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European Myeloma Network Guidelines for the Management of Multiple Myeloma-related Complications
(2015)
The European Myeloma Network provides recommendations for the management of the most common complications of multiple myeloma. Whole body low-dose computed tomography is more sensitive than conventional radiography in depicting osteolytic disease and thus we recommend it as the novel standard for the detection of lytic lesions in myeloma (grade 1A). Myeloma patients with adequate renal function and bone disease at diagnosis should be treated with zoledronic acid or pamidronate (grade 1A). Symptomatic patients without lytic lesions on conventional radiography can be treated with zoledronic acid (grade 1B), but its advantage is not clear for patients with no bone involvement on computed tomography or magnetic resonance imaging. In asymptomatic myeloma, bisphosphonates are not recommended (grade 1A). Zoledronic acid should be given continuously, but it is not clear if patients who achieve at least a very good partial response benefit from its continuous use (grade 1B). Treatment with erythropoietic-stimulating agents may be initiated in patients with persistent symptomatic anemia (hemoglobin < 10g/dL) in whom other causes of anemia have been excluded (grade 1B). Erythropoietic agents should be stopped after 6-8 weeks if no adequate hemoglobin response is achieved. For renal impairment, bortezomib-based regimens are the current standard of care (grade 1A). For the management of treatment-induced peripheral neuropathy, drug modification is needed (grade 1C). Vaccination against influenza is recommended; vaccination against streptococcus pneumonia and hemophilus influenza is appropriate, but efficacy is not guaranteed due to suboptimal immune response (grade 1C). Prophylactic aciclovir (or valacyclovir) is recommended for patients receiving proteasome inhibitors, autologous or allogeneic transplantation (grade 1A).
Background
Human African Trypanosomiasis (HAT) also called sleeping sickness is an infectious disease in humans caused by an extracellular protozoan parasite. The disease, if left untreated, results in 100% mortality. Currently available drugs are full of severe drawbacks and fail to escape the fast development of trypanosoma resistance. Due to similarities in cell metabolism between cancerous tumors and trypanosoma cells, some of the current registered drugs against HAT have also been tested in cancer chemotherapy. Here we demonstrate for the first time that the simple ester, ethyl pyruvate, comprises such properties.
Results
The current study covers the efficacy and corresponding target evaluation of ethyl pyruvate on T. brucei cell lines using a combination of biochemical techniques including cell proliferation assays, enzyme kinetics, phasecontrast microscopic video imaging and ex vivo toxicity tests. We have shown that ethyl pyruvate effectively kills trypanosomes most probably by net ATP depletion through inhibition of pyruvate kinase (Ki = 3.0\(\pm\)0.29 mM). The potential of ethyl pyruvate as a trypanocidal compound is also strengthened by its fast acting property, killing cells within three hours post exposure. This has been demonstrated using video imaging of live cells as well as concentration and time dependency experiments. Most importantly, ethyl pyruvate produces minimal side effects in human red cells and is known to easily cross the blood-brain-barrier. This makes it a promising candidate for effective treatment of the two clinical stages of sleeping sickness. Trypanosome drug-resistance tests indicate irreversible cell death and a low incidence of resistance development under experimental conditions.
Conclusion
Our results present ethyl pyruvate as a safe and fast acting trypanocidal compound and show that it inhibits the enzyme pyruvate kinase. Competitive inhibition of this enzyme was found to cause ATP depletion and cell death. Due to its ability to easily cross the blood-brain-barrier, ethyl pyruvate could be considered as new candidate agent to treat the hemo-lymphatic as well as neurological stages of sleeping sickness.
