TY - JOUR A1 - Jobs, Alexander A1 - Vonthein, Reinhard A1 - König, Inke R. A1 - Schäfer, Jane A1 - Nauck, Matthias A1 - Haag, Svenja A1 - Fichera, Carlo Federico A1 - Stiermaier, Thomas A1 - Ledwoch, Jakob A1 - Schneider, Alisa A1 - Valentova, Miroslava A1 - von Haehling, Stephan A1 - Störk, Stefan A1 - Westermann, Dirk A1 - Lenz, Tobias A1 - Arnold, Natalie A1 - Edelmann, Frank A1 - Seppelt, Philipp A1 - Felix, Stephan A1 - Lutz, Matthias A1 - Hedwig, Felix A1 - Borggrefe, Martin A1 - Scherer, Clemens A1 - Desch, Steffen A1 - Thiele, Holger T1 - Inferior vena cava ultrasound in acute decompensated heart failure: design rationale of the CAVA‐ADHF‐DZHK10 trial JF - ESC Heart Failure N2 - Aims Treating patients with acute decompensated heart failure (ADHF) presenting with volume overload is a common task. However, optimal guidance of decongesting therapy and treatment targets are not well defined. The inferior vena cava (IVC) diameter and its collapsibility can be used to estimate right atrial pressure, which is a measure of right‐sided haemodynamic congestion. The CAVA‐ADHF‐DZHK10 trial is designed to test the hypothesis that ultrasound assessment of the IVC in addition to clinical assessment improves decongestion as compared with clinical assessment alone. Methods and results CAVA‐ADHF‐DZHK10 is a randomized, controlled, patient‐blinded, multicentre, parallel‐group trial randomly assigning 388 patients with ADHF to either decongesting therapy guided by ultrasound assessment of the IVC in addition to clinical assessment or clinical assessment alone. IVC ultrasound will be performed daily between baseline and hospital discharge in all patients. However, ultrasound results will only be reported to treating physicians in the intervention group. Treatment target is relief of congestion‐related signs and symptoms in both groups with the additional goal to reduce the IVC diameter ≤21 mm and increase IVC collapsibility >50% in the intervention group. The primary endpoint is change in N‐terminal pro‐brain natriuretic peptide from baseline to hospital discharge. Secondary endpoints evaluate feasibility, efficacy of decongestion on other scales, and the impact of the intervention on clinical endpoints. Conclusions CAVA‐ADHF‐DZHK10 will investigate whether IVC ultrasound supplementing clinical assessment improves decongestion in patients admitted for ADHF. KW - acute decompensated heart failure KW - inferior vena cava KW - congestion KW - NT‐proBNP KW - ultrasound Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-212692 VL - 7 IS - 3 SP - 973 EP - 983 ER - TY - JOUR A1 - Haake, Markus A1 - Haack, Beatrice A1 - Schäfer, Tina A1 - Harter, Patrick N. A1 - Mattavelli, Greta A1 - Eiring, Patrick A1 - Vashist, Neha A1 - Wedekink, Florian A1 - Genssler, Sabrina A1 - Fischer, Birgitt A1 - Dahlhoff, Julia A1 - Mokhtari, Fatemeh A1 - Kuzkina, Anastasia A1 - Welters, Marij J. P. A1 - Benz, Tamara M. A1 - Sorger, Lena A1 - Thiemann, Vincent A1 - Almanzar, Giovanni A1 - Selle, Martina A1 - Thein, Klara A1 - Späth, Jacob A1 - Gonzalez, Maria Cecilia A1 - Reitinger, Carmen A1 - Ipsen-Escobedo, Andrea A1 - Wistuba-Hamprecht, Kilian A1 - Eichler, Kristin A1 - Filipski, Katharina A1 - Zeiner, Pia S. A1 - Beschorner, Rudi A1 - Goedemans, Renske A1 - Gogolla, Falk Hagen A1 - Hackl, Hubert A1 - Rooswinkel, Rogier W. A1 - Thiem, Alexander A1 - Romer Roche, Paula A1 - Joshi, Hemant A1 - Pühringer, Dirk A1 - Wöckel, Achim A1 - Diessner, Joachim E. A1 - Rüdiger, Manfred A1 - Leo, Eugen A1 - Cheng, Phil F. A1 - Levesque, Mitchell P. A1 - Goebeler, Matthias A1 - Sauer, Markus A1 - Nimmerjahn, Falk A1 - Schuberth-Wagner, Christine A1 - Felten, Stefanie von A1 - Mittelbronn, Michel A1 - Mehling, Matthias A1 - Beilhack, Andreas A1 - van der Burg, Sjoerd H. A1 - Riedel, Angela A1 - Weide, Benjamin A1 - Dummer, Reinhard A1 - Wischhusen, Jörg T1 - Tumor-derived GDF-15 blocks LFA-1 dependent T cell recruitment and suppresses responses to anti-PD-1 treatment JF - Nature Communications N2 - Immune checkpoint blockade therapy