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Mit der vermehrten Nutzung zentralvenöser Katheter in der Pädiatrie stieg die Inzidenz der katheterassoziierten Komplikationen, darunter auch das Auftreten von katheterassoziierten Thrombosen, in den letzten Jahren an. Aufgrund der geringen Studienzahl und großer Unterschiede zwischen den existierenden Studien gibt es diesbezüglich für pädiatrische Patienten bisher noch wenig evidentes Wissen.
Ziel dieser Promotionsarbeit war es einerseits, eine aktuelle epidemiologische Erhebung der katheterassoziierten Thrombose bei onkologisch pädiatrischen Patienten durchzuführen. Zum anderen sollten Zusammenhänge zwischen patienten-/diagnose/katheterspezifischen Charakteristika und dem Auftreten katheterassoziierter Thrombosen erfasst werden, um mögliche Risikogruppen ausfindig zu machen, welche möglicherweise von der Anwendung präventiver Maßnahmen profitieren.
Zu diesem Zweck wurde die retrospektive Untersuchung an der onkologisch pädiatrischen Abteilung der Universitätskinderklinik Würzburg über den Zeitraum von 2008 bis 2012 durchgeführt.
Mittels der Datenerhebung über das klinikinterne SAP-System sowie anhand der Durchsicht von Patientenakten wurden insgesamt 448 neu diagnostizierte onkologisch pädiatrische Patienten, darunter 43 mit katheterassoziierter Thrombose, in die retrospektive Erhebung eingeschlossen.
Durch die statistische Auswertung der Daten konnte eine Inzidenz von 15.9% der katheterassoziierten Thrombose berechnet werden, wobei die Anzahl der neu aufgetretenen, dokumentierten Thrombosefälle im Laufe der beobachteten Jahre um fast das Doppelte anstiegen. Obwohl weder Geschlecht noch Alter als Risikofaktor für das Auftreten von katheterassoziierten Thrombosen identifiziert wurden, waren die weiblichen Patienten zum Zeitpunkt der Thrombose signifikant älter als die männlichen. Auf der Suche nach weiteren Risikofaktoren der katheterassoziierten Thrombose, konnten wir überdies feststellen, dass die Anwendung von Asparaginase Therapie signifikant mit dem Auftreten von Thrombosen assoziiert war.
Neben der Evaluation des thrombotischen Einflusses onkologischer Medikamente beobachteten wir, dass überlebende sowie die an ihrer Primärdiagnose verstorbenen Patienten mit fortschreitender Erkrankung mehr thrombotische Ereignisse zu verzeichnen hatten, als jene in kompletter Remission. Wir konnten folglich also in unseren Daten einen Zusammenhang zwischen Krankheitsstadium und Auftreten von katheterassoziierten Thrombosen nachweisen. Neben der Evaluation von patienten- und diagnoseassoziierter Risikofaktoren untersuchten wir auch, ob die erhobenen Parameter des implantierten Katheters mit einer erhöhten Thromboseinzidenz einhergingen. Dabei zeigte die Statistik unserer Daten, dass die in die Vena subclavia implantierten Katheter häufiger mit Thrombosen assoziiert waren als Katheter in der Vena jugularis externa und Vena cephalica.
Bezüglich der klinischen Manifestation der katheterassoziierten Thrombosen ergab die Auswertung unserer Daten zuletzt, dass sich der Großteil der Thrombosen anhand von Katheterdysfunktion manifestierte, während nur wenige Thrombosen mit klinischen Symptomen, wie lokalen Schmerzen, Schwellung von Arm, Hals und Gesicht, Ödembildung, Dilatation und Kollateralisierung oberflächlicher Venen einhergingen.
Wie in der Literatur weitgehend bekannt, konnten wir das thrombotische Risiko von Asparaginase Therapie bestätigen, wobei die Veränderung der Zusammensetzung der Blutgerinnungsfaktoren möglicherweise eine Rolle spielt.