Cells exposed to extreme physicochemical or mechanical stimuli die in an uncontrollable manner, as a result of their immediate structural breakdown. Such an unavoidable variant of cellular demise is generally referred to as 'accidental cell death' (ACD). In most settings, however, cell death is initiated by a genetically encoded apparatus, correlating with the fact that its course can be altered by pharmacologic or genetic interventions. 'Regulated cell death' (RCD) can occur as part of physiologic programs or can be activated once adaptive responses to perturbations of the extracellular or intracellular microenvironment fail. The biochemical phenomena that accompany RCD may be harnessed to classify it into a few subtypes, which often (but not always) exhibit stereotyped morphologic features. Nonetheless, efficiently inhibiting the processes that are commonly thought to cause RCD, such as the activation of executioner caspases in the course of apoptosis, does not exert true cytoprotective effects in the mammalian system, but simply alters the kinetics of cellular demise as it shifts its morphologic and biochemical correlates. Conversely, bona fide cytoprotection can be achieved by inhibiting the transduction of lethal signals in the early phases of the process, when adaptive responses are still operational. Thus, the mechanisms that truly execute RCD may be less understood, less inhibitable and perhaps more homogeneous than previously thought. Here, the Nomenclature Committee on Cell Death formulates a set of recommendations to help scientists and researchers to discriminate between essential and accessory aspects of cell death.
This dissertation deals with the contract choice of upstream suppliers as well as the consequences on competition and efficiency in a dynamic setting with inter-temporal externalities.
The introduction explains the motivation of the analysis and the comparison of different contract types, as for example standard contracts like simple two-part tariffs and additional specifications as contracts referencing the quantity of the contract-offering firm or the relative purchase level. The features of specific market structures should be considered in the analysis of specific vertical agreements and their policy implications. In particular, the role of dynamic changes regarding demand and cost parameters may have an influence on the results observed.
In the first model, a dominant upstream supplier and a non-strategic rival sell their products to a single downstream firm. The rival supplier faces learning effects which decrease the rival’s costs with respect to its previous sales. Therefore, learning effects represent a dynamic competitive threat to the dominant supplier. In this setup, the dominant supplier can react on inter-temporal externalities by specifying its contract to the downstream firm. The model shows that by offering market-share discounts, instead of simple two-part tariffs or quantity discounts, the dominant supplier maximizes long-run profits, and restricts the efficiency gains of its rival. If demand is linear, the market-share discount lowers consumer surplus and welfare.
The second model analyzes the strategic use of bilateral contracts in a sequential bargaining game. A dominant upstream supplier and its rival sequentially negotiate with a single downstream firm. The contract choice of the dominant supplier as well as the rival supplier’s reaction are investigated. In a single-period sequential contracting game, menus of simple two-part tariffs achieve the industry profit maximizing outcome. In a dynamic setting where the suppliers sequentially negotiate in each period, the dominant supplier uses additional contractual terms that condition on the rival’s quantity. Due to the first-mover advantage of the first supplier, the rival supplier is restricted in its contract choice. The consequences of the dominant supplier’s contract choice depend on bargaining power. In particular, market-share contracts can be efficiency enhancing and welfare-improving whenever the second supplier has a relatively high bargaining position vis-`a-vis the downstream firm. For a relatively low bargaining position of the rival supplier, the result is similar to the one determined in the first model. We show that results depend on the considered negotiating structure.
The third model studies the contract choice of two upstream competitors that simultaneously deal with a common buyer. In a complete information setting where both suppliers get to know whether further negotiations fail or succeed, a singleperiod model solves for the industry-profit maximizing outcome as long as contractual terms define at least a wholesale price and a fixed fee. In contrast, this collusive outcome cannot be achieved in a two-period model with inter-temporal externalities.
We characterize the possible market scenarios, their outcomes and consequences on competition and efficiency. Our results demonstrate that in case a rival supplier is restricted in its contract choice, the contract specification of a dominant supplier can partially exclude the competitor. Whenever equally efficient suppliers can both strategically choose contract specifications, the rivals defend their market shares by adapting appropriate contractual conditions.
The final chapter provides an overview of the main findings and presents some concluding remarks.
