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Since its discovery as a small signaling molecule in the human body, researchers have tried to utilize the beneficial cytoprotective properties of carbon monoxide in therapeutic applications. Initial work focused on the controlled direct application of CO gas. However, to circumvent the disadvantages of this method such as requirement for special equipment, hospitalization of the patient and the risk of overdosing, metal-carbonyl complexes were developed as CO-releasing molecules (CORMs) which are able to deliver CO in a tissue-specific manner. However, upon the release of CO from the metal coordination sphere, complex fragments termed inactivated CORMs (iCORMs) with free coordination sites remain which can undergo nonspecific follow-up reactions under physiological conditions.
Thus, the first aim of the present thesis was the coordination of tetradentate ligands such as tris(2-pyridylmethyl)amine (tpa), bis(2-pyridylmethyl)(2-quinolylmethyl)amine (bpqa), bis(2-quinolylmethyl)(2-pyridylmethyl)amine (bqpa) and tris(2-quinolylmethyl) amine (tmqa) in a tridentate facial manner to a fac-Mn(CO)3 moiety previously established as a photoactivatable CO-releasing molecule (PhotoCORM). The desired coordination of the pedant donor group upon photolytic CO release at 365 nm was demonstrated by UV/Vis-, IR- und 1H NMR experiments and verified by DFT calculations. All complexes of the series showed long-term dark stability in phosphate-buffered saline (PBS), but released between two and three equivalents of carbon monoxide with half-lives of around 5-10 minutes upon illumination at 365 nm. Although the photolytic properties of the complexes were quite similar besides the differences in type of hetereoaromatic ligands, the determination of the logP values showed an increase of lipophilicity with the number of quinoline groups, which might enable tissue-specific uptake. A significant cellular manganese uptake as well as the binding of CO released upon photolysis to the cytochrome c oxidases in E. coli cells was demonstrated for [Mn(CO)3(tpa)]+. Furthermore, this complex exhibited photoinduced bactericidal activity when the cells were grown in succinate-containing medium and thus unable to change their metabolism to mixed acid fermentation.
In the second part of the project, the hexadentate ligand 1,4,7-tris(2-pyridylmethyl)-1,4,7-triazacyclononane (py3tacn) was coordinated to a facial Mn(CO)3 moiety. The resulting [Mn(CO)3(py3tacn-3N)]+ complex has one pedant donor group per labile carbonyl ligand and thus is a significant improvement over the 1st generation tpa-complexes. The metal-coligand inactivated CORM (iCORM) fragment expected to be generated upon complete photolytic CO release, [Mn(py3tacn-6N)]2+, was synthesized independently and will serve as a well-defined negative control in upcoming biological tests. The corresponding CORM has long-term dark stability in pure dimethylsulfoxide or phosphate-buffered myoglobin solution, with three equivalents of CO released with a half-life of 22 minutes upon illumination at 412 nm. The photolysis was also followed by IR spectroscopy and the intermediates, in line with a stepwise release of carbon monoxide, and occupation of vacated sites by the pedant pyridine group were verified by DFT calculations.
Due to possible tissue damage by energy-rich light and the inverse correlation of tissue penetration depth and illumination wavelength, the absorption maxima of PhotoCORMs should ideally be in the phototherapeutic window between 600 and 1200 nm. Thus, in the third part of this work, a series of heterobinuclear Mn(CO)3/Ru(bpy)2 PhotoCORMs was prepared to shift the absorption of these compounds into the red region of the UV/Vis spectrum. For the synthesis of such Mn(I)/Ru(II) complexes, the bridging ligands 2,3-di(2-pyridyl)quinoxaline (dpx) and 3-(pyridin-2-yl)-1,2,4-triazine[5,6-f]-1,10-phenanthroline (pytp) were prepared and the two binding pockets subsequently filled with a Ru(bpy)2 and a fac-Mn(CO)3 moiety. The resulting two heterobinuclear metal complexes [Ru(bpy)2(dpx)MnBr(CO)3]2+ and [Ru(bpy)2(pytp)MnBr(CO)3]2+ as well as [Ru(etx)(tbx)MnBr(CO)3]2+ with etx = ethyl(2,2':6',2''-terpyridine)-4'-carboxylate and tbx = N-((2,2’:6’,2’’-terpyridin)-4’-yl)2,2’-bipyridine-5-carboxamide which was prepared by a metal precursor provided by the group of Prof. Dr. Katja Heinze showed a significant shift of the main absorption bands to higher wavelengths as well as two times higher extinction coefficients than the analogous mononuclear Mn(I) compounds. However, both the Mn(I)/Ru(II) and Mn(I) complexes had a reduced stability in phosphate-buffered myoglobin solution even in the absence of light. The efficiency of the CO-release from [Ru(etx)(tbx)MnBr(CO)3]2+ and [Ru(bpy)2(dpx)MnBr(CO)3]2+ could be controlled by proper choice of the excitation wavelength. A change from 468 to 525 nm or even 660 nm led to a decrease of the number of CO equivalents released from two to one and an elongation of the half-lives.
