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Sonstige beteiligte Institutionen
- Johns Hopkins School of Medicine (18)
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- IZKF Nachwuchsgruppe Geweberegeneration für muskuloskelettale Erkrankungen (7)
- Akademie der Wissenschaften und der Literatur, Mainz (6)
- DFG Forschungsgruppe 2757 / Lokale Selbstregelungen im Kontext schwacher Staatlichkeit in Antike und Moderne (LoSAM) (6)
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Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term complication following an acute pulmonary embolism (PE). It is frequently diagnosed at advanced stages which is concerning as delayed treatment has important implications for favourable clinical outcome. Performing a follow-up examination of patients diagnosed with acute PE regardless of persisting symptoms and using all available technical procedures would be both cost-intensive and possibly ineffective. Focusing diagnostic procedures therefore on only symptomatic patients may be a practical approach for detecting relevant CTEPH.
This study aimed to evaluate if a follow-up program for patients with acute PE based on telephone monitoring of symptoms and further examination of only symptomatic patients could detect CTEPH. In addition, we investigated the role of cardiopulmonary exercise testing (CPET) as a diagnostic tool.
Methods
In a prospective cohort study all consecutive patients with newly diagnosed PE (n=170, 76 males, 94 females within 26 months) were recruited according to the inclusion and exclusion criteria. Patients were contacted via telephone and asked to answer standardized questions relating to symptoms. At the time of the final analysis 130 patients had been contacted. Symptomatic patients underwent a structured evaluation with echocardiography, CPET and complete work-up for CTEPH.
Results
37.7%, 25.5% and 29.3% of the patients reported symptoms after three, six, and twelve months respectively. Subsequent clinical evaluation of these symptomatic patients saw 20.4%, 11.5% and 18.8% of patients at the respective three, six and twelve months time points having an echocardiography suggesting pulmonary hypertension (PH). CTEPH with pathological imaging and a mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg at rest was confirmed in eight subjects. Three subjects with mismatch perfusion defects showed an exercise induced increase of PAP without increasing pulmonary artery occlusion pressure (PAOP). Two subjects with pulmonary hypertension at rest and one with an exercise induced increase of mPAP with normal PAOP showed perfusion defects without echocardiographic signs of PH but a suspicious CPET.
Conclusion
A follow-up program based on telephone monitoring of symptoms and further structured evaluation of symptomatic subjects can detect patients with CTEPH. CPET may serve as a complementary diagnostic tool.
The idea that specific kind of foods may have an addiction potential and that some forms of overeating may represent an addicted behavior has been discussed for decades. In recent years, the interest in food addiction is growing and research on this topic lead to more precise definitions and assessment methods. For example, the Yale Food Addiction Scale has been developed for the measurement of addiction-like eating behavior based on the diagnostic criteria for substance dependence of the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In 2013, diagnostic criteria for substance abuse and-dependence were merged, thereby increasing the number of symptoms for substance use disorders (SUDs) in the DSM-5. Moreover, gambling disorder is now included along SUDs as a behavioral addiction. Although a plethora of review articles exist that discuss the applicability of the DSM-IV substance dependence criteria to eating behavior, the transferability of the newly added criteria to eating is unknown. Thus, the current article discusses if and how these new criteria may be translated to overeating. Furthermore, it is examined if the new SUD criteria will impact future research on food addiction, for example, if "diagnosing" food addiction should also be adapted by considering all of the new symptoms. Given the critical response to the revisions in DSM-5, we also discuss if the recent approach of Research Domain Criteria can be helpful in evaluating the concept of food addiction.
Traumatic brain injury (TBI) induces a strong inflammatory response which includes blood-brain barrier damage, edema formation and infiltration of different immune cell subsets. More recently, microvascular thrombosis has been identified as another pathophysiological feature of TBI. The contact-kinin system represents an interface between inflammatory and thrombotic circuits and is activated in different neurological diseases. C1-Inhibitor counteracts activation of the contact-kinin system at multiple levels. We investigated the therapeutic potential of C1-Inhibitor in a model of TBI. Male and female C57BL/6 mice were subjected to cortical cryolesion and treated with C1-Inhibitor after 1 h. Lesion volumes were assessed between day 1 and day 5 and blood-brain barrier damage, thrombus formation as well as the local inflammatory response were determined post TBI. Treatment of male mice with 15.0 IU C1-Inhibitor, but not 7.5 IU, 1 h after cryolesion reduced lesion volumes by ~75% on day 1. This protective effect was preserved in female mice and at later stages of trauma. Mechanistically, C1-Inhibitor stabilized the blood-brain barrier and decreased the invasion of immune cells into the brain parenchyma. Moreover, C1-Inhibitor had strong antithrombotic effects. C1-Inhibitor represents a multifaceted anti-inflammatory and antithrombotic compound that prevents traumatic neurodegeneration in clinically meaningful settings.