Early life stress, including exposure to prenatal stress (PS), has been shown to affect the developing brain and induce severe effects on emotional health in later life, concomitant with an increased risk for psychopathology. However, some individuals are more vulnerable to early-life stress, while others adapt successfully, i.e. they are resilient and do not succumb to adversity. The molecular substrates promoting resilience in some individuals and vulnerability in other individuals are as yet poorly investigated. A polymorphism in the serotonin transporter gene (5HTT/SLC6A4) has been suggested to play a modulatory role in mediating the effects of early-life adversity on psychopathology, thereby rendering carriers of the lower-expressing short (s)-allele more vulnerable to developmental adversity, while long (l)-allele carriers are relatively resilient. The molecular mechanisms underlying this gene x environment interaction (GxE) are not well understood, however, epigenetic mechanisms such as DNA methylation and histone modifications have been discussed to contribute as they are at the interface of environment and the genome. Moreover, developmental epigenetic programming has also been postulated to underlie differential vulnerability/resilience independent of genetic variation.
The present work comprises two projects investigating the effects of prenatal maternal restraint stress in 5-HTT deficient mice. In the first study, we examined to which extent previously observed changes in behavior and hippocampal gene expression of female 5-Htt+/- prenatally stressed (PS) offspring were associated with changes in DNA methylation patterns. Additionally, we investigated the expression of genes involved in myelination in hippocampus and amygdala of those animals using RT-qPCR. The genome-wide hippocampal DNA methylation screening was performed using methylated-DNA immunoprecipitation (MeDIP) on Affymetrix GeneChip® Mouse Promoter 1.0R arrays. In order to correlate individual gene-specific DNA methylation, mRNA expression and behavior, we used hippocampal DNA from the same mice as assessed before. 5-Htt genotype, PS and their interaction differentially affected the DNA methylation signature of numerous genes, a part of which were also differentially expressed. More specifically, we identified a differentially methylated region in the Myelin basic protein (Mbp) gene, which was associated with Mbp expression in a 5-Htt-, PS- and 5-Htt x PS-dependent manner. Subsequent fine-mapping linked the methylation status of two specific CpG sites in this region to Mbp expression and anxiety-related behavior. We furthermore found that not only the expression of Mbp but of large gene set associated with myelination was affected by a 5-Htt x PS interaction in a brain-region specific manner. In conclusion, hippocampal DNA methylation patterns and expression profiles of female PS 5-Htt+/- mice suggest that distinct molecular mechanisms, some of which are associated with changes in gene promoter methylation, and processes associated with myelination contribute to the behavioral effects of the 5-Htt genotype, PS exposure, and their interaction.
In the second study, we aimed at investing the molecular substrates underlying resilience to PS. For this purpose, we exposed 5-Htt+/+ dams to the same restraint stress paradigm and investigated the effects of PS on depression- and anxiety-like behavior and corticosterone (CORT) secretion at baseline and after acute restraint stress in female 5-Htt+/+ and 5-Htt+/- offspring. We found that PS affected the offspring’s social behavior in a negative manner. When specifically examining those PS animals, we grouped the PS offspring of each genotype into a social, resilient and an unsocial, vulnerable group. While anxiety-like behavior in the EPM was reduced in unsocial, but not social, PS 5-Htt+/+ animals when compared to controls, this pattern could not be found in animals of the other genotype, indicating that social anxiety and state anxiety in the EPM were independent of each other. We then assessed genome-wide hippocampal gene expression profiles using mRNA sequencing in order to identify pathways and gene ontology (GO) terms enriched due to 5-Htt genotype (G), PS exposure (E) and their interaction (GxE) as well as enriched in social, but not unsocial, PS offspring, and vice versa. Numerous genes were affected by 5-Htt genotype, PS and most of all a GxE-interaction. Enrichment analysis using enrichr identified that the genotype affected mitochondrial respiration, while GxE-interaction-affected processes associated primarily with myelination and chromatin remodeling. We furthermore found that 5-Htt+/- mice showed profound expression changes of numerous genes in a genomic region located 10 mio kb upstream of the 5 Htt locus on the same chromosome. When looking at social vs. unsocial mice, we found that a much higher number of genes was regulated in 5 Htt+/- animals than in 5-Htt+/+ animals, reflecting the impact of GxE-interaction. Double the number of genes was regulated in social PS vs. control mice when compared to unsocial PS vs. control in both genotypes, suggesting that the successful adaption to PS might have required more active processes from the social group than the reaction to PS from the unsocial group. This notion is supported by the up-regulation of mitochondrial respiration in social, but not in unsocial, PS 5-Htt+/- mice when compared to controls, as those animals might have been able to raise energy resources the unsocial group was not. Next to this, processes associated with myelination seemed to be down-regulated in social 5-Htt+/- mice, but not in unsocial animals, when compared to controls. Taken together, PS exposure affected sociability and anxiety-like behavior dependent on the 5-Htt genotype in female offspring. Processes associated with myelination and epigenetic mechanisms involved in chromatin remodeling seemed be affected in a GxE-dependent manner in the hippocampus of these offspring. Our transcriptome data furthermore suggest that mitochondrial respiration and, with this, energy metabolism might be altered in 5-Htt+/- offspring when compared to 5-Htt+/+ offspring. Moreover, myelination and mitochondrial respiration might contribute to resilience towards PS exposure in 5-Htt+/- offspring, possibly by affecting brain connectivity and energy capabilities.
