In 2006, 0.18 Mio pediatric nuclear medicine diagnostic exams were performed worldwide. However, for most of the radiopharmaceuticals used data on biokinetics and, as a consequence on dosimetry, are missing or have not been made publicly available. Therefore, most of the dosimetry assessments presented today for diagnostic agents in children and adolescents rely on the biokinetics data of adults. Even for one of the most common nuclear medicine exams for this patient group, renal scintigraphy with 99mTc-MAG3 for assessing renal function measured data on biokinetics is available only from a study performed on four children of different ages. In particular, renal scans are among the most frequent exams performed on infants and toddlers. Due to the young age, this patient group can be classified as a risk group with a higher probability of developing stochastic radiation effects compared to adults. As there are only limited data on biokinetics and dosimetry in this patient group, the aim of this study is to reassess the dosimetry and the associated radiation risk for a larger number of infants undergoing 99mTc-MAG3 renal scans based on a retrospective analysis of existing patient data. Data were collected retrospectively from 34 patients younger than 20 months with normal (20 patients) and abnormal renal function (14 patients) undergoing 99mTc-MAG3 scans. The patient-specific organ activity was estimated based on a retrospective calibration which was performed based on a set of two 3D-printed infant kidneys (newborns: 8.6 ml; 1-year-old: 23.4 ml) filled with known activities. Both phantoms were scanned at different positions along the anteroposterior axis inside a water phantom, providing depth- and size-dependent attenuation correction factors for planar imaging. Time-activity curves were determined by drawing kidney, bladder, and whole body regions-of-interest for each patient, and subsequently applying the calibration factor for conversion of counts to activity. Patient-specific time-integrated activity coefficients were obtained by integrating the organ-specific time-activity curves. Absorbed and effective dose coefficients for each patient were assessed with OLINDA/EXM for the provided newborn and 1-year-old phantom. Based on absorbed dose values, the radiation risk estimation was performed individually for each of the 34 patients with the National Cancer Institute’s Radiation Risk Assessment Tool. The patients’ organ-specific mean absorbed dose coefficients for the patients with normal renal function were 0.04±0.03 mGy/MBq for the kidneys and 0.27±0.24 mGy/MBq for the bladder. This resulted in a mean effective dose coefficient of 0.02±0.02 mSv/MBq. Based on the dosimetry results, the evaluation of the excess lifetime risk (ELR) for the development of radiation-induced cancer showed that the group of newborns has an ELR of 16.8 per 100,000 persons, which is higher in comparison with the 1-year-old group with an ELR of 14.7 per 100,000 persons. With regard to the 14 patients with abnormal renal function, the mean values for the organ absorbed dose coefficients for the patients were: 0.40±0.34 mGy/MBq for the kidneys and 0.46±0.37 mGy/MBq for the bladder. The corresponding effective dose coefficients (mSv/MBq) was: 0.05±0.02 mSv/MBq. The mean ELR (per 100,000 persons) for developing cancer from radiation exposure for patients with abnormal renal function was 29.2±18.7 per 100,000 persons. As a result, the radiation-associated stochastic risk increases with the organ doses, taking age- and gender-specific influences into account. Overall, the lifetime radiation risk associated with the 99mTc-MAG3 scans is very low in comparison to the general population risk for developing cancer. Furthermore, due to the increasing demand for PET-scans in children and adolescents with 68Ga-labelled peptides, in this work published data sets for those compounds were analyzed to derive recommendations for the administered activities in children and adolescents. The recommendation for the activities to be administered were based on the weight-independent effective dose model, proposed by the EANM Pediatric Dosage Card for application in pediatric nuclear medicine. The aim was to derive recommendations on administered activities for obtaining age-independent effective doses. Consequently, the corresponding weight-dependent effective dose coefficients were rescaled according to the formalism of the EANM dosage card, to determine the radiopharmaceutical class of 68Ga-labeled peptides (“multiples”), and to calculate the baseline activities based on the biokinetics of these compounds and an upper limit of the administered activity of 185 MBq for an adult. Analogous to 18F-fluoride, a minimum activity of 14 MBq is recommended. As a result, for those pediatric nuclear medicine applications involving 68Ga-labeled peptides, new values for the EANM dosage card were proposed and implemented based on the results derived in this work. Overall, despite the low additional radiation-related cancer risk, all efforts should be undertaken to optimize administered activities in children and adolescents for obtaining sufficient diagnostic information with minimal associated radiation risk.

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.