Auch das erhöhte Thromboserisiko der Implantation zentralvenöser Katheter in die Vena subclavia wurde bereits in anderen Studien beobachtet und konnte in unserer pädiatrischen Kohorte bestätigt werden. Bezüglich des Zusammenhangs zwischen Tumorprogress und der erhöhten Inzidenz katheterassoziierter Thrombosen vermuten wir anhand unserer Daten und der vorliegenden Daten aus dem adulten Bereich, dass tumorspezifische Faktoren wie beispielsweise Metastasierung mit sekundärer Stase, Immobilisation, Dehydratation und Inflammation in der letzten Lebensphase zu einem erhöhten Risiko von Katheter assoziierten Thrombosen beitragen könnten.
Insgesamt ist die aktuelle Evidenz von Risikofaktoren katheterassoziierter Thrombosen in pädiatrischen Kohorten sehr limitiert. Prospektive, groß angelegte Studien werden daher dringend benötigt.
Anhand der von uns durchgeführten Studie konnte gezeigt werden, dass ein Zusammenspiel aus bestimmten patientenspezifischer, tumor sowie katheter assoziierter Faktoren auf das Auftreten katheterbedingter Thrombosen Einfluss nehmen kann. Da diese gefundenen Risikofaktoren mittels unserer retrospektiven Studie in erster Linie Hypothesen darstellen, die noch nicht eindeutig verifiziert werden können, sollten die beobachteten Tendenzen als auch Signifikanzen in einer größer angelegten prospektiven Studie evaluiert werden.
Bei der Konzeption zukünftiger Studien sollte daher besonders auf die Definition von Thrombose, die Zusammensetzung des Patientenkollektivs sowie die diagnostischen Mittel zur Erhebung der Daten geachtet werden, um eine Vergleichbarkeit der Ergebnisse zu gewährleisten. Ein weiteres Ziel für die Zukunft besteht darin, den Nutzen therapeutischer Antikoagulation, sowie primärer und sekundärer Prophylaxe der katheterassoziierten Thrombose, wie auch weitere thromboseassoziierte Risikofaktoren bei kindlichmalignen Grunderkrankungen zu evaluieren, um auf Grundlage evidenter Daten allgemeingültige Empfehlungen zur optimalen Thromboseprävention aussprechen zu können.
TNF receptor type 2 (TNFR2) has gained attention as a costimulatory receptor for T cells and as critical factor for the development of regulatory T cells (Treg) and myeloid suppressor cells. Using the TNFR2-specific agonist TNCscTNF80, direct effects of TNFR2 activation on myeloid cells and T cells were investigated in mice. \(In\) \(vitro\), TNCscTNF80 induced T cell proliferation in a costimulatory fashion, and also supported \(in\) \(vitro\) expansion of Treg cells. In addition, activation of TNFR2 retarded differentiation of bone marrow-derived immature myeloid cells in culture and reduced their suppressor function. \(In\) \(vivo\) application of TNCscTNF80-induced mild myelopoiesis in naïve mice without affecting the immune cell composition. Already a single application expanded Treg cells and improved suppression of CD4 T cells in mice with chronic inflammation. By contrast, multiple applications of the TNFR2 agonist were required to expand Treg cells in naïve mice. Improved suppression of T cell proliferation depended on expression of TNFR2 by T cells in mice repeatedly treated with TNCscTNF80, without a major contribution of TNFR2 on myeloid cells. Thus, TNFR2 activation on T cells in naïve mice can lead to immune suppression \(in\) \(vivo\). These findings support the important role of TNFR2 for Treg cells in immune regulation.
Background:
According to only a handful of historical sources, Osmunda regalis, the royal fern, has been used already in the middle age as an anti-cancer remedy. To examine this ancient cancer cure, an ethanolic extract of the roots was prepared and analysed in vitro on its effectiveness against head and neck cancer cell lines.
