TY - JOUR A1 - Gulberti, A. A1 - Moll, C.K.E. A1 - Hamel, W. A1 - Buhmann, C. A1 - Koeppen, J.A. A1 - Boelmans, K. A1 - Zittel, S. A1 - Gerloff, C. A1 - Westphal, M. A1 - Schneider, T.R. A1 - Engel, A.K. T1 - Predictive timing functions of cortical beta oscillations are impaired in Parkinson's disease and influenced by L-DOPA and deep brain stimulation of the subthalamic nucleus Impaired beta-band timing functions in PD JF - NeuroImage: Clinical N2 - Cortex-basal ganglia circuits participate in motor timing and temporal perception, and are important for the dynamic configuration of sensorimotor networks in response to exogenous demands. In Parkinson's disease (PD) patients, rhythmic auditory stimulation (RAS) induces motor performance benefits. Hitherto, little is known concerning contributions of the basal ganglia to sensory facilitation and cortical responses to RAS in PD. Therefore, we conducted an EEG study in 12 PD patients before and after surgery for subthalamic nucleus deep brain stimulation (STN-DBS) and in 12 age-matched controls. Here we investigated the effects of levodopa and STN-DBS on resting-state EEG and on the cortical-response profile to slow and fast RAS in a passive-listening paradigm focusing on beta-band oscillations, which are important for auditory–motor coupling. The beta-modulation profile to RAS in healthy participants was characterized by local peaks preceding and following auditory stimuli. In PD patients RAS failed to induce pre-stimulus beta increases. The absence of pre-stimulus beta-band modulation may contribute to impaired rhythm perception in PD. Moreover, post-stimulus beta-band responses were highly abnormal during fast RAS in PD patients. Treatment with levodopa and STN-DBS reinstated a post-stimulus beta-modulation profile similar to controls, while STN-DBS reduced beta-band power in the resting-state. The treatment-sensitivity of beta oscillations suggests that STN-DBS may specifically improve timekeeping functions of cortical beta oscillations during fast auditory pacing. KW - Parkinson's disease KW - interval timing KW - beta oscillations KW - subthalamic nucleus KW - deep brain stimulation Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-150049 VL - 9 ER - TY - JOUR A1 - Quarta, Serena A1 - Vogl, Christian A1 - Constantin, Cristina E. A1 - Üçeyler, Nurcan A1 - Sommer, Claudia A1 - Kress, Michaela T1 - Genetic evidence for an essential role of neuronally expressed IL-6 signal transducer gp130 in the induction and maintenance of experimentally induced mechanical hypersensitivity \(in\) \(vivo\) and \(in\) \(vitro\) JF - Molecular Pain N2 - Tenderness and mechanical allodynia are key symptoms of malignant tumor, inflammation and neuropathy. The proinflammatory cytokine interleukin-6 (IL-6) is causally involved in all three pathologies. IL-6 not only regulates innate immunity and inflammation but also causes nociceptor sensitization and hyperalgesia. In general and in most cell types including immune cells and sensory neurons, IL-6 binds soluble mu receptor subunits which heteromerizes with membrane bound IL-6 signal transducer gp130. In the present study, we used a conditional knock-out strategy to investigate the importance of signal transducer gp130 expressed in C nociceptors for the generation and maintenance of mechanical hypersensitivity. Nociceptors were sensitized to mechanical stimuli by experimental tumor and this nociceptor sensitization was preserved at later stages of the pathology in control mice. However, in mice with a conditional deletion of gp130 in Nav1.8 expressing nociceptors mechanical hypersensitivity by experimental tumor, nerve injury or inflammation recovery was not preserved in the maintenance phase and nociceptors exhibited normal mechanical thresholds comparable to untreated mice. Together, the results argue for IL-6 signal transducer gp130 as an essential prerequisite in nociceptors for long-term mechanical hypersensitivity associated with cancer, inflammation and nerve injury. KW - Leukemia Inhibitory Factor KW - Mediated Inflammatory Hyperalgesia KW - Necrosis-factor-Alpha KW - Oncostatin-M-Receptor KW - Rat Sensory Neurons KW - Rheumatoid-Arthritis KW - Interleukin-6-Deficient mice KW - Peripheral Inflammation KW - Thermal Hyperalgesia KW - Heat Hyperalgesia KW - proinflammatory cytokine KW - Interleukin-6 KW - chronic pain KW - nociceptor sensitization KW - hyperalgesia KW - allodynia Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-140380 VL - 7,73 ER - TY - JOUR A1 - Hopfner, Franziska A1 - Schormair, Barbara A1 - Knauf, Franziska A1 - Berthele, Achim A1 - Tölle, Thomas R. A1 - Baron, Ralf A1 - Maier, Christoph A1 - Treede, Rolf-Detlef A1 - Binder, Andreas A1 - Sommer, Claudia A1 - Maihöfner, Christian A1 - Kunz, Wolfram A1 - Zimprich, Friedrich A1 - Heemann, Uwe A1 - Pfeufer, Arne A1 - Näbauer, Michael A1 - Kääb, Stefan A1 - Nowak, Barbara A1 - Gieger, Christian A1 - Lichtner, Peter A1 - Trenkwalder, Claudia A1 - Oexle, Konrad A1 - Winkelmann, Juliane T1 - Novel SCARB2 mutation in Action Myoclonus-Renal Failure syndrome and evaluation of SCARB2 mutations in isolated AMRF features JF - BMC Neurology N2 - Background: Action myoclonus-renal failure syndrome is a hereditary form of progressive myoclonus epilepsy associated with renal failure. It is considered to be an autosomal-recessive disease related to loss-of-function mutations in SCARB2. We studied a German AMRF family, additionally showing signs of demyelinating polyneuropathy and dilated cardiomyopathy. To test the hypothesis whether isolated appearance of individual AMRF syndrome features could be related to heterozygote SCARB2 mutations, we screened for SCARB2 mutations in unrelated patients showing isolated AMRF features. Methods: In the AMRF family all exons of SCARB2 were analyzed by Sanger sequencing. The mutation screening of unrelated patients with isolated AMRF features affected by either epilepsy (n = 103, progressive myoclonus epilepsy or generalized epilepsy), demyelinating polyneuropathy (n = 103), renal failure (n = 192) or dilated cardiomyopathy (n = 85) was performed as high resolution melting curve analysis of the SCARB2 exons. Results: A novel homozygous 1 bp deletion (c.111delC) in SCARB2 was found by sequencing three affected homozygous siblings of the affected family. A heterozygous sister showed generalized seizures and reduction of nerve conduction velocity in her legs. No mutations were found in the epilepsy, renal failure or dilated cardiomyopathy samples. In the polyneuropathy sample two individuals with demyelinating disease were found to be carriers of a SCARB2 frameshift mutation (c.666delCCTTA). Conclusions: Our findings indicate that demyelinating polyneuropathy and dilated cardiomyopathy are part of the action myoclonus-renal failure syndrome. Moreover, they raise the possibility that in rare cases heterozygous SCARB2 mutations may be associated with PNP features. KW - Demyelinating peripheral neuropathy KW - Beta-glucocerebrosidase KW - Epilepsy KW - LIMP-2 KW - Mice Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-141209 VL - 11 IS - 134 ER - TY - JOUR A1 - Hopp, Sarah A1 - Albert-Weissenberger, Christiane T1 - The kallikrein-kinin system: a promising therapeutic target for traumatic brain injury JF - Neural Regeneration Research N2 - No abstract available. KW - kallikrein-kinin system KW - traumatic brain injury KW - therapy Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-149416 VL - 10 IS - 6 ER - TY - JOUR A1 - Fluri, Felix A1 - Schuhmann, Michael K A1 - Kleinschnitz, Christoph T1 - Animal models of ischemic stroke and their application in clinical research JF - Drug Design, Development and Therapy N2 - This review outlines the most frequently used rodent stroke models and discusses their strengths and shortcomings. Mimicking all aspects of human stroke in one animal model is not feasible because ischemic stroke in humans is a heterogeneous disorder with a complex pathophysiology. The transient or permanent middle cerebral artery occlusion (MCAo) model is one of the models that most closely simulate human ischemic stroke. Furthermore, this model is characterized by reliable and well-reproducible infarcts. Therefore, the MCAo model has been involved in the majority of studies that address pathophysiological processes or neuroprotective agents. Another model uses thromboembolic clots and thus is more convenient for investigating thrombolytic agents and pathophysiological processes after thrombolysis. However, for many reasons, preclinical stroke research has a low translational success rate. One factor might be the choice of stroke model. Whereas the therapeutic responsiveness of permanent focal stroke in humans declines significantly within 3 hours after stroke onset, the therapeutic window in animal models with prompt reperfusion is up to 12 hours, resulting in a much longer action time of the investigated agent. Another major problem of animal stroke models is that studies are mostly conducted in young animals without any comorbidity. These models differ from human stroke, which particularly affects elderly people who have various cerebrovascular risk factors. Choosing the most appropriate stroke model and optimizing the study design of preclinical trials might increase the translational potential of animal stroke models. KW - permanent and transient middle cerebral artery occlusion KW - thromboembolic clot model KW - mouse KW - rat KW - microsphere/macrosphere KW - endothelin-1 KW - photothrombosis KW - thromboembolic stroke Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-149157 VL - 9 ER - TY - THES A1 - Pausch, Jonas Franz T1 - Präferentielle Lokalisation von Makrophagen im räumlichen Umfeld von Ranvier'schen Schnürringen - Morphologische Analysen zur räumlichen Verteilung von Makrophagen in Mausmodellen für erbliche Neuropathien T1 - Preferential localisation of macrophages near nodes of Ranvier - morpholocgical analyses in mose models for ihertited peripheral neuropathie N2 - Die Charcot-Marie-Tooth Typ 1 Erkrankungen sind eine genetisch heterogene Gruppe, aktuell nicht kurativ therapierbarer, erblicher Neuropathien des Peripheren Nervensystems. Klinische Manifestationen reichen von Sensibilitäts-störungen, verminderten Muskeleigenreflexen, sowie fortschreitenden Lähmungen, bis hin zu Muskelatrophie und bedeuten für die betroffenen Patienten eine starke Einschränkung der Lebensqualität. Anhand früherer Studien wurde Makrophagen, als Teil des angeborenen Immunsystems, eine entscheidende Rolle in der Pathogenese dreier CMT1-Unterformen zugeschrieben. Abgesehen von den morphologischen Manifestationen der demyelinisierenden CMT1-Erkrankungen, wie simultanes Auftreten von Dedifferenzierung, sowie Hypo-, und Demyelinisierung erkrankter Schwann-Zellen, sind pathologische Veränderungen der Domänengliederung der Ranvier’schen Schnürringe betroffener Nervenfasern ebenfalls von der Aktivierung pathogener Makrophagen abhängig. Auf der Basis verschiedener veröffentlichter Studien, welche sowohl demyelinisierende Erkrankungen des ZNS, aber auch primär durch axonale Schäden gekennzeichnete Erkrankungen des PNS beinhalten, besteht ein möglicher räumlicher Zusammenhang zwischen Architekturstörungen der RS und aktivierten pathogenen Mikrogliazellen bzw. Makrophagen. In dieser Studie konnte, anhand morphologischer Analysen von peripherem Nervengewebe, in Wt-Mäusen erstmals eine unerwartete präferentielle Lokalisation von Makrophagen im räumlichen Umfeld von RS beobachtet werden. Hierbei scheint, trotz des Fehlens einer direkten Zell-Zell-Interaktion zwischen Makrophagen und RS, vor allem im Hinblick auf die ebenfalls im räumlichen Umfeld von RS nachweisbare EZM und Fibroblasten, eine funktionelle Relevanz der assoziierten Makrophagen für die Aufrechterhaltung der Domänengliederung bzw. elektrophysiologischen Eigenschaften myelinisierter peripherer Nervenfasern denkbar. Im Gegensatz dazu wurde trotz der signifikanten Zunahme der Makrophagenanzahlen in den drei untersuchten CMT1-Mausmodellen keine erhöhte räumliche Assoziation mit den RS der mutierten Schwann-Zellen beobachtet. Vielmehr konnten anhand des Vergleiches mit wildtypischen Kontrollmäusen signifikant erniedrigte Assoziationsraten beider Strukturen in den CMT1-Modelltieren festgestellt werden. Folglich scheint die von der Einwanderung und Aktivierung pathogener Makrophagen abhängige Störung der Domänengliederung der RS der mutierten Schwann-Zellen, nicht durch eine direkte Interaktion bzw. räumliche Assoziation von Makrophagen mit RS ausgelöst zu werden. N2 - The Charcot-Marie-Tooth neuropathies are a heterogenous group of inherited neuropathies oft he peripheral nervous system currenly incurable. Clinical symptoms vary from sensory loss, reduced tendon reflexes, muscular atrophy to progressive disability. According to different studies macrophages, as a part oft he innate immune system, play a crucial role in the pathogenesis of three different CMT-1 subtypes. Apart from morphological changes like dedifferentiation as well as hypo- and demyelination of diseased Schwann-cells, pathological alterations of nodes of Ranvier are also driven by activated marophages. As already described for demyelinating disoders oft he CNS, as well as neruodegenerative disorders oft he PNS, we investigated the spatial association of macrophages with diseased nodes of Ranvier. According to morphological analysis of peripheral nerve tissue this study is the first to describe an unexpected preferential spatial localization of macrophages near nodes of Ranvier in healthy nerves. Despite direct cell-cell interactions macrohages might play a functional role regarding the turnover of ECM and fibroblasts surrounding nodes of Ranvier, as well as the maintenance oft he architecture and electrophysiological features of peripheral nerve fibers. KW - Makrophagen KW - Erbliche Neuropathien KW - Charcot-Marie-Tooth KW - Ranvier'sche Schnürringe KW - CMT KW - Ranvier'sche Schnürringe Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-143801 ER - TY - JOUR A1 - Binder, Andreas A1 - May, Denisa A1 - Baron, Ralf A1 - Maier, Christoph A1 - Tölle, Thomas R. A1 - Treede, Rolf-Detlef A1 - Berthele, Achim A1 - Faltraco, Frank A1 - Flor, Herta A1 - Gierthmühlen, Janne A1 - Haenisch, Sierk A1 - Huge, Volker A1 - Magerl, Walter A1 - Maihöfner, Christian A1 - Richter, Helmut A1 - Rolke, Roman A1 - Scherens, Andrea A1 - Üçeyler, Nurcan A1 - Ufer, Mike A1 - Wasner, Gunnar A1 - Zhu, Jihong A1 - Cascorbi, Ingolf T1 - Transient Receptor Potential Channel Polymorphisms Are Associated with the Somatosensory Function in Neuropathic Pain Patients JF - PLoS ONE N2 - Transient receptor potential channels are important mediators of thermal and mechanical stimuli and play an important role in neuropathic pain. The contribution of hereditary variants in the genes of transient receptor potential channels to neuropathic pain is unknown. We investigated the frequency of transient receptor potential ankyrin 1, transient receptor potential melastin 8 and transient receptor potential vanilloid 1 single nucleotide polymorphisms and their impact on somatosensory abnormalities in neuropathic pain patients. Within the German Research Network on Neuropathic Pain (Deutscher Forscbungsverbund Neuropathischer Schmerz) 371 neuropathic pain patients were phenotypically characterized using standardized quantitative sensory testing. Pyrosequencing was employed to determine a total of eleven single nucleotide polymorphisms in transient receptor potential channel genes of the neuropathic pain patients and a cohort of 253 German healthy volunteers. Associations of quantitative sensory testing parameters and single nucleotide polymorphisms between and within groups and subgroups, based on sensory phenotypes, were analyzed. Single nucleotide polymorphisms frequencies did not differ between both the cohorts. However, in neuropathic pain patients transient receptor potential ankyrin 1 710G>A (rs920829, E179K) was associated with the presence of paradoxical heat sensation (p=0.03), and transient receptor potential vanilloid 1 1911A>G (rs8065080, I585V) with cold hypoalgesia (p=0.0035). Two main subgroups characterized by preserved (1) and impaired (2) sensory function were identified. In subgroup 1 transient receptor potential vanilloid 1 1911A>G led to significantly less heat hyperalgesia, pinprick hyperalgesia and mechanical hypaesthesia (p=0.006, p=0.005 and p<0.001) and transient receptor potential vanilloid 1 1103C>G (rs222747, M315I) to cold hypaesthesia (p=0.002), but there was absence of associations in subgroup 2. In this study we found no evidence that genetic variants of transient receptor potential channels are involved in the expression of neuropathic pain, but transient receptor potential channel polymorphisms contributed significantly to the somatosensory abnormalities of neuropathic pain patients. KW - Paradoxical heat sensation KW - Neurogenic inflammation KW - Capsaicin receptor KW - TRP Channels KW - Cold KW - Mechanisms KW - Hyperalgesia KW - Sensitivity KW - Expression KW - Stimuli Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-142782 VL - 6 IS - 3 ER - TY - JOUR A1 - Tony, Hans-Peter A1 - Burmester, Gerd A1 - Schulze-Koops, Hendrik A1 - Grunke, Mathias A1 - Henes, Joerg A1 - Kötter, Ina A1 - Haas, Judith A1 - Unger, Leonore A1 - Lovric, Svjetlana A1 - Haubitz, Marion A1 - Fischer-Betz, Rebecca A1 - Chehab, Gamal A1 - Rubbert-Roth, Andrea A1 - Specker, Christof A1 - Weinerth, Jutta A1 - Holle, Julia A1 - Müller-Ladner, Ulf A1 - König, Ramona A1 - Fiehn, Christoph A1 - Burgwinkel, Philip A1 - Budde, Klemens A1 - Sörensen, Helmut A1 - Meurer, Michael A1 - Aringer, Martin A1 - Kieseier, Bernd A1 - Erfurt-Berge, Cornelia A1 - Sticherling, Michael A1 - Veelken, Roland A1 - Ziemann, Ulf A1 - Strutz, Frank A1 - von Wussow, Praxis A1 - Meier, Florian MP A1 - Hunzelmann, Nico A1 - Schmidt, Enno A1 - Bergner, Raoul A1 - Schwarting, Andreas A1 - Eming, Rüdiger A1 - Schwarz-Eywill, Michael A1 - Wassenberg, Siegfried A1 - Fleck, Martin A1 - Metzler, Claudia A1 - Zettl, Uwe A1 - Westphal, Jens A1 - Heitmann, Stefan A1 - Herzog, Anna L. A1 - Wiendl, Heinz A1 - Jakob, Waltraud A1 - Schmidt, Elvira A1 - Freivogel, Klaus A1 - Dörner, Thomas A1 - Hertl, Michael A1 - Stadler, Rudolf T1 - Safety and clinical outcomes of rituximab therapy in patients with different autoimmune diseases: experience from a national registry (GRAID) JF - Arthritis Research & Therapy N2 - Introduction: Evidence from a number of open-label, uncontrolled studies has suggested that rituximab may benefit patients with autoimmune diseases who are refractory to standard-of-care. The objective of this study was to evaluate the safety and clinical outcomes of rituximab in several standard-of-care-refractory autoimmune diseases (within rheumatology, nephrology, dermatology and neurology) other than rheumatoid arthritis or non-Hodgkin’s lymphoma in a real-life clinical setting. Methods: Patients who received rituximab having shown an inadequate response to standard-of-care had their safety and clinical outcomes data retrospectively analysed as part of the German Registry of Autoimmune Diseases. The main outcome measures were safety and clinical response, as judged at the discretion of the investigators. Results: A total of 370 patients (299 patient-years) with various autoimmune diseases (23.0% with systemic lupus erythematosus, 15.7% antineutrophil cytoplasmic antibody-associated granulomatous vasculitides, 15.1% multiple sclerosis and 10.0% pemphigus) from 42 centres received a mean dose of 2,440 mg of rituximab over a median (range) of 194 (180 to 1,407) days. The overall rate of serious infections was 5.3 per 100 patient-years during rituximab therapy. Opportunistic infections were infrequent across the whole study population, and mostly occurred in patients with systemic lupus erythematosus. There were 11 deaths (3.0% of patients) after rituximab treatment (mean 11.6 months after first infusion, range 0.8 to 31.3 months), with most of the deaths caused by infections. Overall (n = 293), 13.3% of patients showed no response, 45.1% showed a partial response and 41.6% showed a complete response. Responses were also reflected by reduced use of glucocorticoids and various immunosuppressives during rituximab therapy and follow-up compared with before rituximab. Rituximab generally had a positive effect on patient well-being (physician’s visual analogue scale; mean improvement from baseline of 12.1 mm) KW - GRAID Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-142856 VL - 13 IS - R75 ER - TY - JOUR A1 - Geis, Christian A1 - Weishaupt, Andreas A1 - Grünewald, Benedikt A1 - Wultsch, Thomas A1 - Reif, Andreas A1 - Gerlach, Manfred A1 - Dirkx, Ron A1 - Solimena, Michele A1 - Toyka, Klaus V A1 - Folli, Franco A1 - Perani, Daniela A1 - Heckmann, Manfred A1 - Sommer, Claudia T1 - Human Stiff-Person Syndrome IgG Induces Anxious Behavior in Rats JF - Plos One N2 - Background: Anxiety is a heterogeneous behavioral domain playing a role in a variety of neuropsychiatric diseases. While anxiety is the cardinal symptom in disorders such as panic disorder, co-morbid anxious behavior can occur in a variety of diseases. Stiff person syndrome (SPS) is a CNS disorder characterized by increased muscle tone and prominent agoraphobia and anxiety. Most patients have high-titer antibodies against glutamate decarboxylase (GAD) 65. The pathogenic role of these autoantibodies is unclear. Methodology/Principal Findings: We re-investigated a 53 year old woman with SPS and profound anxiety for GABA-A receptor binding in the amygdala with (11) C-flumazenil PET scan and studied the potential pathogenic role of purified IgG from her plasma filtrates containing high-titer antibodies against GAD 65. We passively transferred the IgG fraction intrathecally into rats and analyzed the effects using behavioral and in vivo electrophysiological methods. In cell culture, we measured the effect of patient IgG on GABA release from hippocampal neurons. Repetitive intrathecal application of purified patient IgG in rats resulted in an anxious phenotype resembling the core symptoms of the patient. Patient IgG selectively bound to rat amygdala, hippocampus, and frontal cortical areas. In cultured rat hippocampal neurons, patient IgG inhibited GABA release. In line with these experimental results, the GABA-A receptor binding potential was reduced in the patient's amygdala/hippocampus complex. No motor abnormalities were found in recipient rats. Conclusion/Significance: The observations in rats after passive transfer lead us to propose that anxiety-like behavior can be induced in rats by passive transfer of IgG from a SPS patient positive for anti-GAD 65 antibodies. Anxiety, in this case, thus may be an antibody-mediated phenomenon with consecutive disturbance of GABAergic signaling in the amygdala region. KW - Glutamic-acid decarboxylase anxiety KW - spinal-cord-injury KW - presynaptic inhibition KW - 65-kda isoform KW - fear memory KW - antibodies KW - disorder KW - neurons KW - anxiety KW - autoantibodies Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-140506 VL - 6 IS - 2 ER - TY - THES A1 - Purrer, Veronika T1 - Nicht-motorische Begleitsymptome bei Patienten mit Essentiellen Tremor T1 - Non-motor symptoms in patients with essential tremor N2 - Der essentielle Tremor (ET) ist eine der häufigsten Bewegungsstörungen, welcher lange Zeit als rein motorische Störung angesehen wurde. Aufgrund zunehmender Belege über nicht-motorisch Begleitsymptome wandelte sich dieses Bild jedoch in den letzten Jahren zunehmend. In der vorliegenden Arbeit untersuchten wir 113 Probanden aus der Allgemeinbevölkerung mit klinisch definitiven oder wahrscheinlichen ET anhand einer breiten Batterie neuro-psychologischer Testverfahren. Es gelang hierbei signifikante Unterschiede im Vergleich zu gesunden Eichstichproben im Hinblick auf neuro-psychologische Charakteristika, wie Apathie, Ängstlichkeit und exekutive Dysfunktion, sowie deren negativen Einfluss auf die Lebensqualität der Probanden darzustellen. Bisher werden im klinischen Alltag nicht-motorische Begleitphänomene beim ET nicht regelhaft erfasst; aufgrund unserer Ergebnisse und der Relevanz vor allem im Hinblick auf die Lebensqualität des Einzelnen halten wir jedoch die Erfassung und gegebenenfalls Behandlung dieser Symptome für ebenso relevant. N2 - Essential tremor (ET) is one of the most common movement disorders, which was previously considered a purely motor disorder. Due to increasing evidence of non-motor symptoms, however, this picture has changed recently. In the present study we investigated 113 subjects from the general population with clinically definite or probable ET using a broad battery of neuro-psychological screening tools. Thereby, significant differences in neuro-psychological characteristics, such as apathy, anxiety and executive dysfunction, as well as their negative impact on the quality of life of the subjects could be demonstrated in comparison to healthy samples. Up to now, non-motor symptoms in ET are generally not been recorded in the clinical routine; however, based on our findings and the relevance to the individual's quality of life in particular, we consider the assessment and, where appropriate, treatment of these symptoms to be equally relevant. KW - Essentieller Tremor KW - Nicht-motorische Begleitsymptome KW - ET Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-193665 ER - TY - JOUR A1 - Hopp, Sarah A1 - Albert-Weissenberger, Christiane A1 - Mencl, Stine A1 - Bieber, Michael A1 - Schuhmann, Michael K. A1 - Stetter, Christian A1 - Nieswandt, Bernhard A1 - Schmidt, Peter M. A1 - Monoranu, Camelia-Maria A1 - Alafuzoff, Irina A1 - Marklund, Niklas A1 - Nolte, Marc W. A1 - Sirén, Anna-Leena A1 - Kleinschnitz, Christoph T1 - Targeting coagulation factor XII as a novel therapeutic option in brain trauma JF - Annals of Neurology N2 - Objective: Traumatic brain injury is a major global public health problem for which specific therapeutic interventions are lacking. There is, therefore, a pressing need to identify innovative pathomechanism-based effective therapies for this condition. Thrombus formation in the cerebral microcirculation has been proposed to contribute to secondary brain damage by causing pericontusional ischemia, but previous studies have failed to harness this finding for therapeutic use. The aim of this study was to obtain preclinical evidence supporting the hypothesis that targeting factor XII prevents thrombus formation and has a beneficial effect on outcome after traumatic brain injury. Methods: We investigated the impact of genetic deficiency of factor XII and acute inhibition of activated factor XII with a single bolus injection of recombinant human albumin-fused infestin-4 (rHA-Infestin-4) on trauma-induced microvascular thrombus formation and the subsequent outcome in 2 mouse models of traumatic brain injury. Results: Our study showed that both genetic deficiency of factor XII and an inhibition of activated factor XII in mice minimize trauma-induced microvascular thrombus formation and improve outcome, as reflected by better motor function, reduced brain lesion volume, and diminished neurodegeneration. Administration of human factor XII in factor XII-deficient mice fully restored injury-induced microvascular thrombus formation and brain damage. Interpretation: The robust protective effect of rHA-Infestin-4 points to a novel treatment option that can decrease ischemic injury after traumatic brain injury without increasing bleeding tendencies. KW - Molecular-weight heparin KW - Thrombus formation KW - Cerebral-ischemia KW - in-vivo KW - Intravascular coagulation KW - Hemodynamic depression KW - Head-injury KW - Rats KW - Model KW - Mice Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-188800 VL - 79 IS - 6 ER - TY - THES A1 - Schneider, Katharina T1 - Nachweis und Analyse von Phospho-Alpha-Synuclein-Ablagerungen in Hautnerven von Patienten mit Morbus Parkinson oder Multisystematrophie T1 - Proof and analysis of phospho-alpha-synuclein in the skin of patients with Parkinsons' disease or multiple system atrophy N2 - Zielsetzung der Studie war es, Ablagerungen des phosphorylierten Alpha-Synucleins in der Haut von Patienten mit Morbus Parkinson und atypischen Parkinson-Syndromen zu untersuchen und deren Auswirkungen auf das periphere Nervensystem zu erforschen. Dazu wurden Hautbiopsien von 92 Patienten mit Morbus Parkinson, 12 Patienten mit MSA und 13 Patienten mit einer Tauopathie sowie 83 gesunden Kontrollpersonen immunhisto-chemisch gefärbt und unter dem Mikroskop untersucht. Mit einer Sensitivität von 52 % für den Morbus Parkinson und 67 % für die MSA bei hoher Spezifität stellt der Nachweis von Phospho-Alpha-Synuclein in den kleinen Nervenfasern der Haut einen geeigneten Biomarker dar. Während die Ablagerungen des phosphorylierten Alpha-Synucleins bei Patienten mit Morbus Parkinson eher in autonomen Strukturen nachweisbar waren, fanden sie sich bei Patienten mit MSA eher in sub- und intraepidermal gelegenen Nervenfasern. Phospho-Alpha-Synuclein konnte in allen untersuchten Nervenfasersubtypen nachgewiesen werden, also in CGRP-, SP-, TH- und VIP-positiven Fasern. Bei den in der vorliegenden Studie untersuchten Parkinson-Patienten waren keine Veränderungen in der sensiblen Neurographie des Nervus suralis erkennbar. Die intraepidermale Nervenfaserdichte sowie die Innervation der Schweißdrüsen waren jedoch teilweise vermindert und auch in der QST zeigten sich Auffälligkeiten. Ein Zusammenhang zu dem Vorhandensein von Phospho-Alpha-Synuclein-Ablagerungen konnte jedoch nur für die Innervation der Musculi arrectores pilorum hergestellt werden. Bei der Untersuchung der pathophysiologischen Hintergründe, durch die Phospho-Alpha-Synuclein-Ablagerungen zu Nervenfaserschädigungen führen, konnten die Hinweise auf eine Beteiligung von axonalen Transportproteinen, Mikrotubuli oder Mitochondrien nicht erhärtet werden. N2 - The aim of this study was to examine dermal phospho-alpha-synuclein deposits of patients with Parkinson's disease or multiple system atrophy. KW - Synuclein KW - Parkinson-Krankheit KW - Alpha-Synuclein Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-169694 ER - TY - JOUR A1 - Coenen, Volker A. A1 - Amtage, Florian A1 - Volkmann, Jens A1 - Schläpfer, Thomas E. T1 - Deep Brain Stimulation in Neurological and Psychiatric Disorders JF - Deutsches Ärzteblatt International N2 - Background: Deep brain stimulation (DBS) is the chronic electrical stimulation of selected target sites in the brain through stereotactically implanted electrodes. More than 150 000 patients around the world have been treated to date with DBS for medically intractable conditions. The indications for DBS include movement disorders, epilepsy, and some types of mental illness. Methods: This review is based on relevant publications retrieved by a selective search in PubMed and the Cochrane Library, and on the current guidelines of the German Neurological Society (Deutsche Gesellschaft fur Neurologie, DGN). Results: DBS is usually performed to treat neurological diseases, most often movement disorders and, in particular, Parkinson's disease. Multiple randomized controlled trials (RCTs) have shown that DBS improves tremor, dyskinesia, and quality of life in patients with Parkinson's disease by 25% to 50%, depending on the rating scales used. DBS for tremor usually involves stimulation in the cerebello-thalamo-cortical regulatory loop. In an RCT of DBS for the treatment of primary generalized dystonia, the patients who underwent DBS experienced a 39.3% improvement of dystonia, compared to only 4.9% in the control group. Two multicenter trials of DBS for depression were terminated early because of a lack of efficacy. Conclusion: DBS is an established treatment for various neurological and psychiatric diseases. It has been incorporated in the DGN guidelines and is now considered a standard treatment for advanced Parkinson's disease. The safety and efficacy of DBS can be expected to improve with the application of new technical developments in electrode geometry and new imaging techniques. Controlled trials would be helpful so that DBS could be extended to further indications, particularly psychiatric ones. KW - treatment-resistant depression KW - randomized controlled trial KW - parkinsons disease KW - essential tremor KW - pallidal stimulation KW - nucleus ventralis intermedius KW - term follow-up KW - subthalamic nucleus