Trotz zahlreicher Fortschritte im Verständnis der Funktionsweise des kostimulatorischen Rezeptors CD28 in Mensch, Maus, Ratte und Makake ist nach wie vor wenig hierüber in Bezug auf das Tiermodell Schwein bekannt. Die vorliegende Arbeit untersucht die Funktion und Expression von CD28 in Schweine-T-Zellen sowie die Regulierbarkeit der T-Zellaktivierung durch anti-pCD28 mAb. Die Ergebnisse zeigen, dass hierbei vor allem CD4+ und CD8+ T-Zellen differenziert betrachtet werden müssen. Grundsätzlich unterscheiden sich die beiden T-Zellpopulationen in der CD28 mRNA Expression, im Expressionsverhältnis zwischen CD28 mRNA und Protein, sowie im proliferativen Ansprechen auf anti-pCD28mAb. So reagierten CD4+ im Vergleich zu CD8+ T-Zellen auf die kostimulatorische Inkubation mit anti-pCD28 mAb des Klons 3D11 sensibler. In direkt stimulatorischen Ansätzen zeigte sich, dass CD4+ und CD8+ T-Zellen durch unterschiedliche anti-pCD28 mAb differentiell angesprochen werden können. Eine superagonistische Funktion konnte für CD4+ T-Zell aktivierende anti-pCD28 mAb in den bisherigen Versuchen noch nicht beobachtet werden. Letzteres ist hierbei vor allem für den Transfer von vielversprechenden Therapiestrategien vom Kleintier- zum Großtiermodell auf dem Weg zur Entwicklung neuer Therapieoptionen für Autoimmunerkrankungen, Erkrankungen mit starker proinflammatorischer Aktivität und dem Myokardinfarkt von Bedeutung.

RNA molecules play diverse roles in biological systems. Post-transcriptional RNA modifications and dynamic structures enhance the functional diversity of RNA. A prerequisite for studying their biological significance is the availability of reliable methods for the detection of RNA modifications and structures. Several promising approaches have been developed in the last few decades; however, efficient, and versatile tools are still required to study the dynamic features of RNA. This thesis focuses on the development of nucleic acid catalysts as a tool to address the current needs in studying RNA. The major part of this thesis aimed at the development of deoxyribozymes as a tool for the detection of RNA modifications. Using in vitro selection from a random DNA library, we found deoxyribozymes that are sensitive to N 6 -isopentenyladenosine (i6A), a native tRNA modification and structural analogue of m6A. The in vitro evolution identified three classes of DNA enzymes: AA, AB08, and AC17 DNAzymes that showed distinct response to i6A modification and showed strong discrimination between structural analogues, i.e., m6A and i6A. In the continuation of the project, we attempted to develop RNA-cleaving deoxyribozymes that differentially respond to monomethylated cytidine isomers, 3-methylcytidine (m3C), N4 - methylcytidine (m4C), and 5-methylcytidine (m5C). Several deoxyribozymes were identified from in vitro selection, which are selective for a specific methylated cytidine isomer. The characterization of AL112, AM101, AN05, and AK104 catalysts confirmed the successful evolution of modification-specific and general deoxyribozymes that showed a broad substrate scope. In order to accelerate the DNAzymes discovery, a high throughput sequencing method (DZ-seq) was established that directly quantifies the RNA cleavage activity and cleavage site from deep sequencing data. The libraries contained information about cleavage status, cleavage site and sequence of deoxyribozymes and RNA substrate. The fraction cleaved (FC) data obtained from Dz-seq was validated for a subset of deoxyribozmes using conventional gel based kinetic assay and showed a good linear correlation (R2 = 0.91). Dz-seq possesses a great potential for the discovery of novel deoxyribozymes for the analysis of various RNA modifications in the future. The second objective of the current study was the development of structure-specific RNA labeling ribozymes. Here, we attempted to develop ribozymes that targets RNA of interest by structure-specific interaction rather than base-pairing and focused on a specific RNA G-quadruplex as the target. Two subsequent selection experiments led to the identification of the adenylyltransferase ribozymes AO10.2 and AR9. The partial characterization of these catalysts showed that A010.2 was unable to recognize intact BCL2 structure, but it turned out as the first reported trans-active ribozyme that efficiently labeled uridine in a defined substrate RNA hybridized to the ribozyme. The other ribozyme AR9 was shown to serve as a trans-active, self-labeling ribozyme that catalyzed adenylyl transferase reaction in the presence of the intact BCL2 sequence. Based on these preliminary findings, we envision that AR9 could potentially serve as a reporter RNA by self-labeling in the presence of an RNA G-quadruplex. However, both AO10.2 and AR9 still require more detailed characterization for their potential applications.