Background
The prevalence of obesity is rising. Obesity can lead to cardiovascular and ventilatory complications through multiple mechanisms. Cardiac and pulmonary function in asymptomatic subjects and the effect of structured dietary programs on cardiac and pulmonary function is unclear.
Objective
To determine lung and cardiac function in asymptomatic obese adults and to evaluate whether weight loss positively affects functional parameters.
Methods
We prospectively evaluated bodyplethysmographic and echocardiographic data in asymptomatic subjects undergoing a structured one-year weight reduction program.
Results
74 subjects (32 male, 42 female; mean age 42±12 years) with an average BMI 42.5±7.9, body weight 123.7±24.9 kg were enrolled. Body weight correlated negatively with vital capacity (R = −0.42, p<0.001), FEV1 (R = −0.497, p<0.001) and positively with P 0.1 (R = 0.32, p = 0.02) and myocardial mass (R = 0.419, p = 0.002). After 4 months the study subjects had significantly reduced their body weight (−26.0±11.8 kg) and BMI (−8.9±3.8) associated with a significant improvement of lung function (absolute changes: vital capacity +5.5±7.5% pred., p<0.001; FEV1+9.8±8.3% pred., p<0.001, ITGV+16.4±16.0% pred., p<0.001, SR tot −17.4±41.5% pred., p<0.01). Moreover, P0.1/Pimax decreased to 47.7% (p<0.01) indicating a decreased respiratory load. The change of FEV1 correlated significantly with the change of body weight (R = −0.31, p = 0.03). Echocardiography demonstrated reduced myocardial wall thickness (−0.08±0.2 cm, p = 0.02) and improved left ventricular myocardial performance index (−0.16±0.35, p = 0.02). Mitral annular plane systolic excursion (+0.14, p = 0.03) and pulmonary outflow acceleration time (AT +26.65±41.3 ms, p = 0.001) increased.
Conclusion
Even in asymptomatic individuals obesity is associated with abnormalities in pulmonary and cardiac function and increased myocardial mass. All the abnormalities can be reversed by a weight reduction program.
Prenatal stress-induced programming of genome-wide promoter DNA methylation in 5-HTT-deficient mice
(2014)
The serotonin transporter gene (5-HTT/SLC6A4)-linked polymorphic region has been suggested to have a modulatory role in mediating effects of early-life stress exposure on psychopathology rendering carriers of the low-expression short (s)-variant more vulnerable to environmental adversity in later life. The underlying molecular mechanisms of this gene-by-environment interaction are not well understood, but epigenetic regulation including differential DNA methylation has been postulated to have a critical role. Recently, we used a maternal restraint stress paradigm of prenatal stress (PS) in 5-HTT-deficient mice and showed that the effects on behavior and gene expression were particularly marked in the hippocampus of female 5-Htt+/- offspring. Here, we examined to which extent these effects are mediated by differential methylation of DNA. For this purpose, we performed a genome-wide hippocampal DNA methylation screening using methylated-DNA immunoprecipitation (MeDIP) on Affymetrix GeneChip Mouse Promoter 1.0 R arrays. Using hippocampal DNA from the same mice as assessed before enabled us to correlate gene-specific DNA methylation, mRNA expression and behavior. We found that 5-Htt genotype, PS and their interaction differentially affected the DNA methylation signature of numerous genes, a subset of which showed overlap with the expression profiles of the corresponding transcripts. For example, a differentially methylated region in the gene encoding myelin basic protein (Mbp) was associated with its expression in a 5-Htt-, PS- and 5-Htt × PS-dependent manner. Subsequent fine-mapping of this Mbp locus linked the methylation status of two specific CpG sites to Mbp expression and anxiety-related behavior. In conclusion, hippocampal DNA methylation patterns and expression profiles of female prenatally stressed 5-Htt+/- mice suggest that distinct molecular mechanisms, some of which are promoter methylation-dependent, contribute to the behavioral effects of the 5-Htt genotype, PS exposure and their interaction.