Methods:
Proliferation inhibition was measured with the MTT assay. Invasion inhibition was tested in a spheroid-based 3-D migration assay on different extracellular matrix surfaces. Corresponding changes in gene expression were analysed by qRT-PCR array. Induction of apoptosis was measured by fluorescence activated cell sorting (FACS) with the Annexin V binding method. The plant extract was analysed by preliminary phytochemical tests, liquid chromatography/mass spectroscopy (LC-MS) and thin layer chromatography (TLC). Anti-angiogenetic activity was determined by the tube formation assay.
Results:
O. regalis extract revealed a growth inhibiting effect on the head and neck carcinoma cell lines HLaC78 and FaDu. The toxic effect seems to be partially modulated by p-glycoprotein, as the MDR-1 expressing HLaC79-Tax cells were less sensitive. O. regalis extract inhibited the invasion of cell lines on diverse extracellular matrix substrates significantly. Especially the dispersion of the highly motile cell line HlaC78 on laminin was almost completely abrogated. Motility inhibition on laminin was accompanied by differential gene regulation of a variety of genes involved in cell adhesion and metastasis. Furthermore, O. regalis extract triggered apoptosis in HNSCC cell lines and inhibited tube formation of endothelial cells. Preliminary phytochemical analysis proved the presence of tannins, glycosides, steroids and saponins. Liquid chromatography/mass spectroscopy (LC-MS) revealed a major peak of an unknown substance with a molecular mass of 864.15 Da, comprising about 50% of the total extract. Thin layer chromatography identified ferulic acid to be present in the extract.
Conclusion:
The presented results justify the use of royal fern extracts as an anti-cancer remedy in history and imply a further analysis of ingredients.
Several important cellular processes, including transcription, nucleotide excision repair and cell cycle control are mediated by the multifaceted interplay of subunits within the general transcription factor II H (TFIIH).
A better understanding of the molecular structure of TFIIH is the key to unravel the mechanism of action of this versatile protein complex within these pathways. This becomes especially important in the context of severe diseases like xeroderma pigmentosum, Cockayne syndrome and trichothiodystrophy, that arise from single point mutations in some of the TFIIH subunits.
In an attempt to structurally characterize the TFIIH complex, we harnessed the qualities of the eukaryotic thermophile Chaetomium thermophilum, a remarkable fungus, which has only recently been recognized as a novel model organism. Homologues of TFIIH from C. thermophilum were expressed in E. coli, purified to homogeneity and subsequently utilized for crystallization trials and biochemical studies.
The results of the present work include the first crystal structure of the p34 subunit of TFIIH, comprising the N-terminal domain of the protein. The structure revealed a von Willebrand Factor A (vWA) like fold, which is generally known to be involved in a multitude of protein-protein interactions. Structural comparison allowed to delineate similarities as well as differences to already known vWA domains, providing insight into the role of p34 within TFIIH. These results indicate that p34 assumes the role of a structural scaffold for other TFIIH subunits via its vWA domain, while likely serving additional functions, which are mediated through its
C-terminal zinc binding domain and are so far unknown.
Within TFIIH p34 interacts strongly with the p44 subunit, a positive regulator of the XPD helicase, which is required for regulation of RNA Polymerase II mediated transcription and essential for eukaryotic nucleotide excision repair. Based on the p34 vWA structure putative protein-protein interfaces were analyzed and binding sites for the p34 p44 interaction suggested. Continuous crystallization efforts then led to the first structure of a p34 p44 minimal complex, comprising the N-terminal vWA domain of p34 and the C-terminal C4C4 RING domain of p44. The structure of the p34 p44 minimal complex verified the previous hypothesis regarding the involved binding sites. In addition, careful analysis of the complex interface allowed to identify critical residues, which were subsequently mutated and analyzed with respect to their significance in mediating the p34 p44 interaction, by analytical size exclusion chromatography, electrophoretic mobility shift assays and isothermal titration calorimetry. The structure of the p34 p44 complex also revealed a binding mode of the p44 C4C4 RING domain, which differed from that of other known RING domains in several aspects, supporting the hypothesis that p44 contains a novel variation of this domain.
