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Human protein kinases play essential roles in cellular signaling pathways and - if deregulated - are linked to a large diversity of diseases such as cancer and inflammation or to metabolic diseases. Because of their key role in disease development or progression, kinases have developed into major drug targets resulting in the approval of 52 kinase inhibitors by the Food and Drug Administration (FDA) so far.
Within the drug discovery process, the affinity of the inhibitors is the parameter that is used most often to predict the later efficacy in humans. However, the kinetics of binding have recently emerged as an important but largely neglected factor of kinase inhibitor efficacy. To efficiently suppress a signaling pathway, the targeted kinase needs to be continuously inhibited. Thus, it has been hypothesized that fast binding on-rates and slow off-rates would be the preferred property of an efficacious inhibitor. Despite optimizing the potency of kinase inhibitors, in the past decade optimization of kinetic selectivity has therefore gained interest as a molecule cannot be active unless it is bound, as Paul Ehrlich once stated. There is increasing evidence of correlations between prolonged drug-target residence time and increased drug efficacy, and that inhibitor selectivity in cellular contexts can be modulated by altered residence times. In order to contribute to the understanding of the effect of long residence times on cellular targets we initiated two projects.
The first of these projects is related to the STE20 kinase Serine/threonine kinase 10 (STK10) and its close relative STE20 like kinase (SLK) which have been reported to be frequent off-targets for kinase inhibitors used in the clinics. Also, an inhibition of STK10 and SLK has been linked to a common side-effect of severe skin rash developed upon treatment with the EGFR inhibitor erlotinib, but not gefitinib and the severity of this rash correlated with the treatment outcome, which fits the known biology of STK10 and SLK to be regulators of lymphocyte migration and PLK kinases. However, there are yet no explanations why these two proteins show such high hit-rates across the kinome among the kinase inhibitors. Using structural analysis, we identified the flexibility of STK10 to be the main reason for this hit-rate. The observed strong in vitro potencies did however not translate to the cellular system which is why we investigated the inhibitors residence time on STK10. We found the same flexibility to be the main reason for slow residence times among several inhibitors. We observed large rearrangements in the hydrophobic backpocket of STK10 including the αC, the P-loop enclosing the inhibitor like a lid and strong π-π-stackings to be the main reasons for prolonged residence times on STK10. Interestingly, we observed an increased residence time for erlotinib, which showed skin-related side-effects, giving rise whether the binding kinetics should be investigated for weak cellular off-target effects in future drug discovery efforts.
In the second project we initiated, we illuminate a structural mechanism that allows kinetic selection between two closely related kinases, focal adhesion kinase (FAK) and proline-rich tyrosine kinase 2 (PYK2). Using an inhibitor series designed to probe the mechanism, residence times measured in vitro and in cells showed a strong correlation. Crystal structures and mutagenesis identified hydrophobic interactions with L567, adjacent to the DFG-motif, as being crucial to kinetic selectivity of FAK over PYK2. This specific interaction was observed only when the DFG-motif was stabilized into a helical conformation upon ligand binding to FAK. The interplay between the protein structural mobility and ligand-induced effect was found to be the key regulator of kinetic inhibitor selectivity for FAK over PYK2.
These two projects showed that the parameter residence time should be considered for different problems among the drug discovery process. First, in an open in vivo system not only the potency of a drug alone, but as well its residence time might be of importance. Here we showed that the weak cellular potency translated to prolonged residence times for several inhibitors in cells and established a link between the phenotypic outcome of skin rash after erlotinib treatment and the residence time of this inhibitor on STK10 in cells. On the other hand, medicinal chemistry efforts should consider structure kinetic relationships (SKR) in the optimization process and aim to understand the molecular basis for prolonged target residence times. Here, we showed that a hydrophobic interaction that is enforced upon inhibitor binding is crucial for an unusual helical DFG conformation which arrests the inhibitor and prolongs its residence time providing the molecular basis for understanding the kinetic selectivity of two closely related protein kinases. Establishing the SKRs will help medicinal chemists to kinetically optimize their drug candidates to select a suitable molecule to proceed into further optimization programs. Hence, the projects showed that the target residence time parameter needs to be considered both as a molecular optimization parameter to improve compound potency and binding behavior as well as a parameter to be understood for proceeding to the open system of in vivo models to later modulate the in vivo efficacy of protein kinase targeting drugs.