is beneficial and even curative for some cancer patients. However, the majority don’t respond to immune therapy. Across different tumor types, pre-existing T cell infiltrates predict response to checkpoint-based immunotherapy. Based on in vitro pharmacological studies, mouse models and analyses of human melanoma patients, we show that the cytokine GDF-15 impairs LFA-1/β2-integrin-mediated adhesion of T cells to activated endothelial cells, which is a pre-requisite of T cell extravasation. In melanoma patients, GDF-15 serum levels strongly correlate with failure of PD-1-based immune checkpoint blockade therapy. Neutralization of GDF-15 improves both T cell trafficking and therapy efficiency in murine tumor models. Thus GDF-15, beside its known role in cancer-related anorexia and cachexia, emerges as a regulator of T cell extravasation into the tumor microenvironment, which provides an even stronger rationale for therapeutic anti-GDF-15 antibody development. KW - cancer microenvironment KW - immunotherapy KW - T cells KW - tumour immunology Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357333 VL - 14 ER - TY - JOUR A1 - Chopra, Martin A1 - Biehl, Marlene A1 - Steinfatt, Tim A1 - Brandl, Andreas A1 - Kums, Juliane A1 - Amich, Jorge A1 - Vaeth, Martin A1 - Kuen, Janina A1 - Holtappels, Rafaela A1 - Podlech, Jürgen A1 - Mottok, Anja A1 - Kraus, Sabrina A1 - Jordán-Garotte, Ana-Laura A1 - Bäuerlein, Carina A. A1 - Brede, Christian A1 - Ribechini, Eliana A1 - Fick, Andrea A1 - Seher, Axel A1 - Polz, Johannes A1 - Ottmueller, Katja J. A1 - Baker, Jeannette A1 - Nishikii, Hidekazu A1 - Ritz, Miriam A1 - Mattenheimer, Katharina A1 - Schwinn, Stefanie A1 - Winter, Thorsten A1 - Schäfer, Viktoria A1 - Krappmann, Sven A1 - Einsele, Hermann A1 - Müller, Thomas D. A1 - Reddehase, Matthias J. A1 - Lutz, Manfred B. A1 - Männel, Daniela N. A1 - Berberich-Siebelt, Friederike A1 - Wajant, Harald A1 - Beilhack, Andreas T1 - Exogenous TNFR2 activation protects from acute GvHD via host T reg cell expansion JF - Journal of Experimental Medicine N2 - Donor CD4\(^+\)Foxp3\(^+\) regulatory T cells (T reg cells) suppress graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (HCT allo-HCT]). Current clinical study protocols rely on the ex vivo expansion of donor T reg cells and their infusion in high numbers. In this study, we present a novel strategy for inhibiting GvHD that is based on the in vivo expansion of recipient T reg cells before allo-HCT, exploiting the crucial role of tumor necrosis factor receptor 2 (TNFR2) in T reg cell biology. Expanding radiation-resistant host T reg cells in recipient mice using a mouse TNFR2-selective agonist before allo-HCT significantly prolonged survival and reduced GvHD severity in a TNFR2-and T reg cell-dependent manner. The beneficial effects of transplanted T cells against leukemia cells and infectious pathogens remained unaffected. A corresponding human TNFR2-specific agonist expanded human T reg cells in vitro. These observations indicate the potential of our strategy to protect allo-HCT patients from acute GvHD by expanding T reg cells via selective TNFR2 activation in vivo. KW - Tumor-necrosis-factor KW - Regulatory-cells KW - Bone marrow transplantantation KW - Graft-versus-leukemia KW - Rheumatoid arthritis KW - Autoimmune diseases KW - Factor receptor KW - Alpha therapy KW - Expression KW - Suppression Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-187640 VL - 213 IS - 9 ER - TY - JOUR A1 - Steinmann, Diana A1 - Paelecke-Habermann, Yvonne A1 - Geinitz, Hans A1 - Aschoff, Raimund A1 - Bayerl, Anja A1 - Bölling, Tobias A1 - Bosch, Elisabeth A1 - Bruns, Frank A1 - Eichenseder-Seiss, Ute A1 - Gerstein, Johanna A1 - Gharbi, Nadine A1 - Hagg, Juliane A1 - Hipp, Matthias A1 - Kleff, Irmgard A1 - Müller, Axel A1 - Schäfer, Christof A1 - Schleicher, Ursula A1 - Sehlen, Susanne A1 - Theodorou, Marilena A1 - Wypior, Hans-Joachim A1 - Zehentmayr, Franz A1 - van Oorschot, Birgitt A1 - Vordermark, Dirk T1 - Prospective evaluation of quality of life effects