The synapse-associated protein of 47 kDa (Sap47) in Drosophila melanogaster is the founding member of a phylogenetically conserved protein family of hitherto unknown molecular function. Sap47 is localized throughout the entire neuropil of adult and larval brains and closely associated with glutamatergic presynaptic vesicles of larval motoneurons. Flies lacking the protein are viable and fertile and do not exhibit gross structural or marked behavioral deficiencies indicating that Sap47 is dispensable for basic synaptic function, or that its function is compensated by other related proteins.
Syap1 - the mammalian homologue of Sap47 - was reported to play an essential role in Akt1 phosphorylation in various non-neuronal cells by promoting the association of mTORC2 with Akt1 which is critical for the downstream signaling cascade for adipogenesis. The function of Syap1 in the vertebrate nervous system, however, is unknown so far.
The present study provides a first description of the subcellular localization of mouse Syap1 in cultured motoneurons as well as in selected structures of the adult mouse nervous system and reports initial functional experiments. Preceding all descriptive experiments, commercially available Syap1 antibodies were tested for their specificity and suitability for this study. One antibody raised against the human protein was found to recognize specifically both the human and murine Syap1 protein, providing an indispensable tool for biochemical, immunocytochemical and immunohistochemical studies.
In the course of this work, a Syap1 knockout mouse was established and investigated. These mice are viable and fertile and do not show obvious changes in morphology or phenotype. As observed for Sap47 in flies, Syap1 is widely distributed in the synaptic neuropil, particularly in regions rich in glutamatergic synapses but it was also detected at perinuclear Golgi-associated sites in certain groups of neuronal somata. In motoneurons the protein is especially observed in similar perinuclear structures, partially overlapping with Golgi markers and in axons, dendrites and axonal growth cones. Biochemical and immunohistochemical analyses showed widespread Syap1 expression in the central nervous system with regionally distinct distribution patterns in cerebellum, hippocampus or olfactory bulb. Besides its expression in neurons, Syap1 is also detected in non-neuronal tissue e.g. liver, kidney and muscle tissue. In contrast, non-neuronal cells in the brain lack the typical perinuclear accumulation.
First functional studies with cultured primary motoneurons on developmental, structural and functional aspects reveal no influence of Syap1 depletion on survival and morphological features such as axon length or dendritic length. Contrary to expectations, in neuronal tissues or cultured motoneurons a reduction of Akt phosphorylation at Ser473 or Thr308 was not detected after Syap1 knockdown or knockout.
Desert ants of the genus Cataglyphis (Formicinae) are widely distributed in arid
areas of the palearctic ecozone. Their habitats range from relatively cluttered environments in the Mediterranean area to almost landmark free deserts. Due to their
sophisticated navigational toolkit, mainly based on the sky-compass, they were
studied extensively for the last 4 decades and are an exceptional model organism
for navigation. Cataglyphis ants exhibit a temporal polyethism: interior workers
stay inside the dark nest and serve as repletes for the first ∼2 weeks of their adult
life (interior I). They then switch to nursing and nest maintenance (interior II)
until they transition to become day-active outdoor foragers after ∼4 weeks. The
latter switch in tasks involves a transition phase of ∼2-3 days during which the
ants perform learning and orientation walks. Only after this last phase do the ants
start to scavenge for food as foragers.
In this present thesis I address two main questions using Cataglyphis desert ants
as a model organism:
1. What are the underlying mechanisms of temporal polyethism?
2. What is the neuronal basis of sky-compass based navigation in Cataglyphis
ants?