Production of free radicals and oxidative damage during physical activity is a topic that is intensively studied and paid a lot of attention, first of all in professional sports. Marathon is categorized as extremely demanding sports discipline, as it induces high energy consumption and also requires special mental self-control. We presented cases of two athletes of different age, who have been on dissimilar level of sports readiness, and also had various approach to physical activity and exercise. During 10 days they ran out 10 marathons, partly on a flat terrain, and partly on hilly, which produced different level of effort in conquering the terrain. Also, both athletes had complex supplementation scheme in order to prevent electrolyte imbalance and excessive production of free radicals. Blood samples were taken in the morning and immediately after the end of the marathon. Measured oxidative stress biomarkers changed without a noticeable pattern, but these changes did not vary greatly among themselves. Catalase activity in both marathon runners was higher after marathon almost after every race for 10 days. On the other hand, amount of reduced glutathione was lower after marathon in both athletes in the same manner. Based on the obtained results we can conclude that adequate supplementation could have crucial role in prevention of oxidative damage.
Inflammation has been recognized as a common trait in the pathogenesis of multifactorial diseases including obesity, where a low-grade inflammation has been established and may be responsible for the cardiovascular risk related to the disease. Obesity has also been associated with the increased incidence and a worse outcome of rheumatoid arthritis (RA) and osteoarthritis (OA). RA is characterized by systemic inflammation, which is thought to play a key role in accelerated atherosclerosis and in the increased incidence of cardiovascular disease, an important comorbidity in patients with RA. The inflammatory process underlying the cardiovascular risk both in obesity and RA may be mediated by adipocytokines, a heterogeneous group of soluble proteins mainly secreted by the adipocytes. Many adipocytokines are mainly produced by white adipose tissue. Adipocytokines may also be involved in the pathogenesis of OA since a positive association with obesity has been found for weight-bearing and nonweight-bearing joints, suggesting that, in addition to local overload, systemic factors may contribute to joint damage. In this review we summarize the current knowledge on experimental models and clinical studies in which adipocytokines were examined in obesity, RA, and OA and discuss the potential of adipocytokines as comorbidity biomarkers for cardiovascular risk.
Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease, and therefore, there is a lack of data regarding its clinical presentation, diagnosis, and management at a national basis. We aimed to describe the demographics and management of patients with CTEPH in Northern Greece. Methods: We conducted a retrospective, observational study by a joint collaboration between two pulmonary hypertension expert centers in Greece, and the study included patients diagnosed with CTEPH. The patient population was divided into two groups depending on their operability. Results: Overall, 27 consecutive patients were included (59% female, mean age 59.3±15.1 years). Dyspnea and fatigue were the most common presenting symptoms. History of pulmonary embolism was present in 82%. Of patients, 18 (67%) were assessed as operable, of whom 10 (55%) finally underwent pulmonary endarterectomy (PEA). There were no differences in symptoms, WHO functional class, 6-min walking test distance, and hemodynamics between the operable and nonoperable groups. At the end of follow-up, all non-operable and operable patients who did not receive surgical treatment were treated with at least one pulmonary hypertension-specific drug. Conclusion: This is the first report that presents data of patients diagnosed with CTEPH in Greece. The percentage of patients who underwent surgical treatment is lower but approaches the reported rates in large registries. Considering that PEA is a relatively safe and potentially curative surgical procedure, we emphasize the need for establishing a designated PEA center in Greece. Keywords: Chronic thromboembolic pulmonary hypertension, pulmonary endarterectomy, registry, riociguat.