in patients undergoing palliative radiotherapy for brain metastases JF - BMC Cancer N2 - Background: Recently published results of quality of life (QoL) studies indicated different outcomes of palliative radiotherapy for brain metastases. This prospective multi-center QoL study of patients with brain metastases was designed to investigate which QoL domains improve or worsen after palliative radiotherapy and which might provide prognostic information. Methods: From 01/2007-01/2009, n=151 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. Most patients (82 %) received whole-brain radiotherapy. QoL was measured with the EORTC-QLQ-C15-PAL and brain module BN20 before the start of radiotherapy and after 3 months. Results: At 3 months, 88/142 (62 %) survived. Nine patients were not able to be followed up. 62 patients (70.5 % of 3-month survivors) completed the second set of questionnaires. Three months after the start of radiotherapy QoL deteriorated significantly in the areas of global QoL, physical function, fatigue, nausea, pain, appetite loss, hair loss, drowsiness, motor dysfunction, communication deficit and weakness of legs. Although the use of corticosteroid at 3 months could be reduced compared to pre-treatment (63 % vs. 37 %), the score for headaches remained stable. Initial QoL at the start of treatment was better in those alive than in those deceased at 3 months, significantly for physical function, motor dysfunction and the symptom scales fatigue, pain, appetite loss and weakness of legs. In a multivariate model, lower Karnofsky performance score, higher age and higher pain ratings before radiotherapy were prognostic of 3-month survival. Conclusions: Moderate deterioration in several QoL domains was predominantly observed three months after start of palliative radiotherapy for brain metastases. Future studies will need to address the individual subjective benefit or burden from such treatment. Baseline QoL scores before palliative radiotherapy for brain metastases may contain prognostic information. KW - breast cancer KW - brain tumours KW - survival KW - validation KW - symptoms KW - EORTC-QLQ-C15-PAL KW - EORTC-BN20 KW - whole-brain radiotherapy KW - partitioning analysis RPA KW - cancer patients KW - lung cancer KW - prognostic index KW - radiation oncology KW - clinical trials Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-135254 VL - 12 IS - 283 ER - TY - JOUR A1 - Bachmann, Friederike A1 - Schreder, Martin A1 - Engelhardt, Monika A1 - Langer, Christian A1 - Wolleschak, Denise A1 - Mügge, Lars Olof A1 - Dürk, Heinz A1 - Schäfer-Eckart, Kerstin A1 - Blau, Igor Wolfgang A1 - Gramatzki, Martin A1 - Liebisch, Peter A1 - Grube, Matthias A1 - Metzler, Ivana v. A1 - Bassermann, Florian A1 - Metzner, Bernd A1 - Röllig, Christoph A1 - Hertenstein, Bernd A1 - Khandanpour, Cyrus A1 - Dechow, Tobias A1 - Hebart, Holger A1 - Jung, Wolfram A1 - Theurich, Sebastian A1 - Maschmeyer, Georg A1 - Salwender, Hans A1 - Hess, Georg A1 - Bittrich, Max A1 - Rasche, Leo A1 - Brioli, Annamaria A1 - Eckardt, Kai-Uwe A1 - Straka, Christian A1 - Held, Swantje A1 - Einsele, Hermann A1 - Knop, Stefan T1 - Kinetics of renal function during induction in newly diagnosed multiple myeloma: results of two prospective studies by the German Myeloma Study Group DSMM JF - Cancers N2 - Background: Preservation of kidney function in newly diagnosed (ND) multiple myeloma (MM) helps to prevent excess toxicity. Patients (pts) from two prospective trials were analyzed, provided postinduction (PInd) restaging was performed. Pts received three cycles with bortezomib (btz), cyclophosphamide, and dexamethasone (dex; VCD) or btz, lenalidomide (len), and dex (VRd) or len, adriamycin, and dex (RAD). The minimum required estimated glomerular filtration rate (eGFR) was >30 mL/min. We analyzed the percent change of the renal function using the International Myeloma Working Group (IMWG) criteria and Kidney Disease: Improving Global Outcomes (KDIGO)-defined categories. Results: Seven hundred and seventy-two