KW - cervical dystonia KW - major depression Y1 - 2015 U6 - https://doi.org/10.3238/arztebl.2015.0519 VL - 112 SP - 519 EP - 526 ER - TY - JOUR A1 - Haarmann, Axel A1 - Nehen, Mathias A1 - Deiß, Annika A1 - Buttmann, Mathias T1 - Fumaric acid esters do not reduce inflammatory NF-\(\kappa\)B/p65 nuclear translocation, ICAM-1 expression and T-cell adhesiveness of human brain microvascular endothelial cells JF - International Journal of Molecular Sciences N2 - Dimethyl fumarate (DMF) is approved for disease-modifying treatment of patients with relapsing-remitting multiple sclerosis. Animal experiments suggested that part of its therapeutic effect is due to a reduction of T-cell infiltration of the central nervous system (CNS) by uncertain mechanisms. Here we evaluated whether DMF and its primary metabolite monomethyl fumarate (MMF) modulate pro-inflammatory intracellular signaling and T-cell adhesiveness of nonimmortalized single donor human brain microvascular endothelial cells at low passages. Neither DMF nor MMF at concentrations of 10 or 50 \(\mu\)M blocked the IL-1\(\beta\)-induced nuclear translocation of NF-\(\kappa\)B/p65, whereas the higher concentration of DMF inhibited the nuclear entry of p65 in human umbilical vein endothelium cultured in parallel. DMF and MMF also did not alter the IL-1\(\beta\)-stimulated activation of p38 MAPK in brain endothelium. Furthermore, neither DMF nor MMF reduced the basal or IL-1\(\beta\)-inducible expression of ICAM-1. In accordance, both fumaric acid esters did not reduce the adhesion of activated Jurkat T cells to brain endothelium under basal or inflammatory conditions. Therefore, brain endothelial cells probably do not directly mediate a potential blocking effect of fumaric acid esters on the inflammatory infiltration of the CNS by T cells. KW - barrier integrity KW - proteins KW - multiple sclerosis KW - monomethyl fumarate KW - p38 mitogen-activated protein kinase KW - cell adhesion KW - NF-\(\kappa\)B KW - dimethyl fumarate KW - blood-brain barrier KW - endothelial cells KW - potent inducer KW - gene KW - drug KW - VCAM-1 Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-148295 VL - 16 ER - TY - JOUR A1 - Ip, Chi Wang A1 - Isaias, Ioannis U. A1 - Kusche-Tekin, Burak B. A1 - Klein, Dennis A1 - Groh, Janos A1 - O´Leary, Aet A1 - Knorr, Susanne A1 - Higuchi, Takahiro A1 - Koprich, James B. A1 - Brotchie, Jonathan M. A1 - Toyka, Klaus V. A1 - Reif, Andreas A1 - Volkmann, Jens T1 - Tor1a+/- mice develop dystonia-like movements via a striatal dopaminergic dysregulation triggered by peripheral nerve injury JF - Acta Neuropathologica Communications N2 - Isolated generalized dystonia is a central motor network disorder characterized by twisted movements or postures. The most frequent genetic cause is a GAG deletion in the Tor1a (DYT1) gene encoding torsinA with a reduced penetrance of 30-40 % suggesting additional genetic or environmental modifiers. Development of dystonia-like movements after a standardized peripheral nerve crush lesion in wild type (wt) and Tor1a+/- mice, that express 50 % torsinA only, was assessed by scoring of hindlimb movements during tail suspension, by rotarod testing and by computer-assisted gait analysis. Western blot analysis was performed for dopamine transporter (DAT), D1 and D2 receptors from striatal and quantitative RT-PCR analysis for DAT from midbrain dissections. Autoradiography was used to assess the functional DAT binding in striatum. Striatal dopamine and its metabolites were analyzed by high performance liquid chromatography. After nerve crush injury, we found abnormal posturing in the lesioned hindlimb of both mutant and wt mice indicating the profound influence of the nerve lesion (15x vs. 12x relative to control) resembling human peripheral pseudodystonia. In mutant mice the phenotypic abnormalities were increased by about 40 % (p < 0.05). This was accompanied by complex alterations of striatal dopamine homeostasis. Pharmacological blockade of dopamine synthesis reduced severity of dystonia-like movements, whereas treatment with L-Dopa aggravated these but only in mutant mice suggesting a DYT1 related central component relevant to the development of abnormal involuntary movements. Our findings suggest that upon peripheral nerve injury reduced torsinA concentration and environmental stressors may act in concert in causing the central motor network dysfunction of DYT1 dystonia. KW - Dystonia KW - DYT1 KW - dopamine KW - peripheral injury KW - second hit Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-147839 VL - 4 IS - 108 ER - TY - JOUR A1 - Korn, Thomas A1 - Kleinschnitz, Christoph A1 - Magnus, Tim A1 - Meuth, Sven G. A1 - Linker, Ralf A. T1 - Report on the 7th scientific meeting of the Association for the Advancement of Young Academics in Neurology (NEUROWIND e.V.) held in Motzen, Germany, October 30–November 1, 2015 JF - Experimental and Translational Stroke Medicine N2 - From October 30–November 1, 2015, the 7th NEUROWIND e.V. meeting was held in Motzen, Brandenburg, Germany. Seventy doctoral students and postdocs from over 25 different groups working in German and Swiss University Hospitals or Research Institutes attended the meeting to discuss their latest experiments and findings in the fields of neuroimmunology, neurodegeneration and neurovascular research. This meeting report summarizes the many diverse presentations and the new preclinical to clinical neurology research data that were shared by the participants at the meeting. KW - NEUROWIND Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146595 VL - 8 IS - 3 ER - TY - JOUR A1 - Israel, Ina A1 - Ohsiek, Andrea A1 - Al-Momani, Ehab A1 - Albert-Weissenberger, Christiane A1 - Stetter, Christian A1 - Mencl, Stine A1 - Buck, Andreas K. A1 - Kleinschnitz, Christoph A1 - Samnick, Samuel A1 - Sirén, Anna-Leena T1 - Combined [\(^{18}\)F]DPA-714 micro-positron emission tomography and autoradiography imaging of microglia activation after closed head injury in mice JF - Journal of Neuroinflammation N2 - Background Traumatic brain injury (TBI) is a major cause of death and disability. Neuroinflammation contributes to acute damage after TBI and modulates long-term evolution of degenerative and regenerative responses to injury. The aim of the present study was to evaluate the relationship of microglia activation to trauma severity, brain energy metabolism, and cellular reactions to injury in a mouse closed head injury model using combined in vivo PET imaging, ex vivo autoradiography, and immunohistochemistry. Methods A weight-drop closed head injury model was used to produce a mixed diffuse and focal TBI or a purely diffuse mild TBI (mTBI) in C57BL6 mice. Lesion severity was determined by evaluating histological damage and functional outcome using a standardized neuroscore (NSS), gliosis, and axonal injury by immunohistochemistry. Repeated intra-individual in vivo μPET imaging with the specific 18-kDa translocator protein (TSPO) radioligand [\(^{18}\)F]DPA-714 was performed on day 1, 7, and 16 and [\(^{18}\)F]FDG-μPET imaging for energy metabolism on days 2–5 after trauma using freshly synthesized radiotracers. Immediately after [\(^{18}\)F]DPA-714-μPET imaging on days 7 and 16, cellular identity of the [\(^{18}\)F]DPA-714 uptake was confirmed by exposing freshly cut cryosections to film autoradiography and successive immunostaining with antibodies against the microglia/macrophage marker IBA-1. Results Functional outcome correlated with focal brain lesions, gliosis, and axonal injury. [\(^{18}\)F]DPA-714-μPET showed increased radiotracer uptake in focal brain lesions on days 7 and 16 after TBI and correlated with reduced cerebral [\(^{18}\)F]FDG uptake on days 2–5, with functional outcome and number of IBA-1 positive cells on day 7. In autoradiography, [\(^{18}\)F]DPA-714 uptake co-localized with areas of IBA1-positive staining and correlated strongly with both NSS and the number of IBA1-positive cells, gliosis, and axonal injury. After mTBI, numbers of IBA-1 positive cells with microglial morphology increased in both brain hemispheres; however, uptake of [\(^{18}\)F]DPA-714 was not increased in autoradiography or in μPET imaging. Conclusions [\(^{18}\)F]DPA-714 uptake in μPET/autoradiography correlates with trauma severity, brain metabolic deficits, and microglia activation after closed head TBI. KW - neuroinflammation KW - TBI KW - immunohistochemistry KW - weight drop KW - PET KW - diffuse KW - focal KW - TSPO KW - autoradiography KW - IBA-1 Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146606 VL - 13 IS - 140 ER - TY - THES A1 - Küsters, Sebastian T1 - Darstellung des nikotinergen Acetylcholinrezeptors bei Patienten mit idiopathischem Parkinson-Syndrom und Levodopa-induzierter Dyskinesie T1 - Nicotinic acetylcholine receptors in patients with idiopathic Parkinson's disease and levodopa-induced dyskinesia N2 - Ziel der Studie war ein Zusammenhang zwischen cholinerger Innervation in den Basalganglien mit Levodopa-induzierter Dyskinesie darzustellen. 26 Patienten mit idiopatischem Parkinson-Syndrom ohne Demenz und Depression wurden in zwei Gruppen mit und ohne Dyskinesie eingeteilt. Es wurde nach klinischer Untersuchung eine SPECT-Bildgebung mit 5-[123I]iodo-3-[2(S)-2-azetidinylmethoxy]pyridine (5IA) durchgeführt und anschließend die Ergebnisse in Zusammenschau mit den klinischen Daten und mit den Ergebnissen der SPECT mit [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane (FP-CIT) bewertet. Dyskinetische Patienten hatten eine höhere Dichte an nikotinergen Acetylcholinrezeptoren im Nucleus caudatus, hauptsächlich der Halbseite mit stärkerer dopaminerger Degeneration. Dies stützt die Hypothese, dass sich die Dyskinesie nach Levodopa-Therapie aufgrund einer verstärkten cholinergen Modulation im stärker degenerierten Striatum entwickelt. N2 - Objective: To explore cholinergic innervation in the basal ganglia in relation to levodopa-induced dyskinesia in patients with Parkinson’s disease. Methods: A total of 26 patients with PD without dementia and depression were divided into two matched groups (dyskinetic and nondyskinetic). We acquired SPECT scan with 5-[123I]iodo-3-[2(S)-2-azetidinylmethoxy]pyridine. We then analyzed binding potentials at basal ganglia structures and correlations with clinical variables and [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane SPECT. Results: Dyskinetic subjects showed higher density of nicotinic acetylcholine receptors in the caudate nucleus, predominant in the hemisphere with lower dopamine transporter density. Conclusion: Our findings support the hypothesis that the expression of dyskinesia following repeated levodopa exposure may result from enhanced cholinergic neuronal excitability in a dopaminergic-depleted striatum. KW - Parkinson-Krankheit KW - Dyskinesie KW - Bewegungsstörung KW - Acetylcholinrezeptor KW - SPECT KW - nACh-Rezeptor Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-178740 ER - TY - JOUR A1 - Feldheim, Jonas A1 - Kessler, Almuth F A1 - Schmitt, Dominik A1 - Wilczek, Lara A1 - Linsenmann, Thomas A1 - Dahlmann, Mathias A1 - Monoranu, Camelia M A1 - Ernestus, Ralf-Ingo A1 - Hagemann, Carsten A1 - Löhr, Mario T1 - Expression of activating transcription factor 5 (ATF5) is increased in astrocytomas of different WHO grades and correlates with survival of glioblastoma patients JF - OncoTargets and Therapy N2 - Background: ATF5 suppresses differentiation of neuroprogenitor cells and is overexpressed in glioblastoma (GBM). A reduction of its expression leads to apoptotic GBM cell death. Data on ATF5 expression in astrocytoma WHO grade II (low-grade astrocytoma [LGA]) are scarce and lacking on recurrent GBM. Patients and methods: ATF5 mRNA was extracted from frozen samples of patients’ GBM (n=79), LGA (n=40), and normal brain (NB, n=10), quantified by duplex qPCR and correlated with retrospectively collected clinical data. ATF5 protein expression was evaluated by measuring staining intensity on immunohistochemistry. Results: ATF5 mRNA was overexpressed in LGA (sevenfold, P<0.001) and GBM (tenfold, P<0.001) compared to NB, which was confirmed on protein level. Although ATF5 mRNA expression in GBM showed a considerable fluctuation range, groups of varying biological behavior, that is, local/multifocal growth or primary tumor/relapse and the tumor localization at diagnosis, were not significantly different. ATF5 mRNA correlated with the patients’ age (r=0.339, P=0.028) and inversely with Ki67-staining (r=-0.421, P=0.007). GBM patients were allocated to a low and a high ATF5 expression group by the median ATF5 overexpression compared to NB. Kaplan–Meier analysis and Cox regression indicated that ATF5 mRNA expression significantly correlated with short-term survival (t<12 months, median survival 18 vs 13 months, P=0.022, HR 2.827) and progression-free survival (PFS) (12 vs 6 months, P=0.024). This advantage vanished after 24 months (P=0.084). Conclusion: ATF5 mRNA expression could be identified as an additional, though not independent factor correlating with overall survival and PFS. Since its inhibition might lead to the selective death of glioma cells, it might serve as a potential ubiquitous therapeutic target in astrocytic tumors. KW - glioblastoma multiforme KW - recurrence KW - growth pattern KW - protein and mRNA expression Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-177541 VL - 11 ER - TY - JOUR A1 - Magg, Barbara A1 - Riegler, Christoph A1 - Wiedmann, Silke A1 - Heuschmann, Peter A1 - Sommer, Claudia A1 - Üçeyler, Nurcan T1 - Self-administered version of the Fabry-associated pain questionnaire for adult patients JF - Orphanet Journal of Rare Diseases N2 - Background Fabry-associated pain may be the first symptom of Fabry disease (FD) and presents with a unique phenotype including mostly acral burning triggerable pain attacks, evoked pain, pain crises, and permanent pain. We recently developed and validated the first Fabry Pain Questionnaire (FPQ) for adult patients. Here we report on the validation of the self-administered version of the FPQ that no longer requires a face-to-face interview but can be filled in by the patients themselves allowing more flexible data collection. Methods At our Würzburg Fabry Center for Interdisciplinary Treatment, Germany, we have developed the self-administered version of the FPQ by adapting the questionnaire to a self-report version. To do this, consecutive Fabry patients with current or past pain history (n = 56) were first interviewed face-to-face. Two weeks later patients’ self-reported questionnaire results were collected by mail (n = 55). We validated the self-administered version of the FPQ by assessing the inter-rater reliability agreement of scores obtained by supervised administration and self-administration of the FPQ. Results The FPQ contains 15 questions on the different pain phenotypes, on pain development during life with and without therapy, and on impairment due to pain. Statistical analysis showed that the majority of questions were answered in high agreement in both sessions with a mean AC1-statistic of 0.857 for 55 nominal-scaled items and a mean ICC of 0.587 for 9 scores. Conclusions This self-administered version of the first pain questionnaire for adult Fabry patients is a useful tool to assess Fabry-associated pain without a time-consuming face-to-face interview but via a self-reporting survey allowing more flexible usage. KW - Fabry disease KW - Fabry-associated pain KW - pain questionnaire Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-145294 VL - 10 IS - 113 ER - TY - THES A1 - Leinders, Mathias T1 - microRNAs in chronic pain T1 - microRNAs bei chronischen Schmerzen N2 - Chronic pain is a common problem in clinical practice, not well understood clinically, and frequently tough to satisfactorily diagnose. Because the pathophysiology is so complex, finding effective treatments for people with chronic pain has been overall less than successful and typically reduced to an unsatisfactory trial-and-error process, all of which translates into a significant burden to society. Knowledge of the mechanisms underlying the development of chronic pain, and moreover why some patients experience pain and others not, may aid in developing specific treatment regimens. Although nerve injuries are major contributors to pain chronification, they cannot explain the entire phenomenon. Considerable research has underscored the importance of the immune system for the development and maintenance of chronic pain, albeit the exact factors regulating inflammatory reactions remain unclear. Understanding the putative molecular and cellular regulator switches of inflammatory reactions will open novel opportunities for immune modulatory analgesics with putatively higher specificity and less adverse effects. It has become clear that small, non- coding RNA molecules known as microRNAs are in fact potent regulators of many thousands of genes and possibly cross-communicate between cellular pathways in multiple systems acting as so-called “master-switches”. Aberrant expression of miRNAs is now implicated in numerous disorders, including nerve injuries as well as in inflammatory processes. Moreover, compelling evidence supports the idea that miRNAs also regulate pain, and in analogy to the oncology field aid in the differential diagnosis of disease subtypes. In fact, first reports describing characteristic miRNA expression profiles in blood or cerebrospinal fluid of patients with distinct pain conditions are starting to emerge, however evidence linking specific miRNA expression profiles to specific pain disorders is still insufficient. The present thesis aimed at first, identifying specific miRNA signatures in two distinct chronic pain conditions, namely peripheral neuropathies of different etiologies and fibromyalgia syndrome. Second, it aimed at identifying miRNA profiles to better understand potential factors that differentiate painful from painless neuropathies and third, study the mechanistic role of miRNAs in the pathophysiology of pain, to pave the way for new druggable targets. Three studies were conducted in order to identify miRNA expression signatures that are characteristic for the given chronic pain disorder. The first study measured expression of miR-21, miR-146a and miR-155 in white blood cells, skin and nerve biopsies of patients with peripheral neuropathies. It shows that peripheral neuropathies of different etiologies are associated with increased peripheral miR-21 and miR-146a, but decreased miR-155 expression. More importantly, it was shown that painful neuropathies have increased sural nerve miR-21 and miR-155 expression, but reduced miR-146a and miR-155 expression in distal skin of painful neuropathies. These results point towards the potential use of miRNAs profiles to stratify painful neuropathies. The seconds study extends these findings and first analyzed the role of miR-132-3p in patients and subsequently in an animal model of neuropathic pain. Interestingly, miR-132-3p was upregulated in white blood cells and sural nerve biopsies of patients with painful neuropathies and in animals after spared nerve injury. Pharmacologically modulating the expression of miR-132-3p dose-dependently reversed pain behavior and pain aversion, indicating the pro-nociceptive effect of miR-132-3p in chronic pain. This study thus demonstrates the potential analgesic impact by modulating miRNA expression. Fibromyalgia is associated with chronic widespread pain and, at least in a subgroup, impairment in small nerve fiber morphology and function. Interestingly, the disease probably comprises subgroups with different underlying pathomechanisms. In accordance with this notion, the third study shows that fibromyalgia is associated with both aberrant white blood cell and cutaneous miRNA expression. Being the first of its kind, this study identified miR-let-7d and its downstream target IGF-1R as potential culprit for impaired small nerve fiber homeostasis in a subset of patients with decreased intra-epidermal nerve fiber density. The work presented in this thesis is a substantial contribution towards the goal of better characterizing chronic pain based on miRNA expression signatures and thus pave the way for new druggable targets. N2 - Chronische Schmerzen sind in der klinischen Praxis ein häufiges Problem, die Ätiologie und Pathogenese jedoch oftmals unklar. Aufgrund der Komplexität des pathophysiologischen Ursprunges chronischer Schmerzen, ist bei einem Teil der Patienten Schmerzfreiheit oder Schmerzreduktion mit gängigen Analgetika nur insuffizient zu erreichen. Dies führt zu einer enormen sozio-ökonomischen Belastung für die Gesellschaft. Daher können Kenntnisse über die Mechanismen, die der Entwicklung von chronischen Schmerzen zugrunde liegen, und darüber hinaus, warum einige Patienten Schmerzen entwickeln und andere nicht, bei der Entwicklung spezifischer und individueller Behandlungsschemata helfen. Eine Vielzahl an Studien belegen die Bedeutung des Immunsystems für die Entwicklung und Aufrechterhaltung chronischer Schmerzen, wenngleich die genauen Faktoren, die entzündliche Reaktionen regulieren, noch unklar bleiben. Rezente Entdeckungen der hochkonservierten, nicht-kodierenden RNA-Moleküle, sogenannten microRNAs, lassen in der Tat darauf schließen, dass diese eine wichtige Rolle im Netzwerk der Genregulation spielen. microRNAs regulieren die hochspezifische „cross-communication“ mehrerer simultaner Signaltransduktionsvorgänge zellulärer Prozesse, und werden daher auch "master-switches" genannt. Interessanterweise, wurden aberrante Expressionen spezifischer miRNAs in zahlreichen Krankheiten, einschließlich Nervenverletzungen, sowie in entzündlichen Prozessen nachgewiesen. Darüber hinaus belegen stichhaltige Beweise nicht nur die Idee, dass miRNAs auch bei der Regulierung von Schmerzen eine wichtige Rolle spielen, sondern auch hilfreich bei der Differentialdiagnose von Krankheits- Subtypen sein können. Dies wurde bei rezenten onkologischen Studien deutlich. Tatsächlich weisen erste Berichte auf ein charakteristisches miRNA- Expressionsprofil in Blut oder Zerebrospinalflüssigkeit von Patienten mit verschiedenen Schmerztypen hin. Jedoch ist die Assoziation spezifischer miRNA-Expressionsprofile mit spezifischen Schmerzstörungen noch unzureichend. Die Zielvorgabe der vorliegenden Arbeit war daher zunächst, spezifische miRNA-Signaturen in zwei verschiedenen chronischen Schmerzzuständen zu identifizieren, nämlich peripheren Neuropathien verschiedener Ätiologien und dem Fibromyalgie-Syndrom. Zweitens wurden die erarbeiteten Ergebnisse dazu verwendet, bestimmte miRNA-Profile zu identifizieren, die schmerzhafte von schmerzlosen Neuropathien unterscheiden lassen und einen Hinweis auf die Pathologie der kleinkalibrigen Fasern bei der Fibromyalgie geben. Darüber hinaus wurde die mechanistische Rolle von miRNAs in der Pathophysiologie von Schmerzen Tierexperimentell untersucht, um künftig neuartige Therapien entwickeln zu können. Die erste Studie untersuchte die Expression von miR-21, miR-146a und miR-155 in weißen Blutkörperchen, Haut- und Nervenbiopsien bei Patienten mit peripheren Neuropathien. Sie zeigt, dass periphere Neuropathien verschiedener Ätiologien mit erhöhten peripheren miR-21 und miR-146a und verminderter miR- 155 Expression assoziiert sind. Wichtiger jedoch, dass Patienten mit schmerzhaften Neuropathien erhöhte miR-21 und miR-155-Expression im Suralis und verminderte miR-146a- und miR-155-Expression in distalen im Vergleich zu proximalen Hautbiopsien aufweisen. Diese Ergebnisse weisen auf die potenzielle Verwendung von miRNA-Profilen zur Stratifizierung schmerzhafter Neuropathien hin. Die zweite Studie baut dieses Ergebnis aus und untersuchte zunächst die Rolle von miR-132-3p im humanen und anschließend bei tierexperimentellen neuropathischen Schmerzen. Interessanterweise war miR-132-3p sowohl in weißen Blutkörperchen und Suralis-Nervenbiopsien von Patienten mit schmerzhaften Neuropathien als auch bei Tieren nach Läsion eines peripheren Nervens hochreguliert. Nach pharmakologischer Intervention gab es eine dosisabhängige Schmerzreduktion und Schmerzaversion, was somit auf den pro- nozizeptiven Effekt von miR-132-3p hinweist. Diese Studie zeigt somit die potenzielle analgetische Wirksamkeit microRNA-gerichteter pharmakologischer Interventionen. Das Fibromyalgie Syndrome ist eine chronische Erkrankung, die von einem multilokulären Schmerzbild und Beeinträchtigungen in kleinen Nervenfasern dominiert wird. Es wird angenommen, dass die Erkrankung wahrscheinlich aus Subgruppen mit unterschiedlichen zugrunde liegenden Pathomechanismen besteht. Die hierzu durchgeführte Studie zeigt, dass Fibromyalgie-Patienten veränderte microRNA Expression sowohl in weißen Blutkörperchen als auch in der Haut aufweisen. Erstmals identifiziert diese Studie miR-let-7d und ihr „downstream-target“ IGF-1R als potentiellen Schädigungsmechanismus kleiner Nervenfaserfunktionen, in einer Subgruppe von Patienten mit verminderter intra-epidermalen Nervenfaserdichte. Die Ergebnisse, die in dieser Arbeit vorgestellt werden, liefern einen wesentlichen Beitrag, die Pathophysiologie chronischer Schmerzen, aufgrund von miRNA-Expressions-Signaturen zu charakterisieren. KW - chronic pain KW - microRNA KW - miRNS KW - Chronischer Schmerz Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-144395 ER - TY - THES A1 - Hopp-Krämer, Sarah T1 - Untersuchungen zur Pathophysiologie und therapeutischer Relevanz des Blutgerinnungsfaktors XII nach experimentellem Schädel-Hirn-Trauma T1 - Studies on the pathophysiology and therapeutic relevance of the coagulation factor XII following experimental traumatic brain injury N2 - Das Schädel-Hirn-Trauma (SHT) entsteht durch äußere Gewalteinwirkung auf den Kopf und verursacht mechanisch eine Schädigung des Hirngewebes. Zusätzlich tragen sekundäre Pathomechanismen, wie Entzündungsprozesse und die Schädigung der Blut-Hirn-Schranke (BHS), dazu bei, dass sich das initial geschädigte Läsionsareal im Laufe der Zeit vergrößert. Vor allem bei jungen Erwachsenen ist das SHT eine der häufigsten Ursachen für bleibende Behinderungen und Todesfälle. Aufgrund der schweren Auswirkungen des SHT und der bislang fehlenden Therapieoptionen ist die Identifizierung neuer Zielstrukturen für eine kausale Therapie von größter Bedeutung. Ausgehend von tierexperimentellen Studien ist das Kallikrein-Kinin-System (KKS) ein besonders erfolgversprechender Angriffspunkt zur Behandlung des SHT. Die Aktivierung des KKS über den Gerinnungsfaktor XII (FXII) und die darauf folgende Bildung von Bradykinin sind mit dem Entstehen von Hirnödemen und Entzündungsreaktionen assoziiert. Vorangegangene Studien haben weiterhin die Frage aufgeworfen, ob und in welchem Maße thrombotische Prozesse einen Einfluss auf die Pathophysiologie und die sekundären Hirnschädigungen nach SHT haben. Da FXII sowohl das KKS als auch die intrinsische plasmatische Gerinnungskaskade initiiert und somit zur Fibrinbildung beiträgt, stand FXII im Mittelpunkt der Untersuchungen dieser Dissertation. Die vorliegende Arbeit beschäftigt sich mit den Fragen, (I) inwiefern FXII eine Rolle bei der sekundären Hirnschädigung nach Trauma spielt und (II) ob thrombotische Prozesse ein pathophysiologisches Merkmal nach Trauma darstellen. In zwei unterschiedlichen Trauma-Modellen wurden FXII-defiziente Tiere und mit einem spezifischen Inhibitor des aktivierten FXII (FXIIa) behandelte Tiere gegen Kontrolltiere nach SHT verglichen. Die Analyse der funktionellen Ausfallerscheinungen und des Ausmaßes an neuronaler Degeneration zeigte, dass FXII-Defizienz und FXIIa-Inhibition vor den Auswirkungen eines SHT schützen. Als zugrundeliegende Mechanismen wurden die Reduktion von thrombotisch verschlossenen Gefäßen in der Mikrovaskulatur des Gehirns sowie der Schutz vor BHS-Störungen und verringerte inflammatorische Prozesse identifiziert. Weiterhin wurde festgestellt, dass eine Blockade der intrinsischen Gerinnungskaskade über FXII keine intrazerebralen Blutungen auslöst. In Gewebeproben von Patienten mit SHT wurde gezeigt, dass Thrombozytenaggregate auch im klinischen Verlauf auftreten und sich somit die tierexperimentellen Befunde auf die humane Situation übertragen lassen. Insgesamt tragen die Ergebnisse dazu bei, die komplexen und vielfältigen Pathomechanismen nach SHT besser zu verstehen und vor allem die Relevanz thrombo-inflammatorischer Prozesse nach SHT aufzuzeigen. Die gezielte Blockade des FXII(a) könnte als therapeutisches Prinzip zur Abschwächung der Sekundärschaden nach SHT geeignet sein. N2 - Traumatic brain injury (TBI) is the result of an outside force causing mechanical disruption of the brain tissue. In addition, delayed pathogenic events, like inflammatory processes and blood-brain barrier damage occur, which collectively exacerbate the injury. In young adults, TBI is one of the main reasons for permanent disability and death. Because of its severe consequences and the lack of causal treatment, the identification of novel therapeutic options is of utmost importance. Based on animal studies, the kallikrein-kinin-system (KKS) is a very promising target to treat secondary injury processes following TBI. The activation of the KKS via coagulation factor XII (FXII) and the subsequent formation of bradykinin are tightly associated with the development of brain edema and inflammation. Recent studies have raised the question to what extent thrombotic processes might influence the pathophysiology and secondary injury processes following TBI. As FXII is not only the starting point of the KKS, but also the initiator of the intrinsic coagulation cascade which leads to fibrin formation, FXII was the center of interest for this dissertation. The work presented here deals with the issue, (I) whether FXII plays a role in the development and aggravation of secondary injury processes after trauma and (II) if thrombotic processes display a pathophysiological feature in TBI. In two different models of brain trauma, FXII-deficient mice and mice treated with a specific inhibitor of activated FXII (FXIIa) were compared to their respective control groups after trauma induction. The analyses of the functional outcome and the amount of neurodegenerative processes showed a distinct amelioration in favor of the genetically modified and treated animals. As underlying mechanisms, the reduction of thrombotic vessels in the brain microvasculature and additionally, protection from blood-brain barrier damages and less inflammation were identified. Moreover, it was observed that interference with the intrinsic coagulation cascade via FXII does not lead to the formation of intracerebral bleedings. The evaluation of human brain tissue surgically obtained following TBI demonstrated that platelet aggregates occur regularly in the course of brain trauma and that they seem to contribute to the secondary injury processes and the ischemia-like injury pattern. Taken together, the results contribute to the understanding of the highly complex and heterogeneous pathomechanisms following TBI, especially concerning thrombo-inflammatory processes. The targeted pharmacological blocking of FXII(a) could be a useful therapeutic principle in the treatment of TBI-associated pathologic processes. KW - Schädel-Hirn-Trauma KW - Blutgerinnungsfaktor XII KW - Pathophysiologie KW - Kallikrein-Kinin-System KW - Intrinsische Gerinnungskaskade Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-144421 ER - TY - THES A1 - Ramirez Pasos, Uri Eduardo T1 - Subthalamic Nucleus Neural Synchronization and Connectivity during Limbic Processing of Emotional Pictures: Evidence from Invasive Recordings in Patients with Parkinson's Disease T1 - Synchronisierung und Konnektivität des Nucleus subthalamicus während limbischer Bearbeitung affektiver Bilder: Evidenz aus invasiven Aufzeichnungen in Patienten mit Morbus Parkinson N2 - In addition to bradykinesia and tremor, patients with Parkinson’s disease (PD) are known to exhibit non-motor symptoms such as apathy and hypomimia but also impulsivity in response to dopaminergic replacement therapy. Moreover, a plethora of studies observe differences in electrocortical and autonomic responses to both visual and acoustic affective stimuli in PD subjects compared to healthy controls. This suggests that the basal ganglia (BG), as well as the hyperdirect pathway and BG thalamocortical circuits, are involved in affective processing. Recent studies have shown valence and dopamine-dependent changes in synchronization in the subthalamic nucleus (STN) in PD patients during affective tasks. This thesis investigates the role of dopamine, valence, and laterality in STN electrophysiology by analyzing event-related potentials (ERP), synchronization, and inter-hemispheric STN connectivity. STN recordings were obtained from PD patients with chronically implanted electrodes for deep brain stimulation during a passive affective picture presentation task. The STN exhibited valence-dependent ERP latencies and lateralized ‘high beta’ (28–40 Hz) event-related desynchronization. This thesis also examines the role of dopamine, valence, and laterality on STN functional connectivity with the anterior cingulate cortex (ACC) and the amygdala. The activity of these limbic structures was reconstructed using simultaneously recorded electroencephalographic signals. While the STN was found to establish early coupling with both structures, STN-ACC coupling in the ‘alpha’ range (7–11 Hz) and uncoupling in the ‘low beta’ range (14–21 Hz) were lateralized. Lateralization was also observed at the level of synchrony in both reconstructed sources and for ACC ERP amplitude, whereas dopamine modulated ERP latency in the amygdala. These results may deepen our current understanding of the STN as a limbic node within larger emotional-motor networks in the brain.