Finally, since nitric oxide also serves as a small messenger molecule in the human body with its signaling pathways interacting with those of CO, a mixed-ligand CO/NO metal complex was sought. [Mo(CO)2(NO)(iPr3tacn)]+ with iPr3tacn = 1,4,7-triisopropyl-1,4,7-triazacyclonane was selected from the literature and its molecular structure determined by single crystal diffraction, demonstrating the presence of an NO+ ligand in the coordination sphere as indicated by a MO-N-O angle close to 180°. Photolysis of [Mo(CO)2(NO)(iPr3tacn)]+ required high-energy UV light, which prevented a quantification of the CO release due to photolytic decomposition of the myoglobin. However, solution IR experiments showed that the complex lost the two carbon monoxide ligands upon illumination at 254 nm while the NO remained tightly bound to the metal. The structures observed of the intermediates were also verified by DFT calculations.
In conclusion, in this project, four different classes of novel transition metal-based photoactivatable CO-releasing molecules (PhotoCORMs) were prepared and studied. The first group incorporated one additional free donor group per LMn(CO)3 moiety but varied in the number of coordinated pyridyl and quinolinyl groups which allows the control of the lipophilicity of these compounds. As an extension of this concept, the second series incorporated one free donor group per labile carbonyl ligand which gives rise to well-defined photolysis products that can be independently prepared and assayed. The third class was based on a Ru(II) photosensitizer unit connected to a MnBr(CO)3 PhotoCORM moiety. This shifts the absorption maximum from 500 nm to about 585 nm in [Ru(bpy)2(dpx)MnBr(CO)3]2+. Finally, a first mixed-ligand CO/NO carrier molecule was evaluated for its photolytic behavior. However, while the carbonyl ligands were photolabile at low excitation wavelengths, release of the NO ligand was not observed under the conditions studied.
In a next step, detailed studies on the bioactivity of the different classes of PhotoCORMs need to be carried out with partner groups from biochemistry to fully explore their biomedical potential.
Im Rahmen der vorliegenden Arbeit werden mit einem Rastertunnelmikroskop (RTM) Ladungsdichtemodulationen
(LDM) auf Oberflächen von drei verschiedenen Probensystemen
untersucht. Bei den Proben handelt es sich um Chrom auf Wolfram(110), Iridiumditellurid
(IrTe2) als Volumenmaterial und Eisen auf Rhodium(001). Es werden sowohl die Temperaturabhängigkeit
der Phasenübergänge als auch die Wechselwirkung zwischen magnetischen
und elektronischen Eigenschaften analysiert.
Chrom (Cr) ist ein einfaches Übergangsmetall, in dem sowohl eine klassische Ladungsdichtewelle
(LDW) als auch eine Spindichtewelle (SDW) auftreten. Die im Experiment
betrachteten Cr-Inseln auf Wolfram(110) schlagen eine Brücke zwischen dem Volumenmaterial
und ultradünnen Schichten. Dabei zeigt sich der Zusammenhang zwischen elektronischen
und magnetischen Eigenschaften in der Ausbildung einer LDW-Lücke und dem
gleichzeitigen Verschwinden des magnetischen Kontrastes bei lokalen Schichtdicken von
dCr = 4nm. Dies kann durch eine Rotation des Spindichtewellenvektors Q erklärt werden.