Thalidomid als Therapieoption beim fortgeschrittenen Nebennierenkarzinom: Eine retrospektive Studie
Das adrenokortikale Karzinom (ACC) ist ein seltener Tumor mit einer schlechten Prognose. Im fortgeschrittenen Stadium gelten Mitotane und zytotoxische Chemotherapien als Standardtherapie, mit denen allerdings nur kurzzeitig eine Tumorkontrolle erreicht werden kann. Daher machte Thalidomid Hoffnung auf eine mögliche ´Rettungs´-Therapie.
Im Rahmen dieser retrospektiven Studie sollte der Nutzen und die Tolerabilität von Thalidomid beim fortgeschrittenen Nebennierenkarzinom untersucht werden. Insgesamt konnten 15 Patienten aus dem deutschen Nebennnierenkarzinomregister herausgefiltert werden, die den Einschlusskriterien entsprachen und Thalidomid als off-label erhalten haben.
Als Endpunkt wurden das progressionsfreie Überleben, ausgewertet geblinded gemäß RECIST 1.1., und das Gesamtüberleben festgelegt.
Alle 15 Patienten (7 Männer; medianes Alter 48,9 (Range 34,4 – 69,0) Jahre) waren bereits mit bis zu sechs systemischen Therapien vorbehandelt. Thalidomid wurde in einer Dosierung gemäß Verträglichkeit verabreicht (mediane Startdosis 100 mg/d) und das Restaging erfolgte alle 12 Wochen, das Erste im Median nach 10,9 Wochen.
Das progressionfreie Überleben lag im Median bei 11,1 Wochen (Range 4,4 – 34,4 Wochen), das Gesamtüberleben lag im Median bei 34,4 Wochen (Range 5,1 – 111,1 Wochen).
Während der erste Patient, der eine Krankheitsstabilisierung erfahren hat, die Behandlung aufgrund von Epistaxis und Diarrhoe Grad I nach 22,3 Wochen abbrach, zeigte der zweite Patient nach 34,4 Wochen weiterhin eine Krankheitsstabilisierung, obwohl er unter den vorangegangenen vier zytotoxischen Therapien progredient war.
Unter Thalidomid wurden nur geringgradige bis mäßige Nebenwirkungen beobachtet (hauptsächlich Fatigue und gastrointestinale Nebenwirkungen).
Schlussfolgerung: Thalidomid ist ein gut verträgliches Medikament, das nur bei einer Minderheit zahlreich vortherapierter Patienten zu einer Krankheitsstabilisierung führte.
Das Leben der beiden Autoren Jean Bodin und Michel de Montaigne wurde von den blutigen Auseinandersetzungen der französischen Religionskriege geprägt. Aus diesem Grund besitzt die Religon in ihren Werken eine herausgehobene Stellung. In "Les six livres de la République" von Jean Bodin gründet dieser sein Prinzip der Souveränität auf die Religion. Diese gibt also die Grundregeln des menschlichen Zusammenlebens vor. In seinem Religionsgespräch "Colloqium Heptaplomeres" vertieft Bodin diese Gedanken und entwickelt ein Toleranzkonzept, das die Möglichkeit des Zusammenlebens verschiedener Religionen in einem Staat vorsieht. Die Religion ist bei Jean Bodin also vor allem ein Instrument, um die Gesellschaft zu organisieren. Michel de Montaigne betrachtet in seinen "Essais" die Religion weit kritischer. Für ihn ist sie eine Instanz, die die Menschen trennt anstatt sie zu vereinen. Er warnt vor ihren zerstörerischen Folgen. Gleichwohl entwickelt Montaigne ein Toleranzkonzept, das auf seiner Grundüberzeugung der Gewaltfreiheit beruht. Es zeigt sich, dass beide Autoren die Religion und ihre Nützlichkeit für die Gesellschaft unter verschiedenen Blickwinkeln betrachten.