The epigenome is thought to mediate between genes and the environment, particularly in response to adverse life experiences. Similar to other psychiatric diseases, the suicide liability of an individual appears to be influenced by many genetic factors of small effect size as well as by environmental stressors. To identify epigenetic marks associated with suicide, which is considered the endpoint of complex gene-environment interactions, we compared the cortex DNA methylation patterns of 6 suicide completers versus 6 non-psychiatric sudden-death controls, using Illumina 450K methylation arrays. Consistent with a multifactorial disease model, we found DNA methylation changes in a large number of genes, but no changes with large effects reaching genome-wide significance. Global methylation of all analyzed CpG sites was significantly (0.25 percentage point) lower in suicide than in control brains, whereas the vast majority (97%) of the top 1,000 differentially methylated regions (DMRs) were higher methylated (0.6 percentage point) in suicide brains. Annotation analysis of the top 1,000 DMRs revealed an enrichment of differentially methylated promoters in functional categories associated with transcription and expression in the brain. In addition, we performed a comprehensive literature research to identify suicide genes that have been replicated in independent genetic association, brain methylation and/or expression studies. Although, in general, there was no significant overlap between different published data sets or between our top 1,000 DMRs and published data sets, our methylation screen strengthens a number of candidate genes (APLP2, BDNF, HTR1A, NUAK1, PHACTR3, MSMP, SLC6A4, SYN2, and SYNE2) and supports a role for epigenetics in the pathophysiology of suicide.
The obligate intracellular bacterium Chlamydia trachomatis invades into host cells to replicate inside a membrane-bound vacuole called inclusion. Multiple different host proteins are recruited to the inclusion and are functionally modulated to support chlamydial development. Invaded and replicating Chlamydia induces a long-lasting activation of the PI3 kinase signaling pathway that is required for efficient replication. We identified the cell surface tyrosine kinase EphrinA2 receptor (EphA2) as a chlamydial adherence and invasion receptor that induces PI3 kinase (PI3K) activation, promoting chlamydial replication. Interfering with binding of C. trachomatis serovar L2 (Ctr) to EphA2, downregulation of EphA2 expression or inhibition of EphA2 activity significantly reduced Ctr infection. Ctr interacts with and activates EphA2 on the cell surface resulting in Ctr and receptor internalization. During chlamydial replication, EphA2 remains active accumulating around the inclusion and interacts with the p85 regulatory subunit of PI3K to support the activation of the PI3K/Akt signaling pathway that is required for normal chlamydial development. Overexpression of full length EphA2, but not the mutant form lacking the intracellular cytoplasmic domain, enhanced PI3K activation and Ctr infection. Despite the depletion of EphA2 from the cell surface, Ctr infection induces upregulation of EphA2 through the activation of the ERK pathway, which keeps the infected cell in an apoptosis-resistant state. The significance of EphA2 as an entry and intracellular signaling receptor was also observed with the urogenital C. trachomatis-serovar D. Our findings provide the first evidence for a host cell surface receptor that is exploited for invasion as well as for receptor-mediated intracellular signaling to facilitate chlamydial replication. In addition, the engagement of a cell surface receptor at the inclusion membrane is a new mechanism by which Chlamydia subverts the host cell and induces apoptosis resistance.
