TY  - THES
A1  - Schmid, Ursula
T1  - Protection against oxidative DNA damage by antioxidants, hormone-receptor blockers and HMG-CoA-reductase inhibitors
T1  - Schutz vor oxidativen DNA-Schäden durch Antioxidantien, Hormonrezeptorantagonisten und HMG-CoA-Reduktase-Inhibitoren
N2  - In the course of this study, several endogenous compounds and model substances were used to mimic the conditions in patients suffering from hypertension. As endogenous compounds, angiotensin II and aldosterone were chosen. As model substances, 4-nitroquinoline-1-oxide (NQO), hydrogen peroxide and phorbol 12-myristate 13-acetate (PMA) were selected. Benfotiamine as well as α-tocopherol proved in the course of the experiments to be able to prevent angiotensin II-induced formation of oxidative DNA strand breaks and micronuclei. This could be due to a prior inhibition of the release of reactive oxygen species and is in contrast to results which were achieved using thiamine. Furthermore, experiments in which cells were pre-incubated with benfotiamine followed by incubation with NQO showed that benfotiamine was not able to prevent the induction of oxidative stress. The hypothesis that benfotiamine has, like α-tocopherol, direct antioxidative capacity was fortified by measurements in cell free systems. In brief, a new working mechanism for benfotiamine in addition to the ones already known could be provided. In the second part of the study, angiotensin II was shown to be dose-dependently genotoxic. This effect is mediated via the angiotensin II type 1 receptor (AT1R) which. Further experiments were extended from in vitro settings to the isolated perfused kidney. Here it could be shown that angiotensin II caused vasoconstriction and DNA strand breaks. Co-perfusion of kidneys with angiotensin II and candesartan prevented vasoconstriction and formation of strand breaks. DNA strand break formation due to mechanical stress or hypoxia could be ruled out after additional experiments with the thromboxane mimetic U 46619. Detailed investigation of the DNA damage in vitro revealed that angiotensin II induces single strand breaks, double strand breaks and 8-hydroxydeoxyguanosine (8-oxodG)-adducts as well as abasic sites. Investigations of the effects of aldosterone-treatment in kidney cells showed an increase of oxidative stress, DNA strand breaks and micronuclei which could be prevented by the steroidal mineralocorticoid receptor antagonist eplerenone. Additional experiments with the non-steroidal mineralocorticoid receptor antagonist (S)-BR-4628 revealed that this substance was also able to prevent oxidative stress and genomic damage and proved to be more potent than eplerenone. In vivo, hyperaldosteronism was imitated in rats by aid of the deoxycorticosteroneacetate (DOCA) salt model. After this treatment, levels of DNA strand breaks and chromosomal aberrations in the kidney could be observed. Furthermore, an increase in the release of ROS could be measured. Treatment of these animals with spironolactone , BR-4628 and enalaprile revealed that all antagonists were effective BR-4628 was the most potent drug. Finally, rosuvastatin was investigated. In HL-60 cells phorbol 12-myristate 13-acetate caused oxidative stress. Rosuvastatin was able to prevent the release of ROS and subsequent oxidative DNA damage when co-incubated with PMA. Furthermore, not only an inhibition of PMA-induced oxidative stress but also inhibition of the unspecific release of ROS induced by hydrogen peroxide was observable. Addition of farnesyl pyrophosphate (FPP), geranylgeranyl pyrophosphate (GGPP), and mevalonate, intermediates of the cholesterol pathway, caused only a marginal increase of oxidative stress in cells treated simultaneously with PMA and rosuvastatin, thus indicating the effect of rosuvastatin to be HMG-CoA-reductase-independent. Investigation of the gene expression of subunits of NAD(P)H oxidase revealed a down-regulation of p67phox following rosuvastatin-treatment. Furthermore, it could be shown that rosuvastatin treatment alone or in combination with PMA increased total glutathione levels probably due to an induction of the gene expression and enzyme activity of γ-glutamylcysteine synthetase (γ-GCS).
