencing to determine the role of T cells and inflammation in this model. Bone marrow transfer from either CD4\(^{+}\)/CD8\(^{-}\), CD4\(^{-}\)/CD8\(^{+}\), or CD4\(^{+}\)/CD8\(^{+}\) (JHD\(^{-/-}\)) mice into the RAG-1\(^{-/-}\) mice was also employed. In addition to the in vivo studies, a newly developed A53T-α-synuclein-expressing neuronal cell culture/immune cell assay was utilized. Results AAV-based overexpression of pathogenic human A53T-α-synuclein in dopaminergic neurons of the SN stimulated T cell infiltration. RNA-sequencing of immune cells from PD mouse brains confirmed a pro-inflammatory gene profile. T cell responses were directed against A53T-α-synuclein-peptides in the vicinity of position 53 (68–78) and surrounding the pathogenically relevant S129 (120–134). T cells were required for α-synuclein-induced neurodegeneration in vivo and in vitro, while B cell deficiency did not protect from dopaminergic neurodegeneration. Conclusions Using T cell and/or B cell deficient mice and a newly developed A53T-α-synuclein-expressing neuronal cell culture/immune cell assay, we confirmed in vivo and in vitro that pathogenic α-synuclein peptide-specific T cell responses can cause dopaminergic neurodegeneration and thereby contribute to PD-like pathology. KW - Parkinson’s disease KW - α-synuclein-specific T cells KW - neurodegeneration Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300600 VL - 101 SP - 194 EP - 210 ER - TY - JOUR A1 - Schulte, Annemarie A1 - Blum, Robert T1 - Shaped by leaky ER: Homeostatic Ca\(^{2+}\) fluxes JF - Frontiers in Physiology N2 - At any moment in time, cells coordinate and balance their calcium ion (Ca\(^{2+}\)) fluxes. The term ‘Ca\(^{2+}\) homeostasis’ suggests that balancing resting Ca2+ levels is a rather static process. However, direct ER Ca\(^{2+}\) imaging shows that resting Ca\(^{2+}\) levels are maintained by surprisingly dynamic Ca\(^{2+}\) fluxes between the ER Ca\(^{2+}\) store, the cytosol, and the extracellular space. The data show that the ER Ca\(^{2+}\) leak, continuously fed by the high-energy consuming SERCA, is a fundamental driver of resting Ca\(^{2+}\) dynamics. Based on simplistic Ca\(^{2+}\) toolkit models, we discuss how the ER Ca\(^{2+}\) leak could contribute to evolutionarily conserved Ca\(^{2+}\) phenomena such as Ca\(^{2+}\) entry, ER Ca\(^{2+}\) release, and Ca\(^{2+}\) oscillations. KW - Ca2+ homeostasis KW - Ca2+ ion analysis KW - ER Ca2+ store KW - ER Ca2+ imaging KW - SERCA KW - store-operated Ca2+ entry KW - Ca2+ leak KW - Ca2+ oscillation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-287102 SN - 1664-042X VL - 13 ER - TY - JOUR A1 - Friedrich, Maximilian A1 - Hartig, Johannes A1 - Prüss, Harald A1 - Ip, Wang Chi A1 - Volkmann, Jens T1 - Rapidly progressive dementia: Extending the spectrum of GFAP-astrocytopathies? JF - Annals of Clinical and Translational Neurology N2 - Autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) is a steroid-responsive meningoencephalomyelitis, sometimes presenting with atypical clinical signs such as movement disorders or psychiatric and autonomic features. Beyond clinical presentation and imaging, diagnosis relies on detection of GFAP-antibodies (AB) in CSF. Using quantitative behavioral, serologic, and immunohistochemical analyses, we characterize two patients longitudinally over 18–24 months who presented with rapidly progressive neurocognitive deterioration in the context of GFAP-AB in CSF and unremarkable cranial MRI studies. Intensified immunotherapy was associated with clinical stabilization. The value of GFAP-AB screening in selected cases of rapidly progressive dementias is discussed. KW - GFAP-astrocytopathies KW - dementia Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312957 VL - 9 IS - 3 ER - TY - JOUR A1 - Braun, Alexandra A1 - Evdokimov, Dimitar A1 - Frank, Johanna A1 - Pauli, Paul A1 - Wabel, Thomas A1 - Üçeyler, Nurcan A1 - Sommer, Claudia T1 - Relevance of Religiosity for Coping Strategies and Disability in Patients with Fibromyalgia Syndrome JF - Journal of Religion and Health N2 - Coping strategies are essential for the outcome of chronic pain. This study evaluated religiosity in a cohort of patients with fibromyalgia syndrome (FMS), its effect on pain and other symptoms, on coping and FMS-related disability. A total of 102 FMS patients were recruited who filled in questionnaires, a subgroup of 42 patients participated in a face-to-face interview, and data were evaluated by correlation and regression analyses. Few patients were traditionally religious, but the majority believed in a higher existence and described their spirituality as "transcendence conviction". The coping strategy "praying-hoping" and the ASP dimension "religious orientation" (r = 0.5, P < 0.05) showed a significant relationship independent of the grade of religiosity (P < 0.05). A high grade of belief in a higher