610 Medizin und Gesundheit
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In der vorliegenden Arbeit wurden die Porcinen Endogenen Retroviren (PERV) erstmals ausführlich biochemisch und biologisch charakterisiert sowie ihr Wirtsspektrum und ihre Expression in vitro näher analysiert. Es wurden sensitive immunologische Nachweismethoden entwickelt, die in experimentellen, präklinischen und ersten klinischen Studien zur Xenotransplantation angewandt wurden. Die Charakterisierung der Viren ergab, daß es sich um TypCRetroviren handelt, wobei ein Teil der Partikel nicht gereift ist. In hoch gereinigten Viruspräparationen aus Überständen produzierender porciner und PERVinfizierter, humaner Zellen konnten alle Strukturproteine identifiziert werden. Dazu wurden neben Elektrophoresen Western BlotAnalysen eingesetzt, wobei kreuzreaktive Antiseren gegen verwandte Viren und neu entwickelte, erstmals gegen PERVProteine gerichtete Antiseren benutzt wurden. Bei der Untersuchung der biologischen Eigenschaften wurde gezeigt, daß PERV in vitro ein mit anderen Retroviren vergleichbares immunsuppressives Potential besitzt. Mit diesen neuen Antiseren und den hoch gereinigten Viruspräparationen wurden sehr sensitive Western BlotVerfahren sowie ELISAs auf der Basis synthetischer Peptide als Nachweissysteme etabliert und validiert. Zuerst wurden Seren gesunder Blutspender mit diesen Tests untersucht. Dann wurden Seren von Schlachtern und von Patienten nach Xenotransplantationen getestet. Erstmals wurden auch Seren von Pavianen, denen u.a. auch ganze Schweineorganen transplantiert wurden und die eine profunde, für zukünftige Anwendungen typische, pharmakologische Immunsuppression erhielten, auf Antikörper gegen PERV untersucht. Bei Seren einiger Patienten und gesunder Blutspendern wurden zwar Kreuzreaktionen mit viralen Proteinen gefunden, es lagen aber keinerlei Anzeichen für eine PERVInfektion vor. Um das Wirtspektrum von PERV zu analysieren, wurden Zellinien und erstmals auch primäre Zellen verschiedener Spezies einschließlich Ratte und Maus mit PERV inokuliert. Dabei wurden erstmals Hinweise auf die Suszeptibilität von humanen Blutzellen erhalten. Es konnte gezeigt werden, daß mitogenstimulierte porcine PBMC PERV freisetzen können, wobei alle drei Subtypen der Hüllproteine nachgewiesen wurden. Eine nähere Analyse ergab daß verschiedene Schweinerassen aber auch einzelne Individuen der gleichen Rasse unterschiedliche Mengen an Virus freisetzen. Unter bestimmten Stimulationsbedingungen wurde PERV von adhärenten Zellen produziert, die nicht näher charakterisiert werden konnten. Eine endgültige Beurteilung des Infektionsrisikos bei Xenotransplantationen ist nach Abschluß dieser Studie noch nicht möglich. Mit der Charakterisierung von PERV und den immunologischen Nachweismethoden wurden die Voraussetzung für die Analyse weiterer experimenteller und klinischer Xenotransplantationen gelegt.