Motoneuron diseases form a heterogeneous group of pathologies characterized by the progressive degeneration of motoneurons. More and more genetic factors associated with motoneuron diseases encode proteins that have a function in RNA metabolism, suggesting that disturbed RNA metabolism could be a common underlying problem in several, perhaps all, forms of motoneuron diseases. Recent results suggest that SMN interacts with hnRNP R and TDP-43 in neuronal processes, which are not part of the classical SMN complex. This point to an additional function of SMN, which could contribute to the high vulnerability of spinal motoneurons in spinal muscular atrophy (SMA) and amyotrophic lateral sclerosis (ALS). The current study elucidates functional links between SMN, the causative factor of SMA (spinal muscular atrophy), hnRNP R, and TDP-43, a genetic factor in ALS (amyotrophic lateral sclerosis). In order to characterize the functional interaction of SMN with hnRNP R and TDP-43, we produced recombinant proteins and investigated their interaction by co-immunoprecipitation. These proteins bind directly to each other, indicating that no other co-factors are needed for this interaction. SMN potentiates the ability of hnRNP R and TDP-43 to bind to ß-actin mRNA. Depletion of SMN alters the subcellular distribution of hnRNP R in motoneurons both in SMN-knockdown motoneurons and SMA mutant mouse (delta7 SMA). These data point to functions of SMN beyond snRNP assembly which could be crucial for recruitment and transport of RNA particles into axons and axon terminals, a mechanism which may contribute to SMA pathogenesis and ALS. ALS and FTLD (frontotemporal lobar degeneration) are linked by several lines of evidence with respect to clinical and pathological characteristics. Both sporadic and familial forms are a feature of the ALS-FTLD spectrum, with numerous genes having been associated with these pathological conditions. Both diseases are characterized by the pathological cellular aggregation of proteins. Interestingly, some of these proteins such as TDP-43 and FUS have also common relations not only with ALS-FTLD but also with SMA. Intronic hexanucleotide expansions in C9ORF72 are common in ALS and FTLD but it is unknown whether loss of function, toxicity by the expanded RNA or dipeptides from non ATG-initiated translation is responsible for the pathophysiology. This study tries to characterize the cellular function of C9ORF72 protein. To address this, lentiviral based knockdown and overexpression of C9ORF72 was used in isolated mouse motoneurons. The results clearly show that survival of these motoneurons was not affected by altered C9ORF72 levels, whereas adverse effects on axon growth and growth cone size became apparent after C9ORF72 suppression. Determining the protein interactome revealed several proteins in complexes with C9ORF72. Interestingly, C9ORF72 is present in a complex with cofilin and other actin binding proteins that modulate actin dynamics. These interactions were confirmed both by co-precipitation analyses and in particular by functional studies showing altered actin dynamics in motoneurons with reduced levels of C9ORF72. Importantly, the phosphorylation of cofilin is enhanced in C9ORF72 depleted motoneurons and patient derived lymphoblastoid cells with reduced C9ORF72 levels. These findings indicate that C9ORF72 regulates axonal actin dynamics and the loss of this function could contribute to disease pathomechanisms in ALS and FTLD.

Die spinale Muskelatrophie (SMA) ist eine monogenetische Erkrankung, bei der es durch den Verlust des SMN Proteins zur Degeneration der α-Motoneurone im Rückenmark kommt. Abhängig vom Schweregrad zeigen die Patienten bereits innerhalb der ersten Lebensmonate ausgeprägte Lähmungen der Skelettmuskulatur und eine Zwerchfellparese einhergehend mit einer reduzierten Lebenserwartung. Mithilfe von Mausmodellen für die SMA konnte gezeigt werden, dass der Motoneuronenverlust bei Smn-defizienten Mäusen mit Störungen der Neurotransmission an der motorischen Endplatte und mit Differenzierungsstörungen der Motoneurone einhergeht. Die Differenzierungs-störungen primärer Smn-defizienter Motoneurone sind eng gekoppelt mit einer verminderten Clusterbildung spannungsabhängiger Kalziumkanäle im distalen axonalen Bereich. Dies wiederum führt zu einer verminderten Frequenz spontaner Kalziumeinströme am Axonterminus und hat eine veränderte axonale Elongation zur Folge. Es wurden folgende Aspekte in Bezug auf die Verstärkung und die Induktion spontaner Kalziumeinströme in Mausmodellen für spinale Muskelatrophien in dieser Arbeit adressiert: 1) Lassen sich spontane Kalziumeinströme in Smn-defizienten Motoneuronen durch die externe Applikation von Kalziumkanalagonisten verstärken? 2) Sind spontane Kalziumeinströme in primären Motoneuronen durch den Brain-derived-neurotrophic-factor (BDNF) induzierbar? 3) Zeigen primäre Motoneurone eines Mausmodells für spinale Muskelatrophie mit Ateminsuffizienz Typ 1 (SMARD1) ebenfalls veränderte Kalziumtransienten? Die Ergebnisse meiner Arbeit zeigen, dass durch den Kalziumkanalagonisten R-Roscovitine die Frequenz der spontanen Kalziumeinströme im distalen Axon von Smn-defizienten Motoneuronen signifikant erhöht wird. Dies hat wiederum einen regulierenden Effekt auf die Differenzierung der SMA Motoneurone zur Folge. Smn-defiziente Motoneurone zeigen somit keine Unterschiede mehr in Bezug auf Axonlängen und Wachstumskegelflächen im Vergleich zu Kontrollzellen. Für R- 10 Roscovitine ist neben der agonistischen Wirkung am Kalziumkanal auch ein inhibitorischer Effekt auf die Cyclin-abhängige Kinase 5 beschrieben. Es konnte jedoch gezeigt werden, dass die erhöhten Kalziumtransienten unter der Behandlung mit R-Roscovitine durch eine direkte Bindung an die Cav2 Kalziumkanäle verursacht werden und nicht durch eine Cdk5 Blockade. Dafür spricht die schnelle und reversible Wirkung von R-Roscovitine, sowie die Aufhebung des R-Roscovitines Effekts bei gleichzeitiger Gabe des Cav2.2 Antagonisten ω-Conotoxin MVIIC. Der zweite Aspekt dieser Arbeit behandelt den Einfluss der neurotrophen Faktoren BDNF, CNTF und GDNF auf die Kalziumtransienten am Wachstumskegel wildtypischer Motoneurone. Der Vergleich der neurotrophen Faktoren zeigt, dass nur BDNF eine induzierende Wirkung auf spontane Kalziumtransienten am Wachstumskegel hat. Der letzte Abschnitt dieser Arbeit beschäftigt sich mit den Kalziumtransienten bei Motoneuronen aus dem Nmd2J (SMARD1) Mausmodell. Die SMARD1 gilt als eigenständige Form der spinalen Muskelatrophien mit unterschiedlicher Genetik und unterschiedlichen klinischen Merkmalen. Die Motoneurone weisen in Bezug auf die Kalziumtransienten keine Unterschiede zwischen Wildtyp und Nmd2J Mutante auf. Es ergibt sich somit kein Hinweis darauf, dass die Degeneration der Motoneurone bei der SMARD1 von einer Störung der Kalziumhomöostase im distalen axonalen Bereich ausgeht.

