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Background:
Oral anticoagulant therapy (OAT) potently prevents strokes in patients with atrial fibrillation. Vitamin K antagonists (VKA) have been the standard of care for long-term OAT for decades, but non-VKA oral anticoagulants (NOAC) have recently been approved for this indication, and raised many questions, among them their influence on medication adherence. We assessed adherence to VKA and NOAC in secondary stroke prevention.
Methods:
All patients treated from October 2011 to September 2012 for ischemic stroke or transient ischemic attack with a subsequent indication for OAT, at three academic hospitals were entered into a prospective registry, and baseline data and antithrombotic treatment at discharge were recorded. At the 1-year follow-up, we assessed the adherence to different OAT strategies and patients' adherence to their respective OAT. We noted OAT changes, reasons to change treatment, and factors that influence persistence to the prescribed OAT.
Results:
In patients discharged on OAT, we achieved a fatality corrected response rate of 73.3% (n=209). A total of 92% of these patients received OAT at the 1-year follow-up. We observed good adherence to both VKA and NOAC (VKA, 80.9%; NOAC, 74.8%; P=0.243) with a statistically nonsignificant tendency toward a weaker adherence to dabigatran. Disability at 1-year follow-up was an independent predictor of lower adherence to any OAT after multivariate analysis, whereas the choice of OAT did not have a relevant influence.
Conclusion:
One-year adherence to OAT after stroke is strong (>90%) and patients who switch therapy most commonly switch toward another OAT. The 1-year adherence rates to VKA and NOAC in secondary stroke prevention do not differ significantly between both therapeutic strategies.
Ischemic stroke is the second leading cause of death worldwide. Only one moderately effective therapy exists, albeit with contraindications that exclude 90% of the patients. This medical need contrasts with a high failure rate of more than 1,000 pre-clinical drug candidates for stroke therapies. Thus, there is a need for translatable mechanisms of neuroprotection and more rigid thresholds of relevance in pre-clinical stroke models. One such candidate mechanism is oxidative stress. However, antioxidant approaches have failed in clinical trials, and the significant sources of oxidative stress in stroke are unknown. We here identify NADPH oxidase type 4 (NOX4) as a major source of oxidative stress and an effective therapeutic target in acute stroke. Upon ischemia, NOX4 was induced in human and mouse brain. Mice deficient in NOX4 (Nox42/2) of either sex, but not those deficient for NOX1 or NOX2, were largely protected from oxidative stress, blood-brain-barrier leakage, and neuronal apoptosis, after both transient and permanent cerebral ischemia. This effect was independent of age, as elderly mice were equally protected. Restoration of oxidative stress reversed the stroke-protective phenotype in Nox42/2 mice. Application of the only validated low-molecular-weight pharmacological NADPH oxidase inhibitor, VAS2870, several hours after ischemia was as protective as deleting NOX4. The extent of neuroprotection was exceptional, resulting in significantly improved long-term neurological functions and reduced mortality. NOX4 therefore represents a major source of oxidative stress and novel class of drug target for stroke therapy.
Helicobacter pylori ist ein pathogenes Bakterium, das verantwortlich gemacht wird für verschiedene Erkrankungen des Magens und Duodenums, wie beispielsweise chronische Gastritis, peptische Ulzera und maligne Lymphome. Das Bakterium zeichnet sich durch eine hohe Rekombinationsrate aus und besitzt ein hohes Maß an genetischer Allelvielfalt. Im ersten Teil dieser Arbeit wurde die Rekombinationsrate und die Länge der rekombinerten DNA-Importe anhand von sequentiellen Isolaten, die zu definierten Zeitpunkten aus dem selben Patienten isoliert wurden, untersucht. Es wurden zehn Gene, darunter sieben 'housekeeping' Gene und drei virulenzassoziierte Gene, amplifiziert und sequenziert. Die Ergebnisse zeigten eine bis dahin noch nicht für Bakterien beschriebene Fragmentlänge der DNA-Importe von durchschnittlich lediglich 417 Basenpaaren. Die Rekombinationsrate war außergewöhnlich hoch. DNA-Microarray-Analysen konnten zeigen, dass es trotz dieser hohen Rekombinationsrate nur wenige Veränderungen in der genomischen Genausstattung gab. Jedoch hing das Auftreten von Rekombinationsereignissen direkt mit Veränderungen der Genausstattung zusammen. Im zweiten Teil der Arbeit wurde ein neues in vitro-Transformationsmodell entwickelt, das die in vivo ermittelten Resultate nachvollziehen sollte. Das Modell konnte sowohl die in vivo gefundene Rekombinationsrate als auch den Import von kurzen DNA-Fragmenten bestätigen, die zu einem Allelmosaik zwischen DNA-Rezipient und Donor führten. Auffällig war eine stark verminderte Transformierbarkeit mit Donor-DNA aus asiatischen H. pylori-Stämmen. Um eine mögliche Beteiligung des Nukleotid-Excisions-Reparatur (NER) Mechanismus an der Rekombination zu ermitteln, wurden zwei Gene des Mechanismus ausgeschaltet. Die Ergebnisse der NER--Mutanten (uvrA-, uvrD-) zeigten eine starke Verminderung der Transformierbarkeit. Diese Verminderung hatte jedoch keinen Einfluss auf die Länge der rekombinierten DNA-Importe. Das Ausschalten des uvrA-Gens führte zudem zu einer erhöhten Sensibilität gegenüber UV-Licht. Der NER-Mechanismus ist bei H. pylori in einer noch nicht aufgeklärten Weise an der Rekombination beteiligt. In einem Rhesusaffen-Tiermodell wurde die initiale Besiedlung mit H. pylori untersucht. Die Tiere stellen einen natürlichen Wirt dar und zeigen ähnliche Krankheitssymptome wie menschliche Patienten. Die Rhesusaffen wurden experimentell mit zwei klinischen H. pylori-Isolaten infiziert. Die Reisolation zu bestimmten Zeitpunkten zeigte, dass sich nur einer der beiden Stämme im Affenmagen etablieren konnte und der zweite Stamm verdrängt worden war. In einem zweiten Versuchsansatz wurden die persistent infizierten Affen mit vier weiteren H. pylori-Stämmen infiziert, um eine transiente Koinfektion zu simulieren. Diese Stämme verdrängten jedoch den bereits etablierten Stamm, und es konnte keine in vivo-Rekombination festgestellt werden. Dennoch ist dieses Modell das Erste, in dem eine persistierende experimentelle H. pylori-Infektion in Rhesusaffen über einen Zeitraum von mehr als vier Jahren nachgewiesen werden konnte. Die Ergebnisse liefern wichtige Hinweise auf den beim Menschen meist unentdeckten Anfang der H. pylori-Infektion. Die Untersuchungen an weiteren Spezies des Genus Helicobacter zeigten, dass die beschriebene Spezies Heelicobacter nemestrinae keine eigene Spezies darstellt, sondern der Spezies H. pylori zugeordnet werden konnte. Den damit nächsten 'Verwandten' stellt die Spezies H. acinonychis dar, deren Stämme sich untereinander wesentlich weniger stark unterscheiden als H. pylori-Stämme. Die Ergebnisse dieser Arbeit liefern wichtige Daten zum Verständnis der Evolution und Mikroevolution innerhalb eines Wirtes von H. pylori, die zu besseren Strategien in der Bekämpfung dieses pathogenen Bakteriums führen können.