 N2 - Neben Bradykinese und Tremor weisen Patienten mit Morbus Parkinson (PD) bekannterweise nicht-motorische Symptome auf wie Apathie und Hypomimie, aber auch Impulsivität, welche durch Dopaminersatztherapien bedingt ist. Viele Studien belegen außerdem Unterschiede von kortikalen und autonomen Reaktionen auf sowohl visuelle als auch akustische Reize bei Patienten mit PD im Vergleich zu gesunden Kontrollgruppen. Dies legt nahe, dass sich die Basalganglien (BG), und auch die hyperdirekte Verbindung sowie die BG-thalamokortikalen Schleifen, an der Affektbearbeitung beteiligen. Jüngere Studien haben Valenz- und Dopamin-bedingte Veränderungen der Synchronisierung im Nucleus subthalamicus (STN) von Parkinson-Patienten bei affektiven Aufgaben belegt. Diese Promotionsarbeit untersucht die Rolle von Dopamin, Valenz und Lateralität in der STN-Elektrophysiologie mittels Analysen von ereigniskorrelierten Potentialen (ERP), Synchronisierung und interhemisphärischer funktioneller Konnektivität. STN-Aufzeichnungen wurden von Patienten mit dauerhaft implantierten Elektroden für die Tiefenhirnstimulation während einer passiven Aufgabe abgeleitet, bei den ihnen Bilder mit emotionalen Inhalten gezeigt wurden. Der STN wies Valenz-bedingte ERP-Latenz und lateralisierte ereigniskorrelierte Desynchronisierung in ‘hohem Beta’ (28–40 Hz) auf. Diese Dissertation untersucht auch die Rolle von Dopamin, Valenz und Lateralität bezüglich der funktionellen Konnektivität zwischen dem STN und dem Gyrus cinguli pars anterior (ACC) sowie der Amygdala. Die Aktivität dieser Strukturen wurde aus simultanen elektroenzephalographischen Aufzeichnungen rekonstruiert. Obwohl eine STN-Kopplung mit beiden Strukturen auftritt, war die STN-ACC-Kopplung im ‘Alpha’- Bereich (7–11 Hz) und die Entkopplung im ‘niedrigen Beta’-Bereich (14–21 Hz) lateralisiert. Lateralisierung wurde auch an der Synchronisierung in beiden rekonstruierten Quellen und an der ACC-ERP-Amplitude festgestellt, wohingegen Dopamin die ERP-Latenz in der Amygdala modulierte. Diese Ergebnisse mögen das gegenwärtige Wissen vom STN als limbischem Knoten innerhalb größerer affektiv-motorischer Schleifen im Gehirn vertiefen. KW - Nucleus subthalamicus KW - subthalamic nucleus KW - Emotionales Verhalten KW - functional connectivity KW - oscillations KW - emotion KW - Affekt KW - Elektrophysiologie Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-169850 ER - TY - JOUR A1 - Ueceyler, Nurcan A1 - Biko, Lydia A1 - Sommer, Claudia T1 - MDL-28170 Has No Analgesic Effect on CCI Induced Neuropathic Pain in Mice N2 - The calpain inhibitor MDL-28710 blocks the early local pro-inflammatory cytokine gene expression in mice after chronic constriction nerve injury (CCI). Onehundred- thirteen wild type mice of C57Bl/6J background received CCI of the right sciatic nerve. Mechanical paw withdrawal thresholds and thermal withdrawal latencies were investigated at baseline and at 1, 3, and 7 days after CCI. Three application regimens were used for MDL-28170: a) single injection 40 min before CCI; b) serial injections of MDL- 28170 40 min before and up to day three after CCI; c) sustained application via intraperitoneal osmotic pumps. The control animals received the vehicle DMSO/PEG 400. The tolerable dose of MDL-28170 for mice was 30 mg/kg body weight, higher doses were lethal within the first hours after application. Mechanical withdrawal thresholds and thermal withdrawal latencies were reduced after CCI and did not normalize after single or serial injections, nor with application of MDL-28170 via osmotic pumps. Although the calpain inhibitor MDL-28170 inhibits the early local cytokine upregulation in the sciatic nerve after CCI, pain behavior is not altered. This finding implies that local cytokine upregulation after nerve injury alone is only one factor in the induction and maintenance of neuropathic pain. KW - Medizin KW - calpain KW - neuropathic pain KW - MDL-28170 KW - chronic constriction nerve injury (CCI) Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68359 ER - TY - JOUR A1 - Geis, Christian A1 - Weishaupt, Andreas A1 - Grünewald, Benedikt A1 - Wultsch, Thomas A1 - Reif, Andreas A1 - Gerlach, Manfred A1 - Dirkx, Ron A1 - Solimena, Michele A1 - Perani, Daniela A1 - Heckmann, Manfred A1 - Toyka, Klaus V. A1 - Folli, Franco A1 - Sommer, Claudia T1 - Human Stiff-Person Syndrome IgG Induces Anxious Behavior in Rats N2 - Background: Anxiety is a heterogeneous behavioral domain playing a role in a variety of neuropsychiatric diseases. While anxiety is the cardinal symptom in disorders such as panic disorder, co-morbid anxious behavior can occur in a variety of diseases. Stiff person syndrome (SPS) is a CNS disorder characterized by increased muscle tone and prominent agoraphobia and anxiety. Most patients have high-titer antibodies against glutamate decarboxylase (GAD) 65. The pathogenic role of these autoantibodies is unclear. Methodology/Principal Findings: We re-investigated a 53 year old woman with SPS and profound anxiety for GABA-A receptor binding in the amygdala with (11)C-flumazenil PET scan and studied the potential pathogenic role of purified IgG from her plasma filtrates containing high-titer antibodies against GAD 65. We passively transferred the IgG fraction intrathecally into rats and analyzed the effects using behavioral and in vivo electrophysiological methods. In cell culture, we measured the effect of patient IgG on GABA release from hippocampal neurons. Repetitive intrathecal application of purified patient IgG in rats resulted in an anxious phenotype resembling the core symptoms of the patient. Patient IgG selectively bound to rat amygdala, hippocampus, and frontal cortical areas. In cultured rat hippocampal neurons, patient IgG inhibited GABA release. In line with these experimental results, the GABA-A receptor binding potential was reduced in the patient’s amygdala/hippocampus complex. No motor abnormalities were found in recipient rats. Conclusion/Significance: The observations in rats after passive transfer lead us to propose that anxiety-like behavior can be induced in rats by passive transfer of IgG from a SPS patient positive for anti-GAD 65 antibodies. Anxiety, in this case, thus may be an antibody-mediated phenomenon with consecutive disturbance of GABAergic signaling in the amygdala region. KW - Medizin Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-74757 ER - TY - THES A1 - Pizon, Dorothea T1 - Prognose des raumfordernden Mediainfarktes bei konservativer vs. operativer Therapie am Universitätsklinikum Würzburg 1993-2005 T1 - Prognosis of conservative vs. surgical treatment of the space-occupying middle cerebral artery infarction at the University Hospital Wuerzburg 1993-2005 N2 - In dieser Studie wurden Schlaganfallpatienten untersucht, die einen ausgedehnten Infarkt im Versorgungsgebiet der A.cerebri media erlitten und wegen Bewusstseinstrübung (sog. Maligner Mediainfarkt) auf der Neurologischen Intensivstation des Universitätsklinikums Würzburg im Zeitraum von 1991 bis 2005 behandelt wurde, um herauszufinden, welchen Einfluss eine operative Behandlung auf den kritisch erhöhten Hirnsdrucks zusätzlich zur konservativen Intensivtherapie auf Mortalität sowie langfristige Lebensqualität hatte. Insgesamt konnten die Daten von 292 Patienten ausgewertet werden, wovon 259 konservativ und 33 operativ behandelt worden waren. Es zeigte sich insgesamt, dass eine stillschweigende günstige Selektion für eine Trepanation sprach (jünger, eher keine Aphasie, weniger Komorbiditäten). Die Hemikraniektomie senkte die Mortalität in der Akutphase hochsignifikant (K: 22, 4%, T: 3,0%; p=0,009). Sie hatte erwartungsgemäß auch einen positiven Einfluss auf das Vigilanzniveau: die Quote von wachen Patienten war bei Entlassung der Trepanierten um 66% höher als bei Aufnahme, bei den konservativ Behandelten war sie nur um 33,3 % gestiegen. Das vorherrschende Symptom bei Aufnahme und Entlassung war eine motorische bzw. sensomotorische Hemiparese. Der Anteil der Aphasiker bei den 201 konservativ therapierten Patienten, die den stationären Aufenthalt überlebt haben, ist von bei Aufnahme 56,2% auf bei Entlassung 48,6% gesunken. Bei den 32 trepanierten Patienten ist er dagegen mit 50% gleich geblieben, obwohl 2/3 aller Patienten an der nicht-dominanten Hemisphäre operiert worden waren. Es war und ist auch nicht zu erwarten, dass eine Entlastung von Hirndruck qualitativ die hirninfarktbedingten Symptome beseitigt. Die Nachbefragung der Patienten fand im Schnitt 64,7 Monate nach erlittenem Mediainfarkt statt. Inzwischen waren von den 259 konservativ Behandelten 47,1% verstorben, von den 33 Hemikraniektomierten nur 24,2%. Die poststationäre Mortalität im weiteren Verlauf war anteilsmäßig gering (K: 24%, T: 21,2%). Die Überlebensdauer der Trepanierten war dreimal so lang wie die der nicht operierten (K: 11,6 Monate, T: 34,4 Monate). Diese Unterschiede im Langzeitüberleben sind wahrscheinlicher auf die geringeren Komorbiditäten der Trepanierten zurückzuführen, als auf die stattgehabte Operation an sich. Allerdings ist nicht auszuschließen, dass die durch Trepanation frühzeitiger verbesserte Wachheit sich auch günstig auf lebensverkürzende Folgekomplikationen ausgewirkt haben könnte. In der Nachbefragung zeigte sich, dass bezüglich der erworbenen körperlichen Funktionsdefizite, gemessen am Barthel Index, zwischen den beiden Kollektiven kein signifikanter Unterschied bestand. Die ehemals konservativ behandelten Patienten kamen auf durchschnittlich 75, die trepanierten Patienten auf 60 von 100 Punkten. Im Lebensalltag schlägt sich dieser Unterschied von 15 Punkten relevant nieder, aber insgesamt liegen beide Patientenkollektive im Bereich einer leichten bis nicht vorhandenen Abhängigkeit. Die vergleichbaren Langzeitdaten von Patienten mit Mediainfarkt liegen in einem ähnlichen Bereich. Erstmalig werden hier Langzeitdaten solcher Patienten über die Lebensqualität vorgelegt, gemessen mit dem SF-36. Nachvollziehbar zeigte sich ein deutlicher Unterschied zur Lebensqualität der Durchschnittsbevölkerung, insbesondere im Bereich der körperlichen Belastbarkeit. Für uns unerwartet günstig fielen die Antworten auf der eher psychologischen Ebene aus. Es zeigten sich bei allen Punkten des SF-36 keine signifikanten Unterschiede zwischen dem konservativ behandelten und den hemikraniektomierten Patienten, so dass die Operation als solche keinen eigenständigen Einfluss auf die langfristige Lebensqualität nahm. Zusammengefasst verbesserte die osteoklastische Trepanation des raumfordernden malignen Mediainfarkts die Überlebenschance in der Akutphase signifikant, was mit inzwischen publizierten kontrollierten Studienergebnissen übereinstimmt. Der Langzeitverlauf nach überlebter Akutkrankheit gestaltet sich unabhängig von der Trepanation. Es gibt aufgrund der erworbenen Behinderung eine weiterhin relativ hohe längerfristige Sterblichkeit. Bemerkenswert ist, dass die Selbsteinschätzung der Lebensqualität von Patienten mit einer erheblichen infarktbedingen körperlichen Behinderung psychologisch-emotional nur geringfügig von der Selbstwahrnehmung in der nicht- behinderten Durchschnittsbevölkerung. Dass bedeutet, dass Spekulationen über die zukünftige Lebensqualität keinen Einfluss auf die Operationsindikation nehmen sollten. N2 - In this retrospective study we looked at the sub-group of stroke patients who suffered a large infarction in the area of the middle cerebral artery and were treated in neurological intensive care between 1991 and 2005 due to imminent or already existent decreased conscious level (so called malignant middle cerebral artery infarction) (n=292). The aim was to find out what influence a surgical treatment has on stroke-related increased intracerebral pressure additionally to the usual conservative intesive therapy with regards to acute and longterm survival. In total data from 292 intensiv care patients was evaluated, which consisted of 259 purely conservatively and 33 surgically treated patients. 
Altogether there was a positive selection for surgically treated patients (younger, no aphasia, less comorbidities). Decompressive hemicraniectomy lowered the mortality in the acute phase significantly (c: 22.4%, h: 3.0%; p=0.009). As expected decompressive hemicraniectomy also positively influenced the conscious level: the number of fully alert patients on discharge was 66% higher than on admission. In the group of the conservatively treated patients this number was only 33% higher (on discharge: c: 87% and h: 90.6% fully alert).The mean physical findings on discharge from neurological intensive care showed no significant difference between the conservatively and surgically treated group. The main symptoms were – as on admission – a motor or sensomotor hemiparesis. The prevalence of aphasia dropped in the group of 201 conservatively patients who survived the hospital stay from 56.2% on admission to 48.% on discharge (p= 0.5). In the 32 patients after hemicraniectomy who survived the hospital admission the number of aphasic patients did not change from admission to discharge (50%). It is not expected that a release of intracerebral pressure completely resolves stroke-connected symptoms. During the stay on intensive care physical and neuropsychological function was not systemically assessed using stroke function scales so we cannot comment on how the symptoms changed quantatively after the treatment. There is a possibility that arguments would be pro-hemicraniectomy. On average 64.7 months passed between the stroke and the follow-up examination. In the meantime 47.1% of the 259 conservatively treated patients had died. Of 33 patients after decompressive hemicraniectomy only 24.2% had died (p=0.01). There was a significant difference in the hospital mortality (c: 24%, h: 21.2%). The longterm mortality showed a smaller difference (c: 24%, h: 21.2%). The survival period of the surgically treated patients was three times longer (c: 11.6%, h: 34.4 months). The difference in survival length is most likely due to less comorbidities in the surgically treated patients than to the hemicraniectomy itself. However it can also not be ruled out that due to the earlier achieved improvement of conscious level postoperatively potential future complications could be prevented. With regards to acquired physical functional deficits, measured with the Barthel index, both groups did not reveal any significant difference (p=0.10). The mean Barthel index in the conservatively treated patients was 75 out of 100 and 60 out of 100 in the patients after decompressive hemicraniectomy. That means that patients from both groups were either independent or slightly dependant from other people in their every day life. For the first time we were presenting longterm data on subjective quality of life from patients after middle cerebral artery infarction, measured with the SF-36 health survey [Bullinger et al. 1998]. As expected there was a major difference between our patient group and a comparable average population, especially in areas like “physical function”. The results on a more psychological level like “vitality” and “mental health” were better than expected. They only mildly differed from the average population. The SF-36 health survey did not show any significant difference between the conservatively treated and the surgically treated group. That indicates how the decompressive hemicraniectomy alone did not have an influence on longterm quality of life. In summary the survival rate was inreased significantly by decompressive hemicraniectomy in malignant middle cerebral artery infarction at the University Hospital Wuerzburg between 1991 and 2005, which was also confirmed by other publicated controlled studies [Jüttler et al. 2007; Vahedi et al. 2007; Fandino et al. 2004]. It is remarkable that the subjective quality of life of patients with a considerable disability differs only slightly from the perception of a non-impaired control group. That means that speculations about a future quality of life should not influence a decision for or against decompressive hemicraniectomy. KW - Arteria cerebri media KW - Schlaganfall KW - Arteria carotis interna KW - Carotisstenose KW - Trepanation KW - Infarkt KW - Hirndruck KW - Hirnödem KW - Sekundärprävention KW - Barthel Index KW - Rehabilitation KW - Matched pairs KW - dekompressive Hemikraniektomie KW - maligner Mediainfarkt KW - Dekompressionskraniektomie KW - Middle cerebral artery infarction KW - malignant middle cerebrial artery infarction KW - decompressive hemicraniectomy KW - Barthel Index Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-70232 ER - TY - THES A1 - Kafke, Waldemar T1 - Bestimmung von Zytokinexpressionsprofilen aus humanen Blut- und Hautproben bei Patienten mit small fiber Neuropathie T1 - Analysis of cytokine expression patterns in affected skin amd blood samples in patients with small fiber neuropathy N2 - Zusammenfassend konnte durch unsere Daten die eingangs gestellte Hypothese, dass Patienten mit SFN eine lokal und systemisch erhöhte Expression pro-inflammatorischer und algetischer Zytokine haben, auf lokaler Ebene bei der Untergruppe mit LD-SFN bestätigt werden. Bei der Untergruppe mit NLD-SFN waren keine Unterschiede bei den Zytokinexpressionen zwischen proximalen und distalen Hautbiopsien im Vergleich zu Kontrollprobanden nachweisbar. Zudem zeigten sich deutliche Unterschiede bei den Quotienten der IENFD zwischen beiden Untergruppen. Dies legt die Vermutung nahe, dass die Unterteilung in LD-SFN und NLD-SFN klinisch bedeutsam und ein möglicher Grundstein für das Verständnis der pathophysiologischen Mechanismen der SFN sein könnte. Hieraus könnten sich Fortschritte in der Diagnostik ergeben und gezielte symptomatische und vielleicht sogar kausale Therapien auf lokaler Ebene bei der SFN entwickeln. N2 - A subgroup of patients with small fiber neuropahties with a lenght-dependent distribution pattern concerning the reduction of intraepidermal nerve fibers (LD-SFN) have a higher cytokine gene expression of pro-inflammatory cytokines in affected skin. KW - Small fiber Neuropathie KW - Zytokine KW - Small fiber Neuropathie KW - Zytokine KW - Small fiber neuropathy KW - Cytokines Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-71132 ER - TY - JOUR A1 - Üceyler, Nurcan A1 - Häuser, Winfried A1 - Sommer, Claudia T1 - Systematic review with meta-analysis: Cytokines in fibromyalgia syndrome N2 - Background: To perform a systematic review and meta-analysis on cytokine levels in patients with fibromyalgia syndrome (FMS). Methods: Through December 2010 we systematically reviewed the databases PubMed, MEDLINE, and PsycINFO and screened the reference lists of 22 review articles for suitable original articles. Original articles investigating cytokines in patients with FMS were included. Data were extracted by two independent authors. Differences of the cytokine levels of FMS patients and controls were summarized by standardized mean differences (SMD) using a random effects model. Study quality was assessed applying methodological scores: modified Center of Evidence Based Medicine, Newcastle-Ottawa-Scale, and Würzburg Methodological Quality Score. Results: Twenty-five articles were included investigating 1255 FMS patients and 800 healthy controls. Data of 13/25 studies entered meta-analysis. The overall methodological quality of studies was low. The results of the majority of studies were not comparable because methods, investigated material, and investigated target cytokines differed. Systematic review of the selected 25 articles revealed that FMS patients had higher serum levels of interleukin (IL)-1 receptor antagonist, IL-6, and IL-8, and higher plasma levels of IL-8. Meta-analysis of eligible studies showed that FMS patients had higher plasma IL-6 levels compared to controls (SMD = -0.34 [-0.64, -0.03] 95% CI; p = 0.03). The majority of investigated cytokines were not different between patients and controls. Conclusions: The pathophysiological role of cytokines in FMS is still unclear. Studies of higher quality and with higher numbers of subjects are needed. KW - Fibromyalgie Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-69189 ER - TY - JOUR A1 - Braeuninger, Stefan A1 - Kleinschnitz, C. A1 - Stoll, G. T1 - Interleukin-18 does not influence infarct volume or functional outcome in the early stage after transient focal brain ischemia in mice N2 - Interleukin-18 (IL-18) is a proinflammatory cytokine of the interleukin-1 family which is upregulated after cerebral ischemia. The functional role of IL-18 in cerebral ischemia is unknown. In the present study, we compared infarct size in IL-18 knock-out and wild-type mice 24 hours and 48 hours after 1-hour transient middle cerebral artery occlusion (tMCAO). Moreover, the functional outcome was evaluated in a modified Bederson score, foot fault test and grip test. There were no significant differences in infarct size or functional outcome tests between wild-type and IL-18 knock-out mice. These data indicate that the early inflammatory response to cerebral ischemia does not involve IL-18, in contrast to other interleukin-1 family members such as interleukin-1. KW - Interleukin-18 Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68141 ER - TY - THES A1 - Dang, Su-Yin Judith T1 - Funktionelle Bedeutung der Neuroplastizität bei Multipler Sklerose T1 - The functional relevance of neuronal plasticity in multiple sclerosis N2 - Die Multiple Sklerose ist eine chronische neurologische Erkrankung, welche in der industrialisierten Welt einen der häufigsten Gründe für eine bleibende Behinderung bei jungen Erwachsenen darstellt. Obwohl die ZNS-Schädigung, charakterisiert durch Demyelinisierung und axonale Schädigung im Rahmen entzündlicher Vorgänge, durch verschiedene Reparaturmechanismen reduziert wird, akkumuliert die Läsionslast im zentralen Nervensystem mit der Zeit. T2-gewichtete MRT-Studien zeigen, dass die dargestellten Pathologien nur mäßig mit den motorischen Defiziten korrelieren. Diese Diskrepanz wird unter anderem auf Vorgänge der Neuroplastizität zurückgeführt, als deren Basismechanismen Langzeitpotenzierung (LTP) und -depression (LTD) gelten. In verschiedenen fMRT-Studien haben sich Hinweise ergeben, dass diese adaptiven Veränderungen zur Reorganisation kortikaler Repräsentationmuster führen können, so dass bei MS-Patienten eine ausgedehntere Aktivierung ipsilateraler sensomotorischer Areale bei motorischen Aufgaben zu beobachten ist. Die transkranielle Magnetstimulation (TMS) bietet die Möglichkeit, mittels virtueller Läsionstechniken eine direkte Aussage über die kausale Beziehung zwischen Struktur und Funktion zu liefern. Die funktionelle Rolle ipsilateraler Motorareale wurde an 26 MS-Patienten, in Relation zu ihrer motorischen Beeinträchtigung und ZNS-Schädigung, und an nach Alter, Geschlecht und Händigkeit zugeordneten Kontrollprobanden, untersucht. Die motorische Leistungsfähigkeit wurde durch verschiedene Tests zur Handfunktion erhoben. Die ZNS-Schädigung wurde mittels MR-Spektroskopie als NAA/Cr Quotient sowie durch die CML erhoben. Die Aufgabe zur einfachen Reaktionszeit (SRT) bestand aus einer isometrischen Abduktionsbewegung des rechten Daumens gegen einen Kraftaufnehmer auf ein akustisches Go-Signal. Mit TMS-Einzelreizen wurde mit Hilfe einer Neuronavigation eine reversible virtuelle Läsion über bestimmten Gehirnarealen, kontralateraler M1, ipsilateraler M1 und ipsilateraler PMd, erzeugt. Es wurde eine Kontrollstimulation über MO durchgeführt. Die TMS-Einzelreize wurden 100ms nach dem Go-Signal appliziert. Als SRT wurde der Zeitraum zwischen dem Go-Signal und EMG-Beginn im APB definiert. Die signifikanten SRT-Verlängerungen bei TMS über dem ipsilateralen M1 und dem ipsilateralen PMd zeigen, dass diese Regionen eine Rolle bei der motorischen Funktion bei MS spielen. Die fehlenden Korrelationen zwischen motorischen Funktionstest und NAA/Cr-Verhältnis sowie die inverse Korrelation zur kortikomuskulären Latenz sind durch strukturell von der krankheitsbedingten Pathologie betroffenen kompensierenden Gehirnregionen erklärbar. Bei dem Theta Burst Experiments (TBS) wurde ein virtueller Läsionseffekt durch eine repetitive TMS-Intervention über dem ipsilateralen M1 induziert. Die Ergebnisse zeigen ähnliche Veränderungen der Exzitabilität bei MS-Patienten und gesunden Kontrollprobanden, was schließen lässt, dass die LTD bei mild bis moderat betroffenen MS-Patienten weitestgehend unbeeinträchtigt ist. MS-Patienten zeigen im Vergleich zu den Kontrollen eine ähnliche Minderung der Verhaltensleistung, Trefferquote in ein Kraftfenster, der MS-Patienten im Kontrollvergleich. Die Ergebnisse zeigen, dass ipsilaterale motorische Areale in der Lage sind den primär motorischen Kortex soweit zu kompensieren, jedoch die Fähigkeit zur Kompensation in fortgeschrittenen Krankheitsstadien eingeschränkt ist. Abschließend kann man zusammenfassen, dass die funktionelle Rekrutierung von ipsilateralen Motorarealen eine adaptive Antwort auf chronische Gehirnschädigung bei MS-Patienten sein kann, allerdings mit Einschränkung der Kapazität in fortgeschrittenen Krankheitsstadien. Nachdem die synaptische Plastizität weitestgehend intakt scheint, sollte man besonders Mechanismen der späten Phase der Plastizität fördern, welche auf eine langfristige kortikale Plastizität abzielen. Weitere Studien in diesem Forschungszweig könnten einen Beitrag zur Entwicklung therapeutischer Konzepte der Neurorehabilitation bei Multipler Sklerose leisten. N2 - Multiple Sclerosis is a chronic neurological disease, which is one of the common reasons in the industrial world causing a lasting disablement at young adults. Despite of reduction by several mechanisms the cns injury characterized by demyelinizing and axonal injury in order of inflammatory processes the lesion load of the cns accumulates over the years. T2-weighted MRI studies only show moderate correlations between the represented pathologies and the motoric deficits. This discrepancy is attributed i.a. to procedures of neuroplasticity whose basic mechanisms are considered as Long-term potentiation (LTP) and -depression (LTD). Several fMRI studies suggest a reogranization of cortical representative pattern due to these adaptive changes. Therefore an extended activation of ipilaterale sensomotoric areas is observed in MS patients performing motoric tasks. Transcranial Magnetic Stimulation (TMS) provides via lesional techniques the possibility of a direct conclusion causal link to structure and function. The functional role of ipsilateral motor areas has been examined in 26 MS patients in relation to their motor impairment and cns injury. Healthy controls were matched for age, sex and handedness. The motor performance was assessed by a test battery of hand function. The cns injury was evaluated using magnetic resonance spectroscopy (NAA/Cr Quotient) and TMS (CML). The Simple Reaction Time task (SRT) consisted of a brisk isometric abduction of the right thumb against a force transducer as a respond to an auditorily Go-Signal. With the help of a neuronavigational device a reversible virtual lesion, delivered by TMS single pulses, were applied to specific brain areas, contralateral M1, ipsilateral M1 and ipsilateral PMD. A control stimulation were assessed to MO??. TMS Single pulses were applied 100ms after Go-Signal. SRT were defined as the time between Go-Signal and EMG onset. Significant extention of SRT after TMS to ipsilateral M1 and ipsilateral PMd evidence the role of these regions in motoric function in MS. The missing correlation between motor performance and NAA/Cr Quotient as well as the inverse correlation to CML are explainable by compensation brain regions which are themselves structurally affected by disease pathologies. In the Thetaburs experiments (TBS) a virtual lesion was induced by a repetitive TMS intervention to ipsilateral M1. The results show a similar change of excitability in MS patients and healthy controls which concludes that LTD is not compromised in mild to moderate affected MS patients. MS patients presented in comparison to controlls a similiar discrease of behavioral performance, hit rate in a force range. The results evidence that ipsilateral motor areas have the ability to compensate the primary motor cortex. But the ability for compensation is limited in advanced stages of illness. The concluding summary is that functional recruitment of ipsilateral motor areas are adaptive response to chronic brain injury in MS patients but with limited capacity in advanced stages of illness. As the synaptic plasticity seem intact to the greatest possible extent mechanism of the late stadium of plasticity should be supported which aim at long term cortical plasticity. Further studies in this branch of research could contribute the development of therapeutic concepts of neurorehabilitation in MS. KW - Neuronale Plastizität KW - Multiple Sklerose KW - Transkranielle Magnetstimulation KW - neuronal plasticity KW - multiple sclerosis KW - transcranial magnetic stimulation Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-73817 ER - TY - JOUR A1 - Chen, Y. A1 - Palm, F. A1 - Lesch, K. P. A1 - Gerlach, M. A1 - Moessner, R. A1 - Sommer, C. T1 - 5-hydroxyindolacetic acid (5-HIAA), a main metabolite of serotonin, is responsible for complete Freund's adjuvant-induced thermal hyperalgesia in mice N2 - Background: The role of serotonin (5-hydroxytrptamine, 5-HT) in the modulation of pain has been widely studied. Previous work led to the hypothesis that 5-hydroxyindolacetic acid (5-HIAA), a main metabolite of serotonin, might by itself influence pain thresholds. Results: In the present study, we investigated the role of 5-HIAA in inflammatory pain induced by intraplantar injection of complete Freund’s adjuvant (CFA) into the hind paw of mice. Wild-type mice were compared to mice deficient of the 5-HT transporter (5-HTT-/- mice) using behavioral tests for hyperalgesia and high-performance liquid chromatography (HPLC) to determine tissue levels of 5-HIAA. Wild-type mice reproducibly developed thermal hyperalgesia and paw edema for 5 days after CFA injection. 