N2  - Im Zuge dieser Studie wurden sowohl endogene Substanzen als auch Modellsubstanzen eingesetzt, um die pathologischen Verhältnisse in Patienten, die an Bluthochdruck leiden, zu imitieren. Als endogene Substanzen wurden Angiotensin II und Aldosteron ausgewählt. Als Modellsubstanzen wurden 4-Nitrochinolin-1-oxid (NQO), Wasserstoffperoxid und Phorbol-12-myristat-13-gewählt. Der erste Teil dieser Arbeit beschäftigt sich mit zwei Vitaminen, nämlich Benfotiamin und α-Tocopherol. Sowohl Benfotiamin als auch α-Tocopherol zeigten im Laufe der Experimente, dass sie in der Lage sind, durch Angiotensin II verursachte DNA-Strangbrüche und chromosomale Aberrationen zu verhindern. Dies ist möglicherweise auf eine ebenfalls beobachtbare vorausgegangene Inhibition der Freisetzung reaktiver Sauerstoffspezies zurückzuführen. Zusammenfassend konnte ein neuer Wirkmechanismus für Benfotiamin vorgestellt werden. Im zweiten Teil dieser Studie konnte nachgewiesen werden, dass Angiotensin II eine dosisabhängige Gentoxizität verursacht. Dieser Effekt wird durch den Angiotensin II-Rezeptor Typ 1 vermittelt. Im weiteren Verlauf der Studie wurden die in vitro Experimente auf das Modell der isolierten perfundierten Mäuseniere ausgeweitet. Hier konnte gezeigt werden, dass Angiotensin II Vasokonstriktion und DNA-Strangbrüche verursacht. Co-Perfusion der Nieren mit Angiotensin II und Candesartan verhinderte hingegen die Vasokonstriktion und die Bildung von DNA-Strangbrüchen. Die Verursachung von Strangbrüchen durch mechanischen Stress oder Hypoxie konnte ausgeschlossen werden. Die Untersuchung der ex vivo beobachteten DNA-Schäden in vitro ließ erkennen, dass Angiotensin II Einzelstrangbrüche, Doppelstrangbrüche, die Bildung des DNA-Addukts 8-OxodG und abasische Stellen induziert. Ein Reparatur-Comet Assay, parallel durchgeführt mit der Messung des phosphorylierten Histons 2AX (γ-H2AX) über 24 h, zeigte eine vollständige Reparatur der Einzelstrangbrüche, wohingegen die Zahl der Doppelstrangbrüche in diesem Zeitraum sogar zunahm. Untersuchungen der Effekte, die eine Aldosteron-Behandlung auf Nierenzellen hat, zeigten einen Anstieg des oxidativen Stress, der DNA Strangbrüche und der Mikrokerne. Diese Effekte konnten durch Eplerenon verhindert werden. Weitere Experimente mit dem nicht-steroidalen Mineralocorticoid Rezeptor-Antagonisten (S)-BR-4628 zeigten, dass auch diese Substanz oxidativen Stress und DNA Schäden verhindern konnte, im Gegensatz hierzu hatte das (R)-Isomer, das keine Aktivität am Mineralocorticoid Rezeptor zeigt, keine präventiven Effekte. In vivo wurde der Hyperaldosteronismus mit Hilfe des Deoxycorticosteronacetat- (DOCA) Salzmodells nachgeahmt. Unter dieser Behandlung konnten Level an DNA-Strangbrüchen und chromosomalen Aberrationen beobachtet werden. Des Weiteren konnten in den DOCA-Tieren erhöhte Level an oxidativem Stress gemessen werden. Wurden die Versuchstiere zusätzlich zur DOCA-Behandlung mit Spironolacton, BR-4628 und dem Enalapril behandelt, konnte gezeigt werden, dass BR-4628 potenter war als Spironolacton Enalapril. Zuletzt wurde mit Rosuvastatin eine Substanz untersucht, die die antioxidative Abwehr der Zellen aktivieren kann. In der humanen Leukämie-Zelllinie HL-60 verursachte Phorbol-12-myristat-13-acetat (PMA) oxidativen Stress. Rosuvastatin war in der Lage, die Freisetzung von ROS und daraus resultierende DNA-Strangbrüche bei Co-Inkubation mit PMA zu verhindern. Außerdem konnte gezeigt werden, dass Rosuvastatin nicht nur PMA-induzierten oxidativen Stress, sondern auch die unspezifische Wasserstoffperoxid-induzierte Freisetzung von ROS verhinderte. Die Untersuchung der Genexpression von Untereinheiten der NAD(P)H Oxidase ergab, dass p67phox nach Rosuvastatin-Behandlung herabreguliert wurde. Behandlung mit Rosuvastatin allein oder zusammen mit PMA konnte außerdem die Glutathion-Spiegel erhöhen. Dies ist vermutlich auf die Induktion der Genexpression und der Enzymaktivität der γ-Glutamylcystein-Synthetase (γ-GCS), des Schrittmacherenzyms des Glutathionsystems, zurückzuführen.