Short tandem repeat (STR) Loci sind ideale Marker für gerichtliche und abstammungs genetische DNAUntersuchungen. Sie bestehen aus sich wiederholenden 26 bp langen Einheiten und sind über das gesamte menschliche Genom verteilt. Aufgrund ihrer geringen Allellängen (100600 bp) lassen sich STRs leicht mit Hilfe der Polymerasekettenreaktion (PCR) amplifizieren. In der vorliegenden Arbeit sind fünf STRPolymorphismen der Loci D11S488, D18S51, D19S246, HUMFIBRA (FGA) und HUMVWFA31/A auf ihre Populationsgenetik und Sequenzstruktur hin untersucht worden. Die Daten wurden anhand genomischer DNA von 100 gesunden, unverwandten kaukasischen Blutspendern aus der Region Hessen gewonnen. Über ein 6 %iges denaturierendes Polyacrylamidgel wurden die PCRProdukte aufgetrennt und unter Gebrauch fluoreszenzmarkierter Primer mit einem 373A DNASequenzer analysiert. Der Locus D11S488 ist durch eine zusammengesetzte Repeatregion (compound repeat) von AAAG und GAAG Blöcken gekennzeichnet. Mit einer Variationsmöglichkeit an vier unter schiedlichen Positionen kam es zum Auftreten von Mikroheterogenitäten in Allelen gleicher Länge. 29 verschiedene Allele wurden gefunden, die basierend auf ihrer Gesamtrepeatanzahl (YAAG) 2641 (242 bp302 bp), in 15 Allelklassen gruppiert wurden. Bei D19S246 (TGTA und TCTA) liegt ebenfalls ein compound repeat vor. Mikroheterogenitäten führten in 11 Allelgruppen (182230 bp) zu 17 unterschiedlichen Allelen. Der Locus D18S51 (AGAA) ist ein STRPolymorphismus mit einer einfachen Repeatstruktur (simple repeat). 12 unter schiedliche Allele wurden beobachtet, die alle einen regelmäßigen Tetranukleotidrepeat aufwiesen. Die Allelspanne reichte von Allel 11 mit 278 bp bis Allel 22 mit 322 bp. Ebenfalls ein einfacher Repeat bestimmt das HUMFIBRA System (TCTT). Eines der beobachteten 10 Allele differierte allerdings um nur 2 bp. Zusammen mit dem compound repeat HUMVWFA31/A (8 Allele) sind alle untersuchten Marker multiplexfähig. Ein ausgeprägter Polymorphismus der individuellen Loci, die dem HardyWeinberg Equilibrium folgen, sowie eine Übereinstimmungswahrscheinlichkeit (pM) der Merkmale zwischen unverwandten Personen von 3 x 10 7 machen eine Analyse dieser fünf TetranukleotidMarker zu einer sinnvollen Ergänzung in der Bearbeitung abstammungs genetischer Fragestellungen.
Die doppelblinde Pilotstudie ''Wirksamkeit und Verträglichkeit einer Enzym oder Vitamin ATherapie bei Patienten mit Plattenepithelkarzinom im Kopf/Halsbereich" wurde in Zusammenarbeit mit der HNOKlinik in dem Zeitraum von Oktober 1994 bis Juni 1996 mit 25 Patienten mit Plattenepithelkarzinomen und 15 gesunden Kontrollpersonen durchgeführt. Den Patienten wurde neben der konventionellen Therapie entweder VitaminA (Retinolpalmitat, 150,000 IE/d), die Enzympräparation (proteolytische Gesamtaktivität 20,880 F.I.P.E/d) oder Placebo zugeteilt. In regelmäßigen Abständen wurde das Allgemeinbefinden/ Nebenwirkungen protokolliert, Blutbild und Leberwerte bestimmt, die peripheren Lymphozyten phänotypisiert und die NK LAK, bzw. LAKZellAktivität gemessen. Zur Auswertung gelangten 16 Patienten. Statistisch signifikant war eine Erhöhung der CD2 und CD3Werte der EnzymGruppe (41 Messungen) gegenüber den Patienten der Gruppen VitaminA (18 Messungen), Placebo (12 Messungen) und den Ausgangswerten der Patienten (25 Messungen). Auch im Verlauf konnte die Erhöhung der CD3Werte bei der Enzymgruppe gegenüber den anderen Patientengruppen bestätigt werden. Der Anteil der TZellen im peripheren Blut lag im Bereich der gesunden Kontrollen. Um die Wirkungen der Prüfmedikationen auf Leukozyten (PBL, PMNL, Monozyten) in vitro zu untersuchen, wurde ein Panel durchflußzytometrischer Tests entwickelt, bzw. etabliert, die die Messung der Funktionen NKZellaktivität, LAKAktivität, ADCC, Phagozytose und Sauerstoffradikalbildung ermöglichten bzw. vereinfachten. Die untersuchte Enzympräparation enthielt Papain, Trypsin und Chymotrypsin im Verhältnis 2,5:1:1. In vitroVersuche ergaben eine dosisabhängige Stimulierung der NK, NKLAK, CTL bzw. LAKAktivität und der ADCC durch NKZellen durch die Enzympräparation. Es war möglich, die Lymphozyten mehrfach zu stimulieren, eine Enzymdauergabe, bzw. hohe Enzymdosen führten zu einem Aktivitätsrückgang. Die Enzymmischung verbesserte die Phagozytose und den oxidativen Burst bei PMNL und erhöhte die CD18 und CD54 bzw. erniedrigte die CD16Expression auf PMNL. Mit alltransRetinsäure bzw. Retinol konnten die Lymphozytenaktivitäten in vitro mit den gewählten Versuchsbedingungen kaum beeinflußt werden, Änderungen konnten meist 48h bis 72h nach Zugabe beobachtet werden, die jedoch nicht signifikant waren. Beobachtungen zu VitaminAWirkungen auf PMNL waren nicht möglich, da diese nur maximal 24h kultiviert werden konnten.