Die sprachlichen Fähigkeiten der Kinder im Vorschulbereich sind eine wichtige Voraussetzung für den späteren Erfolg in der Schule. Während die Sprachfähigkeiten der monolingualen Kinder bis zum Einschulungsalter in der Regel altersgemäß entwickelt sind, können sich bei bilingual aufwachsenden Kindern Probleme unterschiedlicher Ausprägung abzeichnen. Im Rahmen einer empirischen Studie werden die Sprachfähigkeiten von jeweils 8 monolingual deutsch und bilingual russisch-deutsch aufwachsenden Kindern im Alter von 4 bis 6 Jahren untersucht. Die Arbeit befasst sich mit der Frage nach dem Sprachentwicklungsstand der bilingualen gegenüber dem der monolingualen Kinder und mit der Frage nach dem gegenseitigen Verhältnis der beiden Sprachen der bilingualen Kinder. Im Vordergrund stehen dabei die Sprachkompetenzen der Kinder im morphosyntaktischen Bereich und im Bereich der statischen Lokalisierung. Die Analyse der anhand von Elizitierungsmethoden erhobenen Sprachdaten hinsichtlich der Wortstellung, der Formen und Stellung des Verbs, der Subjekt-Verb-Kongruenz, der Verbindung von Sätzen und der irregulären Verben zeigt, dass sich die mono- und bilingualen Kinder auf einem vergleichbaren Niveau befinden. Dieses Ergebnis bestätigt die zusätzlich durchgeführte Wortschatzanalyse. In Bezug auf die Lokalisierung zeigen sich sowohl Gemeinsamkeiten als auch Unterschiede. Hervorzuheben ist, dass die Relation AN den bilingualen Kindern erhebliche Probleme bereitete. Insgesamt liegt die Substitutionsrate der Präpositionen bei ihnen wesentlich höher als bei den monolingualen Kindern. Der Vergleich der Sprachentwicklung im Russisch und im Deutsch der bilingualen Kinder hat deutliche Differenzen in der Beherrschung der beiden Sprachen ergeben. Sie reichen von relativ ausgewogener Zweisprachigkeit über leichte bis starke Dominanz des Deutschen bis zu nahezu passiver Beherrschung der Muttersprache. Dabei zeigte sich, dass eine klare Trennung der Sprachen die bilinguale Sprachentwicklung positiv beeinflusst. Fehlt eine solche klare Trennung, kommt es zu Defiziten in der Erstsprachentwicklung, die sich zudem in Sprachmischungen und Transferelementen aus der Zweitsprache in die Erstsprache manifestieren.
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.
We investigated the ionization profiles for open-ring (OR) and closed-ring (CR) forms of midazolam and drug-binding modes with heptakis-(2,3,6-tri-O-methyl)-β-cyclodextrin (trimethyl-β-cyclodextrin; TRIMEB) using molecular modeling techniques and quantum mechanics methods. The results indicated that the total net charges for different molecular forms of midazolam tend to be cationic for OR and neutral for CR at physiological pH levels. The thermodynamic calculations demonstrated that CR is less water-soluble than OR, mainly due to the maximal solvation energy (ΔG(CR)(solv = -9.98 kcal·mol ⁻¹), which has a minimal ΔG(OR)(solv) of -67.01 kcal·mol⁻¹. A cell viability assay did not detect any signs of TRIMEB and OR/CR-TRIMEB complex toxicity on the cEND cells after 24 h of incubation in either Dulbecco's Modified Eagles Medium or in heat-inactivated human serum. The molecular docking studies identified the more flexible OR form of midazolam as being a better binder to TRIMEB with the fluorophenyl ring introduced inside the amphiphilic cavity of the host molecule. The OR binding affinity was confirmed by a minimal Gibbs free energy of binding (ΔG(bind)) value of -5.57 ± 0.02 kcal·mol⁻¹, an equilibrium binding constant (K(b)) of 79.89 ± 2.706 μM, and a ligand efficiency index (LE(lig)) of -0.21 ± 0.001. Our current data suggest that in order to improve the clinical applications of midazolam via its complexation with trimethyl-β-cyclodextrin to increase drug's overall aqueous solubility, it is important to concern the different forms and ionization states of this anesthetic. All mean values are indicated with their standard deviations.