Für dCr < 3nm verschwindet die LDW erneut. Zusätzlich zur LDW und SDW
entsteht aufgrund der unterschiedlichen Gitterparameter von Chrom und Wolfram bei
lokalen Schichtdicken von dCr < 3nm eine Moiré-Überstruktur.
IrTe2 ist Gegenstand zahlreicher aktueller Forschungsaktivitäten und weist eine LDM mit
gleichzeitiger Transformation des atomaren Gitters auf. Ein Phasenübergang erster Ordnung
erzeugt zunächst bei der Übergangstemperatur TC = 275K eine Modulation mit
dem Wellenvektor q = 1/5(1, 1, 0). Mithilfe temperaturabhängiger RTM-Messungen kann
das Phasendiagramm um einen weiteren Übergang erster Ordnung bei TS = 180K erweitert
werden. Dabei bilden sich zunehmend Te-Dimere an der sichtbaren (001)-Oberfläche
und IrTe2 wechselt in einen Grundzustand mit maximaler Dichte von Dimeren und dem
Wellenvektor q = 1/6(1, 1, 0). Der Mechanismus beider Phasenübergänge wird durch die
Probenqualität und die Oberflächenpräparation beeinflusst, sodass die Phasenübergänge
erster Ordnung teilweise verlangsamt ablaufen. Durch eine Analyse der Oberflächendynamik
am Phasenübergang kann der zugrundeliegende Mechanismus des Domänenwachstums
im Realraum untersucht werden.
Im letzten Teil der Arbeit werden ultradünne Eisenfilme auf Rhodium(001) betrachtet.
Dabei treten auf der Doppellage Eisen (Fe) auf Rhodium (Rh) spannungsabhängige
elektronische Modulationen mit senkrecht zueinander orientierten Wellenvektoren
q1 = [(0, 30 ± 0, 03), 0, 0] und q2 = [0, (0, 30 ± 0, 03), 0] in Richtung [100] und [010] auf.
Temperaturabhängige Messungen zeigen die stetige Verkleinerung der Modulation beim
Erwärmen der Probe und somit einen Phasenübergang zweiter Ordnung. Die LDM tritt
auch auf der dritten und vierten Lage Eisen mit gleichgerichteten aber kleineren Wellenvektoren
q auf. Spinpolarisierte RTM-Daten zeigen einen c(2×2)-Antiferromagnetismus auf
einer Monolage Eisen. Für Fe-Bedeckungen von 1ML - 5ML tritt Ferromagnetismus
perpendikular zur Oberfläche auf. Diese Messungen zeigen erstmals gleichzeitiges Auftreten
einer elektronischen und magnetischen Phase in einem reinen 3d-Übergangsmetall
im Realraum.
Das Ewing-Sarkom (EFT) ist nach dem Osteosarkom das zweihäufigste Knochen-assoziierte Malignom im Kindesalter. Das entscheidende Ereignis in der Pathogenese dieser Entität stellt eine chromosomale Translokation dar, welche zur Entstehung eines chimären Transkriptionsfaktors, meist EWS-FLI1, führt. Unsere Absicht war es, die Mechanismen zu verstehen, die letztlich zur Metastasierung von Ewing-Sarkomen mit der damit verbundenen, infausten Prognose führen.
Die Mitglieder der Zyxin-Proteinfamilie sind in vielfältige zelluläre Funktionen involviert. Hierbei nehmen sie, teilweise funktionell redundant, Einfluss auf zytoplasmatische und nukleäre Prozesse. Durch Analyse von öffentlich verfügbaren Microarraydaten konnten wir belegen, dass lediglich das Protein TRIP6 (thyroid receptor interacting protein 6) aus der Familie in EFT deutlich überexprimiert ist. Dieses Protein ist, neben seiner Funktion in der Organisation des Zytoskeletts, auch nukleär als Kotranskriptionsfaktor und als Element der Telomerprotektion tätig. Vielfach wurde eine Implikation des multifunktionellen Adaptorproteins in maligne Prozesse dokumentiert. Die Überexpression von TRIP6 in EFT ist jedoch unabhängig von EWS-FLI1. Eine Bindung von EWS-FLI1 an eine putative Bindungsstelle im Promotor von TRIP6 konnte nicht nachgewiesen werden.