Einen vielversprechenden Ansatz auf dem Gebiet der Entwicklung kolloidaler Arzneiträgersysteme stellen die proteinbasierten Nanopartikel dar, da sie biodegradierbar und nicht toxisch sind und eine Reihe möglicher Angriffspunkte zur kovalenten Bindung von Arzneistoffen und zur Oberflächenmodifikation aufweisen. Im Rahmen dieser Arbeit wurde der Herstellungsprozeß von HSANanopartikeln und sein Einfluß auf die physikochemischen Eigenschaften des resultierenden Partikelsystems evaluiert. Durch Oberflächenmodifikation wurde eine Kopplung von Proteinen mittels bifunktionaler Crosslinker ermöglicht und die zelladhäsiven Eigenschaften des Trägersystems vermindert. Durch Kopplung funktioneller Proteine wurden die ersten Schritte in Richtung eines ligandenvermittelten DrugTargetings unternommen. Evaluierung des Herstellungsprozesses und Charakterisierung des resultierenden partikulären Systems Die Evaluierung des Desolvatationsprozesses von HSANanopartikeln ergab eine Abhängigkeit der Partikelgröße und der Partikelanzahl vom zugesetzten Desolvatationsmittel Ethanol. Die Quervernetzung des resultierenden Systems beeinflußte die Anzahl der freien Aminogruppen an der Partikeloberfläche: Je mehr Glutaraldehyd zugesetzt wurde, desto weniger Aminogruppen waren nachweisbar. Die Härtung der Partikel durch Einwirkung hoher Temperaturen führte ebenfalls zu stabilen Partikeln. Die Anzahl der verfügbaren Aminogruppen lag im Vergleich zu den Glutaraldeydquervernetzten höher. Die Art und das Ausmaß der Quervernetzung hatten keinerlei Einfluß auf die mittlere Partikelgröße. Das Zetapotential dagegen zeigte eine Tendenz, mit steigender Quervernetzung negativer zu werden. Ein Vergleich dieser Ergebnisse mit den Aminogruppen an der Oberfläche von GelatineA und BNanopartikeln verdeutlichte, daß HSANanopartikel signifikant mehr freie Aminogruppen an der Partikeloberfläche, und damit mehr Angriffspunkte zur kovalenten Kopplung und Oberflächenmodifikation aufweisen, als GelatineNanopartikel, wobei Gelatine ANanopartikel mehr als doppelt so viele Aminogruppen an der Oberfläche besitzen als Gelatine BPartikel. Die höchsten Aminogruppenzahlen zeigten die hitzedenaturierten HSANanopartikel. Einführung von Sulfhydrylgruppen an die Partikeloberfläche Im Rahmen dieser Arbeit wurden sechs Methoden zur Einführung von Thiolgruppen auf die Oberfläche von HSANanopartikeln evaluiert. Die effektivste Methode ergab sich aus der Kopplung von Cystamin mit dem Kopplungsreagenz EDC, gefolgt von einer reduktiven Spaltung der Cystamindisulfidbindungen und der Disulfidbrücken der HSAPartikelmatrix mit DTT. Bedauerlicherweise zeigte diese Partikelpräparation die höchste Toxizität der untersuchten Zubereitungen in der Zellkultur. Die Kopplung von LCystein mit EDC war aufgrund unerwünschter Nebenreaktionen wesentlich weniger effektiv. Die einfachste Art, Thiolgruppen einzuführen, war die reduktive Spaltung der Disulfidbrücken der HSAPartikelmatrix mit DTT. Doch Bindungsexperimente zeigten, daß diese Thiolgruppen zwar mit Ellmans Reagenz nachweisbar waren, aber zu Bindungszwecken wahrscheinlich aus sterischen Gründen nur in untergeordnetem Maße zur Verfügung standen. Die Verwendung von 2Iminothiolan (Trauts Reagenz) war eine im Vergleich zur Cystamin/EDCMethode einfache und leicht zu handhabende Methode zur Einführung von SHGruppen, allerdings mit relativ geringer Effizienz. Das Quenchen freier Glutaraldehydreste an der Partikeloberfläche mit Cystamin führte zu einem sehr niedrigen SHGruppengehalt, mit LCystein waren so gut