Für die Diagnose und Therapie von Brustkrebs existiert die nationale evidenz- und konsensbasierte S3-Leitlinie. Die klinischen Krebsregister stellen sektor- und facharztübergreifende Diagnose- und Therapiedaten zur Qualitätssicherung bereit. Bislang fehlen jedoch Daten bezüglich patient-reported outcome measures (PROMs). Aufgrund des demographischen Wandels werden Brustkrebserkrankungen vor allem in ländlichen Regionen weiter zunehmen, weshalb Versorgungsstrukturen für alle Patientinnen erreichbar sein sollten. Es wurde ein patientenorientiertes Registerkonzept (Breast Cancer Care for patients with metastatic disease (BRE-4-MED)) für den metastasierten Brustkrebs entwickelt und hinsichtlich vordefinierter Machbarkeitskriterien pilotiert. An der BRE-4-MED-Pilotstudie nahmen 31 Patientinnen (96.8% weiblich) teil. Die bayernweite Erreichbarkeit zu brustkrebsspezifischen Versorgungsstrukturen wurde mithilfe einer Geographic Information System (GIS)-Analyse untersucht. Anhand von Leitlinienempfehlungen und Ergebnissen der BRE-4-MED-Pilotstudie wurden relevante Versorgungsstrukturen identifiziert. Die Ergebnisse der Pilotstudie zeigen, dass die Integration von Primär- und Sekundärdaten aus verschiedenen Quellen in ein zentrales Studienregister machbar ist und die erforderlichen organisatorischen Prozesse (z. B. data linkage mit Krebsregister) funktionieren. Die Ergebnisse der Erreichbarkeitsanalyse verdeutlichen, dass es keine bayernweite Erreichbarkeit zu brustkrebsspezifischen Versorgungsstrukturen gibt. Am stärksten war dieser Zusammenhang in grenznahen Regionen ausgeprägt. Die vorliegende Arbeit zeigt Chancen für eine patientenorientierte, qualitätsgesicherte Brustkrebsversorgung unabhängig vom Wohnort auf.

1 Summary Left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) are the most commonly used measures of LV function. Yet, they are highly dependent on loading conditions since higher afterload yields lower systolic deformation and thereby a lower LVEF and GLS – despite presumably unchanged LV myocardial contractile strength. Invasive pressure-volume loop measurements represent the reference standard to assess LV function, also considering loading conditions. However, this procedure cannot be used in serial investigations or large sample populations due to its invasive nature. The novel concept of echocardiography-derived assessment of myocardial work (MyW) is based on LV pressure-strain loops, may be a valuable alternative to overcome these challenges, and may also be used with relative ease in large populations. As MyW also accounts for afterload, it is considered less load-dependent than LVEF and GLS. The current PhD work addresses the application and clinical characterization of MyW, an innovative echocardiographic tool. As the method is new, we focused on four main topics: (a) To establish reference values for MyW indices, i.e., Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), and Global Work Efficiency (GWE); we addressed a wide age range and evaluated the association of MyW indices with age, sex and other clinical and echocardiography parameters in apparently cardiovascular healthy individuals. (b) To investigate the impact of cardiovascular (CV) risk factors on MyW indices and characterize the severity of subclinical LV deterioration in the general population. (c) To assess the association of the LV geometry, i.e., LV mass and dimensions, with MyW indices. (d) To evaluate in-hospital dynamics of MyW indices in patients hospitalized for acute heart failure (AHF). For the PhD thesis, we could make use of two larger cohorts: The STAAB population-based cohort study prospectively recruited and phenotyped a representative sample (5,000 individuals) of the general population of the City of Würzburg, aged 30-79 years and free from symptomatic heart failure at the time of inclusion. We focused on the first half of the study sample (n=2473 individuals), which fulfilled the anticipated strata regarding age and sex. The Acute Heart Failure (AHF) Registry is a prospective clinical registry recruiting and phenotyping consecutive patients admitted for decompensated AHF to the Department of Medicine I, University Hospital Würzburg, and observing the natural course of the disease. The AHF Registry focuses on the pathophysiological understanding, particularly in relation to the early phase after cardiac decompensation, with the aim to improve diagnosis and better-tailored treatment of patients with AHF. For the current study, we concentrated on patients who provided pairs of echocardiograms acquired early after index hospital admission and prior to discharge. The main findings of the PhD thesis were: From the STAAB cohort study, we determined the feasibility of large-scale MyW derivation and the accuracy of the method. We established reference values for MyW indices based on 779 analyzable, apparently healthy participants (mean age 49 ± 10 years, 59% women), who were in sinus rhythm, free from CV risk factors or CV disease, and