patients were eligible. Three hundred and fifty-six received VCD, 214 VRd, and 202 RAD. VCD patients had the best baseline eGFR. The proportion of pts with eGFR <45 mL/min decreased from 7.3% at baseline to 1.9% PInd (p < 0.0001). Thirty-seven point one percent of VCD versus 49% of VRd patients had a decrease of GFR (p = 0.0872). IMWG-defined “renal complete response (CRrenal)” was achieved in 17/25 (68%) pts after VCD, 12/19 (63%) after RAD, and 14/27 (52%) after VRd (p = 0.4747). Conclusions: Analyzing a large and representative newly diagnosed myeloma (NDMM) group, we found no difference in CRrenal that occurred independently from the myeloma response across the three regimens. A trend towards deterioration of the renal function with VRd versus VCD may be explained by a better pretreatment “renal fitness” in the latter group. KW - multiple myeloma KW - renal failure KW - kidney KW - bortezomib KW - lenalidomide KW - induction regimen Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234139 SN - 2072-6694 VL - 13 IS - 6 ER - TY - THES A1 - Schäfer, Matthias T1 - Molecular mechanisms of floor plate formation and neural patterning in zebrafish T1 - Molekulare Mechanismen der Bodenplatten Entwicklung und neuronale Musterbildung im Zebrafisch N2 - The vertebrate spinal cord is composed of billions of neurons and glia cells, which are formed in a highly coordinated manner during early neurogenesis. Specification of these cells at distinct positions along the dorsoventral (DV) axis of the developing spinal cord is controlled by a ventrally located signaling center, the medial floor plate (MFP). Currently, the origin and time frame of specification of this important organizer are not clear. During my PhD thesis, I have analyzed the function of the novel secreted growth factor Midkine-a (Mdka) in zebrafish. In higher vertebrates, mdk and the related factor pleiotrophin (ptn) are widely expressed during embryogenesis and are implicated in a variety of processes. The in-vivo function of both factors, however, is unclear, as knock-out mice show no embryonic phenotype. We have isolated two mdk co-orthologs, mdka and mdkb, and one single ptn gene in zebrafish. Molecular phylogenetic analyses have shown that these genes evolved after two large gene block duplications. In contrast to higher vertebrates, zebrafish mdk and ptn genes have undergone functional divergence, resulting in mostly non-redundant expression patterns and functions. I have shown by overexpression and knock-down analyses that Mdka is required for MFP formation during zebrafish neurulation. Unlike the previously known MFP inducing factors, mdka is not expressed within the embryonic shield or tailbud but is dynamically expressed in the paraxial mesoderm. I used epistatic and mutant analyses to show that Mdka acts independently from these factors. This indicates a novel mechanism of Mdka dependent MFP formation during zebrafish neurulation. To get insight into the signaling properties of zebrafish Mdka, the function of both Mdk proteins and the candidate receptor Anaplastic lymphoma kinase (Alk) have been compared. Knock-down of mdka and mdkb resulted in the same reduction of iridophores as in mutants deficient for Alk. This indicates that Alk could be a putative receptor of Mdks during zebrafish embryogenesis. In most vertebrate species a lateral floor plate (LFP) domain adjacent to the MFP has been defined. In higher vertebrates it has been shown that the LFP is located within the p3 domain, which forms V3 interneurons. It is unclear, how different cell types in this domain are organized during early embryogenesis. I have analyzed a novel homeobox gene in zebrafish, nkx2.2b, which is exclusively expressed in the LFP. Overexpression, mutant and inhibitor analyses showed that nkx2.2b is activated by Sonic hedgehog (Shh), but repressed by retinoids and the motoneuron-inducing factor Islet-1 (Isl1). I could show that in zebrafish LFP and p3 neuronal cells are located at the same level along the DV axis, but alternate along the