Vacancy-related centres in silicon carbide are attracting growing attention because of their appealing optical and spin properties. These atomic-scale defects can be created using electron or neutron irradiation; however, their precise engineering has not been demonstrated yet. Here, silicon vacancies are generated in a nuclear reactor and their density is controlled over eight orders of magnitude within an accuracy down to a single vacancy level. An isolated silicon vacancy serves as a near-infrared photostable single-photon emitter, operating even at room temperature. The vacancy spins can be manipulated using an optically detected magnetic resonance technique, and we determine the transition rates and absorption cross-section, describing the intensity-dependent photophysics of these emitters. The on-demand engineering of optically active spins in technologically friendly materials is a crucial step toward implementation of both maser amplifiers, requiring high-density spin ensembles, and qubits based on single spins.
Energy Transfer Between Squaraine Polymer Sections: From helix to zig-zag and All the Way Back
(2015)
Joint experimental and theoretical study of the absorption spectra of squaraine polymers in solution provide evidence that two different conformations are present in solution: a helix and a zig-zag structure. This unique situation allows investigating ultrafast energy transfer processes between different structural segments within a single polymer chain in solution. The understanding of the underlying dynamics is of fundamental importance for the development of novel materials for light-harvesting and optoelectronic applications. We combine here femtosecond transient absorption spectroscopy with time-resolved 2D electronic spectroscopy showing that ultrafast energy transfer within the squaraine polymer chains proceeds from initially excited helix segments to zig-zag segments or vice versa, depending on the solvent as well as on the excitation wavenumber. These observations contrast other conjugated polymers such as MEH-PPV where much slower intrachain energy transfer was reported. The reason for the very fast energy transfer in squaraine polymers is most likely a close matching of the density of states between donor and acceptor polymer segments because of very small reorganization energy in these cyanine-like chromophores.
The focus of this work was the investigation of energy transfer between charge transfer states. For this purpose the multidimensional chromophores HAB-S, HAB-A, B1 and B2 were synthesised, each consisting of three electron donor and three electron acceptor redox centres linked symmetrically or asymmetrically by the hexaarylbenzene framework. Triarylamines represent in all these compounds the electron donors, whereas the electron poor centres were triarylboranes in B1 and B2 and PCTM centres in HAB-S and HAB-A, respectively. The hexaarylbenzenes were obtained by cobalt catalysed cyclotrimerisation of the respective tolan precursors. In addition, Star was synthesised, which consists of a central PCTM linked to three triarylamin centres by tolan bridging units in a star-like configuration. The hexaarylbenzene S1a/b substituted with six squaraine chromophores could not be realised. It is assumed that the cyclotrimerisation catalyst Co2(CO)8 does not tolerate the essential hydroxyl groups in the tolan precursor S2a. The alternative reaction pathway to execute the cyclotrimerisation reaction first and introduce the hydroxyl groups thereafter failed as well, because the required hexaarylbenzene substituted by six semisquaric acid moieties could not be synthesised. However, energy transfer interactions could be investigated in the tolan precursor S2a with two squaraine units to obtain information about the electronic coupling provided by the tolan bridge. For all multidimensional compounds model molecules were synthesised with only a single donor-acceptor pair (B3, Star-Model and HAB-Model). This allows a separate consideration of energy and charge transfer processes. It has to be stressed that in all before mentioned multidimensional compounds the “through bond” energy transfer interaction between neighbouring IV-CT states is identical to a transfer of a single electron between two redox centres of the same kind (e.g. TAA -> TAA+). The latter can be analysed by electron transfer theory. This situation is observed when the two IV-CT states transferring energy share one redox centre.