existence was negatively associated with the choice of ignoring as coping strategy (r = - 0.4, P < 0.05). Mood and affect-related variables had the highest impact on disability (b = 0.5, P < 0.05). In this cohort, the grade of religiosity played a role in the choice of coping strategies, but had no effects on health and mood outcome. KW - Fibromyalgia syndrome KW - religiosity KW - coping KW - disability Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-269135 SN - 1573-6571 VL - 61 IS - 1 ER - TY - JOUR A1 - Lau, Kolja A1 - Üçeyler, Nurcan A1 - Cairns, Tereza A1 - Lorenz, Lora A1 - Sommer, Claudia A1 - Schindehütte, Magnus A1 - Amann, Kerstin A1 - Wanner, Christoph A1 - Nordbeck, Peter T1 - Gene variants of unknown significance in Fabry disease: Clinical characteristics of c.376AG (p.Ser126Gly) JF - Molecular Genetics & Genomic Medicine N2 - Background Anderson–Fabry disease (FD) is an X-linked lysosomal storage disorder with varying organ involvement and symptoms, depending on the underlying mutation in the alpha-galactosidase A gene (HGNC: GLA). With genetic testing becoming more readily available, it is crucial to precisely evaluate pathogenicity of each genetic variant, in order to determine whether there is or might be not a need for FD-specific therapy in affected patients and relatives at the time point of presentation or in the future. Methods This case series investigates the clinical impact of the specific GLA gene variant c.376A>G (p.Ser126Gly) in five (one heterozygous and one homozygous female, three males) individuals from different families, who visited our center between 2009 and 2021. Comprehensive neurological, nephrological and cardiac examinations were performed in all cases. One patient received a follow-up examination after 12 years. Results Index events leading to suspicion of FD were mainly unspecific neurological symptoms. However, FD-specific biomarkers, imaging examinations (i.e., brain MRI, heart MRI), and tissue-specific diagnostics, including kidney and skin biopsies, did not reveal evidence for FD-specific symptoms or organ involvement but showed normal results in all cases. This includes findings from 12-year follow-up in one patient with renal biopsy. Conclusion These findings suggest that p.Ser126Gly represents a benign GLA gene variant which per se does not cause FD. Precise clinical evaluation in individuals diagnosed with genetic variations of unknown significance should be performed to distinguish common symptoms broadly prevalent in the general population from those secondary to FD. KW - diagnosis in Fabry disease KW - Fabry disease KW - gene variant KW - genotype/phenotype correlation KW - lysosomal storage disease Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312817 VL - 10 IS - 5 ER - TY - JOUR A1 - Hiew, Shawn A1 - Nguemeni, Carine A1 - Zeller, Daniel T1 - Efficacy of transcranial direct current stimulation in people with multiple sclerosis: a review JF - European Journal of Neurology N2 - Background and purpose Multiple sclerosis (MS) is a chronic inflammatory disease causing a wide range of symptoms including motor and cognitive impairment, fatigue and pain. Over the last two decades, non-invasive brain stimulation, especially transcranial direct current stimulation (tDCS), has increasingly been used to modulate brain function in various physiological and pathological conditions. However, its experimental applications for people with MS were noted only as recently as 2010 and have been growing since then. The efficacy for use in people with MS remains questionable with the results of existing studies being largely conflicting. Hence, the aim of this review is to paint a picture of the current state of tDCS in MS research grounded on studies applying tDCS that have been done to date. Methods A keyword search was performed to retrieve articles from the earliest article identified until 14 February 2021 using a combination of the groups (1) ‘multiple sclerosis’, ‘MS’ and ‘encephalomyelitis’ and (2) ‘tDCS’ and ‘transcranial direct current stimulation’. Results The analysis of the 30 articles included in this review underlined inconsistent effects of tDCS on the motor symptoms of MS based on small sample sizes. However, tDCS showed promising benefits in ameliorating fatigue, pain and cognitive symptoms. Conclusion Transcranial direct current stimulation is attractive as a non-drug approach in ameliorating MS symptoms, where other treatment options remain limited. The development of protocols tailored to the individual's own neuroanatomy using high definition tDCS and the introduction of network mapping in the experimental designs might help to overcome the variability between studies. KW - transcranial direct current stimulation KW - cognitive KW - effects KW - motor KW - multiple sclerosis Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259424 VL - 29 IS - 2 ER -