Die Analyse von Microarrays nach TRIP6-Knockdown in EFT-Zelllinien identifizierte mehrere Gensets, welche mit Proliferation und Invasivität assoziiert sind und die nach TRIP6-Knockdown vermindert exprimiert werden. Die für Malignome pathogenetisch relevanten Zielgene Radixin, CD164 und CRYZ konnten als Zielgene des Kotranskriptionsfaktors TRIP6 durch qRT-PCR und Western Blot bestätigt werden. Durch RNA-Interferenz-mediierte Verminderung der Proteinmenge von TRIP6 in EFT kam es zu einer deutlich reduzierten Klonogenität und Migration der Zellen in vitro. Nach induzierbarem TRIP6-Knockdown konnte eine verminderte Tumorigenität und hepatische Metastasierung von hierfür generierten EFT-Einzelzellklonen in vivo beobachtet werden. Zusammengefasst deuten diese Daten auf eine Rolle von TRIP6 in der Pathogenese der EFT und insbesondere beim Prozess der Metastasierung hin. Somit legen diese Ergebnisse eine weitere Evaluierung von TRIP6 als Biomarker oder molekulare Zielstruktur für therapeutische Ansätze in EFT nahe.
India's economic rise since the 1990s has been followed by a more prominent global role for the country. Despite economic setbacks in recent years and huge domestic challenges like poverty, caste issues, and gender inequality, India today is almost universally characterised as an “emerging power”. At the same time, the country continues to show an enormous diversity. Thus, exploring emerging India can surely not be confined to economic analysis only. Instead, it is vital to take current developments in domestic and international politics, society, culture, religion, and political thinking into consideration as well. Following an interdisciplinary approach, contributions from Political Science, International Relations, Indology, Political Theory, and Economics are fundamental in order to grasp the country's diversity. This collection assembles eight essays which, individually, serve as working papers reflecting the authors' various research focuses, while collectively composing a multifaceted and multidis-ciplinary picture of emerging India. It thereby reflects the approach the University of Würz-burg’s Centre for Modern India and the Institute for Political Science and Sociology’s India Forum are committed to: bringing together different academic disciplines in order to generate nuanced insights into India’s manifold diversity.
Utility is perhaps the most central concept in modern economic theorizing. However, the behaviorist reduction to Revealed Preference not only removed the psychological content of utility but experimental investigations also exposed numerous anomalies in this theory.
This program of research focused on the psychological processes by which utility judgments are generated. For this purpose, the standard assumption of a homogeneous concept is substituted by the Utilitarian Duality Hypothesis.
In particular, judgments concerning categorical utility (uCat) infer an object's category based on its attributes which may subsequently allow the transfer of evaluative information like feelings or attitudes. In contrast, comparative utility (uCom) depends on the distance to a reference value on a specific dimension of comparison. Importantly, dimensions of comparison are manifold and context dependent.
In a series of experiments, we show that the resulting Dual Utility Model is able to explain several known anomalies in a parsimonious fashion. Moreover, we identify central factors determining the relative weight assigned to both utility components.
Finally, we discuss the implications of the Utilitarian Duality for both, the experimental practice in economics as well as the consequences for economic theorizing. In sum, we propose that the Dual Utility Model can serve as an integrative framework for both the rational model and its anomalies.