Introduction. The use of ultrasound during resuscitation is emphasized in the latest European resuscitation council guidelines of 2013 to identify treatable conditions such as pericardial tamponade. The recommended standard treatment of tamponade in various guidelines is pericardiocentesis. As ultrasound guidance lowers the complication rates and increases the patient’s safety, pericardiocentesis should be performed under ultrasound guidance. Acute care physicians actually need to train emergency pericardiocentesis. Methods. We describe in detail a pericardiocentesis ultrasound model, using materials at a cost of about 60 euros. During training courses of focused echocardiography n=67, participants tested the phantom and completed a 16-item questionnaire, assessing the model using a visual analogue scale (VAS). Results. Eleven of fourteen questions were answered with a mean VAS score higher than 60% and thus regarded as showing the strengths of the model. Unrealistically outer appearance and heart shape were rated as weakness of the model. A total mean VAS score of all questions of 63% showed that participants gained confidence for further interventions. Conclusions. Our low-cost pericardiocentesis model, which can be easily constructed, may serve as an effective training tool of ultrasound-guided pericardiocentesis for acute and critical care physicians.
Geoarchaeological reconstructions of land-use changes may help to reveal driving cultural factors and incentives behind these processes and relate them to supra-regional economic and political developments. This is particularly true in the context of complete abandonment of a settlement. Here we present a case study from the site of Faule Pfütze, a small catchment in the Eastern Ore Mountains (Saxony). The historical record of this site is confined to the report of a settlement called Hohenwalde in 1404 CE and two later references to the then-abandoned settlement in 1492 and 1524 CE in this area. Combined geoarchaeological studies allowed for the reconstruction of several phases of land use. While a first phase of alluvial sedimentation occurred during the late 12th century, archaeological evidence for a permanent settlement is absent during this period. The onset of settlement activity is identified during the late 14th century and included a hitherto unknown massive stone building. Mining features are present nearby and are dated to the early 15th century. The local palynological record shows evidence for reforestation during the mid 15th century and thereby corroborates the time of abandonment indicated by written sources. These processes are discussed in the context of a local political conflict (Dohna Feud) leading to the redistribution of properties and the development of a mining economy during this time. Later land use from the mid 16th century onwards appears restricted to charcoal production, probably in the context of smelting works operating in nearby Schmiedeberg as indicated by rising lead concentrations in the alluvial record.
During translation initiation, the heterotrimeric archaeal translation initiation factor 2 (aIF2) recruits the initiator tRNAi to the small ribosomal subunit. In the stationary growth phase and/or during nutrient stress, Sulfolobus solfataricus aIF2 has a second function: It protects leaderless mRNAs against degradation by binding to their 5′‐ends. The S. solfataricus protein Sso2509 is a translation recovery factor (Trf) that interacts with aIF2 and is responsible for the release of aIF2 from bound mRNAs, thereby enabling translation re‐initiation. It is a member of the domain of unknown function 35 (DUF35) protein family and is conserved in Sulfolobales as well as in other archaea. Here, we present the X‐ray structure of S. solfataricus Trf solved to a resolution of 1.65 Å. Trf is composed of an N‐terminal rubredoxin‐like domain containing a bound zinc ion and a C‐terminal oligosaccharide/oligonucleotide binding fold domain. The Trf structure reveals putative mRNA binding sites in both domains. Surprisingly, the Trf protein is structurally but not sequentially very similar to proteins linked to acyl‐CoA utilization—for example, the Sso2064 protein from S. solfataricus—as well as to scaffold proteins found in the acetoacetyl‐CoA thiolase/high‐mobility group‐CoA synthase complex of the archaeon Methanothermococcus thermolithotrophicus and in a steroid side‐chain‐cleaving aldolase complex from the bacterium Thermomonospora curvata. This suggests that members of the DUF35 protein family are able to act as scaffolding and binding proteins in a wide variety of biological processes.