5-HTT-/- mice treated with CFA had reduced thermal hyperalgesia on day 1 after CFA injection and normal responses to heat hereafter. The 5-HIAA levels in spinal cord and sciatic nerve as measured with HPLC were lower in 5-HTT-/- mice than in wild-type mice after CFA injection. Pretreatment of wild-type mice with intraperitoneal injection of para-chlorophenylalanine (p-CPA), a serotonin synthesis inhibitor, resulted in depletion of the 5-HIAA content in spinal cord and sciatic nerve and decrease in thermal hyperalgesia in CFA injected mice. The application of exogenous 5-HIAA resulted in potentiation of thermal hyperalgesia induced by CFA in 5-HTT-/- mice and in wild-type mice pretreated with p- CPA, but not in wild-type mice without p-CPA pretreatment. Further, methysergide, a broad-spectrum serotonin receptor antagonist, had no effect on 5-HIAA-induced potentiation of thermal hyperalgesia in CFA-treated wildtype mice. Conclusion: Taken together, the present results suggest that 5-HIAA plays an important role in modulating peripheral thermal hyperalgesia in CFA induced inflammation, probably via a non-serotonin receptor mechanism. KW - Medizin Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68858 ER - TY - JOUR A1 - Chen, Yong A1 - Boettger, Michael K. A1 - Reif, Andreas A1 - Schmitt, Angelika A1 - Ueceyler, Nurcan A1 - Sommer, Claudia T1 - Nitric oxide synthase modulates CFA-induced thermal hyperalgesia through cytokine regulation in mice N2 - Background: Although it has been largely demonstrated that nitric oxide synthase (NOS), a key enzyme for nitric oxide (NO) production, modulates inflammatory pain, the molecular mechanisms underlying these effects remain to be clarified. Here we asked whether cytokines, which have well-described roles in inflammatory pain, are downstream targets of NO in inflammatory pain and which of the isoforms of NOS are involved in this process. Results: Intraperitoneal (i.p.) pretreatment with 7-nitroindazole sodium salt (7-NINA, a selective neuronal NOS inhibitor), aminoguanidine hydrochloride (AG, a selective inducible NOS inhibitor), L-N(G)-nitroarginine methyl ester (L-NAME, a non-selective NOS inhibitor), but not L-N(5)-(1-iminoethyl)-ornithine (L-NIO, a selective endothelial NOS inhibitor), significantly attenuated thermal hyperalgesia induced by intraplantar (i.pl.) injection of complete Freund’s adjuvant (CFA). Real-time reverse transcription-polymerase chain reaction (RT-PCR) revealed a significant increase of nNOS, iNOS, and eNOS gene expression, as well as tumor necrosis factor-alpha (TNF), interleukin-1 beta (IL-1b), and interleukin-10 (IL-10) gene expression in plantar skin, following CFA. Pretreatment with the NOS inhibitors prevented the CFA-induced increase of the pro-inflammatory cytokines TNF and IL-1b. The increase of the antiinflammatory cytokine IL-10 was augmented in mice pretreated with 7-NINA or L-NAME, but reduced in mice receiving AG or L-NIO. NNOS-, iNOS- or eNOS-knockout (KO) mice had lower gene expression of TNF, IL-1b, and IL-10 following CFA, overall corroborating the inhibitor data. Conclusion: These findings lead us to propose that inhibition of NOS modulates inflammatory thermal hyperalgesia by regulating cytokine expression. KW - Medizin Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68349 ER - TY - JOUR A1 - Kraft, P. A1 - Schwarz, T. A1 - Pochet, L. A1 - Stoll, G. A1 - Kleinschnitz, Christoph T1 - COU254, a specific 3-carboxamide-coumarin inhibitor of coagulation factor XII, does not protect mice from acute ischemic stroke N2 - Background: Anticoagulation is an important means to prevent from acute ischemic stroke but is associated with a significant risk of severe hemorrhages. Previous studies have shown that blood coagulation factor XII (FXII)- deficient mice are protected from pathological thrombus formation during cerebral ischemia without bearing an increased bleeding tendency. Hence, pharmacological blockade of FXII might be a promising and safe approach to prevent acute ischemic stroke and possibly other thromboembolic disorders but pharmacological inhibitors selective over FXII are still lacking. In the present study we investigated the efficacy of COU254, a novel nonpeptidic 3-carboxamide-coumarin that selectively blocks FXII activity, on stroke development and post stroke functional outcome in mice. Methods: C57Bl/6 mice were treated with COU254 (40 mg/kg i.p.) or vehicle and subjected to 60 min transient middle cerebral artery occlusion (tMCAO) using the intraluminal filament method. After 24 h infarct volumes were determined from 2,3,5-Triphenyltetrazoliumchloride(TTC)-stained brain sections and functional scores were assessed. Hematoxylin and eosin (H&E) staining was used to estimate the extent of neuronal cell damage. Thrombus formation within the infarcted brain areas was analyzed by immunoblot. Results: Infarct volumes and functional outcomes on day 1 after tMCAO did not significantly differ between COU254 pre-treated mice or untreated controls (p > 0.05). Histology revealed extensive ischemic neuronal damage regularly including the cortex and the basal ganglia in both groups. COU254 treatment did not prevent intracerebral fibrin(ogen) formation. Conclusions: COU254 at the given concentration of 40 mg/kg failed to demonstrate efficacy in acute ischemic stroke in this preliminary study. Further preclinical evaluation of 3-carboxamide-coumarins is needed before the antithrombotic potential of this novel class of FXII inhibitors can be finally judged. KW - Schlaganfall KW - Maus KW - COU254 Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68103 ER - TY - JOUR A1 - Pham, Mirko A1 - Helluy, X. A1 - Braeuninger, S. A1 - Jakob, P. A1 - Stoll, G. A1 - Kleinschnitz, Christoph A1 - Bendszus, M. T1 - Outcome of experimental stroke in C57Bl/6 and Sv/129 mice assessed by multimodal ultra-high field MRI N2 - Transgenic mice bred on C57Bl/6 or Sv/129 genetic background are frequently used in stroke research. It is well established that variations in cerebrovascular anatomy and hemodynamics can influence stroke outcome in different inbred mouse lines. We compared stroke development in C57Bl/6 and Sv/129 mice in the widely used model of transient middle cerebral artery occlusion (tMCAO) by multimodal ultra-high field magnetic resonance imaging (MRI). C57Bl/6 and Sv/129 mice underwent 60 min of tMCAO and were analyzed by MRI 2 h and 24 h afterwards. Structural and functional images were registered to a standard anatomical template. Probability maps of infarction were rendered by automated segmentation from quantitative T2-relaxometric images. Whole-brain segmentation of infarction was accomplished manually on high-resolution T2-weighted (T2-w) RARE images. Cerebral perfusion (cerebral blood flow, CBF) was measured quantitatively by modified continuous arterial-spin-labeling (CASL) and apparent diffusion coefficients (ADC) by spin-echo diffusion-weighted imaging (DWI). Probabilities of cortical (95.1% ± 3.1 vs. 92.1% ± 2.5; p > 0.05) and subcortical (100% vs. 100%; p > 0.05) infarctions at 24 h were similar in both groups as was the whole-brain volumetric extent of cerebral infarction. In addition, CBF and ADC values did not differ between C57Bl/6 and Sv/129 mice at any time point or region of interest. The C57Bl/6 and Sv/129 genetic background is no major confounding factor of infarct size and cerebral perfusion in the tMCAO model. KW - NMR-Tomographie Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68115 ER - TY - JOUR A1 - Ehling, P. A1 - Bittner, S. A1 - Bobak, N. A1 - Schwarz, T. A1 - Wiendl, H. A1 - Budde, T. A1 - Kleinschnitz, Christoph A1 - Meuth, S. G. T1 - Two pore domain potassium channels in cerebral ischemia: a focus on K2p9.1 (TASK3, KCNK9) N2 - BACKGROUND: Recently, members of the two-pore domain potassium channel family (K2P channels) could be shown to be involved in mechanisms contributing to neuronal damage after cerebral ischemia. K2P3.1-/- animals showed larger infarct volumes and a worse functional outcome following experimentally induced ischemic stroke. Here, we question the role of the closely related K2P channel K2P9.1. METHODS: We combine electrophysiological recordings in brain-slice preparations of wildtype and K2P9.1-/- mice with an in vivo model of cerebral ischemia (transient middle cerebral artery occlusion (tMCAO)) to depict a functional impact of K2P9.1 in stroke formation. RESULTS: Patch-clamp recordings reveal that currents mediated through K2P9.1 can be obtained in slice preparations of the dorsal lateral geniculate nucleus (dLGN) as a model of central nervous relay neurons. Current characteristics are indicative of K2P9.1 as they display an increase upon removal of extracellular divalent cations, an outward rectification and a reversal potential close to the potassium equilibrium potential. Lowering extracellular pH values from 7.35 to 6.0 showed comparable current reductions in neurons from wildtype and K2P9.1-/- mice (68.31 +/- 9.80% and 69.92 +/- 11.65%, respectively). These results could be translated in an in vivo model of cerebral ischemia where infarct volumes and functional outcomes showed a none significant tendency towards smaller infarct volumes in K2P9.1-/- animals compared to wildtype mice 24 hours after 60 min of tMCAO induction (60.50 +/- 17.31 mm3 and 47.10 +/- 19.26 mm3, respectively). CONCLUSIONS: Together with findings from earlier studies on K2P2.1-/- and K2P3.1-/- mice, the results of the present study on K2P9.1-/- mice indicate a differential contribution of K2P channel subtypes to the diverse and complex in vivo effects in rodent models of cerebral ischemia. KW - Kaliumkanal KW - Ischemia Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68129 ER - TY - THES A1 - Stenner, Max-Philipp T1 - Diapedese und immuntolerogene Funktion regulatorischer T Zellen in der schubförmigen Multiplen Sklerose unter Therapie mit Natalizumab T1 - Diapedesis and tolerogenic function of regulatory T cells under natalizumab therapy of relapsing-remitting multiple sclerosis N2 - Die schubförmige Multiple Sklerose (MS) ist eine chronisch-entzündliche, demyelinisierende, multifokale Erkrankung des Zentralnervensystems (ZNS). Autoreaktive immunologische Prozesse, insbesondere der T-Zell vermittelten Immunität, leisten einen entscheidenden Beitrag zur Pathogenese der schubförmigen MS. Ein wesentlicher Schritt in immunpathogenetischen Modellen ist die transendotheliale Migration von Immunzellen über die Blut-Hirn-Schranke. Die Interaktion des very late antigen 4 (VLA-4) mit dem vascular cell adhesion molecule 1 (VCAM-1) und mit Fibronectin leistet einen wesentlichen Beitrag zur Extravasation von T Zellen in das ZNS. Auf dieser Schlüsselfunktion des VLA-4 gründet die Therapie mit Natalizumab, einem monoklonalen Antikörper gegen die α4 Integrinkette. Ziel der vorliegenden Studie war es, die Auswirkungen der Therapie der schubförmigen MS mit Natalizumab auf die transendotheliale Migration von CD4+CD25+FOXP3+ und CD4+HLA-G+ regulatorischen T Zellen (Treg) und auf die antiproliferative Funktion von FOXP3+ Treg zu untersuchen. Zentrale Hypothese war, dass Natalizumab über eine universelle Blockade der Immunzellinvasion in das ZNS hinaus immunmodulatorisch wirkt. Unter Verwendung eines prospektiven, longitudinalen Studiendesigns wurden die T Zellen von RR-MS Patienten unter Therapie mit Natalizumab (n=31) sowie von stabilen RR-MS Patienten ohne Therapie und gesunden Spendern in jeweils zwei in vitro Modellen der Blut-Hirn-Schranke sowie Treg vermittelter Immuntoleranz untersucht. FOXP3+ regulatorische T-Zellen banden weniger Natalizumab und exprimierten weniger VLA-4 als nicht-regulatorische T Helferzellen, bewahrten unter Therapie jedoch einen höheren Anteil ihrer ursprünglichen VLA-4 Expression. FOXP3+ Treg gesunder Spender wiesen in vitro höhere Migrationsraten über mikrovaskuläre humane Hirnendothelzellen als nicht-regulatorische T Helferzellen auf und akkumulierten innerhalb der T-Zell Population nach Migration. Dagegen reicherten sich FOXP3+ Treg von MS Patienten in Folge der Migration nur nach Vorbehandlung des Endothel mit inflammatorischen Zytokinen an, nicht jedoch ohne diese Vorbehandlung. Natalizumab beeinträchtigte die transendotheliale Migration von FOXP3+ Treg und nicht-regulatorischen T Helferzellen von MS Patienten in vergleichbaren Ausmaßen. HLA-G+ Treg zeigten in den Migrationsanalysen ein den FOXP3+ Treg entgegengesetztes Muster und wiesen ausschließlich in der MS, nicht jedoch im Gesunden, eine höhere Migrationsrate auf als HLA-G- T Helferzellen. Diese Akkumulation von HLA-G+ Treg in der migrierten Zellfraktion ließ sich nach Therapiebeginn nicht mehr nachweisen. Eine ergänzende Einzelfallstudie zu Auswirkungen des LFA-1 Antagonisten Efalizumab auf Treg ergab Hinweise auf eine Schlüsselfunktion dieses Integrins für die Migration von FOXP3+ Treg. Die Analyse der FOXP3+ Treg Suppressorfunktion zeigte eine schrittweise Zunahme des suppressiven Einflusses von FOXP3+ Treg auf die Reifung dendritischer Zellen unter Natalizumabtherapie. Zeitlich parallel kam es zu einem Ungleichgewicht in der Expression von LFA-1 auf der Oberfläche von FOXP3+ Treg und nicht-regulatorischen T Helferzellen. Zusammenfassend stützt die Studie die Hypothese immunmodulatorischer Effekte von Natalizumab in der schubförmigen Multiplen Sklerose, insbesondere auf den Antagonismus von regulatorischen und Effektor-T Zellen. Die Arbeit belegt, dass Natalizumab in vivo über die Blockade von VLA-4 hinaus modulatorisch in das Netzwerk von Adhäsionsmolekülen auf T Zellen eingreift. Die Studienergebnisse ergeben ein Überwiegen regulatorischer Einflüsse auf die Reifung dendritischer Zellen unter Therapie. Berichte zum Beitrag von LFA-1 zur Suppressorfunktion von FOXP3+ Treg werden durch Daten der vorliegenden Studie unterstützt und um Hinweise auf eine zusätzliche, spezifische Bedeutung des Integrins zur präferentiellen Diapedese dieser Treg über die Blut-Hirn-Schranke im Gesunden erweitert. Zudem liefert die Arbeit erstmals Hinweise auf einen Defekt der transendothelialen Migration von FOXP3+ Treg über die Blut-Hirn-Schranke in der schubförmigen Multiplen Sklerose, der zur Entstehung neuer Läsionen beitragen könnte. N2 - Relapsing-remitting multiple sclerosis (MS) is a multifocal, chronic, inflammatory, demyelinating disease of the central nervous system (CNS). Autoreactive processes, in particular T-cell mediated immunity, are essential to the pathogenesis of MS. A pivotal step in immunopathogenetic models is the diapedesis of immune cells across the blood-brain barrier. Transendothalial migration of encephalitogenic T cells across the blood-brain barrier depends critically on the interaction between very late antigen 4 (VLA-4) and vascular cell adhesion molecule 1 (VCAM-1) as well as fibronectin. The therapeutic rationale for natalizumab, a monoclonal antibody against the α4 chain of VLA-4, is based on this pivotal role of VLA-4 for T-cell diapedesis. This study aimed to examine transendothelial migration of CD4+CD25+FOXP3+ and CD4+HLA-G+ regulatory T cells (Treg) as well as the suppressive capacity of FOXP3+ Treg in relapsing-remitting multiple sclerosis under natalizumab therapy. The study tested the hypothesis that natalizumab exerts immunmodulatory effects beyond a universal blockade of immune cell invasion into the CNS. T cells from MS patients under natalizumab therapy (n=31) were compared to T cells from stable MS patients without treatment and from healthy controls according to a prospective, longitudinal study design. Two in vitro models of the blood-brain barrier and two models of Treg-mediated tolerance were employed. FOXP3+ regulatory T cells exhibited reduced natalizumab binding and VLA-4 expression when compared to non-regulatory T helper cells but preserved a greater proportion of their initial VLA-4 expression under natalizumab therapy. FOXP3+ Treg from healthy controls showed enhanced migration across human brain microvascular endothelial cells when compared to non-regulatory T cells in vitro and accumulated within the T-cell population after migration. FOXP3+ Treg from MS patients, in contrast, accumulated only after pre-treatment of the endothelium with inflammatory cytokines. Natalizumab inhibited transendothelial migration of FOXP3+ Treg and non-regulatory T cells to a similar extent. HLA-G+ Treg showed a reverse pattern in these migration assays: HLA-G+ Treg from MS patients, but not from healthy controls, exhibited enhanced migratory rates when compared to non-regulatory, HLA-G- TH cells. This accumulation of HLA-G+ Treg within the fraction of migrated cells could no longer be detected any more after initiation of natalizumab therapy. The results of a supplementary single case study on the effects of the LFA-1 antagonist efalizumab on Treg pointed towards a pivotal role of this integrin for the preferential migration of FOXP3+ Treg. Suppression of the maturation of dendritic cells by FOXP3+ Treg gradually increased under natalizumab therapy. A growing imbalance in the surface distribution of LFA-1 among FOXP3+ Treg and non-regulatory TH cells parallelled this recovery of MS Treg suppression. In summary, this study supports the hypothesis of immunomodulatory effects of natalizumab in relapsing-remitting multiple sclerosis, particularly on the antagonism between regulatory and effector T cells. The study documents interference of natalizumab with the network of adhesion molecules on T cells in vivo that extends beyond its blockade of VLA-4. Furthermore, it demonstrates a dominance of Treg-mediated suppression on the maturation of dendritic cells under therapy. It supports recent reports on a pivotal role of LFA-1 for suppressive mechanisms of FOXP3+ Treg and points towards a similar relevance for preferential Treg migration across the blood-brain barrier. Lastly, the study provides the first evidence for deficient transendothelial migration of FOXP3+ Treg in multiple sclerosis, which could contribute to early lesion formation. KW - Neuroimmunologie KW - Multiple Sklerose KW - Natalizumab KW - regulatorische T Zellen KW - FOXP3 KW - HLA-G KW - Diapedese KW - natalizumab KW - regulatory T cells KW - FOXP3 KW - HLA-G KW - diapedesis Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-70573 ER - TY - JOUR A1 - Sommer, Claudia A1 - Richter, Helmut A1 - Rogausch, Jan P. A1 - Frettloh, Jule A1 - Lungenhausen, Margitta A1 - Maier, Christoph T1 - A modified score to identify and discriminate neuropathic pain: a study on the German version of the neuropathic pain symptom inventory (NPSI) N2 - Background: Neuropathic pain must be correctly diagnosed for optimal treatment. The questionnaire named Neuropathic Pain Symptom Inventory (NPSI) was developed in its original French version to evaluate the different symptoms of neuropathic pain. We hypothesized that the NPSI might also be used to differentiate neuropathic from non-neuropathic pain. Methods: We translated the NPSI into German using a standard forward-backward translation and administered it in a case-control design to patients with neuropathic (n = 68) and non-neuropathic pain (headache and osteoarthritis, n = 169) to validate it and to analyze its discriminant properties, its sensitivity to change, and to detect neuropathic pain subgroups with distinct profiles. Results: Using a sum score (the NPSI-G score), we found sensitivity to change (r between 0.37 and 0.5 for pain items of the graded chronic pain scale) and could distinguish between neuropathic and other pain on a group basis, but not for individual patients. Post hoc development of a discriminant score with optimized diagnostic properties to distinguish neuropathic pain from non-neuropathic pain resulted in an instrument with high sensitivity (91%) and acceptable specificity (70%). We detected six different pain profiles in the patient group with neuropathic pain; three profiles were found to be distinct. Conclusions: The NPSI-G potentially combines the properties of a diagnostic tool and an instrument to identify subtypes of neuropathic pain. KW - Neuralgie KW - NPSI Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68716 ER - TY - JOUR A1 - Kreissl, Michael C. A1 - Stout, David B. A1 - Wong, Koon-Pong A1 - Wu, Hsiao-Ming A1 - Caglayan, Evren A1 - Ladno, Waldemar A1 - Zhang, Xiaoli A1 - Prior, John A1 - Reiners, Christoph A1 - Huang, Sung-Cheng A1 - Schelbert, Heinrich R. T1 - Influence of Dietary Interventions and Insulin on Myocardial, Skeletal Muscle and Brain [18F]-Fluorodeoxyglucose Kinetics in Mice N2 - Background: We evaluated the effect of insulin stimulation and dietary changes on myocardial, skeletal muscle and brain [18F]-fluorodeoxyglucose (FDG) kinetics and uptake in vivo in intact mice. Methods: Mice were anesthetized with isoflurane and imaged under different conditions: non-fasted (n = 7; "controls"), non-fasted with insulin (2 IU/kg body weight) injected subcutaneously immediately prior to FDG (n = 6), fasted (n = 5), and fasted with insulin injection (n = 5). A 60-min small-animal PET with serial blood sampling and kinetic modeling was performed. Results: We found comparable FDG standardized uptake values (SUVs) in myocardium in the non-fasted controls and non-fasted-insulin injected group (SUV 45-60 min, 9.58 ± 1.62 vs. 9.98 ± 2.44; p = 0.74), a lower myocardial SUV was noted in the fasted group (3.48 ± 1.73; p < 0.001). In contrast, the FDG uptake rate constant (Ki) for myocardium increased significantly by 47% in non-fasted mice by insulin (13.4 ± 3.9 ml/min/100 g vs. 19.8 ± 3.3 ml/min/100 g; p = 0.030); in fasted mice, a lower myocardial Ki as compared to controls was observed (3.3 ± 1.9 ml/min/100 g; p < 0.001). Skeletal muscle SUVs and Ki values were increased by insulin independent of dietary state, whereas in the brain, those parameters were not influenced by fasting or administration of insulin. Fasting led to a reduction in glucose metabolic rate in the myocardium (19.41 ± 5.39 vs. 3.26 ± 1.97 mg/min/100 g; p < 0.001), the skeletal muscle (1.06 ± 0.34 vs. 0.34 ± 0.08 mg/min/100 g; p = 0.001) but not the brain (3.21 ± 0.53 vs. 2.85 ± 0.25 mg/min/100 g; p = 0.19). Conclusions: Changes in organ SUVs, uptake rate constants and metabolic rates induced by fasting and insulin administration as observed in intact mice by small-animal PET imaging are consistent with those observed in isolated heart/muscle preparations and, more importantly, in vivo studies in larger animals and in humans. When assessing the effect of insulin on the myocardial glucose metabolism of non-fasted mice, it is not sufficient to just calculate the SUV - dynamic imaging with kinetic modeling is necessary. KW - Insulin KW - Gehirn KW - Skelettmuskel KW - Maus Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68775 ER - TY - JOUR A1 - Puschmann, Anne-Katrin A1 - Sommer, Claudia T1 - Hypervigilance or avoidance of trigger related cues in migraineurs? - A case-control study using the emotional stroop task N2 - Background: “Negative affect” is one of the major migraine triggers. The aim of the study was to assess attentional biases for negative affective stimuli that might be related to migraine triggers in migraine patients with either few or frequent migraine and healthy controls. Methods: Thirty-three subjects with frequent migraine (FM) or with less frequent episodic migraine, and 20 healthy controls conducted two emotional Stroop tasks in the interictal period. In task 1, general affective words and in task 2, pictures of affective faces (angry, neutral, happy) were used. For each task we calculated two emotional Stroop indices. Groups were compared using one-way ANOVAs. Results: The expected attentional bias in migraine patients was not found. However, in task 2 the controls showed a significant attentional bias to negative faces, whereas the FM group showed indices near zero. Thus, the FM group responded faster to negative than to positive stimuli. The difference between the groups was statistically significant. Conclusions: The findings in the FM group may reflect a learned avoidance mechanism away from affective migraine triggers. KW - Migräne Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-69103 ER - TY - THES A1 - Subramanian, Narayan T1 - Role of NaV1.9 in activity dependent axon growth in embryonic cultured motoneurons T1 - Die Rolle der NaV1.9 in Aktivität abhängig Axonwachstum in embryonalen kultivierten Motoneuronen N2 - Spontaneous neural activity has been shown to regulate crucial events in neurite growth including axonal branching and path finding. In animal models of spinal muscular atrophy (SMA) cultured embryonic mouse motoneurons show distinct defect in axon elongation and neural activity. This defect is governed by abnormal clustering of Ca2+ channels in the axonal regions and the protruding growth cone area. The mechanisms that regulate the opening of calcium channels in developing motoneurons are not yet clear. The question was addressed by blocking neural activity in embryonic cultured motoneurons by pharmacological inhibition of voltage-gated sodium channels (VGSC) by saxitoxin (STX) and tetrodotoxin (TTX). Low dosages of STX resulted in significant reduction of axon growth and neural activity in cultured motoneurons. This pharmacological treatment did not affect survival of motoneurons in comparison to control motoneurons that was grown in the presence of survival neurotrophic factors BDNF and CNTF. It was also found that STX was 10 times more potent than TTX a common inhibitor of VGSC with a reduced activity on the TTX-insensitive sodium channels NaV1.5, NaV1.8 and NaV1.9. Reverse Transcriptase-PCR experiments revealed the presence of NaV1.9 as the likely candidate that begins to express from embryonic stage sixteen in the mouse spinal cord. Immunolabelling experiments showed that the channel is expressed in the axonal compartments and axonal growth cones in cultured motoneurons. Suppression of NaV1.9 in cultured motoneurons by lentivirus mediated short hairpin-RNA (shRNA) resulted in shorter axon length in comparison with uninfected and scrambled constructs. Further, embryonic motoneurons cultured from NaV1.9 knockout mice also showed a significant reduction in neural activity and axon growth. The findings of this work highlight the role of NaV1.9 as an important contender in regulating activity dependent axon growth in embryonic cultured motoneurons. NaV1.9 could therefore be considered as a prospective molecule that could play an important role in regulating axon growth in motoneuron disease models like spinal muscular atrophy (SMA). N2 - Spontane neuronale Aktivität reguliert essentielle Ereignisse im Neuritenwachstum, wie beispielsweise die axonale Verzweigung und die Erkennung des Wachstumspfades. Motoneurone, die aus Tiermodellen der Spinalen Muskelatrophie (SMA) gewonnen werden, zeigen einen auffälligen Defekt im Streckenwachstum von Axonen und in der neuronalen Aktivität. Dieser Defekt wird von anormaler Clusterbildung von Ca2+ Kanälen in axonalen Regionen und in Wachstumskegeln begleitet. Die Mechanismen, die das Öffnen von Kalziumkanälen in embryonalen Motoneuronen in der Entwicklung regulieren, und die für das aktivitätsabhängige Axonwachstum benötigt werden, sind nicht bekannt. Diese Frage wurde in dieser Studie bearbeitet, indem neuronale Aktivität in embryonalen Motoneuronen durch pharmakologische Inhibition von spannungsabhängigen Natriumkanälen durch Saxitoxin (STX) und Tetrodotoxin blockiert wurde. Geringe Dosen von Saxitoxin bewirkten eine deutliche Reduktion des Axonwachstums und der neuronalen Aktivität in kultivierten Motoneuronen. Diese pharmakologische Behandlung beeinflusste nicht das Überleben von Motoneuronen im Vergleich zu Kontroll-Motoneuronen, die in der Anwesenheit der neurotrophen Faktoren BDNF und CNTF kultiviert wurden. Saxitoxin war etwa 5-10-mal potenter als TTX, ein üblicher Blocker spannungsabhängiger Natriumkanäle mit einer verminderte Aktivität auf die TTX-insensitiven Natriumkanäle NaV1.5, NaV1.8, und NaV1.9. Reverse-Transkriptase-PCR Experimente bestätigten die Anwesenheit von NaV1.9 am Tag E16 (embryonaler Tag 16) im Rückenmark der Maus. NaV1.9 ist ein einzigartiger Typus von einem Natriumkanal welcher in der Lage ist neuronale Erregbarkeit in der Nähe des Ruhemembranpotentials zu steuern. Deshalb war NaV1.9 ein guter Kandidat für einen Kanal, der spontane Erregung in Motoneuronen vermittelt. Immunofärbungen zeigten, dass NaV1.9 in axonalen Kompartimenten und axonalen Wachstumskegeln von kultivierten Motoneuronen exprimiert ist. Die Unterdrückung von NaV1.9 in kultivierten Motoneuronen durch lentiviralexprimierte short hairpin-RNA (shRNA) resultierte in kürzerer Axonlänge, im Vergleich zu nicht-infizierten Motoneuronen oder Motoneuronen, die eine sinnlose Kontroll-shRNA Sequenz exprimierten. Embryonale, kultivierte Motoneurone von NaV1.9 knockout Mäusen zeigten eine signifikante Verringerung der neuronalen Aktivität und verkürzte Axone. Diese Ergebnisse weisen auf eine Bedeutung von NaV1.9 im aktivitätsabhängigen Axonwachstum hin KW - Axon KW - Embryonalentwicklung KW - Motoneuron KW - Natriumkanal KW - Motoneuronen KW - NaV1.9 KW - motoneuron KW - Nav1.9 KW - axon growth Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-57536 ER - TY - THES A1 - Graulich, Michael T1 - Spinale Effekte von TNF-α am Modell des tumorinduzierten Knochenschmerzes der Maus T1 - Spinal effects of TNF-α in a mouse model of bone cancer pain N2 - Am Modell des tumorinduzierten Schmerzes der Maus wurden sowohl das Schmerzverhalten der Tiere als auch spezifische morphologische Veränderungen im Hinterhorn des Rückenmarks (Aktivierung von Astrozyten) und im tumorbefallenen Knochen analysiert. Durch Analyse von Mäusen mit Defizienz für TNF-Rezeptor 1, TNF-Rezeptor 2 oder für beide Rezeptoren konnte die Rolle von TNF-α seiner Rezeptoren bei der Entstehung von tumorinduziertem Schmerz untersucht werden. Im Unterschied zu neuropathischen Schmerzmodellen konnte gezeigt werden, dass beide TNF-Rezeptoren ausgeschaltet werden müssen, um eine signifikante Schmerzreduktion zu erzielen. Die systemische Behandlung mit dem TNF-neutralisierenden Fusionsprotein Etanercept konnte die im genetischen Modell gezeigte Reduktion der mechanischen Allodynie teilweise, aber nicht vollständig reproduzieren. Eine Hemmung der Mikrogliaaktivierung mittels Minocyclin erbrachte im Tumor-schmerzmodell keinen Effekt auf das Schmerzverhalten der Tiere. Die histologische Analyse der tumoraffizierten Knochen zeigte eine signifikante Zunahme der Osteoklastenaktivität in tumortragenden Tieren. Die Behandlung mit Minocyclin war ohne erkennbaren Effekt auf die Differenzierung und die Aktivität der Osteoklasten. Es ergaben sich jedoch Hinweise, dass TNF-α einen hemmenden Einfluss auf die Osteoklastenaktivität im Knochentumormodell hat, da sowohl in den TNFR-KO-Tieren als auch unter Gabe von Etanercept eine Steigerung der Osteoklastenaktivität nachgewiesen werden konnte. Die Ergebnisse dieser Arbeit zeigen, dass TNF-α eine wichtige Rolle, sowohl in der Entstehung, als auch in der Aufrechterhaltung von tumorinduziertem Schmerz spielt. Hier liegt der Ansatzpunkt für weitere Studien mit dem Ziel, eine spezifische Pharmakotherapie zu entwickeln mit wirksamer TNF-α Blockade auch bei Patienten mit Tumorschmerzen. Nach den Erkenntnissen dieser Arbeit mit Etanercept sollte ein spezielles Augenmerk auf die ZNS-Gängigkeit dieser Substanzen gelegt werden und die Gefahr der Möglichkeit eines vermehrten Tumorwachstum bedacht werden. N2 - Bone-cancer-related pain is one of the most disabling factors in patients suffering from primary bone cancer or bone metastases. Recent studies point toward an important role of proinflammatory cytokines, example tumor necrosis factor-alpha (TNF), for tumor growth and bone-cancer-associated pain. Mechanisms by which TNF, through its receptor subtypes, TNF receptor 1 (TNFR1) and -2 (TNFR2), elicits altered sensation and pain behavior, are still incompletely understood. To look for a potential role of TNF in bone cancer pain, cancer-related pain was analyzed in fibrosarcoma-bearing C57Bl/6J wild type mice after systemic antagonism of TNF. To further clarify the role of TNF receptor (TNFR) in bone-cancer pain, naive and fibrosarcoma-bearing C57Bl/ 6J wild type and transgenic mice with a deficiency of TNFR1 (TNFR1ko), TNFR2 (TNFR2ko), and TNFR1+2 (TNFR1+2ko) were compared regarding cancer-related pain and hyperalgesia, tumor growth, osteoclast activation, and spinal astrogliosis. Systemic antagonism of TNF significantly alleviated tactile hypersensitivity and spontaneous bone-cancer-related pain behavior. Most interestingly, combined deletion of the TNFR1 and TNFR2, but not of either gene alone, almost completely inhibited the development of tactile hypersensitivity, whereas spontaneous pain behavior was transiently increased. Accordingly, spinal astrogliosis was markedly reduced, whereas tumor growth was significantly increased in TNFR1+2ko mice. In contrast, deletion of the TNFR1 or TNFR2 gene alone did not change tumor growth or spinal astrogliosis. Our findings suggest that the combined absence of TNFR1 and TNFR2 is necessary for the attenuation of cancer-related tactile hypersensitivity and concomitant spinal astrogliosis, whereas tumor growth seems to be inhibited by combined TNFR activation. These findings support the hypothesis of cytokine-dependent pain development in cancer pain. Differential targeting of TNFR activation could be an interesting strategy in bone-cancer-related pain conditions. KW - Neuralgie KW - Schmerz KW - Schmerzforschung KW - Tumor-Nekrose-Faktor KW - Tumor-Nekrose-Faktor -Inhibitor KW - Experimentaltumor KW - Knochentumor KW - pain KW - tumor KW - bone KW - neuropathy KW - tnf KW - glia KW - minocycline KW - etanercept Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-54439 ER - TY - JOUR A1 - Frerichs, K. A1 - Sirèn, Anna-Leena A1 - Feuerstein, G. A1 - Hallenbeck, JM T1 - The onset of postischemic hypoperfusion in rats is precipitous and may be controlled by local neurons N2 - Background and Purpose: Reperfusion following transient global cerebral ischemia is characterized by an initial hyperemic phase, which precedes hypo perfusion. The pathogenesis of these flow derangements remains obscure. Our study investigates the dynamics of postischemic cerebral blood flow changes, with particular attention to the role of local neurons. Metho(Js: We assessed local cortical blood flow continuously by laser Doppler flowmetry to permit observation of any rapid flow changes after forebrain ischemia induced by four-vessel occlusion for 20 minutes in rats. To investigate the role of local cortical neurons in the regulation of any blood flow fluctuations, five rats received intracortical microinjections of a neurotoxin (10 p,g ibotenic acid in 1 p,1; 1.5-mm-depth parietal cortex) 24 hours before ischemia to induce selective and localized neuronal depletion in an area corresponding to the sampie volume of the laser Doppler probe (1 mm3 ). Local cerebral blood flow was measured within the injection site and at an adjacent control site. Results: Ischemia was followed by marked hyperemia (235 ±23% of control, n =7), followed by secondary hypoperfusion (45±3% of control, n=7). The transition from hyperemia to hypoperfusioo occurred not gradually but precipitously (maximal slope of flow decay: 66±6%/min; n=7). In ibotenic acid-injected rats, hyperemia was preserved at the injection site, but the sudden decline of blood flow was abolished (maximal slope of flow decay: 5±3%/min compared with 53±8%/min at the control site; n=5, p3.2 mm distinguished between men with Fabry disease and controls (sensitivity: 87%, specificity: 86%, p<0.001), but not from stroke patients. Enlarged arterial diameters of the posterior circulation are present only in men with Fabry disease independent of disease severity. KW - Arterial Diameters KW - ischemic stroke KW - magnetic resonance imaging KW - stroke KW - cerebral arteries KW - renal system KW - central nervous system KW - blood flow KW - lesions Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-112614 ER - TY - JOUR A1 - Üçeyler, Nurcan A1 - Sommer, Claudia T1 - High-Dose Capsaicin for the Treatment of Neuropathic Pain: What We Know and What We Need to Know JF - Pain and Therapy N2 - Neuropathic pain is a frequent and disabling condition with diverse underlying etiologies and is often difficult to treat. Systemic drug treatment is often limited in efficacy. Furthermore, adverse effects may be a limiting factor when trying to reach the necessary dose. Analgesics that can be applied topically have the potential to largely overcome this problem. They may be of particular advantage in localized neuropathic pain syndromes such as postherpetic neuralgia or small fiber neuropathy. Capsaicin, the pungent component of chili peppers, is a natural ligand of the transient receptor potential vanilloid 1 channel and has long been used as topically applicable cream with concentrations of 0.025 to 0.075%. In 2009, a high-concentration transdermal capsaicin 8% patch (Qutenza ; Acorda Therapeutics, Inc., Ardsley, NY, USA; Astellas Pharma Europe Ltd., Chertsey, Surrey, UK) was introduced for the treatment of peripheral neuropathic pain syndromes other than of diabetic origin in adults. It has since been widely used in diverse neuropathic pain disorders. In this review article, we summarize current knowledge on Qutenza, its advantages and problems, and expose unmet needs. KW - transient receptor potential vanilloid 1 (TRPV1) KW - analgesia KW - capsaicin KW - neuropathic pain KW - qutenza Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-120669 SN - 2193-651X VL - 3 IS - 2 ER - TY - JOUR A1 - Niemann, Axel A1 - Huber, Nina A1 - Wagner, Konstanze M. A1 - Somandin, Christian A1 - Horn, Michael A1 - Lebrun-Julien, Frédéric A1 - Angst, Brigitte A1 - Pereira, Jorge A. A1 - Halfter, Hartmut A1 - Welzl, Hans A1 - Feltri, M. Laura A1 - Wrabetz, Lawrence A1 - Young, Peter A1 - Wessig, Carsten A1 - Toyka, Klaus V. A1 - Suter, Ueli T1 - The Gdap1 knockout mouse mechanistically links redox control to Charcot–Marie–Tooth disease JF - Brain N2 - The ganglioside-induced differentiation-associated protein 1 (GDAP1) is a mitochondrial fission factor and mutations in GDAP1 cause Charcot–Marie–Tooth disease. We found that Gdap1 knockout mice (\(Gdap1^{−/−}\)), mimicking genetic alterations of patients suffering from severe forms of Charcot–Marie–Tooth disease, develop an age-related, hypomyelinating peripheral neuropathy. Ablation of Gdap1 expression in Schwann cells recapitulates this phenotype. Additionally, intra-axonal mitochondria of peripheral neurons are larger in \(Gdap1^{−/−}\) mice and mitochondrial transport is impaired in cultured sensory neurons of \(Gdap1^{−/−}\) mice compared with controls. These changes in mitochondrial morphology and dynamics also influence mitochondrial biogenesis. We demonstrate that mitochondrial DNA biogenesis and content is increased in the peripheral nervous system but not in the central nervous system of \(Gdap1^{−/−}\) mice compared with control littermates. In search for a molecular mechanism we turned to the paralogue of GDAP1, GDAP1L1, which is mainly expressed in the unaffected central nervous system. GDAP1L1 responds to elevated levels of oxidized glutathione by translocating from the cytosol to mitochondria, where it inserts into the mitochondrial outer membrane. This translocation is necessary to substitute for loss of GDAP1 expression. Accordingly, more GDAP1L1 was associated with mitochondria in the spinal cord of aged \(Gdap1^{−/−}\) mice compared with controls. Our findings demonstrate that Charcot–Marie–Tooth disease caused by mutations in GDAP1 leads to mild, persistent oxidative stress in the peripheral nervous system, which can be compensated by GDAP1L1 in the unaffected central nervous system. We conclude that members of the GDAP1 family are responsive and protective against stress associated with increased levels of oxidized glutathione. KW - animal models KW - Charcot-Marie-Tooth disease KW - mitochondria KW - axonal transport KW - demyelinating disease Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-120731 VL - 137 IS - 3 ER - TY - THES A1 - Klein, Dennis T1 - The pathogenic role of endogenous antibodies in a mouse model for Charcot-Marie-Tooth 1B neuropathy T1 - Die pathogenetische Funktion von endogenen Antikörpern in einem Maus-Modell der Charcot-Marie-Tooth 1B Neuropathie N2 - Charcot-Marie-Tooth (CMT) type 1 neuropathies are a genetically heterogeneous group of non-treatable inherited disorders affecting the peripheral nervous system that lead to sensory and motor dysfunction. Secondary low grade inflammation, implicating the innate and adaptive immune system, could previously be identified as a substantial disease modifier in two mouse models for CMT1, CMT1B and 1X, respectively. However, the exact mechanism how the adaptive immune system contributes to disease pathogenesis is not completely understood. Based on observations that the accumulation of endogenous antibodies to myelin components is important for rapid myelin clearance after nerve injury during Wallerian degeneration, a possibly similar mechanism was considered for endogenous antibodies as disease amplifier in mice heterozygously deficient for P0 (P0het), mimicking some typical features of CMT1B. In this study an increased antibody deposition was detected in the affected peripheral nerves of P0het myelin mutant mice. By crossbreeding P0het mutants with mice specifically lacking B-lymphocytes, and therefore antibodies (JHD-/-), a decline of endoneurial macrophages together with a substantially ameliorated demyelination could be demonstrated in 6-month-old mutant mice. Moreover, reconstitution with murine IgGs reverted the neuropathic phenotype, substantiating that endogenous antibodies are potentially pathogenic at this early stage of disease. Unexpectedly, in 12-months-old P0het mutants, JHD deficiency resulted in disease aggravation accompanied by an increased inflammatory reaction and M2-polarized macrophage response. These observations suggest that in a mouse model for CMT1B, the lack of endogenous antibodies has a dichotomous effect: ameliorating early macrophage-mediated demyelination, as opposed to increasing inflammatory reactions leading to disease aggravation at older ages. N2 - Als Charcot-Marie-Tooth (CMT) Typ 1 Erkrankungen bezeichnet man eine genetisch heterogene Gruppe von nicht behandelbaren, erblichen Neuropathien, die das periphere Nervensystem betreffen und letztendlich zu starken motorischen und sensorischen Defiziten führen. Anhand verschiedener Studien konnte gezeigt werden, dass sekundäre Entzündungsreaktionen, insbesondere des angeborenen und adaptiven Immunsystems, eine entscheidende Rolle bei der Pathogenese von zwei verschiedenen CMT1-Mausmodellen (CMT1B und CMT1X) spielen. Jedoch ist der genaue Mechanismus, in dem das adaptive Immunsystem zur Pathogenese beiträgt, nicht komplett bekannt. In einer veröffentlichten Studie wurden gebundenen endogenen Antiköpern eine wichtige Rolle beim raschen Myelinabbau nach Nervläsion während der Waller´schen Degeneration zugeschrieben. In Mäusen, die heterozygot defizient für P0 (P0het) sind und einige typische Merkmale der CMT1B Neuropathie aufweisen, sollte ein möglicherweise ähnlicher Mechanismus von endogenen Antikörpern untersucht werden, der zur Verstärkung der Krankheitsentwicklung führt. In dieser Studie konnte eine vermehrte Antikörperbindung in den betroffenen peripheren Nerven von P0het Myelinmutanten beobachtet werden. Anhand von Verkreuzungs-Experimenten von P0het Mutanten mit Mäusen, die keine B-Lymphozyten besitzen und daher keine Antikörper bilden können (JHD-/-), konnte zudem in den untersuchten 6 Monate alten Doppelmutanten eine verringerte Anzahl endoneuraler Makrophagen und eine deutliche Verbesserung der Demyelinisierung aufgezeigt werden. Zusätzlich konnte anhand von Rekonstitutions-Experimenten mit mausspezifischen-IgGs der neuropathische Phänotyp in peripheren Nerven wiederhergestellt werden, was die mögliche pathogenetische Rolle endogener Antikörper im frühen Stadium der Erkrankung bekräftigt. Unerwarteterweise führte die JHD-Defizienz jedoch in 12 Monate alten P0het Mausmutanten eher zu einer Verschlechterung der Neuropathie, zusammen mit einer verstärkten Entzündungsreaktion und M2-polarisierten Makrophagen-Aktivierung. Diese Beobachtungen deuten darauf hin, dass das Fehlen von Antikörpern in einem etablierten Mausmodell für CMT1B unterschiedliche Folgen hat, da dies zu einer verringerten Makrophagen-vermittelten Demyelinisierung im frühen Erkrankungsverlauf führt, gleichzeitig aber im späteren Alter in einer verstärkten Entzündungsreaktion und einem vermehrten Nervschaden resultiert. KW - Charcot-Marie-Tooth KW - Demyelinisierung KW - Adaptives Immunsystem KW - Antikörper KW - Makrophagen KW - B-Lymphocyten KW - Fc-Rezeptor KW - Komplement KW - demyelination KW - antibodies KW - macrophages KW - adaptive immune system KW - B-lymphocytes KW - Fc-receptor KW - complement KW - Maus KW - Charcot-Marie-Syndrom KW - Immunsystem KW - Antikörper Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-121941 ER - TY - JOUR A1 - Albert-Weissenberger, Christiane A1 - Mencl, Stine A1 - Schuhmann, Michael K. A1 - Salur, Irmak A1 - Göb, Eva A1 - Langhauser, Friederike A1 - Hopp, Sarah A1 - Hennig, Nelli A1 - Meuth, Sven G. A1 - Nolte, Marc W. A1 - Sirén, Anna-Leena A1 - Kleinschnitz, Christoph T1 - C1-Inhibitor protects from focal brain trauma in a cortical cryolesion mice model by reducing thrombo-inflammation JF - Frontiers in Cellular Neuroscience N2 - Traumatic brain injury (TBI) induces a strong inflammatory response which includes blood-brain barrier damage, edema formation and infiltration of different immune cell subsets. More recently, microvascular thrombosis has been identified as another pathophysiological feature of TBI. The contact-kinin system represents an interface between inflammatory and thrombotic circuits and is activated in different neurological diseases. C1-Inhibitor counteracts activation of the contact-kinin system at multiple levels. We investigated the therapeutic potential of C1-Inhibitor in a model of TBI. Male and female C57BL/6 mice were subjected to cortical cryolesion and treated with C1-Inhibitor after 1 h. Lesion volumes were assessed between day 1 and day 5 and blood-brain barrier damage, thrombus formation as well as the local inflammatory response were determined post TBI. Treatment of male mice with 15.0 IU C1-Inhibitor, but not 7.5 IU, 1 h after cryolesion reduced lesion volumes by ~75% on day 1. This protective effect was preserved in female mice and at later stages of trauma. Mechanistically, C1-Inhibitor stabilized the blood-brain barrier and decreased the invasion of immune cells into the brain parenchyma. Moreover, C1-Inhibitor had strong antithrombotic effects. C1-Inhibitor represents a multifaceted anti-inflammatory and antithrombotic compound that prevents traumatic neurodegeneration in clinically meaningful settings. KW - thrombosis KW - traumatic brain injury KW - C1-inhibitor KW - blood-brain barrier KW - contact-kinin system KW - edema KW - inflammation Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-119263 SN - 1662-5102 VL - 8 ER - TY - JOUR A1 - Mencacci, Niccoló E. A1 - Isaias, Ioannis U. A1 - Reich, Martin M. A1 - Ganos, Christos A1 - Plagnol, Vincent A1 - Polke, James M. A1 - Bras, Jose A1 - Hersheson, Joshua A1 - Stamelou, Maria A1 - Pittman, Alan M. A1 - Noyce, Alastair J. A1 - Mok, Kin Y. A1 - Opladen, Thomas A1 - Kunstmann, Erdmute A1 - Hodecker, Sybille A1 - Münchau, Alexander A1 - Volkmann, Jens A1 - Samnick, Samuel A1 - Sidle, Katie A1 - Nanji, Tina A1 - Sweeney, Mary G. A1 - Houlden, Henry A1 - Batla, Amit A1 - Zecchinelli, Anna L. A1 - Pezzoli, Gianni A1 - Marotta, Giorgio A1 - Lees, Andrew A1 - Alegria, Paulo A1 - Krack, Paul A1 - Cormier-Dequaire, Florence A1 - Lesage, Suzanne A1 - Brice, Alexis A1 - Heutink, Peter A1 - Gasser, Thomas A1 - Lubbe, Steven J. A1 - Morris, Huw R. A1 - Taba, Pille A1 - Koks, Sulev A1 - Majounie, Elisa A1 - Gibbs, J. Raphael A1 - Singleton, Andrew A1 - Hardy, John A1 - Klebe, Stephan A1 - Bhatia, Kailash P. A1 - Wood, Nicholas W. T1 - Parkinson’s disease in GTP cyclohydrolase 1 mutation carriers JF - Brain N2 - GTP cyclohydrolase 1, encoded by the GCH1 gene, is an essential enzyme for dopamine production in nigrostriatal cells. Loss-of-function mutations in GCH1 result in severe reduction of dopamine synthesis in nigrostriatal cells and are the most common cause of DOPA-responsive dystonia, a rare disease that classically presents in childhood with generalized dystonia and a dramatic long-lasting response to levodopa. We describe clinical, genetic and nigrostriatal dopaminergic imaging ([(123)I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) tropane single photon computed tomography) findings of four unrelated pedigrees with DOPA-responsive dystonia in which pathogenic GCH1 variants were identified in family members with adult-onset parkinsonism. Dopamine transporter imaging was abnormal in all parkinsonian patients, indicating Parkinson's disease-like nigrostriatal dopaminergic denervation. We subsequently explored the possibility that pathogenic GCH1 variants could contribute to the risk of developing Parkinson's disease, even in the absence of a family history for DOPA-responsive dystonia. The frequency of GCH1 variants was evaluated in whole-exome sequencing data of 1318 cases with Parkinson's disease and 5935 control subjects. Combining cases and controls, we identified a total of 11 different heterozygous GCH1 variants, all at low frequency. This list includes four pathogenic variants previously associated with DOPA-responsive dystonia (Q110X, V204I, K224R and M230I) and seven of undetermined clinical relevance (Q110E, T112A, A120S, D134G, I154V, R198Q and G217V). The frequency of GCH1 variants was significantly higher (Fisher's exact test P-value 0.0001) in cases (10/1318 = 0.75%) than in controls (6/5935 = 0.1%; odds ratio 7.5; 95% confidence interval 2.4-25.3). Our results show that rare GCH1 variants are associated with an increased risk for Parkinson's disease. These findings expand the clinical and biological relevance of GTP cycloydrolase 1 deficiency, suggesting that it not only leads to biochemical striatal dopamine depletion and DOPA-responsive dystonia, but also predisposes to nigrostriatal cell loss. Further insight into GCH1-associated pathogenetic mechanisms will shed light on the role of dopamine metabolism in nigral degeneration and Parkinson's disease. KW - DOPA-responsive-dystonia KW - GCH1 KW - Parkinson's disease KW - dopamine KW - exome sequencing Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-121268 VL - 137 IS - 9 ER - TY - JOUR A1 - Hohnmann, Christopher A1 - Milles, Bianca A1 - Schinke, Michael A1 - Schroeter, Michael A1 - Ulzheimer, Jochen A1 - Kraft, Peter A1 - Kleinschnitz, Christoph A1 - Lehmann, Paul V. A1 - Kuerten, Stefanie T1 - Categorization of multiple sclerosis relapse subtypes by B cell profiling in the blood JF - Acta Neuropathologica Communications N2 - Introduction B cells are attracting increasing attention in the pathogenesis of multiple sclerosis (MS). B cell-targeted therapies with monoclonal antibodies or plasmapheresis have been shown to be successful in a subset of patients. Here, patients with either relapsing-remitting (n = 24) or secondary progressive (n = 6) MS presenting with an acute clinical relapse were screened for their B cell reactivity to brain antigens and were re-tested three to nine months later. Enzyme-linked immunospot technique (ELISPOT) was used to identify brain-reactive B cells in peripheral blood mononuclear cells (PBMC) directly ex vivo and after 96 h of polyclonal stimulation. Clinical severity of symptoms was determined using the Expanded Disability Status Scale (EDSS). Results Nine patients displayed B cells in the blood producing brain-specific antibodies directly ex vivo. Six patients were classified as B cell positive donors only after polyclonal B cell stimulation. In 15 patients a B cell response to brain antigens was absent. Based on the autoreactive B cell response we categorized MS relapses into three different patterns. Patients who displayed brain-reactive B cell responses both directly ex vivo and after polyclonal stimulation (pattern I) were significantly younger than patients in whom only memory B cell responses were detectable or entirely absent (patterns II and III; p = 0.003). In one patient a conversion to a positive B cell response as measured directly ex vivo and subsequently also after polyclonal stimulation was associated with the development of a clinical relapse. The evaluation of the predictive value of a brain antigen-specific B cell response showed that seven of eight patients (87.5%) with a pattern I response encountered a clinical relapse during the observation period of 10 months, compared to two of five patients (40%) with a pattern II and three of 14 patients (21.4%) with a pattern III response (p = 0.0005; hazard ratio 6.08 (95% confidence interval 1.87-19.77). Conclusions Our data indicate actively ongoing B cell-mediated immunity against brain antigens in a subset of MS patients that may be causative of clinical relapses and provide new diagnostic and therapeutic options for a subset of patients. KW - predictive value KW - MS KW - ELISPOT KW - B cells KW - relapse Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-126124 VL - 2 IS - 138 ER - TY - JOUR A1 - Doppler, Kathrin A1 - Appeltshauser, Luise A1 - Krämer, Heidrun H. A1 - King Man Ng, Judy A1 - Meinl, Edgar A1 - Villmann, Carmen A1 - Brophy, Peter A1 - Dib-Hajj, Sulayman D. A1 - Waxman, Stephen G. A1 - Weishaupt, Andreas A1 - Sommer, Claudia T1 - Contactin-1 and Neurofascin-155/-186 Are Not Targets of Auto-Antibodies in Multifocal Motor Neuropathy JF - PLoS One N2 - Multifocal motor neuropathy is an immune mediated disease presenting with multifocal muscle weakness and conduction block. IgM auto-antibodies against the ganglioside GM1 are detectable in about 50% of the patients. Auto-antibodies against the paranodal proteins contactin-1 and neurofascin-155 and the nodal protein neurofascin-186 have been detected in subgroups of patients with chronic inflammatory demyelinating polyneuropathy. Recently, auto-antibodies against neurofascin-186 and gliomedin were described in more than 60% of patients with multifocal motor neuropathy. In the current study, we aimed to validate this finding, using a combination of different assays for auto-antibody detection. In addition we intended to detect further auto-antibodies against paranodal proteins, specifically contactin-1 and neurofascin-155 in multifocal motor neuropathy patients’ sera. We analyzed sera of 33 patients with well-characterized multifocal motor neuropathy for IgM or IgG anti-contactin-1, anti-neurofascin-155 or -186 antibodies using enzyme-linked immunosorbent assay, binding assays with transfected human embryonic kidney 293 cells and murine teased fibers. We did not detect any IgM or IgG auto-antibodies against contactin-1, neurofascin-155 or -186 in any of our multifocal motor neuropathy patients. We conclude that auto-antibodies against contactin-1, neurofascin-155 and -186 do not play a relevant role in the pathogenesis in this cohort with multifocal motor neuropathy. KW - motor proteins KW - enzyme-linked immunoassays KW - binding analysis KW - neuropathy KW - nerve fibers KW - cell binding assay KW - antibodies KW - enzyme assays Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-126156 VL - 10 IS - 7 ER - TY - THES A1 - Ebert, Sönke T1 - Small- und Large-fiber-Beteiligung bei Morbus Parkinson T1 - Small- and large-fiber-neuropathy in Parkinson's disease N2 - Die hier vorliegende Forschungsarbeit überprüfte eine mögliche Beteiligung des peripheren Nervensystems bei M. Parkinson und den atypischen Parkinson-Syndromen. 31 Patienten mit einem idiopathischen Parkinson-Syndrom (IPD-Patienten) und neun Patienten mit einem atypischen Parkinson-Syndrom (APD-Patienten) sowie 35 altersentsprechende Kontrollprobanden wurden zwischen 2011 und 2012 für diese Studie rekrutiert. Neben der Eigenanamnese und der neurologischen Untersuchung erhielten die Patienten eine Suralisneurographie zur Überprüfung der large fibers und eine Quantitative sensorische Testung (QST) zur Detektion einer möglichen Small-fiber-Dysfunktion. Die Vitamin-Bestimmung diente der Untersuchung möglicher Zusammenhänge zwischen der Levodopa-Therapie, eventuell daraus resultierenden Vitamin-Mangelzuständen und einer reduzierten intraepidermalen Nervenfaser-Dichte (IENF-Dichte) beim M. Parkinson. Für die histologische Auswertung der IENF-Dichte und der dermalen, myelinisierten Nervenfaserbündel (PGP 9.5- / MBP- Doppelfärbung) sowie für die immunohistochemische Untersuchung der Nervenfasersubtypen (anti-alpha-CGRP- und anti-Substanz P-Antikörper) wurden bei jedem Probanden vier Hautbiopsien von den Extremitäten und dem Körperstamm entnommen. Sieben IPD-Patienten und ein Proband mit einem atypischen Parkinson-Syndrom wiesen ein vermindertes sensorisches Nervenaktionspotenzial (SNAP) in der Suralisneurographie auf. Dagegen war eine pathologisch reduzierte Nervenleitgeschwindigkeit nur bei einem IPD-Patienten nachweisbar. Auffällig war zudem eine negative Korrelation zwischen der Erkrankungsdauer und dem SNAP (Korrelationskoeffizient -0,367, p<0,03). In der Auswertung der Hautbiopsien konnte eine statistisch signifikante Reduktion der myelinisierten Bündel am Unterschenkel der IPD-Patienten festgestellt werden. Bei zehn von 30 IPD-Patienten, jedoch bei keinem der Probanden mit einem atypischen Parkinson-Syndrom, konnte eine verminderte IENF-Dichte nachgewiesen werden. In der statistischen Überprüfung wurde außerdem am Unterschenkel ein signifikanter Unterschied zwischen den IPD-Patienten und der Kontrollkohorte sowie eine negative Korrelation zwischen der Krankheitsdauer und der IENF-Dichte (Korrelationskoeffizient -0,320, p<0,05) festgestellt. Die QST konnte dagegen keinen statistisch signifikanten Unterschied zwischen den einzelnen Kohorten aufzeigen. Im Kontrast dazu fand sich eine längenunabhängige Reduktion der CGRP-positiven und der Substanz P-positiven IENF-Dichte bei den Patienten mit einem idiopathischen Parkinson-Syndrom. Bemerkenswert war zudem eine signifikante Verminderung der Substanz P-positiven intraepidermalen Nervenfasern am Oberschenkel und Rücken bei den APD-Patienten. Eine statistisch signifikante Abweichung der CGRP- und Substanz P-positiven Bündel konnte dagegen nicht festgestellt werden. In der laborchemischen Untersuchung war ein Zusammenhang zwischen den bestimmten Vitamin-Spiegeln und der kumulativen Levodopa-Dosis sowie zwischen den Vitaminen und der IENF-Dichte lediglich bei dem Vitamin B6 nachweisbar. Zusammengefasst erscheint eine Beteiligung des peripheren Nervensystems beim idiopathischen Parkinson als wahrscheinlich, wohingegen bei den atypischen Parkinson-Syndromen vor allem von einer zentralen Genese ausgegangen werden kann. Basierend auf den Ergebnissen der Suralisneurographie und der Bestimmung der myelinisierten Bündel erscheint eine krankheitsbedingte Large-fiber-Beeinträchtigung beim M.Parkinson möglich. Die nachgewiesene längenabhängige Small-fiber-Reduktion bei IPD-Patienten wird vermutlich durch eine axonale Transportstörung verursacht. Einen krankheitsbedingten Erklärungsansatz für die längenunabhängige Reduktion der CGRP-positiven und der Substanz P-positiven IENF-Dichte bei IPD-Patienten liefert der Nachweis von neurotoxischem α-Synuclein in den sensiblen Spinatganglien mit einem daraus resultierenden Untergang von sensorischen Nervenfasern. Aufgrund der geringen Anzahl an Parkinson-Patienten mit sensiblen Symptomen und dem fehlenden Nachweis eines statistisch signifikanten Unterschiedes in der QST liegt der Verdacht nahe, dass die ermittelte intraepidermale Nervenfaserreduktion der IPD-Patienten nicht stark genug ausgeprägt ist, um eine signifikante Abweichung der QST-Ergebnisse zu verursachen. Weiterhin konnte kein Zusammenhang zwischen der kumulativen Levodopa-Menge, den Vitaminen B12, Methylmalonsäure sowie Homocystein und dem Auftreten einer Nervenfaserverminderung nachgewiesen werden, was gegen eine iatrogene Beteiligung des peripheren Nervensystems als Nebenwirkung der Levodopa-Therapie spricht. Das idiopathische Parkinson-Syndrom geht mit einer Reduktion der kleinen Nervenfasern einher, welche vermutlich auf die Grunderkrankung selbst zurückzuführen ist. Die Untersuchung der Haut erscheint somit vielversprechend für die Erforschung der Pathogenese und für die Differentialdiagnostik des M. Parkinson. N2 - Small- and large-fiber-neuropathy in Parkinson's disease KW - Parkinson-Krankheit KW - Parkinson KW - Nervenfaser KW - Biopsie KW - Fluoreszenzmikroskopie KW - Hautbiopsie KW - Quantitative Sensorische Testung KW - Suralisneurographie KW - Neuropathie Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-124647 ER - TY - JOUR A1 - Langhauser, Friederike L. A1 - Heiler, Patrick M. A1 - Grudzenski, Saskia A1 - Lemke, Andreas A1 - Alonso, Angelika A1 - Schad, Lothar R. A1 - Hennerici, Michael G. A1 - Meairs, Stephen A1 - Fata, Marc T1 - Thromboembolic stroke in C57BL/6 mice monitored by 9.4 T MRI using a 1H cryo probe JF - Experimental and Translational Stroke Medicine N2 - Background A new thromboembolic animal model showed beneficial effects of t-PA with an infarct volume reduction of 36.8% in swiss mice. Because knock-out animal experiments for stroke frequently used C57BL76 mice we evaluated t-PA effects in this mouse strain and measured infarct volume and vascular recanalisation in-vivo by using high-field 9.4 T MRI and a 1H surface cryo coil. Methods Clot formation was triggered by microinjection of murine thrombin into the right middle cerebral artery (MCA). Animals (n = 28) were treated with 10 mg/kg, 5 mg/kg or no tissue plasminogen activator (t-PA) 40 min after MCA occlusion. For MR-imaging a Bruker 9.4 T animal system with a 1H surface cryo probe was used and a T2-weighted RARE sequence, a diffusion weighted multishot EPI sequence and a 3D flow-compensated gradient echo TOF angiography were performed. Results The infarct volume in animals treated with t-PA was significantly reduced (0.67 ± 1.38 mm3 for 10 mg/kg and 10.9 ± 8.79 mm3 for 5 mg/kg vs. 19.76 ± 2.72 mm3 ; p < 0.001) compared to untreated mice. An additional group was reperfused with t-PA inside the MRI. Already ten minutes after beginning of t-PA treatment, reperfusion flow was re-established in the right MCA. However, signal intensity was lower than in the contralateral MCA. This reduction in cerebral blood flow was attenuated during the first 60 minutes after reperfusion. 