An efficient and accurate computational framework for solving control problems governed by quantum spin systems is presented. Spin systems are extremely important in modern quantum technologies such as nuclear magnetic resonance spectroscopy, quantum imaging and quantum computing. In these applications, two classes of quantum control problems arise: optimal control problems and exact-controllability problems, with a bilinear con- trol structure. These models correspond to the Schrödinger-Pauli equation, describing the time evolution of a spinor, and the Liouville-von Neumann master equation, describing the time evolution of a spinor and a density operator. This thesis focuses on quantum control problems governed by these models. An appropriate definition of the optimiza- tion objectives and of the admissible set of control functions allows to construct controls with specific properties. These properties are in general required by the physics and the technologies involved in quantum control applications. A main purpose of this work is to address non-differentiable quantum control problems. For this reason, a computational framework is developed to address optimal-control prob- lems, with possibly L1 -penalization term in the cost-functional, and exact-controllability problems. In both cases the set of admissible control functions is a subset of a Hilbert space. The bilinear control structure of the quantum model, the L1 -penalization term and the control constraints generate high non-linearities that make difficult to solve and analyse the corresponding control problems. The first part of this thesis focuses on the physical description of the spin of particles and of the magnetic resonance phenomenon. Afterwards, the controlled Schrödinger- Pauli equation and the Liouville-von Neumann master equation are discussed. These equations, like many other controlled quantum models, can be represented by dynamical systems with a bilinear control structure. In the second part of this thesis, theoretical investigations of optimal control problems, with a possible L1 -penalization term in the objective and control constraints, are consid- ered. In particular, existence of solutions, optimality conditions, and regularity properties of the optimal controls are discussed. In order to solve these optimal control problems, semi-smooth Newton methods are developed and proved to be superlinear convergent. The main difficulty in the implementation of a Newton method for optimal control prob- lems comes from the dimension of the Jacobian operator. In a discrete form, the Jacobian is a very large matrix, and this fact makes its construction infeasible from a practical point of view. For this reason, the focus of this work is on inexact Krylov-Newton methods, that combine the Newton method with Krylov iterative solvers for linear systems, and allows to avoid the construction of the discrete Jacobian. In the third part of this thesis, two methodologies for the exact-controllability of quan- tum spin systems are presented. The first method consists of a continuation technique, while the second method is based on a particular reformulation of the exact-control prob- lem. Both these methodologies address minimum L2 -norm exact-controllability problems. In the fourth part, the thesis focuses on the numerical analysis of quantum con- trol problems. In particular, the modified Crank-Nicolson scheme as an adequate time discretization of the Schrödinger equation is discussed, the first-discretize-then-optimize strategy is used to obtain a discrete reduced gradient formula for the differentiable part of the optimization objective, and implementation details and globalization strategies to guarantee an adequate numerical behaviour of semi-smooth Newton methods are treated. In the last part of this work, several numerical experiments are performed to vali- date the theoretical results and demonstrate the ability of the proposed computational framework to solve quantum spin control problems.
FAZIT:
Die EQUAL-Studie stellt eine europäische Initiative zur Beantwortung wichtiger Fragen rund um die Betreuung älterer Patienten mit fortschreitender chronischen Niereninsuffizienz dar.
Die Pilotstudie konnte in Deutschland erfolgreich durchgeführt werden. Es konnten insgesamt 30 Patienten eingeschlossen werden. Hierbei wurden geeignete Rekrutierungsarten und Rekrutierungsstrategien identifiziert.
Die Hauptstudie konnte mit Modifikationen im Design und Organisation aktuell erfolgreich in Deutschland und Europa durchgeführt werden.
SUMMARY
Insulin-like growth factor I (IGF-I) is a polypeptide with a molecular weight of 7.649 kDa and an anabolic potential. Thereby, IGF-I has a promising therapeutic value e.g. in muscle wasting diseases such as sarcopenia. IGF-I is mainly secreted by the liver in response to growth hormone (GH) stimulation and is rather ubiquitously found within all tissues. The effects of IGF-I are mediated by its respective IGF-I transmembrane tyrosine kinase receptor triggering the stimulation of protein synthesis, glucose uptake and the regulation of cell growth. The actions of IGF-I are modulated by six IGF binding proteins binding and transporting IGF-I in a binary or ternary complex to tissues and receptors and modulating the binding of IGF-I to its receptor. The nature of the formed complexes impacts IGF-I`s half-life, modulating the half-life between 10 minutes (free IGF-I) to 12 - 15 hours when presented in a ternary complex with IGF binding protein 3 and an acid labile subunit (ALS). Therefore, sustained drug delivery systems of free IGF-I are superficially seen as interesting for the development of controlled release profiles, as the rate of absorption is apparently and easily set slower by simple formulation as compared to the rapid rate of elimination. Thereby, one would conclude, the