anteroposterior (AP) axis. Moreover, these two different cell populations require different levels of HH signaling and nkx2.2 activities. This provides new insights into the structure of the vertebrate spinal cord and suggests a novel mechanism of neural patterning. N2 - Das Rückenmark von Vertebraten besteht aus Milliarden von Neuronen und Gliazellen, die in einem sehr komplexen Muster während der frühen Neurogenese gebildet werden. Die Spezifizierung dieser Zellen an spezifischen Positionen entlang der dorsoventralen (DV) Achse des Rückenmarks wird durch ein ventrales Organisationszentrum, die mediale Bodenplatte (MFP), kontrolliert. Die Herkunft und der Zeitraum der Spezifizierung dieses wichtigen Organisationszentrums sind zurzeit nicht klar. In meiner Doktorarbeit habe ich die Funktionen des neuen Wachstumsfaktors Midkine-a (Mdka) im Zebrafisch charakterisiert. Mdka und der verwandte Faktor pleiotrophin (ptn) zeigen ein breites Expressionsmuster während der Embryogenese von höheren Vertebraten und sind offenbar an einer Vielzahl von Prozessen beteiligt. Die exakten in-vivo Funktionen sind jedoch nicht bekannt, da knock-out Mäuse keinen embryonalen Phänotyp zeigen. Im Zebrafisch haben wir zwei co-orthologe mdk Gene, mdka und mdkb, sowie ein ptn Gen-Ortholog isoliert. Molekulare phylogenetische Analysen ergaben, dass diese Gene durch zwei unabhängige Duplikationen eines Gen-Blocks entstanden sind. Im Gegensatz zu höheren Vertebraten haben mdk und ptn Gene divergente Funktionen entwickelt, was zu weitestgehend nicht redundanten Funktionen und Expressionsmustern geführt hat. Mittels Überexpressions- und knock-down Analysen konnte ich zeigen, dass Mdka für die Bildung der MFP im Zebrafisch benötigt wird. Anders als bisher bekannte MFP induzierende Faktoren ist Mdka nicht im embryonalen Gastrula-Organisator, dem ‚Shield’ oder der Schwanzknospe exprimiert, sondern dynamisch im paraxialen Mesoderm. Durch epistatische Analysen und Mutanten-Experimente konnte ich weiterhin zeigen, dass Mdka unabhängig von diesen Faktoren wirkt. Dies deutet auf einen neuen Mdka abhängigen Mechanismus der MFP- Bildung während der Neurogenese im Zebrafisch hin. Um Einblick in den Signalweg von Mdka im Zebrafisch zu erhalten, wurde die Funktion der midkine Gene mit der des potentiellen Rezeptors, der Anaplastischen Lymphom-Kinase (Alk), verglichen. Ein ‚Knock-down’ beider Mdk Proteine führte zu einer vergleichbaren Reduktion von Iridophoren wie bei Alk defizienten Mutanten. Demnach könnte Alk ein Rezeptor beider Mdk Proteine während der Zebrafisch-Embryogenese sein. In vielen Vertebratenspezies wurde neben der MFP eine laterale Bodenplatten (LFP) Domäne definiert. In höheren Vertebraten wurde gezeigt, dass LFP Zellen innerhalb der p3 neuronalen Domäne lokalisiert sind, welche V3 Interneuronen bilden. Es ist zurzeit nicht klar, wie diese Zelltypen angeordnet sind und wie sie während der Embryogenese gebildet werden. Ich habe ein neues Homeobox Gen nkx2.2b im Zebrafisch analysiert, welches ausschließlich in der LFP exprimiert ist. Überexpressions-, Mutanten- und Inhibitorenanalysen haben gezeigt, dass nkx2.2b durch Sonic Hedgehog (Shh) aktiviert, durch Retinolsäure und den Motoneuronen induzierenden Faktor Islet-1 (Isl1) aber reprimiert wird. Ich konnte weiterhin zeigen, dass im Zebrafisch LFP und p3 neuronale Zellen auf der gleichen Ebene entlang der DV Achse lokalisiert sind und entlang der anteroposterioren (AP) Achse alternieren. Diese zwei Zellpopulationen benötigen verschiedene Aktivitäten von Hedgehog und nkx2.2b. Dies stellt einen neuen Aspekt für den Aufbau des Rückenmarks von Vertebraten dar und deutet auf einen bisher unbekannten Mechanismus der neuronalen Musterbildung hin. KW - Zebrabärbling KW - Wachstumsfaktor KW - Neurogenese KW - Homöobox KW - Bodenplatte KW - neuronale Musterbildung KW - Midkine KW - Homeobox Gene KW - Zebrafisch KW - floor plate KW - neural patterning KW - Midkine KW - Homeobox genes KW - zebrafish Y1 - 2005 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-15789 ER -