Five new species of Hercostomus Loew, 1857 from Kenya, Namibia, Tanzania and South Africa are described and illustrated. They belong to the Hercostomus longiventris lineage, which also appears similar to the Palaearctic H. chetifer subgroup and the Oriental H. takagii and H. absimilis groups on the basis of the modified male fore tarsus. The male cercus of almost all Afrotropical species is remarkable in having ventral processes or projections and are conditionally divided into H. nectarophagus and H. perturbus subgroups on the basis of the presence of one or two ventral projections on the cercus, respectively. Hercostomus brandbergensis sp. nov. and H. fedotovae sp. nov. are associated with the H. nectarophagus subgroup; H. koshelevae sp. nov., H. vikhrevi sp. nov., and H. sanipass sp. nov. are associated with the H. perturbus subgroup. The new species differ by fine structures of the male fore tarsus, cercus and postgonite. An identification key to males of 23 Afrotropical species of Hercostomus is compiled for the first time. New records are given for some known species.
Background & Aims: Renal function assessed by creatinine is a key prognostic factor in cirrhotic patients. However, creatinine is influenced by several factors, rendering interpretation difficult in some situations. This is especially important in early stages of renal dysfunction where renal impairment might not be accompanied by an increase in creatinine. Other parameters, such as cystatin C (CysC) and beta‐trace protein (BTP), have been evaluated to fill this gap. However, none of these studies have considered the role of the patient's sex. The present study analysed CysC and BTP to evaluate their prognostic value and differentiate them according to sex.
Patients and methods: CysC and BTP were measured in 173 transjugular intrahepatic portosystemic shunt (TIPS)‐patients from the NEPTUN‐STUDY(NCT03628807) and analysed their relationship with mortality and sex. Propensity score for age, MELD, etiology and TIPS indication was used.
Results_ Cystatin C and BTP showed excellent correlations with creatinine values at baseline and follow‐up. CysC was an independent predictor of overall mortality (HR = 1.66(1.33‐2.06)) with an AUC of 0.75 and identified a cut‐off of 1.55 mg/L in the whole cohort. Interestingly, CysC was significantly lower in females, also after propensity score matching. In males, the only independent predictor was the creatinine level (HR = 1.54(1.25‐1.58)), while in females CysC levels independently predicted mortality (HR = 3.17(1.34‐7.52)).
Conclusion: This study demonstrates for the first time that in TIPS‐patients creatinine predicts mortality in males better than in females, whereas CysC is a better predictor of mortality in females. These results may influence future clinical decisions on therapeutic options for example, allocation for liver transplantation in TIPS‐patients.
Rationale: The clinical relevance of sensitization to Aspergillus (A) fumigatus in cystic fibrosis (CF) is unclear. Some researchers propose that specific A fumigatus IgE is an innocent bystander, whereas others describe it as the major cause of TH‐2‐driven asthma‐like disease.
Objectives: Lung function parameters in mild CF patients may be different in patients with and without A fumigatus sensitization. We aimed to ascertain whether allergen exposure to A fumigatus by bronchial allergen provocation (BAP) induces TH‐2 inflammation comparable to an asthma‐like disease.
Methods: A total of 35 patients, aged 14.8 ± 8.5 years, and 20 healthy controls were investigated prospectively. The patients were divided into two groups: group 1 (n = 18): specific (s)IgE negative, and group 2 (n = 17): sIgE positive (≥0.7 KU/L) for A fumigatus. Lung function, exhaled NO, and induced sputum were analysed. All sensitized patients with an FEV1 > 75% (n = 13) underwent BAP with A fumigatus, and cell counts, and the expression of IL‐5, IL‐13, INF‐γ, and IL‐8 as well as transcription factors T‐bet, GATA‐3, and FoxP3, were measured.
Results: Lung function parameters decreased significantly compared to controls, but not within the CF patient group. After BAP, 8 of 13 patients (61%) had a significant asthmatic response and increased eNO 24 hours later. In addition, marked TH‐2‐mediated inflammation involving eosinophils, IL‐5, IL‐13, and FoxP3 became apparent in induced sputum cells.
Conclusion: Our study demonstrated the clinical relevance of A fumigatus for the majority of sensitized CF patients. A distinct IgE/TH‐2‐dominated inflammation was found in induced sputum after A fumigatus exposure.