24 h after MCA occlusion and reperfusion, no difference in signal intensity of the contralateral and ipsilateral MCAs was observed. Conclusions We confirm a t-Pa effect using this stroke model in the C57BL76 mouse strain and demonstrate a chronological sequence MRI imaging after t-PA using a 1H surface cryo coil in a 9.4 T MRI. This setting will allow testing of new thrombolytic strategies for stroke treatment in-vivo in C57BL76 knock-out mice. KW - animal models KW - MRI KW - experimental KW - embolic stroke KW - T-PA Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-124218 VL - 4 IS - 18 ER - TY - JOUR A1 - Üçeyler, Nurcan A1 - Kewenig, Susanne A1 - Kittel-Schneider, Sarah A1 - Fallgatter, Andreas J. A1 - Sommer, Claudia T1 - Increased cortical activation upon painful stimulation in fibromyalgia syndrome JF - BMC Neurology N2 - Background Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread pain and associated symptoms. We investigated cerebral activation in FMS patients by functional near-infrared spectroscopy (fNIRS). Methods Two stimulation paradigms were applied: a) painful pressure stimulation at the dorsal forearm; b) verbal fluency test (VFT). We prospectively recruited 25 FMS patients, ten patients with unipolar major depression (MD) without pain, and 35 healthy controls. All patients underwent neurological examination and all subjects were investigated with questionnaires (pain, depression, FMS, empathy). Results FMS patients had lower pressure pain thresholds than patients with MD and controls (p < 0.001) and reported higher pain intensity (p < 0.001). Upon unilateral pressure pain stimulation fNIRS recordings revealed increased bilateral cortical activation in FMS patients compared to controls (p < 0.05). FMS patients also displayed a stronger contralateral activity over the dorsolateral prefrontal cortex in direct comparison to patients with MD (p < 0.05). While all three groups performed equally well in the VFT, a frontal deficit in cortical activation was only found in patients with depression (p < 0.05). Performance and cortical activation correlated negatively in FMS patients (p < 0.05) and positively in patients with MD (p < 0.05). Conclusion Our data give further evidence for altered central nervous processing in patients with FMS and the distinction between FMS and MD. KW - fibromyalgia syndrome KW - depression KW - cortical activation KW - pain KW - near-infrared spectroscopy Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125230 VL - 15 IS - 210 ER - TY - JOUR A1 - Horn, Michael A1 - Baumann, Reto A1 - Pereira, Jorge A. A1 - Sidiropoulos, Páris N. M. A1 - Somandin, Christian A1 - Welzl, Hans A1 - Stendel, Claudia A1 - Lühmann, Tessa A1 - Wessig, Carsten A1 - Toyka, Klaus V. A1 - Relvas, João B. A1 - Senderek, Jan A1 - Suter, Ueli T1 - Myelin is dependent on the Charcot–Marie–Tooth Type 4H disease culprit protein FRABIN/FGD4 in Schwann cells JF - Brain N2 - Studying the function and malfunction of genes and proteins associated with inherited forms of peripheral neuropathies has provided multiple clues to our understanding of myelinated nerves in health and disease. Here, we have generated a mouse model for the peripheral neuropathy Charcot–Marie–Tooth disease type 4H by constitutively disrupting the mouse orthologue of the suspected culprit gene FGD4 that encodes the small RhoGTPase Cdc42-guanine nucleotide exchange factor Frabin. Lack of Frabin/Fgd4 causes dysmyelination in mice in early peripheral nerve development, followed by profound myelin abnormalities and demyelination at later stages. At the age of 60 weeks, this was accompanied by electrophysiological deficits. By crossing mice carrying alleles of Frabin/Fgd4 flanked by loxP sequences with animals expressing Cre recombinase in a cell type-specific manner, we show that Schwann cell-autonomous Frabin/Fgd4 function is essential for proper myelination without detectable primary contributions from neurons. Deletion of Frabin/Fgd4 in Schwann cells of fully myelinated nerve fibres revealed that this protein is not only required for correct nerve development but also for accurate myelin maintenance. Moreover, we established that correct activation of Cdc42 is dependent on Frabin/Fgd4 function in healthy peripheral nerves. Genetic disruption of Cdc42 in Schwann cells of adult myelinated nerves resulted in myelin alterations similar to those observed in Frabin/Fgd4-deficient mice, indicating that Cdc42 and the Frabin/Fgd4–Cdc42 axis are critical for myelin homeostasis. In line with known regulatory roles of Cdc42, we found that Frabin/Fgd4 regulates Schwann cell endocytosis, a process that is increasingly recognized as a relevant mechanism in peripheral nerve pathophysiology. Taken together, our results indicate that regulation of Cdc42 by Frabin/Fgd4 in Schwann cells is critical for the structure and function of the peripheral nervous system. In particular, this regulatory link is continuously required in adult fully myelinated nerve fibres. Thus, mechanisms regulated by Frabin/Fgd4–Cdc42 are promising targets that can help to identify additional regulators of myelin development and homeostasis, which may crucially contribute also to malfunctions in different types of peripheral neuropathies. KW - Frabin/Fgd4 KW - myelination KW - hereditary motor and sensory neuropathy KW - Charcot–Marie–Tooth disease KW - Rho-GTPase Cdc42 Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125390 VL - 135 ER - TY - JOUR A1 - Walter, Maggie C. A1 - Reilich, Peter A1 - Thiele, Simone A1 - Schessl, Joachim A1 - Schreiber, Herbert A1 - Reiners, Karlheinz A1 - Kress, Wolfram A1 - Müller-Reible, Clemens A1 - Vorgerd, Matthias A1 - Urban, Peter A1 - Schrank, Bertold A1 - Deschauer, Marcus A1 - Schlotter-Weigel, Beate A1 - Kohnen, Ralf A1 - Lochmüller, Hans T1 - Treatment of dysferlinopathy with deflazacort: a double-blind, placebo-controlled clinical trial JF - Orphanet Journal of Rare Diseases N2 - Background: Dysferlinopathies are autosomal recessive disorders caused by mutations in the dysferlin (DYSF) gene encoding the dysferlin protein. DYSF mutations lead to a wide range of muscular phenotypes, with the most prominent being Miyoshi myopathy (MM) and limb girdle muscular dystrophy type 2B (LGMD2B). Methods: We assessed the one-year-natural course of dysferlinopathy, and the safety and efficacy of deflazacort treatment in a double-blind, placebo-controlled cross-over trial. After one year of natural course without intervention, 25 patients with genetically defined dysferlinopathy were randomized to receive deflazacort and placebo for six months each (1 mg/kg/day in month one, 1 mg/kg every 2nd day during months two to six) in one of two treatment sequences. Results: During one year of natural course, muscle strength declined about 2% as measured by CIDD (Clinical Investigation of Duchenne Dystrophy) score, and 76 Newton as measured by hand-held dynamometry. Deflazacort did not improve muscle strength. In contrast, there is a trend of worsening muscle strength under deflazacort treatment, which recovers after discontinuation of the study drug. During deflazacort treatment, patients showed a broad spectrum of steroid side effects. Conclusion: Deflazacort is not an effective therapy for dysferlinopathies, and off-label use is not warranted. This is an important finding, since steroid treatment should not be administered in patients with dysferlinopathy, who may be often misdiagnosed as polymyositis. KW - Deflazacort KW - muscle strength KW - gridle muscular-dystrophy KW - Duchenne dystrphy KW - Miyoshi myopathy KW - mutation KW - prednisone KW - gene KW - 2B KW - children KW - design KW - steroids KW - therapy KW - dysferlinopathy KW - Limb girdle muscular dystrophy (LGMD) Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125663 SN - 1750-1172 VL - 8 IS - 26 ER - TY - JOUR A1 - Karle, Kathrin N. A1 - Schüle, Rebecca A1 - Klebe, Stephan A1 - Otto, Susanne A1 - Frischholz, Christian A1 - Liepelt-Scarfone, Inga A1 - Schöls, Ludger T1 - Electrophysiological characterisation of motor and sensory tracts in patients with hereditary spastic paraplegia (HSP) JF - Orphanet Journal of Rare Diseases N2 - Background: Hereditary spastic paraplegias (HSPs) are characterised by lower limb spasticity due to degeneration of the corticospinal tract. We set out for an electrophysiological characterisation of motor and sensory tracts in patients with HSP. Methods: We clinically and electrophysiologically examined a cohort of 128 patients with genetically confirmed or clinically probable HSP. Motor evoked potentials (MEPs) to arms and legs, somato-sensory evoked potentials of median and tibial nerves, and nerve conduction studies of tibial, ulnar, sural, and radial nerves were assessed. Results: Whereas all patients showed clinical signs of spastic paraparesis, MEPs were normal in 27% of patients and revealed a broad spectrum with axonal or demyelinating features in the others. This heterogeneity can at least in part be explained by different underlying genotypes, hinting for distinct pathomechanisms in HSP subtypes. In the largest subgroup, SPG4, an axonal type of damage was evident. Comprehensive electrophysiological testing disclosed a more widespread affection of long fibre tracts involving peripheral nerves and the sensory system in 40%, respectively. Electrophysiological abnormalities correlated with the severity of clinical symptoms. Conclusions: Whereas HSP is primarily considered as an upper motoneuron disorder, our data suggest a more widespread affection of motor and sensory tracts in the central and peripheral nervous system as a common finding in HSP. The distribution patterns of electrophysiological abnormalities were associated with distinct HSP genotypes and could reflect different underlying pathomechanisms. Electrophysiological measures are independent of symptomatic treatment and may therefore serve as a reliable biomarker in upcoming HSP trials. KW - motor evoked potential (MEP) KW - amyotrophic-lateral-sclerosis KW - somatosensory-evoked-potentials KW - Silver-syndrome KW - gene mutations KW - SPG4 KW - mouse model KW - ALSIN gene KW - neuropathy KW - paraparesis KW - protein KW - electrophysiology KW - hereditary spastic paraplegia (HSP) Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-124763 SN - 1750-1172 VL - 8 IS - 158 ER - TY - JOUR A1 - Hansen, Niels A1 - Kahn, Ann-Kathrin A1 - Zeller, Daniel A1 - Katsarava, Zaza A1 - Sommer, Claudia A1 - Üçeyler, Nurcan T1 - Amplitudes of pain-related evoked potentials are useful to detect small fiber involvement in painful mixed fiber neuropathies in addition to quantitative sensory testing – an electrophysiological study JF - Frontiers in Neurology N2 - To investigate the usefulness of pain-related evoked potentials (PREP) elicited by electrical stimulation for the identification of small fiber involvement in patients with mixed fiber neuropathy (MFN). Eleven MFN patients with clinical signs of large fiber impairment and neuropathic pain and ten healthy controls underwent clinical and electrophysiological evaluation. Small fiber function, electrical conductivity and morphology were examined by quantitative sensory testing (QST), PREP, and skin punch biopsy. MFN was diagnosed following clinical and electrophysiological examination (chronic inflammatory demyelinating neuropathy: n = 6; vasculitic neuropathy: n = 3; chronic axonal ­neuropathy: n = 2). The majority of patients with MFN characterized their pain by descriptors that mainly represent C-fiber-mediated pain. In QST, patients displayed elevated cold, warm, mechanical, and vibration detection thresholds and cold pain thresholds indicative of MFN. PREP amplitudes in patients correlated with cold (p < 0.05) and warm detection thresholds (p < 0.05). Burning pain and the presence of par-/dysesthesias correlated negatively with PREP amplitudes (p < 0.05). PREP amplitudes correlating with cold and warm detection thresholds, burning pain, and par-/dysesthesias support employing PREP amplitudes as an additional tool in conjunction with QST for detecting small fiber impairment in patients with MFN. KW - burning pain KW - quantitative sensory testing KW - mixed fiber neuropathy KW - pain-related evoked potentials KW - Aδ- and C-fibers KW - neuropathic pain Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-124824 VL - 6 ER - TY - JOUR A1 - Westermaier, Thomas A1 - Koehler, Stefan A1 - Linsenmann, Thomas A1 - Kinderlen, Michael A1 - Pakos, Paul A1 - Ernestus, Ralf-Ingo T1 - Intraoperative Myelography in Cervical Multilevel Stenosis Using 3D Rotational Fluoroscopy: Assessment of Feasibility and Image Quality JF - Radiology Research and Practice N2 - Background. Intraoperative myelography has been reported for decompression control in multilevel lumbar disease. Cervical myelography is technically more challenging. Modern 3D fluoroscopy may provide a new opportunity supplying multiplanar images. This study was performed to determine the feasibility and image quality of intraoperative cervical myelography using a 3D fluoroscope. Methods. The series included 9 patients with multilevel cervical stenosis. After decompression, 10 mL of water-soluble contrast agent was administered via a lumbar drainage and the operating table was tilted. Thereafter, a 3D fluoroscopy scan (O-Arm) was performed and visually evaluated. Findings. The quality of multiplanar images was sufficient to supply information about the presence of residual stenosis. After instrumentation, metal artifacts lowered image quality. In 3 cases, decompression was continued because myelography depicted residual stenosis. In one case, anterior corpectomy was not completed because myelography showed sufficient decompression after 2-level discectomy. Interpretation. Intraoperative myelography using 3D rotational fluoroscopy is useful for the control of surgical decompression in multilevel spinal stenosis providing images comparable to postmyelographic CT. The long duration of contrast delivery into the cervical spine may be solved by preoperative contrast administration. The method is susceptible to metal artifacts and, therefore, should be applied before metal implants are placed. Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125779 VL - 2015 ER - TY - JOUR A1 - Klein, Dennis A1 - Groh, Janos A1 - Weishaupt, Andreas A1 - Martini, Rudolf T1 - Endogenous antibodies contribute to macrophage-mediated demyelination in a mouse model for CMT1B JF - Journal of Neuroinflammation N2 - Background We could previously identify components of both the innate and the adaptive immune system as disease modifiers in the pathogenesis of models for Charcot-Marie-Tooth (CMT) neuropathies type 1B and 1X. As part of the adaptive immune system, here we investigated the role of antibodies in a model for CMT1B. Methods Antibodies were localized and characterized in peripheral nerves of the CMT1B model by immunohistochemistry and Western blot analysis. Experimental ablation of antibodies was performed by cross breeding the CMT1B models with mutants deficient in B-lymphocytes (JHD−/− mutants). Ameliorated demyelination by antibody deficiency was reverted by intravenous injection of mouse IgG fractions. Histopathological analysis was performed by immunocytochemistry and light and quantitative electron microscopy. Results We demonstrate that in peripheral nerves of a mouse model for CMT1B, endogenous antibodies strongly decorate endoneurial tubes of peripheral nerves. These antibodies comprise IgG and IgM subtypes and are preferentially, but not exclusively, associated with nerve fiber aspects nearby the nodes of Ranvier. In the absence of antibodies, the early demyelinating phenotype is substantially ameliorated. Reverting the neuropathy by reconstitution with murine IgG fractions identified accumulating antibodies as potentially pathogenic at this early stage of disease. Conclusions Our study demonstrates that in a mouse model for CMT1B, endogenous antibodies contribute to early macrophage-mediated demyelination and disease progression. Thus, both the innate and adaptive immune system are mutually interconnected in a genetic model for demyelination. Since in Wallerian degeneration antibodies have also been shown to be involved in myelin phagocytosis, our study supports our view that inherited demyelination and Wallerian degeneration share common mechanisms, which are detrimental when activated under nonlesion conditions. KW - adaptive immune system KW - macrophages KW - antibodies KW - demyelination KW - Charcot-Marie-Tooth KW - B-lymphocytes KW - Fc-receptor KW - complement Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125036 VL - 12 IS - 49 ER - TY - JOUR A1 - Kleinschnitz, Christoph A1 - Linker, Ralf A. A1 - Magnus, Tim A1 - Korn, Thomas A1 - Meuth, Sven G. T1 - Report on the 6th scientific meeting of the “Verein zur Förderung des Wissenschaftlichen Nachwuchses in der Neurologie” (NEUROWIND e.V.) held in Motzen, Germany, Oct. 31th – Nov. 2nd, 2014 JF - Experimental & Translational Stroke Medicine N2 - From October 31th – November 2nd, 2014, the 6th NEUROWIND e.V. meeting was held in Motzen, Brandenburg, Germany. 70 doctoral students and postdocs from over 25 different groups working in German and Swiss university hospitals or research institutes attended the meeting to discuss their latest experiments and findings in the fields of neuroimmunology, neurodegeneration and neurovascular research. The meeting was regarded as a very well organized platform to support research of young investigators in Germany and all participants enjoyed the stimulating environment for lively in depth discussions. According to the major aim of NEUROWIND e.V. to support younger researchers in Germany the 4th NEUROWIND YOUNG SCIENTIST AWARD for experimental neurology was awarded to Michael Breckwoldt on his work in the group of Thomas Misgeld (Institute of Neuronal Cell Biology, Technische Universität München, Germany). The successful project was published in Nature Medicine entitled “Multiparametric optical analysis of mitochondrial redox signals during neuronal physiology and pathology in vivo”. This outstanding paper deals with a molecular imaging approach in living mice to optically analyze the role of mitochondrial redox signals in axons in health and disease. The award is endowed with 20.000 Euro sponsored by Merck Serono GmbH, Darmstadt, Germany (unrestricted educational grant). This year’s keynote lecture was given by Bernhard Hemmer, Head of the Department of Neurology at the Klinikum rechts der Isar, Technische Universität München. Dr. Hemmer highlighted the particular role of B cells and (auto)antibodies in multiple sclerosis (MS). As a new highlight Dr. Urbahns, head of global discovery technologies at Merck research laboratories, gave insights from research practice in the pharmaceutical industry and introduced a shift in the view on present-day drug discovery paradigms. Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125049 VL - 7 IS - 1 ER - TY - JOUR A1 - Albert-Weissenberger, Christiane A1 - Stetter, Christian A1 - Meuth, Sven G. A1 - Göbel, Kerstin A1 - Bader, Michael A1 - Sirén, Anna-Leena A1 - Kleinschnitz, Christoph T1 - Blocking of Bradykinin Receptor B1 Protects from Focal Closed Head Injury in Mice by Reducing Axonal Damage and Astroglia Activation JF - Journal of Cerebral Blood Flow and Metabolism N2 - The two bradykinin receptors B1R and B2R are central components of the kallikrein–kinin system with different expression kinetics and binding characteristics. Activation of these receptors by kinins triggers inflammatory responses in the target organ and in most situations enhances tissue damage. We could recently show that blocking of B1R, but not B2R, protects from cortical cryolesion by reducing inflammation and edema formation. In the present study, we investigated the role of B1R and B2R in a closed head model of focal traumatic brain injury (TBI; weight drop). Increased expression of B1R in the injured hemispheres of wild-type mice was restricted to the later stages after brain trauma, i.e. day 7 (P<0.05), whereas no significant induction could be observed for the B2R (P>0.05). Mice lacking the B1R, but not the B2R, showed less functional deficits on day 3 (P<0.001) and day 7 (P<0.001) compared with controls. Pharmacological blocking of B1R in wild-type mice had similar effects. Reduced axonal injury and astroglia activation could be identified as underlying mechanisms, while inhibition of B1R had only little influence on the local inflammatory response in this model. Inhibition of B1R may become a novel strategy to counteract trauma-induced neurodegeneration. KW - R-715 KW - kinin receptors KW - closed head injury KW - β-APP KW - astrocytes KW - TNF-α Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125903 VL - 32 IS - 9 ER - TY - JOUR A1 - Isaias, Ioannis Ugo A1 - Spiegel, Jörg A1 - Brumberg, Joachim A1 - Cosgrove, Kelly P. A1 - Marotta, Giorgio A1 - Oishi, Naoya A1 - Higuchi, Takahiro A1 - Küsters, Sebastian A1 - Schiller, Markus A1 - Dillmann, Ulrich A1 - van Dyck, Christopher H. A1 - Buck, Andreas A1 - Herrmann, Ken A1 - Schloegl, Susanne A1 - Volkmann, Jens A1 - Lassmann, Michael A1 - Fassbender, Klaus A1 - Lorenz, Reinhard A1 - Samnick, Samuel T1 - Nicotinic acetylcholine receptor density in cognitively intact subjects at an early stage of Parkinson's disease JF - Frontiers in Aging Neuroscience N2 - We investigated in vivo brain nicotinic acetylcholine receptor (nAChR) distribution in cognitively intact subjects with Parkinson's disease (PD) at an early stage of the disease. Fourteen patients and 13 healthy subjects were imaged with single photon emission computed tomography and the radiotracer 5-[(123)I]iodo-3-[2(S)-2-azetidinylmethoxy]pyridine ([(123)I]5IA). Patients were selected according to several criteria, including short duration of motor signs (<7 years) and normal scores at an extensive neuropsychological evaluation. In PD patients, nAChR density was significantly higher in the putamen, the insular cortex and the supplementary motor area and lower in the caudate nucleus, the orbitofrontal cortex, and the middle temporal gyrus. Disease duration positively correlated with nAChR density in the putamen ipsilateral (ρ = 0.56, p < 0.05) but not contralateral (ρ = 0.49, p = 0.07) to the clinically most affected hemibody. We observed, for the first time in vivo, higher nAChR density in brain regions of the motor and limbic basal ganglia circuits of subjects with PD. Our findings support the notion of an up-regulated cholinergic activity at the striatal and possibly cortical level in cognitively intact PD patients at an early stage of disease. KW - nicotinic receptors KW - Parkinson disease KW - 5IA-SPECT KW - dopamine acetylcholine KW - cognitive decline Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-119351 VL - 6 ER - TY - JOUR A1 - Albert-Weissenberger, Christiane A1 - Mencl, Stine A1 - Hopp, Sarah A1 - Kleinschnitz, Christoph A1 - Siren, Anna-Leena T1 - Role of the kallikrein-kinin system in traumatic brain injury JF - Frontiers in Cellular Neuroscience N2 - Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. Despite improvements in acute intensive care, there are currently no specific therapies to ameliorate the effects of TBI. Successful therapeutic strategies for TBI should target multiple pathophysiologic mechanisms that occur at different stages of brain injury. The kallikrein-kinin system is a promising therapeutic target for TBI as it mediates key pathologic events of traumatic brain damage, such as edema formation, inflammation, and thrombosis. Selective and specific kinin receptor antagonists and inhibitors of plasma kallikrein and coagulation factor XII have been developed, and have already shown therapeutic efficacy in animal models of stroke and TBI. However, conflicting preclinical evaluation, as well as limited and inconclusive data from clinical trials in TBI, suggests that caution should be taken before transferring observations made in animals to humans. This review summarizes current evidence on the pathologic significance of the kallikrein-kinin system during TBI in animal models and, where available, the experimental findings are compared with human data. KW - bradykinin KW - factor XII KW - kallikrein–kinin system KW - kinin receptor KW - traumatic brain injury Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-118226 SN - 1662-5102 VL - 8 ER - TY - JOUR A1 - Hohmann, Christopher A1 - Milles, Bianca A1 - Schinke, Michael A1 - Schroeter, Michael A1 - Ulzheimer, Jochen A1 - Kraft, Peter A1 - Kleinschnitz, Christoph A1 - Lehmann, Paul V. A1 - Kuerten, Stefanie T1 - Categorization of multiple sclerosis relapse subtypes by B cell profiling in the blood JF - Acta Neuropathologica Communications N2 - INTRODUCTION: B cells are attracting increasing attention in the pathogenesis of multiple sclerosis (MS). B cell-targeted therapies with monoclonal antibodies or plasmapheresis have been shown to be successful in a subset of patients. Here, patients with either relapsing-remitting (n = 24) or secondary progressive (n = 6) MS presenting with an acute clinical relapse were screened for their B cell reactivity to brain antigens and were re-tested three to nine months later. Enzyme-linked immunospot technique (ELISPOT) was used to identify brain-reactive B cells in peripheral blood mononuclear cells (PBMC) directly ex vivo and after 96 h of polyclonal stimulation. Clinical severity of symptoms was determined using the Expanded Disability Status Scale (EDSS). RESULTS: Nine patients displayed B cells in the blood producing brain-specific antibodies directly ex vivo. Six patients were classified as B cell positive donors only after polyclonal B cell stimulation. In 15 patients a B cell response to brain antigens was absent. Based on the autoreactive B cell response we categorized MS relapses into three different patterns. Patients who displayed brain-reactive B cell responses both directly ex vivo and after polyclonal stimulation (pattern I) were significantly younger than patients in whom only memory B cell responses were detectable or entirely absent (patterns II and III; p = 0.003). In one patient a conversion to a positive B cell response as measured directly ex vivo and subsequently also after polyclonal stimulation was associated with the development of a clinical relapse. The evaluation of the predictive value of a brain antigen-specific B cell response showed that seven of eight patients (87.5%) with a pattern I response encountered a clinical relapse during the observation period of 10 months, compared to two of five patients (40%) with a pattern II and three of 14 patients (21.4%) with a pattern III response (p = 0.0005; hazard ratio 6.08 (95% confidence interval 1.87-19.77). CONCLUSIONS: Our data indicate actively ongoing B cell-mediated immunity against brain antigens in a subset of MS patients that may be causative of clinical relapses and provide new diagnostic and therapeutic options for a subset of patients. KW - ELISPOT KW - MS KW - predictive value KW - relapse KW - B cells Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-120580 SN - 2051-5960 VL - 2 IS - 138 ER - TY - JOUR A1 - Isaias, Ioannis Ugo A1 - Dipaola, Mariangela A1 - Michi, Marlies A1 - Marzegan, Alberto A1 - Volkmann, Jens A1 - Rodocanachi Roidi, Mariana L. A1 - Frigo, Carlo Albino A1 - Cavallari, Paolo T1 - Gait Initiation in Children with Rett Syndrome JF - PLoS ONE N2 - Rett syndrome is an X-linked neurodevelopmental condition mainly characterized by loss of spoken language and a regression of purposeful hand use, with the development of distinctive hand stereotypies, and gait abnormalities. Gait initiation is the transition from quiet stance to steady-state condition of walking. The associated motor program seems to be centrally mediated and includes preparatory adjustments prior to any apparent voluntary movement of the lower limbs. Anticipatory postural adjustments contribute to postural stability and to create the propulsive forces necessary to reach steady-state gait at a predefined velocity and may be indicative of the effectiveness of the feedforward control of gait. In this study, we examined anticipatory postural adjustments associated with gait initiation in eleven girls with Rett syndrome and ten healthy subjects. Muscle activity (tibialis anterior and soleus muscles), ground reaction forces and body kinematic were recorded. Children with Rett syndrome showed a distinctive impairment in temporal organization of all phases of the anticipatory postural adjustments. The lack of appropriate temporal scaling resulted in a diminished impulse to move forward, documented by an impairment in several parameters describing the efficiency of gait start: length and velocity of the first step, magnitude and orientation of centre of pressure-centre of mass vector at the instant of (swing-)toe off. These findings were related to an abnormal muscular activation pattern mainly characterized by a disruption of the synergistic activity of antagonistic pairs of postural muscles. This study showed that girls with Rett syndrome lack accurate tuning of feedforward control of gait. KW - syndrome KW - ankles   KW - biological locomotion KW - kinematics KW - rett KW - soleus muscles KW - walking KW - velocity KW - children Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-119789 SN - 1932-6203 VL - 9 IS - 4 ER - TY - JOUR A1 - Kraft, Peter A1 - Drechsler, Christiane A1 - Gunreben, Ignaz A1 - Nieswandt, Bernhard A1 - Stoll, Guido A1 - Heuschmann, Peter Ulrich A1 - Kleinschnitz, Christoph T1 - Von Willebrand Factor Regulation in Patients with Acute and Chronic Cerebrovascular Disease: A Pilot, Case-Control Study JF - PLoS ONE N2 - Background and Purpose In animal models, von Willebrand factor (VWF) is involved in thrombus formation and propagation of ischemic stroke. However, the pathophysiological relevance of this molecule in humans, and its potential use as a biomarker for the risk and severity of ischemic stroke remains unclear. This study had two aims: to identify predictors of altered VWF levels and to examine whether VWF levels differ between acute cerebrovascular events and chronic cerebrovascular disease (CCD). Methods A case–control study was undertaken between 2010 and 2013 at our University clinic. In total, 116 patients with acute ischemic stroke (AIS) or transitory ischemic attack (TIA), 117 patients with CCD, and 104 healthy volunteers (HV) were included. Blood was taken at days 0, 1, and 3 in patients with AIS or TIA, and once in CCD patients and HV. VWF serum levels were measured and correlated with demographic and clinical parameters by multivariate linear regression and ANOVA. Results Patients with CCD (158±46%) had significantly higher VWF levels than HV (113±36%, P<0.001), but lower levels than AIS/TIA patients (200±95%, P<0.001). Age, sex, and stroke severity influenced VWF levels (P<0.05). Conclusions VWF levels differed across disease subtypes and patient characteristics. Our study confirms increased VWF levels as a risk factor for cerebrovascular disease and, moreover, suggests that it may represent a potential biomarker for stroke severity, warranting further investigation. KW - cerebrovascular diseases KW - sex addiction KW - biomarkers KW - ischemic stroke KW - blood KW - stroke KW - platelets KW - demography Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-119588 SN - 1932-6203 VL - 9 IS - 6 ER - TY - JOUR A1 - Wurmb, Thomas Erik A1 - Schlereth, Stefan A1 - Kredel, Markus A1 - Muellenbach, Ralf M. A1 - Wunder, Christian A1 - Brederlau, Jörg A1 - Roewer, Norbert A1 - Kenn, Werner A1 - Kunze, Ekkehard T1 - Routine Follow-Up Cranial Computed Tomography for Deeply Sedated, Intubated, and Ventilated Multiple Trauma Patients with Suspected Severe Head Injury JF - BioMed Research International N2 - Background. Missed or delayed detection of progressive neuronal damage after traumatic brain injury (TBI) may have negative impact on the outcome. We investigated whether routine follow-up CT is beneficial in sedated and mechanically ventilated trauma patients. Methods. The study design is a retrospective chart review. A routine follow-up cCT was performed 6 hours after the admission scan. We defined 2 groups of patients, group I: patients with equal or recurrent pathologies and group II: patients with new findings or progression of known pathologies. Results. A progression of intracranial injury was found in 63 patients (42%) and 18 patients (12%) had new findings in cCT 2 (group II). In group II a change in therapy was found in 44 out of 81 patients (54%). 55 patients with progression or new findings on the second cCT had no clinical signs of neurological deterioration. Of those 24 patients (44%) had therapeutic consequences due to the results of the follow-up cCT. Conclusion. We found new diagnosis or progression of intracranial pathology in 54% of the patients. In 54% of patients with new findings and progression of pathology, therapy was changed due to the results of follow-up cCT. In trauma patients who are sedated and ventilated for different reasons a routine follow-up CT is beneficial. KW - Computertomographie Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-120084 IS - 361949 ER - TY - THES A1 - Schwab, Nicholas T1 - The importance of CD8\(^+\) T cells and antigen-presenting cells in the immune reaction of primary inflammatory versus degenerative diseases T1 - Die Bedeutung CD8\(^+\) T-Zellen und Antigen-präsentierender Zellen in der Immunreaktion primär inflammatorischer gegenüber degenerativen Erkrankungen N2 - The bidirectional influence of parenchymal cells and cells of the immune system, especially of antigen-presenting and CD8\(^+\) T cells, in situations of putative auto- immune pathogenicity and degeneration was the main topic of this thesis. In the first part, the influence of human muscle cells on antigen-presenting cells was investigated. In inflammatory myopathies prominent infiltrates of immune cells containing T cells and antigen-presenting cells like macrophages and dendritic cells are present. The hypothesis was that human myoblasts have an inhibiting influence on these antigen-presenting cells under homeostatic conditions. A dysfunction or impairment under inflammatory circumstances might contribute to the development of myopathic conditions. The surface analysis of dendritic cells cocultured with myoblasts showed that immature dendritic cells could be driven into a reversible semi- mature state with significantly elevated levels of CD80. These dendritic cells were additionally characterized by their inhibiting function on T-cell proliferation. It was also shown that the lysates of healthy myoblasts could strongly enhance the phagocytic ability of macrophages, which could help with muscle regeneration and which might be disturbed in myositis patients. The second part of this thesis was about the clonal specificity of CD8\(^+\) T cells in a mouse model with genetically induced over-expression of PLP in oligodendrocytes. Here, we could show that the cytotoxic T lymphocytes, which had previously been shown to be pathogenic, were clonally expanded in the CNS of the transgenic mice. The amino acid sequences of the corresponding receptor chains were not identical, yet showed some similarities, which could mean that these clones recognize similar antigens (or epitopes of the same antigen). The knockout of PD-1 in this setting allowed for an analysis of the importance of tissue immune regulation. It became evident that the absence of PD-1 induced a larger number of clonal expansions in the CNS, hinting towards a reduced threshold for clonal disturbance and activation in these T cells. The expansions were, however, not pathogenic by themselves. Only in the presence of tissue damage and an antigenic stimulus (in our case the overexpression of PLP), the PD-1 limitation exacerbated the immune pathogenicity. Therefore, only in the presence of a “tissue damage signal”, the dyshomeostasis of T cells lacking PD-1 achieved high pathogenetic relevance. Finally, we investigated the pathogenetic role of CD8 T cells in Rasmussen encephalitis, a rare and chronic neurological disease mainly affecting children. The analysis of the T-cell receptor repertoire in Rasmussen encephalitis patients in the peripheral CD4\(^+\) and CD8\(^+\) T-cell compartments as well as the brain revealed the involvement of T cells in the pathogenicity of this disease. Many clonal expansions in the brain matched CD8\(^+\) T-cell expansions in the periphery on the sequence level. These putatively pathogenic clones could be visualized by immunohistochemistry in the brain and were found in close proximity to astrocytes and neurons. Additionally, the expanded clones could be found in the periphery of patients for at least one year. N2 - Der Einfluss von Parenchymzellen auf Immunzellen und umgekehrt, im Besonderen von Antigen-präsentierenden Zellen und CD8\(^+\) T-Zellen, im Zusammenhang von auto- immuner Pathogenese und Degeneration war das Hauptthema dieser Dissertation. Im ersten Teil wurde der Einfluss menschlicher Muskelzellen auf Antigen- präsentierende Zellen untersucht. In entzündlichen Myopathien kommt es zu massiven Infiltraten von Immunzellen, die T-Zellen und auch Antigen-präsentierende Zellen wie Makrophagen und dendritische Zellen enthalten. Die Hypothese war, dass menschliche Myoblasten einen hemmenden Einfluss auf die Antigen-präsentierenden Zellen unter homöostatischen Bedingungen haben. Eine Störung dieses Einflusses oder eine Beeinträchtigung unter entzündlichen Rahmenbedingungen könnte eventuell zur Entwicklung eines myopathischen Zustands beitragen. In der Oberflächenanalyse der dendritischen Zellen, die mit Myoblasten kultiviert wurden, zeigte sich, dass unreife dendritische Zellen in einen halb-reifen Zustand versetzt werden konnten, der sich beispielsweise durch stark erhöhte CD80 Expression kennzeichnet. Diese dendritischen Zellen wurden weiterhin charakterisiert über ihre hemmende Funktion auf die T-Zell Proliferation. Außerdem wurde gezeigt, dass Zelllysate gesunder Myoblasten die Phagozytoserate von Makrophagen enorm verstärken, was die Regeneration des Muskelgewebes erhöhen und möglicherweise in Myositispatienten gestört sein könnte. Im zweiten Teil der Dissertation ging es um die klonale Spezifität von CD8\(^+\) T-Zellen in einem Mausmodell mit genetisch induzierter Überexpression von PLP in Oligodendrozyten. Hier konnte gezeigt werden, dass die zytotoxischen T-Zellen, deren Pathogenität Gegenstand früherer Arbeiten war, im ZNS der transgenen Mäuse klonal expandiert waren. Die Aminosäuresequenzen der TCRβ Kette der expandierten Klone waren nicht identisch, zeigten jedoch einige Ähnlichkeiten, die darauf hinweisen könnten, dass diese Klone ähnliche Antigene (oder Epitope des gleichen Antigens) erkennen. Die genetisch induzierte Abwesenheit von PD-1 ermöglichte es, in diesem Zusammenhang den Einfluss von spezifischer Immunregulation im Gewebe zu untersuchen. Es zeigte sich, dass die Deletion von PD-1 eine erhöhte Anzahl von klonalen Expansionen im ZNS der Mäuse erzeugte, was auf eine herabgesetzte Schwelle für klonale Störungen und Aktivierung schließen lässt. Diese Expansionen 