had no significant LV valve disease. Apart from GWI, there were no associations of other MyW indices with sex. Further, we found a disparate association with age, where MyW showed stable values until the age of 45 years, with an upward shift occurring beyond the age of 45. A higher age decade was associated with higher GWW and lower GWE, respectively. MyW indices only correlated weakly with common echocardiographic parameters, suggesting that MyW may add incremental information to clinically established parameters. Further analyses from the STAAB cohort study contributed to a better understanding of the impact of CV risk factors on MyW indices and the association of LV geometry with LV performance. We demonstrated that CV risk factors impacted selectively on GCW and GWW. Hypertension appears to profoundly compromise the work of the myocardium, in particular, by increasing both GCW and GWW. The LV in hypertension seems to operate at a higher energy level yet lower efficiency. Other classical CV risk factors (Diabetes mellitus, Obesity, Dyslipidemia, Smoking) – independent of blood pressure – impacted consistently and adversely on GCW but did not affect GWW. Further, all CV risk factors affected GWE adversely. We observed that any deviation from a normal LV geometric profile was associated with alterations on MyW. Of note, MyW was sensitive to early changes in LV mass and dimensions. Individuals with normal LV geometry yet established arterial hypertension exhibited a MyW pattern that is typically found in LV hypertrophy. Therefore, such a pattern might serve as an early sign of myocardial damage in hypertensive heart disease and might aid in risk stratification and primary prevention. From the AHF Registry, we selected individuals with serial in-hospital echocardiograms and described in-hospital changes in myocardial performance during recompensation. In patients presenting with a reduced ejection fraction (HFrEF), decreasing N-terminal pro-natriuretic peptide (NT-proBNP) levels as a surrogate of successful recompensation were associated with an improvement in GCW and GWI and consecutively in GWE. In contrast, in patients presenting with a preserved ejection fraction (HFpEF), there was no significant change in GCW and GWI. However, unsuccessful recompensation, i.e., no change or an increase in NT-proBNP levels, was associated with an increase in GWW. This suggests a differential myocardial response to de- and recompensation depending on the HF phenotype. Further, GWW as a surrogate of inappropriate LV energy consumption was elevated in all patients with AHF (compared to reference values) and was not associated with conventional markers as LVEF or NT-proBNP. In an exploratory analysis, GWW predicted the risk of death or rehospitalization within six months after discharge. Hence, GWW might carry incremental information beyond conventional markers of HF severity.

Wilms tumor (WT) is the most common renal tumor in childhood. Among others, MYCN copy number gain and MYCN P44L and MAX R60Q mutations have been identified in WT. The proto-oncogene MYCN encodes a transcription factor that requires dimerization with MAX to activate transcription of numerous target genes. MYCN gain has been associated with adverse prognosis. The MYCN P44L and MAX R60Q mutations, located in either the transactivating or basic helix-loop-helix domain, respectively, are predicted to be damaging by different pathogenicity prediction tools. These mutations have been reported in several other cancers and remain to be functionally characterized. In order to further describe these events in WT, we screened both mutations in a large cohort of unselected WT patients, to check for an association of the mutation status with certain histological or clinical features. MYCN P44L and MAX R60Q revealed frequencies of 3 % and 0.9 % and also were significantly associated to higher risk of relapse and metastasis, respectively. Furthermore, to get a better understanding of the MAX mutational landscape in WT, over 100 WT cases were analyzed by Sanger sequencing to identify other eventual MAX alterations in its coding sequence. R60Q remained the only MAX CDS alteration described in WT to date. To analyze the potential functional consequences of these mutations, we used a doxycycline-inducible system to overexpress each mutant in HEK293 cells. This biochemical characterization identified a reduced transcriptional activation potential for MAX R60Q, while the MYCN P44L mutation did not change activation potential or protein stability. The protein interactome of N-MYC-P44L was likewise not altered as shown by mass spectrometric analyses of purified N-MYC complexes. However, we could identify a number of novel N-MYC partner proteins, several of these known for their oncogenic potential. Their correlated expression in WT samples suggested a role in WT oncogenesis and they expand the range of potential biomarkers for WT stratification and targeting, especially for high-risk WT.