formulation scientist can rapidly develop systems for which the pharmacokinetics of IGF-I are dominated by the formulation release kinetics. However, the in vivo situation is more complex and as mentioned (vide supra), the half-life may easily be prolonged up to hours providing proper IGF-I complexation takes place upon systemic uptake. These and other aspects are reviewed in Chapter I, within which we introduce IGF-I as a promising therapeutic agent detailing its structure and involved receptors along with the resulting signaling pathways. We summarize the control of IGF-I pharmacokinetics in nature within the context of its complex system of 6 binding proteins to control half-life and tissue distribution. Furthermore, we describe IGF-I variants with modulated properties in vivo and originated from alternative splicing. These insights were translated into sophisticated IGF-I delivery systems for therapeutic use. Aside from safety aspects, the challenges and requirements of an effective IGF-I therapy are discussed. Localized and systemic IGF-I delivery strategies, different routes of administration as well as liquid and solid IGF-I formulations are reviewed. Effective targeting of IGF-I by protein decoration is outlined and consequently this chapter provides an interesting guidance for successful IGF-I-delivery. In Chapter II, we firstly outline the stability of IGF-I in liquid formulations with the intention to deliver the biologic through the lung and the impact of buffer type, sodium chloride concentration and pH value on IGF-I stability is presented. IGF-I integrity was preserved in histidine buffer over 4 months at room temperature, but methionine 59 oxidation (Met(o)) along with reducible dimer and trimer formation was observed in an acidic environment (pH 4.5) and using acetate buffer. Strong aggregation resulted in a complete loss of IGF-I bioactivity, whereas the potency was partly maintained in samples showing a slight aggregation and complete IGF-I oxidation. Atomization by air-jet or vibrating-mesh nebulizers yielded in limited Met(o) formation and no aggregation. The results of IGF-I nebulization experiments regarding aerosol output rate, mass median aerodynamic diameter and fine particle fraction were comparable with 0.9% sodium chloride reference, approving the applicability of liquid IGF-I formulations for pulmonary delivery. In Chapter III we escalated the development to solid delivery systems designed for alveolar landing upon inhalation and by deploying trehalose and the newly introduced for pulmonary application silk-fibroin as carriers. Microparticles were produced using nano spray drying following analyses including IGF-I integrity, IGF-I release profiles and aerodynamic properties. In vitro transport kinetics of IGF-I across pulmonary Calu-3 epithelia were suggesting similar permeability as compared to IGF-I’s cognate protein, insulin that has already been successfully administered pulmonary in clinical settings. These in vivo results were translated to an ex vivo human lung lobe model. This work showed the feasibility of pulmonary IGF-I delivery and the advantageous diversification of excipients for pulmonary formulations using silk-fibroin. Chapter IV focuses on an innovative strategy for safe and controllable IGF-I delivery. In that chapter we escalated the development to novel IGF-I analogues. The intention was to provide a versatile biologic into which galenical properties can be engineered through chemical synthesis, e.g. by site directed coupling of polymers to IGF-I. For this purpose we genetically engineered two IGF-I variants containing an unnatural amino acid at two positions, respectively, thereby integrating alkyne functions into the primary sequence of the protein. These allowed linking IGF-I with other molecules in a site specific manner, i.e. via a copper catalyzed azide-alkyne Huisgen cycloaddition (click reaction). In this chapter we mainly introduce the two IGF-I variants, detail the delivery concept and describe the optimization of the expression conditions of the IGF-I variants.
In conclusion, we span from simple liquid formulations for aerolization through solid systems for tailored for maximal alveolar landing to novel engineered IGF-I analogues. Thereby, three strategies for advanced IGF-I delivery were addressed and opportunities and limitations of each were outlined. Evidence was provided that sufficiently stable and easy to manufacture formulations can be developed as typically required for first in man studies. Interestingly, solid systems – typically introduced in later stages of pharmaceutical development – were quite promising. By use of silk-fibroin as a new IGF-I carrier for pulmonary administration, a new application was established for this excipient. The demonstrated success using the ex vivo human lung lobe model provided substantial confidence that pulmonary IGF-I delivery is possible in man. Finally, this work describes the expression of two IGF-I variants containing two unnatural amino acids to implement an innovative strategy for IGF-I delivery. This genetic engineering approach was providing the fundament for novel IGF-I analogues. Ideally, the biologic is structurally modified by covalently linked moieties for the control of pharmacokinetics or for targeted delivery, e.g. into sarcopenic muscles. One future scenario is dicussed in the ‘conclusion and outlook’ section for which IGF-I is tagged to a protease sensitive linker peptide and this linker peptide in return is coupled to a polyethylenglykole (PEG) polymer (required to prolong the half-life). Some proteases may serve as proxy for sarcopenia such that protease upregulation in compromised muscle tissues drives cleavage of IGF-I from the PEG. Thereby, IGF-I is released at the seat of the disease while systemic side effects are minimized.