 waren jedoch für sich genommen nicht pathogen. Nur in der Anwesenheit eines Gewebeschadens und eines zusätzlicher Antigenstimulus (in unserem Fall in Form der PLP Überexpression) konnte man die erhöhte Pathogenität durch die PD-1 Deletion erkennen. Deswegen erreichten die PD-1 deletierten T-Zellen nur in der Gegenwart eines „Gewebeschaden-Signals“ hohe pathogenetische Relevanz. Schließlich untersuchten wir die pathogenetische Rolle von CD8\(^+\) T-Zellen in der Rasmussen Enzephalitis, einer seltenen, chronischen Erkrankung des Gehirns, die hauptsächlich in Kindern vorkommt. Die Analyse des T-Zell-Rezeptor Repertoires in Rasmussen Enzephalitis Patienten in peripheren CD4\(^+\) und CD8\(^+\) T-Zell Populationen und im Gehirn zeigte die Beteiligung von T-Zellen in der Pathogenese dieser Krankheit auf. Viele klonale Expansionen waren zwischen Gehirn und der peripheren CD8\(^+\) Population bis hin zur Aminosäuresequenz identisch. Diese vermutlich pathogenen Klone konnten in Gehirnbiopsien von Rasmussenpatienten histochemisch nachgewiesen werden und wurden in enger Nachbarschaft zu Astrozyten und Neuronen gefunden. Zusätzlich konnten diese expandierten Kone in der Peripherie von Patienten für die beobachteten Zeiträume (mindestens ein Jahr) nachgewiesen werden. KW - T-Lymphozyt KW - Entzündung KW - Degeneration KW - Immunsystem KW - Rasmussen-Syndrom KW - T lymphocyte KW - inflammation KW - degeneration KW - immune system KW - rasmussen encephalitis Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-37330 ER - TY - THES A1 - Fischer, Cindy Erika Elisabeth T1 - Expression des fetalen Acetylcholinrezeptors im Muskel bei experimenteller Nervenläsion der Ratte und bei Neuropathien des Menschen N2 - No abstract available KW - Acetylcholinrezeptor KW - Nicotinischer Acetylcholinrezeptor KW - Denervierung KW - Nervenregeneration KW - Muskel KW - Muskelhypertonie KW - Motorische Endplatte KW - Alkoholische Polyneuropathie KW - Diabetische Polyneuropathie KW - Polyneuropathie KW - Atrophie KW - neurogen KW - fetal KW - SMA Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-36619 ER - TY - THES A1 - Hirschmann, Anna T1 - microRNA-Genexpressionsprofile in Blut-, Haut- und Nervenproben von Patienten mit Polyneuropathien T1 - microRNA gene expression profiles in blood, skin and nerve samples of patients with polyneuropathy N2 - Die Polyneuropathie (PNP) ist die häufigste Störung des peripheren Nervensystems bei Erwachsenen. Die Suche nach der Ursache bleibt in vielen Fällen erfolglos, ist aber unverzichtbar, da die Therapiewahl von der Ätiologie der Erkrankung abhängt. Geeignete Biomarker könnten die Differentialdiagnose unter Umständen erleichtern. microRNAs (miRNAs) sind in dieser Hinsicht vielversprechend, da in vielen Studien bei Nervende- und regenerationsprozessen sowie in neuropathischen Schmerzmodellen eine Dysregulation beschrieben wurde. In dieser Studie wurde die Expression zweier miRNAs, miR-103a und miR-let-7d, sowie eines Zielmoleküls der miR-103a, des Kalziumkanals Cav1,2, in einer großen Kohorte von PNP-Patienten unterschiedlicher Ätiologie in Blut, Haut- und Nervenbiopsien untersucht. Insgesamt wurden 116 Patienten und 22 Kontroll-probanden in die Studie eingeschlossen. Nach der Isolation von RNA aus weißen Blutzellen (WBC), Haut- und Nervenbiopsien folgte die Expressionsbestimmung mittels qRT-PCR. Während sich jeweils Unterschiede zwischen PNP-Patienten und Kontrollen und zwischen Patienten mit entzündlicher und solchen mit nicht-entzündlicher PNP zeigten, wurden keine Unterschiede in der Expression zwischen den ätiologischen Subgruppen oder zwischen Patienten mit schmerzhafter und schmerzloser PNP festgestellt. In den Nervenbiopsien der Patientenkohorte ergab sich eine inverse Korrelation der miR-103a und ihrem Zielgen Cacna1c, die darauf hinweisen könnte, dass Cacna1c von der miR-103a negativ reguliert wird. Da in unserer Patientenkohorte keine Unterschiede zwischen den PNP-Subgruppen auftraten, scheint der Einsatz der miR-103a und miR-let-7d als diagnostische Biomarker zur ätiologischen Einordnung einer PNP nicht gerechtfertigt. Dennoch deuten unsere Ergebnisse auf eine mögliche Rolle der untersuchten miRNAs bei Entstehung und Verlauf von PNP hin. Für ein tieferes pathophysiologisches Verständnis der miRNAs vor allem bei entzündlichen Neuropathien, könnte die Untersuchung von weiteren miRNAs und Zielgenen Aufschluss geben. N2 - Polyneuropathies (PNP) are the most frequent disorder of the peripheral nervous system in adults. Since the choice of therapy depends on it, the etiological diagnostic is essential but often remains without results so far. The differential diagnosis could be facilitated by a suitable biomarker. In this respect, microRNA (miRNA) are promising because their dysregulation has been described in processes of nerve degeneration and regeneration as well as in neuropathic pain models. This study investigated the expression of two miRNA, miR-103a and miR-let-7d, and the calcium channel Cav1.2, a target of miR-103a, in a large cohort of PNP patients with different etiology in blood, skin and nerve samples. Altogether, 116 patients and 22 controls have been included in the study. Expressional analysis via qRT-PCR succeeded the isolation of RNA out of white blood cells (WBC), skin and nerve biopsies. Differences have been found between PNP patients and controls and between patients with inflammatory and non-inflammatory PNP. No differences have been recorded between the etiological subgroups or between painful and painless PNP. miR-103a and its target Cacna1c correlated inversely in nerve which could be an indication for Cacna1c being negatively regulated by miR-103a. miR-103a and miR-let-7d do not seem to be appropriate diagnostic biomarkers for the etiological classification of PNP as there have not been found any differences between the PNP subgroups. Nevertheless, our results suggest that miRNA may play a part in the development and the progression of PNP. The investigation of further miRNA and targets could provide insight into a deeper pathophysiological understanding of miRNA, especially in inflammatory neuropathies. KW - miRNS KW - Polyneuropathie KW - Genexpression KW - microRNA KW - miRNA KW - PNP KW - Neuropathischer Schmerz KW - neuropathic pain KW - gene expression Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-217010 ER - TY - THES A1 - Pozzi, Nicoló Gabriele T1 - Parkinson’s disease revisited: multiple circuitopathies T1 - Neuinterpretation des Morbus Parkinson als multiple Netzwerkerkrankung N2 - Parkinson’s disease (PD) is among the most common neurodegenerative conditions, and it is characterized by the progressive loss of dopaminergic neurons and a great variability in clinical expression. Despite several effective medications, it still causes disability as all patients show treatment-resistant symptoms and complications. A possible reason for this therapeutic-burden and great clinical variability lies in a probable misconception about its pathophysiology, one that focuses on neurodegeneration, while largely neglecting its functional consequences and the related compensatory changes. In this thesis, I expand on the hypothesis that some PD symptoms have a dysfunctional origin and reflect derangements of neural network dynamics, the means by which brain coordination supports any motor behaviour. In particular, I have investigated resting tremor and freezing of gait, two common symptoms with an enigmatic mechanism and suboptimal management. In the case of tremor, I predicted a pathological change in response to dopamine loss, which included the activation of noradrenergic (NA) neurons of the locus coeruleus (LC) projecting to the cerebellum. This compensatory LC activation that supports dopaminergic neurons might indeed come at the expense of tremor development. To assess the role of LC-NA in tremor development, I recorded tremor occurrence in the reserpinized rat model of PD, one of very few showing tremor, after selective lesioning (with the neurotoxin DSP-4) of the LC-NA terminal axons. DSP-4 induced a severe reduction of LC-NA terminal axons in the cerebellar cortex and this was associated with a significant reduction in tremor development. Unlike its development, tremor frequency and the akinetic rigid signs did not differ between the groups, thus suggesting a dopaminergic dependency. These findings suggest that the LC-NA innervation of the cerebellum has a critical role for PD tremor, possibly by exerting a network effect, which gates the cerebello-thalamic-cortical circuit into pathological oscillations upon a dopaminergic loss in the basal ganglia. In contrast, for the study of freezing of gait, I worked with human PD subjects and deep brain stimulation, a therapeutic neuromodulation device that in some prototypes also allows the recording of neural activity in freely-moving subjects. Gait freezing is a disabling PD symptom that suddenly impairs effective stepping, thus causing falls and disability. Also in this study, I hypothesized that the underlying pathophysiology may be represented by dysfunctional neural network dynamics that abruptly impair locomotor control by affecting the communication in the supraspinal locomotor network. To test this hypothesis, I investigated the coupling between the cortex and the subthalamic nucleus, two main nodes of the supraspinal locomotor network, in freely-moving subjects PD patients and also performed molecular brain imaging of striatal dopamine receptor density and kinematic measurements. I found that in PD patients, walking is associated with cortical-subthalamic stable coupling in a low-frequency band (i.e. θ-α rhythms). In contrast, these structures decoupled when gait freezing occurred in the brain hemisphere with less dopaminergic innervation. These findings suggest that freezing of gait is a “circuitopathy”, with dysfunctional cortical-subcortical communication. Altogether the results of my experiments support the hypothesis that the pathophysiology of PD goes beyond neurodegenerative (loss-of-function) processes and that derangement of neural network dynamics coincides with some disabling PD symptoms, thus suggesting that PD can be interpreted as the combination of multiple circuitopathies. N2 - Die Parkinson-Krankheit ist eine neurodegenerative Erkrankung mit einem progressiven Verlust dopaminerger Neurone, die trotz wirksamer Medikamente zur Einschränkung in der Lebensqualität führen kann. Eine mögliche Ursache für diese unzureichende Behandlung der Symptome liegt in einem möglichen Missverständnis über die Pathophysiologie der Krankheit, die sich auf die Neurodegeneration konzentriert. Bei der Parkinson-Krankheit können jedoch funktionelle Veränderungen aufgrund der Neurodegeneration sowie die damit verbundenen kompensatorischen Modifikationen sehr wichtig sein. Der Fokus meiner Dissertation liegt in der Bearbeitung der Hypothese, dass einige Symptome der Parkinson-Krankheit einen dysfunktionellen Ursprung haben können. Insbesodere habe ich den Ruhetremor und das Freezing-Phänomen, das eine Blockade des Gehens bedeutet, untersucht, um zu erklären, ob ein Störung der neuronalen Netzwerkdynamik diese Symptome verursachen kann. In dieser Arbeit wurde zuerst die Entwicklung des Ruhetremors bei der Parkinson-Krankheit untersucht. Meine Hypothese war, dass eine Aktivierung von projizierenden noradrenergen Fasern des Locus-Coeruleus zum Cerebellum das Auftreten des Tremors verursachen kann, welches durch den Verlust dopaminerger Neurone verursacht wird. Da die Aktivität des Locus-Coeruleus bei Patienten mit Parkisnon-Krankheit nicht messbar ist, wurde dies in einem Parkinson-Rattenmodell untersucht. Die Ratten wurden etweder mit Reserpin oder mit Reserpine plus eine Neurotoxin gegen noradrenerger Neuronen (DSP-4) behandelt. Diese Behandlung mit DSP-4 führte zur Degeneration noradrenerger Terminalen im Locus-Coeruleus. Das Auftreten von Tremor zwischen die beiden Gruppen von Ratten war unterschiedlich. Insbesondere entwickelten DSP-4 behandelte Ratten einen niedrigen Ruhetremor. Dieses Ergebnis deutet darauf hin, dass die noradrenerge Innervation des Cerebellums vom Locus-Ceruleus für das Auftreten des Ruhetremors eine große Rolle spielt. In der Frequenz des Tremors sowie in den akinetischen Symptomen konnte kein Unterschied zwischen den Gruppen festgestellt werden. Das zeigt, dass diese akinetischen Symptome vom Dopaminverlust abhängig sind. Die Kombination von Tremor und akinetischen Symptomen kann aufgrund eines patologischen Netzwerkeffekts entstehen, welche vom Verlust dopaminerger Neurone in den Basalganglien im Zusammenspiel mit der kompensatorischen Aktivierung noradrenerger Neurone des Locus-Coeruleus verursacht werden kann. Des Weiteren wurde der Ursprung des Freezing-Phänomens bei Patienten, die an der Parkinson-Krankheit leiden und eine therapeutische Behandlung mittels Tiefer Hirnstimulation (THS) bekommen haben, untersucht. Insbesodere konnten mittels neuer THS-Prototypen Messungen neuronaler Aktivität von Bewegungen durchgeführt werden. In dieser Studie stellte ich die Hypothese auf, dass die Pathophysiologie des Freezings durch eine fehlerhafte neuronale Dynamik der Bewegungsnetzwerke erklärt werden kann. Um dies zu testen, wurde die Kommunikation zwischen den zwei Hauptknoten des Bewegungsnetzwerkes, dem Kortex und dem Nucleus Subthalamicus, bei THS behandelten Parkinson-Patienten während des Gehens und den Freezing-Episoden untersucht. Zudem wurde bei diesen Patienten eine molekulare Darstellung der dopaminergen Rezeptoren in den Basalganglien durchgeführt. Zusätzlich wurden kinematischen Messungen der Bewegungen vorgenommen, die eine präzise Beschreibung des Freezings ermöglichen. Es konnte gezeigt werden, dass bei Patienten mit der Parkinson-Krankheit ein Zusammenhang von stabiler Kommunikation zwischen dem Kortex und dem Nucleus Subthalamicus bei einer bestimten Frequenz (d.h. θ-α-Rhythmen) beim Gehen besteht. Beim Auftreten des Freezing-Phänomens konnte diese Kommunikation in der Gehirnhemisphäre mit weniger dopaminerger Innervation nicht mehr nachgewiesen werden. Diese Ergebnisse deuten darauf hin, dass das Freezing-Phänomen eine „Circuitopathie“ ist, in der eine fehlerhafte Kommunikation zwischen kortikalen und subkortikalen Arealen zur Bewegungsblockade führen kann. Insgesamt stützen die Ergebnisse meiner Experimente die Hypothese, dass die Pathophysiologie der Parkinson-Krankheit sowohl über neurodegenerative Prozesse (Zellverlust) als auch über Störungen der neuronalen Netzwerkdynamik (Funktionsverlust) hinausgeht. Das deutet darauf hin, dass die Parkison-Krankheit als „Circuitopathie“ interpretiert werden kann. KW - Parkinson-Krankheit KW - freezing of gait KW - resting tremor KW - circuitopathies Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-216715 ER - TY - THES A1 - Beaucamp, Marcel T1 - Prädiktion des Verschlusses großer intrakranieller Arterien anhand präklinischer Schlaganfallscores T1 - Prediction of large vessel oclusions by using preclinical stroke scores N2 - 2015 konnte in mehreren Studien ESCAPE, EXTENDED IA, MR CLEAN, REVASCAT, SWIFT-PRIME eine signifikante Überlegenheit der mechanischen Thrombektomie verglichen mit der alleinigen i. v. Lysetherapie mit rtPA bezogen auf Revaskularisierung bei Patienten mit einer LVO (large vessel occlusion) nachgewiesen werden. Diese neue Therapiemöglichkeit erforderte eine Aufteilung der Patienten die von einer Thrombektomie profitieren (LVO) und der Patienten, die keiner Thrombektomie zugeführt werden können (nLVO). Die zentrale Fragestellung der Studie ist: Kann ein symptomorientierter Schlaganfallscore die Wahrscheinlichkeit eines großen intrakraniellen Gefäßverschlusses mit hinreichender Präzision vorhersagen und kann auf Basis dieser Vorhersage ein Patient direkt in ein übergeordnetes Schlagfanfallzentrum gebracht werden, obwohl sich dadurch eine Bridging Lysetherapie verzögern würde? Um diesen Fragen auf den Grund zu gehen führten wir eine monozentrische Querschnittstudie durch, in deren Rahmen 215 Patienten rekrutiert wurden. Die Rekrutierung erfolgte mittels eines aus Subitems bereits etablierter Schlafanfallscores (FAST, CPSS, LAPSS, 3ISS, RACE), zusammengesetzten Fragebogens. Die ausgefüllten Fragebögen wurde in Excel digitalisiert und mittels SPSS, Signifikanz und Odds Ratio berechnet. Anschließend wurde aus den signifikanten Subitems mit der höchsten Odds Ratio ein neuer einfach anzuwendender Schlaganfallscore, bestehend aus den präklinisch erhobenen Daten gebildet (Würzburg Score of Large Vessel Occlusions, WOLVE- Score). Weiter wurden Signifikanz, Odds Ratio, Sensitivität und Spezifität des WOLVE-Score mit denen der oben genannten etablieren Scores verglichen. N2 - 2015 several publications ESCAPE, EXTENDED IA, MR CLEAN, REVASCAT, SWIFT-PRIME proofed a significant superiority of the mechanical thrombectomy in Patients suffering from a LVO (large vessel occlusion) concerning revascularization rates compared to i. v. thrombolysis with rtPA, alone. This newly discovered therapy required a new distribution of patients who could profit from a thrombectomy (LVO) and those who would not profit from a thrombectomy (nLVO). The key question is: Can a symptom related stroke score predict the probability of a large vessel occlusion with a sufficient precision and is it possible to admit a patient to a comprehensive stroke center based on this prediction, even though an early bridging thrombolysis is delayed. To answer this question we performed a cross-sectional study in which 215 patients were recruited by using a composite questionnaire consisting of subitems from established stroke scores (FAST, CPSS, LAPSS, 3ISS, RACE). The questionnaire was digitalized in Ecxel. Statistical calculations of the significancy and the odds ratio were conducted in SPSS. The significant subitems with the highest odds ratio were used to construct a new simple stroke score for LVO recognition in the field (Würzburg Score of Large Vessel Occlusions, WOLVE- Score). Eventually the significancy, odds ratio sensitivity and specificity of the WOLVE-Score were calculated and compared to the ones of the established scores. KW - Schlaganfall KW - Gefäßverschluss KW - Score KW - Thrombektomie KW - Revaskularisierung KW - Stroke KW - Score KW - LVO Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-215117 ER - TY - THES A1 - Frank, Franziska T1 - Veränderung der Ranvier’schen Schnürringarchitektur bei Patienten mit diabetischer Neuropathie T1 - Disruption of the nodal architecture in patients with diabetic neuropathy N2 - In der Krankheitsentstehung der diabetischen Neuropathie wird die paranodale Demyelinisierung als ein möglicher Pathomechanismus diskutiert, wobei Studien mit Gewebeproben von Patienten aufgrund der Invasivität limitiert sind. In der vorliegenden Studie wurden periphere Nervenfasern in Hautbiopsien von Patienten mit diabetischer Neuropathie und in Patienten mit Diabetes mellitus ohne Neuropathie untersucht. Ziel war es, nodale und paranodale Veränderungen, wie eine Dispersion der paranodalen Proteine Caspr und Neurofascin oder der nodalen Na-Kanäle, zu detektieren und die Proben auf verlängerte Ranvier`sche Schnürringe zu untersuchen. Es wurde die Hypothese überprüft, dass paranodale Demyelinisierungen bei Patienten mit diabetischer Neuropathie in Hautbiopsien, als minimal-invasive Methode, nachweisbar sind. Hautproben von Patienten mit Diabetes mellitus ohne Neuropathie sollten zudem in einem frühen Krankheitsstadium untersucht werden. Für die Untersuchung konnten 35 Patienten mit einer diabetischen Neuropathie, 17 Patienten mit Diabetes mellitus und 31 Kontrollen eingeschlossen werden. Immunfluoreszenzfärbungen mit Antikörpern gegen Caspr, Neurofascin und Natrium-Kanälen wurden zur Analyse der Ranvier`schen Schnürringarchitektur durchgeführt und ausgewertet. Eine erhöhte Anzahl an verlängerten Schnürringen, als Zeichen einer segmentalen Demyelinisierung, konnte in den Patienten mit diabetischer Neuropathie aber auch in Patienten mit Diabetes mellitus nachgewiesen werden. Weiterhin waren vermehrt Veränderungen der paranodalen Proteine, wie eine Dispersion von Caspr und Neurofascin in den Proben des Fingers der Patienten mit diabetischer Neuropathie sowie eine Dispersion von Neurofascin im Unterschenkel in beiden Patientengruppen nachweisbar. Interessanterweise waren einzelne Veränderungen auch in den gesunden Kontrollen auffindbar. Veränderungen der Schnürringarchitektur lassen sich mithilfe der Hautbiopsie nachweisen und quantifizieren. Nodale und paranodale Veränderungen weisen auf demyelinisierende Prozesse in Patienten mit diabetischer Neuropathie hin und finden sich auch bereits in einem frühen Krankheitsstadium. N2 - During the course of diabetic neuropathy, paranodal demyelination has been discussed as a possible mechanism, although studies with tissue samples from patients are limited due to its invasiveness. In the present study, peripheral nerve fibers were examined in skin biopsies from patients with diabetic neuropathy and in patients with diabetes mellitus without neuropathy. The aim was to detect nodal and paranodal changes, such as a dispersion of the paranodal proteins Caspr and Neurofascin or the nodal sodium channels, and to examine the samples for elongated nodes of Ranvier. The hypothesis was tested that paranodal demyelination in patients with diabetic neuropathy can be detected in skin biopsies as a minimally invasive method. Skin samples from patients with diabetes mellitus without neuropathy should also be examined at an early stage of the disease. 35 patients with diabetic neuropathy, 17 patients with diabetes mellitus and 31 controls could be included in the study. Immunofluorescence staining with antibodies against Caspr, Neurofascin and sodium channels were carried out and evaluated in order to analyze the architecture of nodes of Ranvier. An increased number of elongated nodes, as a sign of segmental demyelination, could be demonstrated in patients with diabetic neuropathy, but also in patients with diabetes mellitus. An increased number of changes in paranodal proteins, such as a dispersion of Caspr and Neurofascin in the samples of the finger of the patients with diabetic neuropathy and a dispersion of Neurofascin in the lower leg in both patient groups, were detectable. Interestingly, alterations of the nodal architecture could also be found in healthy controls. A disruption of the architecture of the node of Ranvier can be detected and quantified using skin biopsies. Nodal and paranodal alterations indicate demyelinating processes in patients with diabetic neuropathy and are also found at an early stage of the disease. KW - Ranvier-Schnürring KW - Diabetische Neuropathie KW - Diabetes mellitus KW - Hautbiopsie KW - skin biopsy KW - Caspr KW - Neurofascin KW - Caspr KW - Neurofascin KW - node of Ranvier KW - diabetic neuropathy Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219668 ER - TY - THES A1 - Kohl, Bianca Dorothea T1 - PMP22-overexpressing mice as a model for Charcot-Marie-Tooth 1A neuropathy implicate a role of immune-related cells T1 - PMP22-überexprimierende Mäuse als Modell einer Charcot-Marie-Tooth 1A Neuropatie. N2 - Charcot-Marie-Tooth disease (CMT) is a cohort of human hereditary disorders of the peripheral nervous system (PNS) which exhibit symptoms like sensory dysfunction, muscle weakness and gait disturbances. Different mutations are described as causation for this neuropathy, such as a duplication of chromosome 17 comprising the gene for the peripheral myelin protein-22 (PMP22). Based on different animal models former studies identified immune cells, i.e. macrophages and T-lymphocytes, as crucial mediators of pathology in these neuropathies. In this study, PMP22-overexpressing mice (PMP22tg, C61), serving as a model for a specific type of CMT – CMT1A – were crossbred with immune-deficient mutant mice to examine the impact of the immune system on nerve pathology. Crossbreeding of PMP22tg mice with recombination activating gene-1 (RAG-1) deficient mice, lacking mature T- and B-lymphocytes, caused no striking alterations of pathogenesis in peripheral nerves of mutant mice. In contrast, crossbreeding of PMP22tg myelin mutants with mice deficient in the chemokine monocyte chemoattractant protein-1 (MCP-1, CCL2) caused an amelioration of the demyelinating phenotype of peripheral nerves when MCP-1 was either reduced or completely absent. Furthermore, functional investigations, i.e. neurographic recordings and examinations of the grip strength of the extremities, revealed an amelioration in PMP22tg/MCP-1-/- mice in regard to a symptomatic improvement in the compound action muscle potential (CMAP) and stronger grip strength of the hindlimbs. Interestingly, peripheral nerves of PMP22tg mice showed an irregular distribution of potassium channels in presence of MCP-1, whereas the absence of MCP-1 in the myelin mutants rescued the ion channel distribution and resulted in a more wild type-like phenotype. Having shown the impact of MCP-1 as an important mediator of nerve pathology in PMP22/MCP-1 double mutants, the regulation of this chemokine became an important target for potential treatment strategies. We found that the signaling cascade MEK1/2/ERK1/2 was more strongly activated in peripheral nerves of PMP22tg mice compared to nerves of wild type mice. This activation corresponded to an increase in MCP-1 mRNA expression in peripheral nerves at the same age. Furthermore, a MEK1/2-inhibitor was used in vivo to confirm the regulation of MCP-1 by the MEK1/2/ERK1/2 pathway. After a treatment period of three weeks, a clear reduction of ERK1/2-phosphorylation as well as a reduction of MCP-1 mRNA expression was observed, accompanied by a decline in macrophage number in peripheral nerves of PMP22tg mice. These observations suggest that the expression of MCP-1 is crucial for the neuropathological progression in a mouse model for CMT1A. Therefore, this chemokine could provide a basis for a putative treatment strategy of inherited neuropathies. N2 - Die Charcot-Marie-Tooth Erkrankungen (CMT) sind eine Gruppe von humanen, erblichen Erkrankungen des peripheren Nervensystems (PNS), welche Symptome wie sensible Störungen, Muskelschwäche und Gangstörungen verursachen können. Verschiedene Mutationen, z.B. eine Duplikation des Chromosoms 17, welches das Gen für das periphere Myelinprotein-22 (PMP22) enthält, sind als Ursache für diese Neuropathie beschrieben. Anhand verschiedener Tiermodelle wurde in früheren Studien gezeigt, dass Immunzellen, insbesondere Makrophagen und T-Lymphozyten, maßgeblich an der Pathogenese dieser Neuropathien beteiligt sind. In der vorliegenden Studie wurden PMP22-überexprimierende Mäuse (PMP22tg, C61) als Modell einer spezifischen CMT-Form – CMT1A – mit immun-defizienten Mutanten verkreuzt, um die modulierende Rolle des Immunsystems innerhalb der Pathogenese peripherer Nerven untersuchen zu können. Die Verkreuzung von PMP22tg Mäusen mit „recombination activating gene-1“-defizienten Mutanten (RAG-1-/-), die keine reifen T- und B-Lymphozyten besitzen, resultierte in keiner deutlich veränderten Pathologie der peripheren Nerven. Im Gegensatz hierzu führte die Verkreuzung der Myelinmutanten mit Mäusen, defizient für das Chemokin „monocyte chemoattractant protein-1“ (MCP-1), zu einer Abschwächung des demyelinisierenden Phänotyps in peripheren Nerven, wenn MCP-1 reduziert war oder völlig fehlte. Funktionelle Analysen, wie elektrophysiologische Messungen und Untersuchungen der Kraft in den Extremitäten, zeigten zudem in PMP22tg/MCP-1-/- Mäusen eine symptomatische Verbesserung, was sich in einer höheren Amplitude (compound muscle action potential, CMAP) und einer erhöhten Kraft in den Hinterpfoten der Mäuse widerspiegelte. Interessanterweise zeigten periphere Nerven der PMP22tg Mäuse eine abnorme Verteilung von Kalium-Kanälen, wohingegen das Fehlen von MCP-1 in den Myelinmutanten zu einer Verteilung dieser Ionenkanäle führte, die ähnlich zu Wildtyp-Mäusen war. Da MCP-1 in den PMP22/MCP-1 Doppelmutanten einen deutlichen Einfluss auf die Pathogenese aufwies, wurde die Regulation dieses Chemokins im Hinblick auf mögliche Therapie-Ansätze untersucht. Diese Untersuchung zeigte, dass die MEK1/2/ERK1/2-Signalkaskade in peripheren Nerven von PMP22tg Mäusen stärker aktiviert wird als in Nerven von Wildtyp-Tieren. Die Aktivierung dieser Signalkaskade ging dabei mit einer erhöhten MCP-1 mRNA Expression in peripheren Nerven von Tieren des gleichen Alters einher. Ergänzend wurde ein MEK1/2-Inhibitor in vivo verwendet, um die Regulation von MCP-1 durch die MEK1/2/ERK1/2 Kaskade zu bestätigen. Nach einer Behandlungszeit von drei Wochen wurde eine deutliche Reduktion der ERK1/2-Phosphorylierung, sowie eine Reduktion der MCP-1 mRNA Expression und eine geringere Makrophagen-Anzahl in peripheren Nerven von PMP22tg Mäusen detektiert. Diese Untersuchungen zeigen, dass die Expression von MCP-1 entscheidend für den neuropathologischen Verlauf in einem Mausmodell für CMT1A ist. Somit bietet dieses Chemokin eine Basis für die Entwicklung neuer Behandlungsstrategien peripherer Neuropathien. KW - Myelin KW - Makrophage KW - Entmarkung KW - Schwann Zellen KW - PMP22 KW - MCP-1 KW - Immunzellen KW - Periphere Nerven KW - Schwann cells KW - PMP22 KW - MCP-1 KW - immune cells KW - peripheral nerves Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-43066 ER - TY - THES A1 - Raban, Rebecca Emmi Hildegard T1 - Sicherheit und Wirksamkeit von intrathekalem Triamcinolon bei Patienten mit chronisch-progredienter Multipler Sklerose : eine retrospektive Longitudinalstudie T1 - Safety and efficacy of intrathecal triamcinolone in chronic progressive multiple sclerosis - a retrospective longitudinal study N2 - Im Zeitraum von 2004 bis 2016 erhielten an der Neurologischen Universitätsklinik Würzburg Patienten mit einer chronisch progredienten Multiplen Sklerose insgesamt 595 Injektionen von intrathekalem Triamcinolonacetonid. Diese Arbeit befasst sich mit Sicherheit, Nebenwirkungen und Wirksamkeit der intrathekalen Therapieform. N2 - In the period from 2004 to 2016 patients with chronic progressive multiple sclerosis at the Neurological University Clinic Würzburg received a total of 595 injections of intrathecal triamcinolone acetonide. This work deals with safety, side effects and effectiveness of intrathecal therapy. KW - Intrathekale Applikation KW - Triamcinolon KW - Multiple Sklerose KW - intrathekal KW - intrathecal KW - Volon A KW - chronische Multiple Sklerose KW - triamcinolone acetonide KW - progressive multiple sclerosis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-220478 ER - TY - THES A1 - Küttner [geb. Weber], Sarah-Lucia T1 - Der Optikusnervenscheidendurchmesser als Instrument zur Prognoseeinschätzung bei Patienten mit hypoxischer Enzephalopathie nach erfolgreicher Reanimation T1 - Optic nerve sheath diameter for prognostication in resuscitated patients with hypoxic-ischemic encephalopathy N2 - Eine Prognoseeinschätzung bei Patienten mit hypoxischer Enzephalopathie (HIE) nach Reanimation wird frühestens 72 Stunden nach Reanimation empfohlen. Bis zu diesem Zeitpunkt besteht eine für Ärzte und Angehörige belastende prognostische Lücke. Und auch nach 72 Stunden bestehen nur ungenaue Angaben zum weiteren Vorgehen, sodass eine fundierte Prognoseeinschätzung aktuell eine deutliche Herausforderung im Alltag klinisch tätiger Ärzte darstellt. Der Nervus opticus ist als Bestandteil des zentralen Nervensystems mit dem Liquorsystem verbunden. Intrazerebrale Druckerhöhungen wirken sich daher unmittelbar auf die ihn ummantelnde Nervenscheide und deren Durchmesser aus, sodass sich die Bestimmung des Optikusnervenscheidendurchmessers (ONSD) mittels transorbitaler Sonographie in der Diagnostik unterschiedlicher intrakranieller Erkrankungen bereits bewährt hat. Das Krankheitsbild der HIE wurde als weiteres mögliches Einsatzgebiet des ONSD jedoch bisher nicht untersucht. 