1. Zusammenfassung Während der Embryogenese und nach Verletzungen von Nerven regulieren neurotrophe Faktoren Signalwege für Apoptose, Differenzierung, Wachstum und Regeneration von Neuronen. In vivo Experimente an neugeborenen Nagern haben gezeigt, dass der Verlust von Motoneuronen nach peripherer Nervenläsion durch die Behandlung mit GDNF, BDNF, und CNTF reduziert werden kann In der pmn-Mausmutante, einem Modell für die Amyotrophe Lateralsklerose, führt die Gabe von CNTF, nicht aber von GDNF zu einem verzögerten Krankheitsbeginn und einem verlangsamten Fortschreiten der Motoneuronendegeneration. Auslöser der Motoneuronendegeneration in der pmn-Maus ist eine Mutation im Tubulin spezifischen Chaperon E (Tbce) Gen, das für eines von fünf Tubulin spezifischen Chaperonen (TBCA-TBCE) kodiert und an der Bildung von -Tubulinheterodimeren beteiligt ist. Diese Arbeit sollte dazu beitragen, die CNTF-induzierten Signalwege zu entschlüsseln, die sich lindernd auf den progredienten Verlauf der Motoneuronendegeneration in der pmn-Maus auswirken. Primäre pmn mutierte Motoneurone zeigen ein reduziertes Axonwachstum und eine erhöhte Anzahl axonaler Schwellungen mit einer anomalen Häufung von Mitochondrien - ein frühes Erkennungsmerkmal bei ALS-Patienten. Die Applikation von CNTF nicht aber von BDNF oder GDNF, kann in vitro die beobachteten Wachstumsdefekte und das bidirektionale axonale Transportdefizit in pmn mutierten Motoneurone verhindern. Aus älteren Untersuchungen war bekannt, dass CNTF über den dreiteiligen transmembranen Rezeptorkomplex, bestehend aus CNTFR, LIFR und gp130, Januskinasen aktiviert, die STAT3 an Tyrosin 705 phosphorylieren (pSTAT3Y705). Ich konnte beobachten, dass axonales fluoreszenzmarkiertes pSTAT3Y705 nach CNTF-Gabe nicht retrograd in den Nukleus transportiert wird. Stattdessen führt die CNTF-induzierte Phosphorylierung von STAT3 an Tyrosin 705 zu einer transkriptionsunabhängigen lokalen Reaktion im Axon. Diese pSTAT3Y705 abhängige Reaktion ist notwendig und ausreichend, um das reduzierte Axonwachstum pmn mutierter Motoneurone zu beheben. Wie die Kombination einer CNTF Behandlung mit dem shRNA vermittelten knock-down von Stathmin in pmn mutierten Motoneuronen zeigt, zielt die CNTF-STAT3 Signalkaskade auf die Stabilisierung axonaler Mikrotubuli ab und wirkt sich positiv auf die anterograde und retrograde Mobilität von axonalen Mitochondrien aus. Interessanter Weise konnte ich außerdem feststellen, dass eine akute Gabe von CNTF das mitochondriale Membranpotential in Axonen primärer pmn mutierter und wildtypischer Motoneurone erhöht und einen Anstieg von ATP auslöst. Meine Beobachtungen legen nahe, dass CNTF unerwarteter Weise auch eine transiente Phosphorylierung an STAT3 Serin 727 (pSTAT3S727) auslöst, die zur anschließenden Translokation von pSTAT3S727 in Mitochondrien führt. Diese Ergebnisse zeigen, dass STAT3 mehrere lokale Ziele im Axon besitzt, nämlich axonale Mikrotubuli und Mitochondrien.