Die Prognose von hämatologischen und onkologischen Systemerkrankungen wird dank immer komplexerer und intensiverer Therapien zunehmend besser. Im Zuge dessen spielen Infektionskomplikationen und insbesondere systemische Mykosen, eine immer größere Rolle. Die Zahl der antimykotischen Wirkstoffe ist begrenzt. Die zunehmenden Resistenzen verschlechtern die Situation zusätzlich. Mit der Einführung von Posaconazol, einem Wirkstoff aus der Gruppe der Triazole, steht ein Präparat mit sehr breitem antimykotischem Wirkspektrum zur Verfügung. Entsprechend der Daten aus einer therapeutischen Studie sind ausreichend hohe Medikamentenspiegel zur Erzielung einer klinischen Effektivität erforderlich.
Dieses Triazol wird im Gegensatz zu anderen und insbesondere zu Voriconazol nicht über Cytochrom P450 metabolisiert. Es ist jedoch ein Substrat für die Uridindiphosphatglucuronosyltransferase und unterliegt hier ebenso relevanten Interaktionen mit anderen Medikamenten. Diese bestehen zumeist in Veränderungen der Aktivität der abbauenden Enzyme sowohl durch Induktion wie auch durch Inhibition. Zudem zeichnet sich dieses Triazol besonders als orale Suspension durch eine eingeschränkte Resorption aus. Diese ist unter anderem abhängig von der Magensäure, einer begleitenden Nahrungsaufnahme der Dosisintervalle und ist limitiert. So konnten durch eine Dosissteigerung über 800 mg am Tag keine höheren Serumkonzentrationen erzielt werden. Daher erscheint die therapeutische Spiegelbestimmung von Posaconazol zumindest bei Verwendung der Suspension sehr sinnvoll.
In dieser Arbeit wurden für Posaconazol patientenbezogene Einflussfaktoren und spezifische Veränderungen des Serumspiegels durch verschiedene Komedikationen untersucht. Die Daten stammen aus einer Würzburger Patientenkohorte, bestehend aus überwiegend hämatologischen Patienten, die eine antimykotische Therapie oder Prophylaxe von Januar 2006 bis März 2008 in stationärer oder ambulanter Behandlung in der Medizinischen Klinik und Poliklinik II der Universitätsklinik Würzburg erhalten haben.
Es konnte gezeigt werden, dass die Posaconzolspiegel unabhängig von Alter und Geschlecht der Patienten sind. Im Gegensatz zu anderen Arbeiten konnten wir einen kontinuierlichen Anstieg der Serumspiegel bei langer Posaconazoleinnahme nachweisen. Zudem konnte in dieser Arbeit erstmals ein Anstieg der Posaconazolkonzentrationen bei Patienten mit höherem BMI gezeigt werden.
Von unseren untersuchten Laborparametern zeigte sich bei erhöhten Posaconazolspiegeln eine signifikante Erhöhung der GPT. Die anderen Transaminasen und Cholestaseparameter zeigten in der Korrelation mit dem Posaconazolspiegel keine signifikanten Änderungen.
Bezüglich der Nierenretentionsparameter zeigte sich eine signifikante Erniedrigung der GFR bei höheren Posaconazolspiegeln. Dies gilt entsprechend gegenläufig für die Kreatininwerte.
Auf Grund der Plasmaeiweißbindung von Posaconazol stiegen die Spiegel mit höherem Albumin und Gesamteiweiß signifikant an.