Neuropeptides are important regulators of insect physiology and behavior and as
such are promising candidates regarding the regulation of temporal polyethism in
Cataglyphis ants. Neuropeptides are processed from large precursor proteins and undergo substantial post-translational modifications. Therefore, it is crucial to biochemically identify annotated peptides. As hardly any peptide data are available
for ants and no relevant genomic data has been recorded for Cataglyphis, I started
out to identify the neuropeptidome of adult Camponotus floridanus (Formicinae)
workers (manuscript 1). This resulted in the first neuropeptidome described in an
ant species – 39 neuropeptides out of 18 peptide families. Employing a targeted
approach, I identified allatostatin A (AstA), allatotropin (AT), short neuropeptide
F (sNPF) and tachykinin (TK) using mass spectrometry and immunohistology to
investigate the distribution of AstA, AT and TK in the brain (manuscript 2). All
three peptides are localized in the central complex, a brain center for sensory integration and high-order control of locomotion behavior. In addition, AstA and
TK were also found in visual and olfactory input regions and in the mushroom
bodies, the centers for learning and memory formation. Comparing the TK immunostaining in the brain of 1, 7 and 14 days old dark kept animals revealed that
the distribution in the central complex changes, most prominently in the 14 day
old group. In the Drosophila central complex TK modulates locomotor activity
levels. I therefore hypothesize that TK is involved in the internal regulation of the
interior I–interior II transition which occurs after ∼2 weeks of age.
I designed a behavioral setup to test the effect of neuropeptides on the two traits:
’locomotor activity level’ and ’phototaxis’ (manuscript 3). The test showed that
interior I ants are less active than interior II ants, which again are less active
than foragers. Furthermore, interior ants are negatively phototactic compared to
a higher frequency of positive phototaxis in foragers. Testing the influence of AstA
and AT on the ants’ behavior revealed a stage-specific effect: while interior I behavior is not obviously influenced, foragers become positively phototactic and more
active after AT injection and less active after AstA injection. I further tested the
effect of light exposure on the two behavioral traits of interior workers and show that it rises locomotor activity and results in decreased negative phototaxis in
interior ants. However, both interior stages are still more negatively phototactic
than foragers and only the activity level of interior II ants is raised to the forager
level. These results support the hypothesis that neuropeptides and light influence
behavior in a stage-specific manner.
The second objective of this thesis was to investigate the neuronal basis of skycompass navigation in Cataglyphis (manuscript 4). Anatomical localization of the
sky-compass pathway revealed that its general organization is highly similar to
other insect species. I further focused on giant synapses in the lateral complex,
the last relay station before sky-compass information enters the central complex.
A comparison of their numbers between newly eclosed ants and foragers discloses
a rise in synapse numbers from indoor worker to forager, suggesting task-related
synaptic plasticity in the sky-compass pathway. Subsequently I compared synapse
numbers in light preexposed ants and in dark-kept, aged ants. This experiment
showed that light as opposed to age is necessary and sufficient to trigger this rise
in synapse number. The number of newly formed synapses further depends on the
spectral properties of the light to which the ants were exposed to.
Taken together, I described neuropeptides in C. floridanus and C. fortis, and provided first evidence that they influence temporal polyethism in Cataglyphis ants.
I further showed that the extent to which neuropeptides and light can influence
behavior depends on the animals’ state, suggesting that the system is only responsive under certain circumstances. These results provided first insight into the
neuronal regulation of temporal polyethism in Cataglyphis. Furthermore, I characterized the neuronal substrate for sky-compass navigation for the first time in
Cataglyphis. The high level of structural synaptic plasticity in this pathway linked
to the interior–forager transition might be particularly relevant for the initial calibration of the ants’ compass system.
In der vorliegenden Arbeit wurde erfolgreich eine neue Gasphasen-Apparatur für
Photoelektronen-Imaging-Experimente simuliert, aufgebaut und in Verbindung mit einem ps-Lasersystem in Betrieb genommen.
Neben dem Aufbau der Apparatur stand die Aufklärung der Dynamik angeregter Zustände von aromatischen Heterocyclen und Pyrenen im Fokus dieser Arbeit. Die untersuchten Moleküle wurden durch Resonanzverstärkte Mehrphotonenionisation in einem Molekularstrahlexperiment sowohl zeit-, als auch frequenzaufgelöst untersucht.