Ziel dieser Dissertation war es daher, den ONSD grundsätzlich auf seine Verlässlichkeit als Prognoseparameter bei HIE nach Reanimation zu überprüfen. Besonderes Augenmerk lag hierbei auf der Ermöglichung einer frühzeitigen Prognoseeinschätzung innerhalb von 24 Stunden sowie auf der Definition eines prognostischen Cut-Off-Wertes als klare Entscheidungshilfe für weitere therapeutische Strategien. 24, 48 und 72 Stunden nach Reanimation werden signifikant unterschiedliche ONSD unter überlebenden und verstorbenen Patienten nachgewiesen. Letztere weisen dabei im Vergleich sowohl höhere als auch im zeitlichen Verlauf signifikant ansteigende ONSD-Werte auf. Als prognostischer Cut-Off-Wert konnte eine Grenze bei 5,75mm festgelegt werden. Zusammenfassend stellt die sonographische Bestimmung des ONSD eine sinnvolle Zusatzdiagnostik in der Prognoseeinschätzung bei Patienten mit HIE nach Reanimation dar. N2 - Prognostication of neurological outcome in resuscitated patients with hypoxic-ischemic encephalopathy (HIE) is recommended 72 hours after cardiac arrest. Until this time, there is a prognostic gap that is burdensome for physicians and relatives. And even after 72 hours, there is only imprecise information on the further course of action, so that a well-founded prognostication remains challenging in the everyday life of physicians. As a component of the central nervous system, the optic nerve is connected to the cerebrospinal fluid system. Increase in intracerebral pressure therefore directly affects the optic nerve sheath and its diameter, so that measurement of the optic nerve sheath diameter (ONSD) by means of transorbital sonography has already proven its worth in the diagnosis of various intracranial diseases. However, HIE has not yet been investigated as another possible field of application of ONSD. 
Therefore, the aim of this dissertation was to evaluate the reliability of ONSD as a prognostic parameter in HIE after resuscitation. Particular emphasis was placed on enabling early prognostication within 24 hours and on defining a prognostic cut-off-value as a clear decision aid for further therapeutic strategies. Significantly different ONSD are demonstrated among surviving and deceased patients 24, 48, and 72 hours after resuscitation. The latter show both higher ONSD values and significantly increasing ONSD values over time. A prognostic cut-off value of 5.75mm could be established. In conclusion, sonographic measurement of ONSD is a useful additional diagnostic tool for prognostication in patients with HIE after resuscitation. KW - Wiederbelebung KW - Prognostik KW - Ultraschalldiagnostik KW - Optikusnervenscheidendurchmesser KW - hypoxische Enzephalopathie KW - optic nerve sheath diameter KW - hypoxic-ischemic encephalopathy Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-237669 ER - TY - THES A1 - Auchter, Antonia T1 - Schlafassoziierte Veränderung der lokalen Feldpotential Aktivität im Nucleus subthalamicus bei Patienten mit Morbus Parkinson T1 - Sleep-associated changes in local field potential activity in the nucleus subthalamicus in patients with Parkinson's disease N2 - Die tiefe Hirnstimulation ist eine etablierte und hocheffiziente operative Behandlungsmethode für Patienten mit idiopathischem Parkinson- Syndrom (IPS). Als Zielgebiet dient in den meisten Fällen der Nucleus subthalamicus. Die Indikationen zur Implantation einer tiefen Hirnstimulation (THS) sind medikamentös nicht behandelbare motorische Fluktuationen und Dyskinesien oder ein medikamentös nicht kontrollierbarer Tremor. Bislang erfolgt eine kontinuierliche Stimulation. Little et al. konnten jedoch bereits in ihrer 2013 veröffentlichen Studie zeigen, dass eine adaptive Stimulation, gemessen am UPDRS, um 27 % effektiver war und entsprechend die Stimulationszeit um 56 % gesenkt werden konnte. Voraussetzung für die Anwendbarkeit einer adaptiven Stimulation im klinischen Alltag ist der Nachweis eines oder mehrerer Physiomarker, welche als Rückkopplungssignal für den Stimulationsbeginn dienen. Diese Marker müssen verlässlich mit dem Auftreten und der Ausprägung der Bewegungsstörungen korrelieren. Die Systeme müssen die Signale auslesen und entsprechend darauf reagieren können, damit ein sogenanntes Closed- loop- Verfahren entstehen kann. Bei diesen Markern handelt es sich um sogenannte lokale Feldpotenzialaktivitäten, das heißt niederfrequente Potentialänderungen von Zellen in subkortikalen Arealen des Gehirns, welche über Elektroden der THS abgeleitet werden können. Der Stimulator Activa PC+S (Medtronic) ermöglicht es erstmalig Aufzeichnungen von LFP- Daten, außerhalb eines experimentellen Laboraufbaus, mittels dauerhaft implantiertem Gerät vorzunehmen und damit auch Langzeitanalysen durchzuführen. Erkenntnisse vergangener Studien ergaben, dass die synchronisierte, pathologisch gesteigerte oszillatorische Aktivität im Beta-Frequenzband (13- 35 Hz) eine bedeutende Rolle im Bezug auf die Pathophysiologie des IPS spielt und als krankheitsspezifische Aktivität gilt. Es konnte bereits belegt werden, dass die Verbesserung der motorischen Symptome (Bradykinese und Rigor) mit dem Ausmaß der Suppression der Betaband- Aktivität korreliert. Die Betabandaktivität als lokale Feldpotentialaktivität kann als Physiomarker einer adaptiven Stimulation dienen. Unser Hauptaugenmerk galt daher der Analyse der Betabandaktivität oder anderer Frequenzbereiche während des Schlafes um hier die THS bedarfsgerecht einzusetzen. Hierfür wurden nächtliche subkortikale LFP- Aufzeichnungen parallel zur Schlaf- Polysomnographie durchgeführt. Zudem erfolgte in der vorliegenden Arbeit sowohl in unserem Vorversuch als auch in unserem Hauptversuch die Anwendung des UPDRS Teil III zur Erfassung der motorischen Symptome, sowie die Durchführung von Fragebögen zur Erfassung der nicht- motorischen Symptome, insbesondere des Schlafes vor und nach Implantation der tiefen Hirnstimulation. Wir konnten belegen, dass es nach Implantation der THS zu einer Erhöhung der Schlafeffizienz und zu einer Erhöhung des Anteils der Schlafstadien II und III und damit einhergehend zu einer Steigerung der Schlafqualität kommt. Übereinstimmend mit anderen Studien konnten wir zeigen, dass sich die Motorik unter Stimulation deutlich verbessert. Im Vorversuch reduzierte sich der mittlere präoperative MDS- UPDRS III im MedsOFF verglichen mit dem mittleren postoperativ MDS- UPDRS III im MedsOFF/StimON um 37 %. In der PC+S- Studie imponierte eine Reduktion um 67%. Zudem zeigte sich eine Reduktion der nicht- motorischen Symptome durch die THS, insbesondere in der Kategorie Schlaf. Die Ergebnisse der vorliegenden Arbeit ergaben außerdem, dass die Betabandaktivität im Schlafstadium II und vor allem im Schlafstadium III am geringsten ist. Im Schlafstadium I und REM ist die Betabandaktivität höher als im Schlafstadium II und III. Hierbei war entscheidend, dass die Patienten eine klar abgrenzbare Betabandaktivität im Wachstadium aufwiesen und die Elektrodenkontakte im dorsolateralen Kerngebiet des STN lokalisiert waren. Gegenläufig dazu verhält sich die Deltaaktivität. Sie ist im Schlafstadium II und besonders im Stadium III am höchsten. Stadium I ist mit durchschnittlich um 7,3 % niedriger als im Wachstadium. Am geringsten ist sie jedoch im REM-Schlafstadium. Indem wir mit der Betabandaktivität und Deltaaktivität in den einzelnen Schlafstadien einen stabilen und reproduzierbaren Physiomarker finden konnten, sind wir unserem Ziel der adaptiven THS ein Stück näher gekommen. N2 - Deep brain stimulation is an established and highly efficient surgical treatment modality for patients with idiopathic Parkinson's syndrome (IPS). The target area in most cases is the subthalamic nucleus. The indications for implantation of deep brain stimulation (THS) are motor fluctuations and dyskinesias that cannot be treated with medication or tremor that cannot be controlled with medication. To date, continuous stimulation has been used. However, Little et al. were already able to show in their study published in 2013 that adaptive stimulation was 27% more effective, as measured by UPDRS, and that the stimulation time could be reduced by 56% accordingly. A prerequisite for the applicability of adaptive stimulation in clinical practice is the detection of one or more physiomarkers that serve as feedback signals for the onset of stimulation. These markers must correlate reliably with the occurrence and severity of movement disorders. The systems must be able to read out the signals and react to them accordingly, so that a so-called closed-loop procedure can be created. These markers are so-called local field potential activities, i.e. low-frequency potential changes of cells in subcortical areas of the brain, which can be derived via electrodes of the THS. The Activa PC+S stimulator (Medtronic) makes it possible for the first time to record LFP data outside of an experimental laboratory setup using a permanently implanted device and thus also to perform long-term analyses. Findings of past studies revealed that synchronized, pathologically enhanced oscillatory activity in the beta frequency band (13- 35 Hz) plays a significant role in relation to the pathophysiology of IPS and is considered disease-specific activity. It has already been demonstrated that the improvement of motor symptoms (bradykinesia and rigor) correlates with the extent of suppression of beta-band activity. Beta-band activity as local field potential activity may serve as a physiomarker of adaptive stimulation. Therefore, our main focus was on the analysis of beta-band activity or other frequency ranges during sleep in order to apply THS as needed. For this purpose, nocturnal subcortical LFP recordings were performed in parallel to sleep polysomnography. In addition, the UPDRS Part III was used to record motor symptoms in our preliminary trial as well as in our main trial, and questionnaires were administered to record nonmotor symptoms, especially sleep before and after implantation of deep brain stimulation. We were able to prove that after implantation of THS there is an increase in sleep efficiency and an increase in the proportion of sleep stages II and III and thus an associated increase in sleep quality. Consistent with other studies, we demonstrated that motor function improves significantly under stimulation. In the preliminary trial, the mean preoperative MDS- UPDRS III in MedsOFF was reduced by 37% compared with the mean postoperative MDS- UPDRS III in MedsOFF/StimON. In the PC+S- study, a reduction of 67% was impressive. In addition, THS showed a reduction in non-motor symptoms, especially in the sleep category. The results of the present work also revealed that beta-band activity is lowest in sleep stage II and especially in sleep stage III. In sleep stage I and REM, beta-band activity is higher than in sleep stage II and III. Here, it was crucial that the patients showed a clearly delineable beta-band activity in the waking stage and that the electrode contacts were localized in the dorsolateral nucleus area of the STN. Opposite to this is the delta activity. It is highest in sleep stage II and especially in stage III. Stage I is lower than in the waking stage, with an average of 7.3%. However, it is lowest in the REM sleep stage. By finding a stable and reproducible physiomarker with beta band activity and delta activity in the individual sleep stages, we have come a step closer to our goal of adaptive THS. KW - Parkinson KW - Lokale Feldpotentialaktivität KW - Nucleus subthalamicus Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-237822 ER - TY - THES A1 - Köberle, Philipp T1 - High-resolution ultrasound for the identification of pathological patterns in patients with polyneuropathies and amyotrophic lateral sclerosis T1 - Hochauflösender Ultraschall zur Identifizierung von pathologischen Mustern bei Patienten mit Polyneuropathien und amyotropher Lateralsklerose N2 - Neuropathies are a group of potentially treatable diseases with an often disabling and restricting course. Amyotrophic lateral sclerosis (ALS) is a lethal disease without causal treatment possibilities. The objective of this study was to examine the diagnostic utility of HRUS for the differentiation of subtypes of axonal and demyelinating neuropathies and to investigate its utility for the sonological differentiation of ALS. The hypothetical statement that neuropathy causes enlargement of peripheral nerves compared to healthy controls proved to be right, but the adjunctive assumption that ALS does not cause enlargement of peripheral nerves proved to be wrong – in patients with ALS slight enlargement of peripheral nerves was visible as well. The statement that nerve enlargement can be detected by measurement of the cross-sectional area (CSA) and the longitudinal diameter (LD) with comparable results proved to be right, but the enlargement was slightly less present by measurement of the LD. The statement that axonal and demyelinating neuropathies show distinct patterns of nerve enlargement must be answered differentiated: The comparison between axonal and demyelinating neuropathies showed a stronger nerve enlargement in patients with demyelinating neuropathies than in patients with axonal neuropathies at proximal nerve segments of upper extremities. In the comparison of diagnose-defined subgroups of inflammatory demyelinating neuropathies a respective specific pattern of nerve enlargement was visible. However, remarkable in this context was the strong nerve enlargement found in patients with NSVN, which is classified as an axonal neuropathy. Stratification for specific findings in nerve biopsy did not lead to constructive differences in comparison between the different groups. To sum up, HRUS showed to provide a useful contribution in the diagnostic process of neuropathies and ALS but needs to be integrated in a multimodal diagnostic approach. N2 - Neuropathien stellen eine Gruppe potenziell behandelbarer Erkrankungen mit häufig behinderndem und einschränkendem Verlauf dar. Die amyotrophe Lateralsklerose (ALS) ist eine tödliche Erkrankung ohne Möglichkeiten der kausalen Behandlung. Das Ziel dieser Studie war es, den diagnostischen Nutzen von hochauflösendem Ultraschall für die Differenzierung von Subtypen axonaler und demyelinisierender Neuropathien, sowie der amyotrophen Lateralsklerose zu untersuchen. Die hypothetische Aussage, dass durch Neuropathien eine Vergrößerung von peripheren Nerven im Vergleich zu gesunden Kontrollen nachgewiesen werden kann, erwies sich als richtig. Entgegen der hiermit verknüpften Aussage, dass es bei amyotropher Lateralsklerose zu keiner Größenzunahme peripherer Nerven kommt, konnte bei diesen Patienten ebenfalls eine leichte Kaliberzunahme der Nerven nachgewiesen werden. Die Aussage, dass eine Nervenvergrößerung durch die Messung von Querschnittsfläche und longitudinalem Durchmesser mit vergleichbaren Ergebnissen erfolgen kann, erwies sich als richtig, jedoch zeigte sich die Nervenvergrößerung bei der Messung des longitudinalen Durchmessers etwas geringer ausgeprägt. Die Aussage, dass axonale und demyelinisierende Neuropathien unterschiedliche Muster der Nervenvergrößerung aufweisen, muss differenziert beantwortet werden: Der Vergleich axonalen und demyelinisierenden Neuropathien zeigte bei Patienten mit demyelinisierenden Neuropathien, insbesondere an proximalen Nervensegmenten der oberen Extremitäten, eine stärkere Nervenvergrößerung als bei Patienten mit axonalen Neuropathien. Im Vergleich diagnose-definierter Subgruppen demyelinisierender Neuropathien zeigte sich ein jeweils spezifisches Verteilungsmuster der Nervenvergrößerung. In diesem Zusammenhang bemerkenswert war jedoch die starke Nervenvergrößerung bei Patienten mit nicht-systemischer vaskulitischer Polyneuropahie, welche als axonale Neuropathie klassifiziert wird. Die Stratifikation nach spezifischen Befunden in der Nervenbiopsie führte nicht zu konstruktiven Unterschieden im Vergleich der Untergruppen. Zusammenfassend zeigte sich, dass der hochauflösende Nervenultraschall einen nützlichen Beitrag im diagnostischen Prozess von Neuropathien und ALS leisten kann, jedoch in eine multimodale diagnostische Herangehensweise integriert werden muss. KW - Polyneuropathie KW - Ultraschall KW - HRUS KW - polyneuropathy KW - ALS KW - pattern KW - biopsy KW - Nervenultraschall KW - Muster KW - Nervenbiopsie KW - Polyneuropathie KW - amyotrophe Lateralsklerose Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-245800 ER - TY - THES A1 - Christ, Nicolas T1 - Die Auswirkung zerebraler Mikroblutungen auf die kognitive Leistungsfähigkeit nach ischämischem Schlaganfall T1 - The impact of cerebral microbleeds on the Cognition after ischemic stroke N2 - In der vorliegenden Studie wurde untersucht, ob zerebrale Mikroblutungen (CMB) bereits im frühen Verlauf nach ischämischem Schlaganfall (IS) oder Transitorisch-Ischämischer Attacke (TIA) mit kognitivem Abbau assoziiert sind und ob spezifische kognitive Domänen besonders betroffen sind. Der Vergleich zweier Probandengruppen mit IS/TIA und CMB bzw. IS/TIA ohne CMB hinsichtlich ihrer Ergebnisse in der neuropsychologischen Testbatterie CERAD ergab, dass CMB bereits sechs Monate nach dem zerebrovaskulären Ereignis mit einem kognitiven Abbau assoziiert sind. Multilokuläre CMB zeigen eine stärkere Auswirkung auf die Kognition als solche CMB, die in einer einzigen Hirnregion gefunden wurden. Zudem wurde eine signifikante Korrelation zwischen dem Grad der kognitiven Einschränkung und der Anzahl der CMB errechnet. Die separate Betrachtung derjenigen Testungen, welche das episodische Gedächtnis erfassen, zeigte eine Beeinträchtigung der Testpersonen beim Wiedererkennen von zuvor gelernten Wörtern. Bei der Untersuchung des semantischen Gedächtnisses der ProbandInnen fiel eine signifikant eingeschränkte phonematische Wortflüssigkeit auf, die semantische Flüssigkeit und das Benennen jedoch waren weniger betroffen. Die Domäne „Visuokonstruktive Fähigkeiten“ wurde ebenfalls in drei Untertests beurteilt. Hierbei zeigten sich keine Defizite der Testgruppe beim Abzeichnen der dargebotenen Figuren, die Reproduktion hingegen war signifikant gestört. Es zeigte sich keine CMB-bedingte Einschränkung der exekutiven Funktionen. N2 - In this study, we aimed to investigate (1) whether cerebral microbleeds (CMB) are associated with cognitive decline 6 months after ischemic stroke and if so (2) whether there are some cognitive domains that are affected more preferentially by CMB. In a prospective cohort study, cognitive function was investigated in 33 patients with ischemic stroke or transient ischemic attack (TIA) and ≥ 1 CMB valuated by the Consortium to Establish a Registry for Alzheimer’s Diseases (CERAD)-plus test battery. The cognitive performance of these patients was compared with 33 stroke survivors without CMB . Both groups were matched for age, gender, clinical and radiological characteristics. This study yielded the following main findings: (1) within 6 months after ischemic stroke or TIA, CMB-positive patients revealed cognitive decline in more than one cognitive domain; (2) among tested domains, memory and phonemic fluency were most affected in CMB-positive patients, and (3) an occurrence of CMB in more than one of the predefined brain regions was associated with more pronounced cognitive deficits. KW - Hirnblutung KW - Kognition KW - Schlaganfall KW - Neuropsychologischer Test KW - Consortium to Establish a Registry for Alzheimer's Disease KW - Mikroblutung Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-243679 ER - TY - JOUR A1 - Schrewe, L. A1 - Lill, C. M. A1 - Liu, T. A1 - Salmen, A. A1 - Gerdes, L. A. A1 - Guillot-Noel, L. A1 - Akkad, D. A. A1 - Blaschke, P. A1 - Graetz, C. A1 - Hoffjan, S. A1 - Kroner, A. A1 - Demir, S. A1 - Böhme, A. A1 - Rieckmann, P. A1 - El Ali, A. A1 - Hagemann, N. A1 - Hermann, D. M. A1 - Cournu-Rebeix, I. A1 - Zipp, F. A1 - Kümpfel, T. A1 - Buttmann, M. A1 - Zettl, U. K. A1 - Fontaine, B. A1 - Bertram, L. A1 - Gold, R. A1 - Chan, A. T1 - Investigation of sex-specific effects of apolipoprotein E on severity of EAE and MS JF - Journal of Neuroinflammation N2 - Background: Despite pleiotropic immunomodulatory effects of apolipoprotein E (apoE) in vitro, its effects on the clinical course of experimental autoimmune encephalomyelitis (EAE) and multiple sclerosis (MS) are still controversial. As sex hormones modify immunomodulatory apoE functions, they may explain contentious findings. This study aimed to investigate sex-specific effects of apoE on disease course of EAE and MS. Methods: MOG\(_{35-55}\) induced EAE in female and male apoE-deficient mice was assessed clinically and histopathologically. apoE expression was investigated by qPCR. The association of the MS severity score (MSSS) and APOE rs429358 and rs7412 was assessed across 3237 MS patients using linear regression analyses. Results: EAE disease course was slightly attenuated in male apoE-deficient (apoE\(^{-/-}\)) mice compared to wildtype mice (cumulative median score: apoE\(^{-/-}\) = 2 [IQR 0.0-4.5]; wildtype = 4 [IQR 1.0-5.0]; n = 10 each group, p = 0.0002). In contrast, EAE was more severe in female apoE\(^{-/-}\) mice compared to wildtype mice (cumulative median score: apoE\(^{-/-}\) = 3 [IQR 2.0-4.5]; wildtype = 3 [IQR 0.0-4.0]; n = 10, p = 0.003). In wildtype animals, apoE expression during the chronic EAE phase was increased in both females and males (in comparison to naive animals; p < 0.001). However, in MS, we did not observe a significant association between MSSS and rs429358 or rs7412, neither in the overall analyses nor upon stratification for sex. Conclusions: apoE exerts moderate sex-specific effects on EAE severity. However, the results in the apoE knock-out model are not comparable to effects of polymorphic variants in the human APOE gene, thus pinpointing the challenge of translating findings from the EAE model to the human disease. KW - immune KW - apoE KW - gender KW - inflammation KW - association studies in genetics KW - apoe KW - CNS disease KW - system KW - multiple sclerosis KW - MSSS KW - experimental autoimmune encephalomyelitis KW - disease severity KW - cognitive function KW - Alzheimer disease Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-136252 VL - 12 IS - 234 ER - TY - THES A1 - Reymann, Stephan Andreas T1 - Pathophysiologische Rolle und therapeutische Relevanz von Plasmakallikrein beim experimentellen Schlaganfall T1 - Pathophysiological role and therapeutic relevance of plasma kallikrein in experimental stroke N2 - Die Rolle thromboinflammatorischer Vorgänge in der Pathogenese des ischämischen Schlaganfalls ist in den letzten Jahren immer mehr in den wissenschaftlichen Fokus gerückt. Plasmakallikrein (PK) spaltet von hochmolekularem Kininogen (KNG) Bradykinin (BK) ab und ist dadurch Ausgangspunkt des proinflammatorischen Kallikrein-Kinin-Systems (KKS). Zum anderen kann es den Gerinnungsfaktor XII (FXII) aktivieren, den Ausgangspunkt der intrinsischen Gerinnungskaskade. Es initiiert also sowohl inflammatorische als auch thrombotische Vorgänge. Daher wurde in dieser Arbeit der Effekt einer Blockade PKs in einem Mausmodell der fokalen zerebralen Ischämie untersucht – und zwar sowohl durch genetische Depletion als auch durch pharmakologische Blockade. Beide Ansätze brachten einen nachhaltigen protektiven Effekt in Bezug auf Infarktgrößen und funktionelles Outcome, ohne die Blutungsgefahr zu erhöhen. N2 - Recent scientific evidence raises the question whether ischemic stroke is a thromboinflammatory disease. Plasma kallikrein (PK) cleaves high–molecular-weight kininogen to release bradykinin (BK) and is a key constituent of the proinflammatory contact-kinin system. In addition, PK can activate coagulation factor XII, the origin of the intrinsic coagulation cascade. Thus, PK triggers 2 important pathological pathways of stroke formation, thrombosis and inflammation. Therefore we investigated the consequences of both genetic and pharmacological PK inhibition in a model of ischemic stroke and found out that PK-inhibition leads to significantly smaller brain infarctions and less severe neurological deficits compared with controls without an increase in infarct-associated hemorrhage. KW - Plasmakallikrein KW - Schlaganfall KW - Plasmakallikrein ischämischer Schlaganfall Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-135834 ER - TY - JOUR A1 - Minnerup, Jens A1 - Sutherland, Brad A. A1 - Buchan, Alastair M. A1 - Kleinschnitz, Christoph T1 - Neuroprotection for Stroke: Current Status and Future Perspectives JF - International Journal of Molecular Science N2 - Neuroprotection aims to prevent salvageable neurons from dying. Despite showing efficacy in experimental stroke studies, the concept of neuroprotection has failed in clinical trials. Reasons for the translational difficulties include a lack of methodological agreement between preclinical and clinical studies and the heterogeneity of stroke in humans compared to homogeneous strokes in animal models. Even when the international recommendations for preclinical stroke research, the Stroke Academic Industry Roundtable (STAIR) criteria, were followed, we have still seen limited success in the clinic, examples being NXY-059 and haematopoietic growth factors which fulfilled nearly all the STAIR criteria. However, there are a number of neuroprotective treatments under investigation in clinical trials such as hypothermia and ebselen. Moreover, promising neuroprotective treatments based on a deeper understanding of the complex pathophysiology of ischemic stroke such as inhibitors of NADPH oxidases and PSD-95 are currently evaluated in preclinical studies. Further concepts to improve translation include the investigation of neuroprotectants in multicenter preclinical Phase III-type studies, improved animal models, and close alignment between clinical trial and preclinical methodologies. Future successful translation will require both new concepts for preclinical testing and innovative approaches based on mechanistic insights into the ischemic cascade. KW - free radical scavenger KW - ischemic cascade KW - acute ischemic stroke KW - trial KW - focal cerebral-ischemia KW - interleukin-1 receptor antagonist KW - colony-stimulating factor KW - tissue-plasminogen activator KW - traumatic brain injury KW - placebo-controlled KW - alias pilot trial KW - damage cool aid KW - neuroprotection KW - ischemic stroke KW - translation KW - STAIR Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-134730 VL - 13 IS - 9 ER - TY - JOUR A1 - Golombeck, Stefanie Kristin A1 - Wessig, Carsten A1 - Monoranu, Camelia-Maria A1 - Schütz, Ansgar A1 - Solymosi, Laszlo A1 - Melzer, Nico A1 - Kleinschnitz, Christoph T1 - Fatal atypical reversible posterior leukoencephalopathy syndrome: a case report JF - Journal of Medical Case Reports N2 - Introduction: Reversible posterior leukoencephalopathy syndrome – a reversible subacute global encephalopathy clinically presenting with headache, altered mental status, visual symptoms such as hemianopsia or cortical blindness, motor symptoms, and focal or generalized seizures – is characterized by a subcortical vasogenic edema symmetrically affecting posterior brain regions. Complete reversibility of both clinical signs and magnetic resonance imaging lesions is regarded as a defining feature of reversible posterior leukoencephalopathy syndrome. Reversible posterior leukoencephalopathy syndrome is almost exclusively seen in the setting of a predisposing clinical condition, such as pre-eclampsia, systemic infections, sepsis and shock, certain autoimmune diseases, various malignancies and cytotoxic chemotherapy, transplantation and concomitant immunosuppression (especially with calcineurin inhibitors) as well as episodes of abrupt hypertension. We describe for the first time clinical, radiological and histological findings in a case of reversible posterior leukoencephalopathy syndrome with an irreversible and fatal outcome occurring in the absence of any of the known predisposing clinical conditions except for a hypertensive episode. Case presentation: A 58-year-old Caucasian woman presented with a two-week history of subacute and progressive occipital headache, blurred vision and imbalance of gait and with no evidence for raised arterial blood pressure during the two weeks previous to admission. Her past medical history was unremarkable except for controlled arterial hypertension. Cerebral magnetic resonance imaging demonstrated cortical and subcortical lesions with combined vasogenic and cytotoxic edema atypical for both venous congestion and arterial infarction. Routine laboratory and cerebrospinal fluid parameters were normal. The diagnosis of reversible posterior leukoencephalopathy syndrome was established. Within hours after admission the patient showed a rapidly decreasing level of consciousness, extension and flexion synergisms, bilaterally extensor plantar responses and rapid cardiopulmonary decompensation requiring ventilatory and cardiocirculatory support. Follow-up cerebral imaging demonstrated widespread and confluent cytotoxic edematous lesions in different arterial territories, global cerebral swelling, and subsequent upper and lower brainstem herniation. Four days after admission, the patient was declared dead because of brain death. Conclusion: This case demonstrates that fulminant and fatal reversible posterior leukoencephalopathy syndrome may occur spontaneously, that is, in the absence of any of the known predisposing systemic conditions. KW - reversible posterior leukoencephalopathy syndrome KW - generalized cerebral edema KW - cerebral autoregulation KW - blood pressure Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-135517 VL - 7 IS - 14 ER -