Von unseren beobachteten Komedikationen zeigte sich eine signifikante Erniedrigung des Posaconazolserumspiegels bei gleichzeitiger Gabe von Pantoprazol. Ciclosporin und Mycophenolat-Mofetil erhöhten den Posaconazolspiegel signifikant. Bei den Patienten, die Lorazepam erhielten, zeigte sich ein Trend zu erniedrigten Posaconazolspiegeln. Für Temazepam zeigten sich einmalig signifikant erhöhte Posaconazolspiegel. Es ist davon auszugehen, dass die Posaconazolserumspiegel in jedem Fall durch die gleichzeitige Gabe dieser Benzodiazepine verändert werden können. Weitere Untersuchungen hierzu erfolgten bereits und sind erforderlich.
Bedingt durch diese Ergebnisse ist ein Therapeutisches Drug Monitoring besonders bei Patienten mit zahlreicher Komedikation dringend zu empfehlen, da potentielle Interaktionen die Bioverfügbarkeit von Posaconazol nicht nur signifikant, sondern auch in einem relevanten Bereich verändern können.
Aim of this thesis was to combine the versatility of sulfur-chemistry, regarding redox-sensitivity as well as chemo- and site-specific conjugation, with multifunctionality of poly(glycidol)s as an alternative to poly(ethylene glycol).
First the homo- and copolymerizations of EEGE and AGE were performed with respect to molar-mass distribution and reaction kinetics. A detailed study was given, varying the polymerization parameters such as DP, counter ion, solvent and monomer influence. It can be concluded that in general the rates for all polymerizations are higher using K+, in contrast to Cs+, as counter ion for the active alkoxide species. Unfortunately, K+ as counter ion commonly leads to a reduced control over polymer dispersity. In this thesis it was shown that the broad molar-mass distributions might be reduced by adding the monomer in a step-wise manner. In experiments with a syringe pump, for continuously adding the monomer, a significant reduction of the dispersities could be found using K+ as counter ion.
In analogy to the oxyanionic polymerization of epoxides, the polymerization of episulfides via a thioanionic mechanism with various DPs was successful with thiols/DBU as initiator. In most experiments bimodality could be observed due to the dimerization, caused by oxidation processes by introduced oxygen during synthesis. Reducing this was successful by modifying the degassing procedure, e.g. repeated degassing cycles after each step, i.e. initiation, monomer addition and quenching. Unfortunately, it was not always possible to completely avoid the dimerization due to oxidation. Thiophenol, butanethiol, mercaptoethanol and dithiothreitol were used as thiol initiators, all being capable to initiate the polymerization. With the prediction and the narrow molar-mass distributions, the living character of the polymerization is therefore indicated.
Homo- and copolymers of poly(glycidol) were used to functionalize these polymers with side-chains bearing amines, thiols, carboxylic acids and cysteines. The cysteine side-chains were obtained using a newly synthesized thiol-functional thiazolidine. For this, cysteine was protected using a condensation reaction with acetone yielding a dimethyl-substituted thiazolidine. Protection of the ring-amine was obtained via a mixed-anhydride route using formic acid and acetic anhydride. The carboxylic acid of 2,2-dimethylthiazolidine-4-carboxylic acid was activated with CDI and cysteamine attached. The obtained crystalline mercaptothiazolidine was subjected to thiol-ene click chemistry with allyl-functional poly(glycidol). A systematic comparison of thermal- versus photo-initiation showed a much higher yield and reaction rate for the UV-light mediated thiol-ene synthesis with DMPA as photo-initiator. Hydrolysis of the protected thiazolidine-functionalities was obtained upon heating the samples for 5 d at 70 °C in 0.1 M HCl. Dialysis against acetic acid lead to cysteine-functional poly(glycidol)s, storable as the acetate salt even under non-inert atmosphere. An oxidative TNBSA assay was developed to quantify the cysteine-content without the influence of the thiol-functionality. A cooperation partner coupled C-terminal thioester peptides with the cysteine-functional poly(glycidol)s and showed the good accessibility and reactivity of the cysteines along the backbone. SDS-PAGE, HPLC and MALDI-ToF measurements confirmed the successful coupling.