Genome-wide association studies (GWAS) have identified more than 170 breast cancer susceptibility loci. Here we hypothesize that some risk-associated variants might act in non-breast tissues, specifically adipose tissue and immune cells from blood and spleen. Using expression quantitative trait loci (eQTL) reported in these tissues, we identify 26 previously unreported, likely target genes of overall breast cancer risk variants, and 17 for estrogen receptor (ER)-negative breast cancer, several with a known immune function. We determine the directional effect of gene expression on disease risk measured based on single and multiple eQTL. In addition, using a gene-based test of association that considers eQTL from multiple tissues, we identify seven (and four) regions with variants associated with overall (and ER-negative) breast cancer risk, which were not reported in previous GWAS. Further investigation of the function of the implicated genes in breast and immune cells may provide insights into the etiology of breast cancer.
(1) Background: During maturation of the Hepatitis B virus, a viral polymerase inside the capsid transcribes a pre-genomic RNA into a partly double stranded DNA-genome. This is followed by envelopment with surface proteins inserted into a membrane. Envelopment is hypothetically regulated by a structural signal that reports the maturation state of the genome. NMR data suggest that such a signal can be mimicked by the binding of the detergent Triton X 100 to hydrophobic pockets in the capsid spikes. (2) Methods: We have used electron cryo-microscopy and image processing to elucidate the structural changes that are concomitant with the binding of Triton X 100. (3) Results: Our maps show that Triton X 100 binds with its hydrophobic head group inside the pocket. The hydrophilic tail delineates the outside of the spike and is coordinated via Lys-96. The binding of Triton X 100 changes the rotamer conformation of Phe-97 in helix 4, which enables a π-stacking interaction with Trp-62 in helix 3. Similar changes occur in mutants with low secretion phenotypes (P5T and L60V) and in a mutant with a pre-mature secretion phenotype (F97L). (4) Conclusion: Binding of Triton X 100 is unlikely to mimic structural maturation because mutants with different secretion phenotypes show similar structural responses.
The serine/threonine protein kinase AKT1 is a downstream target of the chemokine receptor 4 (CXCR4), and both proteins play a central role in the modulation of diverse cellular processes, including proliferation and cell survival. While in chronic myeloid leukemia (CML) the CXCR4 is downregulated, thereby promoting the mobilization of progenitor cells into blood, the receptor is highly expressed in breast cancer cells, favoring the migratory capacity of these cells. Recently, the LIM and SH3 domain protein 1 (LASP1) has been described as a novel CXCR4 binding partner and as a promoter of the PI3K/AKT pathway. In this study, we uncovered a direct binding of LASP1, phosphorylated at S146, to both CXCR4 and AKT1, as shown by immunoprecipitation assays, pull-down experiments, and immunohistochemistry data. In contrast, phosphorylation of LASP1 at Y171 abrogated these interactions, suggesting that both LASP1 phospho-forms interact. Finally, findings demonstrating different phosphorylation patterns of LASP1 in breast cancer and chronic myeloid leukemia may have implications for CXCR4 function and tyrosine kinase inhibitor treatment.
Quantitative high-confidence human mitochondrial proteome and its dynamics in cellular context
(2021)
Mitochondria are key organelles for cellular energetics, metabolism, signaling, and quality control and have been linked to various diseases. Different views exist on the composition of the human mitochondrial proteome. We classified >8,000 proteins in mitochondrial preparations of human cells and defined a mitochondrial high-confidence proteome of >1,100 proteins (MitoCoP). We identified interactors of translocases, respiratory chain, and ATP synthase assembly factors. The abundance of MitoCoP proteins covers six orders of magnitude and amounts to 7% of the cellular proteome with the chaperones HSP60-HSP10 being the most abundant mitochondrial proteins. MitoCoP dynamics spans three orders of magnitudes, with half-lives from hours to months, and suggests a rapid regulation of biosynthesis and assembly processes. 460 MitoCoP genes are linked to human diseases with a strong prevalence for the central nervous system and metabolism. MitoCoP will provide a high-confidence resource for placing dynamics, functions, and dysfunctions of mitochondria into the cellular context.