All compounds containing PCTM centres were characterised by paramagnetic resonance spectroscopy. Thereby, a weak interaction between the three PCTM units in HAB-S and HAB-A was observed. In addition, when oxidising Star-Model, a strongly interacting singlet or triplet state was obtained. In contrast, signals corresponding to a weakly interacting biradical were obtained for HAB-Model+. This indicates a strong electronic coupling between the redox centres provided by the tolan bridge and a weak coupling when linked by the hexaarylbenzene. This trend is supported by UV/Vis/NIR absorption measurements. The analysis of the observed IV-CT absorption bands by electron transfer theory reveals a weak electronic coupling of V = 340 cm-1 in HAB-Model and a distinctly stronger coupling of V = 1190-2900 cm-1 in Star-Model. In the oxidised HAB-S+, Star+ and Star-Model+ a charge transfer reversed from that of the neutral species, that is, from the PCTM radical to the electron poorer cationic TAA centre, was observed by spectroelectrochemistry. The temporal evolution of the excited states was monitored by ultrafast transient absorption measurements. Within the first picosecond stabilisation of the charge transfer state was observed, induced by solvent rotation. Anisotropic transient absorption measurements revealed that within the lifetime of the excited state (tau = 1-4 ps) energy transfer does not occur in the HABs whereas in the star-like system ultrafast and possibly coherent energy redistribution is observed. Taken this information together the identity between energy transfer and electron transfer in the specific systems were made apparent. It has to be remarked that neither energy transfer nor charge transfer theory can account for the very fast energy transfer in Star.
The electrochemical and photophysical properties of B1 and B2 were investigated by cyclic voltammetry, absorption and fluorescence measurements and were compared to B3 with only one neighbouring donor-acceptor pair. For the asymmetric B2 CV measurements show three oxidations as well as three reduction peaks whose peak separation is greatly influenced by the conducting salt due to ion-pairing and shielding effects. Consequently, peak separations cannot be interpreted in terms of electronic couplings in the generated mixed valence species. Transient absorption, fluorescence solvatochromism and absorption spectra show that charge transfer states from the amine to the boron centres are generated after optical excitation. The electronic donor-acceptor interaction is weak though as the charge transfer has to occur predominantly through space. The electronic coupling could not be quantified as the CT absorption band is superimposed by pi-pi* transitions localised at the amine and borane centres. However, this trend is in good agreement to the weak coupling measured for HAB-Model. Both transient absorption and fluorescence upconversion measurements indicate an ultrafast stabilisation of the charge transfer state in B1- B3 similar to the corresponding observations in HAB-S and Star. Moreover, the excitation energy of the localised excited charge transfer states can be redistributed between the aryl substituents of these multidimensional chromophores within fluorescence lifetime (ca. 60 ns). This was proved by steady state fluorescence anisotropy measurements, which further indicate a symmetry breaking in the superficially symmetric HAB. Anisotropic fluorescence upconversion measurements confirm this finding and reveal a time constant of tau = 2-3 ps for the energy transfer in B1 and B2. It has to be stressed that, although the geometric structures of B1 and HAB-S are both based on the same framework and furthermore the neighbouring CT states show in both cases similar Coulomb couplings and negligible “through bond” couplings, very fast energy transfer is observed in B1 whereas in HAB-S the energy is not redistributed within the excited state lifetime. To explain this, it has to be kept in mind that the energy transfer and the relaxation of the CT state are competing processes. The latter is influenced moreover by the solvent viscosity. Hence, it is assumed that this discrepancy in energy transfer behaviour is caused by monitoring the excited state in solvents of varying viscosity. Adding fluoride ions causes the boron centres to lose their acceptor ability due to complexation. Consequently, the charge transfer character in the donor-acceptor chromophores vanishes which could be observed in both the absorption and fluorescence spectra. However, the fluoride sensor ability of the boron centre is influenced strongly by the moisture content of the solvent possibly due to hydrogen bonding of water to the fluoride anions.
UV/Vis/NIR absorption measurements of S2a show a red-shift by 1800 cm-1 of the characteristic squarain band compared to the model compound S20. From exciton theory a Coulomb coupling of V = 410 cm-1 is calculated which cannot account for this strong spectral shift. Consequently, “through-bond” interactions have to contribute to the strong communication between the two squaraine chromophores in S2a. This is in accordance with the strong charge transfer coupling calculated for the tolan spacer in Star-Model.