KW  - Oxidativer Stress
KW  - Angiotensin II
KW  - Angiotensin-II-Blocker
KW  - Aldosteron
KW  - Aldosteronantagonist
KW  - Renin-Angiotensin-System
KW  - Benfotiamin
KW  - Statin
KW  - Di
KW  - DNA-Schaden
KW  - Mikrokerne
KW  - Comet Assay
KW  - DNA damage
KW  - Micronuclei
KW  - Comet Assay
Y1  - 2008
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-28379
ER  - 
TY  - JOUR
A1  - Spinner, Christoph D
A1  - Wille, Florian
A1  - Schwerdtfeger, Christiane
A1  - Thies, Philipp
A1  - Tanase, Ursula
A1  - Von Figura, Guido
A1  - Schmid, Roland M
A1  - Heinz, Werner J
A1  - Klinker, Hartwig Hf
T1  - Pharmacokinetics of chewed vs. swallowed raltegravir in a patient with AIDS and MAI infection: some new conflicting data
JF  - AIDS Research and Therapy
N2  - Background: 
While HIV, AIDS and atypical Mycobacterium infections are closely linked, the use of Integrase-Inhibitor based cART, notably raltegravir-based regimens is more widespread. RAL should be double-dosed to 800 mg semi-daily in situation of rifampicin co-medication, because RAL is more rapidly metabolized due to rifampicin-induced Uridine-5'-diphosph-gluronosyl-transferase (UGT1A1). Recently, it was speculated that chewed RAL might lead to increased absorption, which might compensate the inductive effect of rifampicin-rapid metabolized RAL, as part of cost-saving effects in countries with high-tuberculosis prevalence and less economic power. 

Methods: 
We report measurement of raltegravir pharmacokinetics in a 34-year AIDS-patient suffering from disseminated Mycobacterium avium infection with necessity of parenteral rifampicin treatment. RAL levels were measured with HPLC (internal standard: carbamazepine, LLQ 11 ng/ml, validation with Valistat 2.0 program (Arvecon, Germany)). For statistical analysis, a two-sided Wilcoxon signed rank test for paired samples was used. 

Results: 
High intra-personal variability in raltegravir serum levels was seen. Comparable C\(_{max}\) concentrations were found for 800 mg chewed and swallowed RAL, as well as for 400 mg chewed and swallowed RAL. While C\(_{max}\) seems to be more dependent from overall RAL dosing than from swallowed or chewed tablets, increased AUC(12) is clearly linked to higher RAL dosages per administration. Anyway, chewed raltegravir showed a rapid decrease in serum levels. 

Conclusions: 
We found no evidence that chewed 400 mg semi-daily raltegravir in rifampicin co-medication leads to optimized pharmacokinetics. There is need for more data from randomized trials for further recommendations.
KW  - pharmacology
KW  - drug
KW  - HIV
KW  - chewed
KW  - Mycobacterium avium
KW  - raltegravir
KW  - pharmacokinetic
Y1  - 2015
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-144058
VL  - 12
IS  - 1
ER  - 
TY  - JOUR
A1  - Schwaab, Bernhard
A1  - Bjarnason-Wehrens, Birna
A1  - Meng, Karin
A1  - Albus, Christian
A1  - Salzwedel, Annett
A1  - Schmid, Jean-Paul
A1  - Benzer, Werner
A1  - Metz, Matthes
A1  - Jensen, Katrin
A1  - Rauch, Bernhard
A1  - Bönner, Gerd
A1  - Brzoska, Patrick
A1  - Buhr-Schinner, Heike
A1  - Charrier, Albrecht
A1  - Cordes, Carsten
A1  - Dörr, Gesine
A1  - Eichler, Sarah
A1  - Exner, Anne-Kathrin
A1  - Fromm, Bernd
A1  - Gielen, Stephan
A1  - Glatz, Johannes
A1  - Gohlke, Helmut
A1  - Grilli, Maurizio
A1  - Gysan, Detlef
A1  - Härtel, Ursula
A1  - Hahmann, Harry
A1  - Herrmann-Lingen, Christoph
A1  - Karger, Gabriele
A1  - Karoff, Marthin
A1  - Kiwus, Ulrich
A1  - Knoglinger, Ernst
A1  - Krusch, Christian-Wolfgang
A1  - Langheim, Eike
A1  - Mann, Johannes
A1  - Max, Regina
A1  - Metzendorf, Maria-Inti
A1  - Nebel, Roland
A1  - Niebauer, Josef
A1  - Predel, Hans-Georg
A1  - Preßler, Axel
A1  - Razum, Oliver
A1  - Reiss, Nils
A1  - Saure, Daniel
A1  - von Schacky, Clemens
A1  - Schütt, Morten
A1  - Schultz, Konrad
A1  - Skoda, Eva-Maria
A1  - Steube, Diethard
A1  - Streibelt, Marco
A1  - Stüttgen, Martin
A1  - Stüttgen, Michaela
A1  - Teufel, Martin
A1  - Tschanz, Hansueli
A1  - Völler, Heinz
A1  - Vogel, Heiner
A1  - Westphal, Ronja
T1  - Cardiac rehabilitation in German speaking countries of Europe — evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH — part 2
JF  - Journal of Clinical Medicine
N2  - Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients' groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
KW  - cardiac rehabilitation
KW  - scientific guidelines
KW  - secondary prevention
KW  - physical activity
KW  - exercise training
KW  - psychological interventions
KW  - education
KW  - gender
KW  - frailty
KW  - migration
KW  - old patients
KW  - young patients
KW  - tele-medicine
KW  - home-based-rehabilitation
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242645
SN  - 2077-0383
VL  - 10
IS  - 14
ER  -