wie keine Thiolgruppen nach der Umsetzung nachweisbar. Die SHGruppen wurden bei einer Lagerung bei 4°C mit einer Halbwertszeit von 28,2 Tagen abgebaut, unabhängig von der Art der SHGruppeneinführung. Die Reaktivität der SHGruppen dagegen nahm wesentlich schneller ab als ihre Nachweisbarkeit: Bereits am dritten Tag nach der SHGruppeneinführung lag die Bindungsrate von mit SHreaktiven Crosslinkern aktivierten Proteinen um 2030 % niedriger, verglichen mit dem ersten Tag. Durch Veränderung der Reaktionsparameter konnte bei allen Methoden die Anzahl der eingeführten Thiolgruppen kontrolliert werden. Durch die Einführung der SHGruppen zeigten die Nanopartikel eine deutlich höhere Mukoadhäsion. Oberflächenmodifikationen Das Ziel der Oberflächenmodifikation der HSANanopartikel war zum einen eine Positivierung des Zetapotentials, um die Bindung negativ geladener Arzneistoffe wie DNA über elektrostatische Wechselwirkungen zu ermöglichen. Die Umsetzung der Partikel mit EDC allein oder mit EDC und Cystamin bzw. Cholamin führte zu einer deutlichen Verschiebung des Zetapotentials in den positiven Bereich. Durch Veränderung der Cholamin bzw. Cystaminkonzentration war die Verschiebung des Zetapotentials steuerbar. Gleiches galt für die Umsetzung der Gelatine APartikel, allerdings waren hier deutlich geringere Konzentrationen zur Erlangung der gleichen positiven Zetapotentiale notwendig. Zum anderen sollte durch die Modifikation der Partikeloberfläche ein verändertes Verhalten hinsichtlich der Zelladhäsion der Partikel erzielt werden. Es zeigte sich eine verstärkte Zelladhäsion nach der Einführung weiterer Aminogruppen und nach der Einführung lipophiler Gruppen. Eine verminderte Zelladhäsion wurde durch eine Maskierung der Aminogruppen erreicht. Die besten Ergebnisse erbrachte hierbei die Umsetzung der HSANanopartikel mit Jodessigsäure. Bindung funktioneller Proteine Um zu überprüfen, ob funktionelle Proteine an das evaluierte Trägersystem unter Erhalt der Funktionalität gebunden werden können, wurden zunächst Enzyme über den bifunktionalen Crosslinker SulfoMBS kovalent gekoppelt. Analysen der Bindungsrate und der tatsächlichen enzymatischen Aktivität differierten zwar, doch ist dies wohl auf eine noch nicht hinreichend optimierte Analytik zurückzuführen. Eine enzymatische Aktivität der alkalischen Phosphatase und der bGalaktosidase war nach der Bindung an das Trägersystem eindeutig nachweisbar. Als weiteres funktionelles Protein wurde das Avidinderivat NeutrAvidin(TM) gewählt und mit SulfoMBS an Gelatine ANanopartikel gekoppelt. Durch die Bindung biotinylierter Antikörper konnte der Erhalt der Funktionalität des gebunden NeutrAvidins(TM) gezeigt werden. Die Konjugation eines biotinylierten, humanen CD3 Antikörpers an das NeutrAvidin(TM)konjugierte Partikelsystem führte zu einer selektiven Bindung des Trägersystems an primäre humane Lymphozyten. Auch eine Aufnahme des Trägersystems in die Zellen konnte gezeigt werden. Die Experimente zum Antikörpervermittelten Targeting konnten mit HSANanopartikeln nicht reproduziert werden, da HSAPartikel eine so starke Zelladhäsion zeigten, daß ein Targeting aufgrund des Antikörpers nicht mehr ersichtlich war. Erste Versuche mit oberflächenmodifizierten HSAPräparationen, wie beispielsweise einer Jodessigsäure Umsetzung, führten zu einer deutlich verminderten Zelladhäsion. Weitergehende Experimente zur Evaluierung dieses Effektes sind für die Weiterentwicklung dieses Trägersystems entscheidend.
Bedingt durch den demographischen Wandel in der Bevölkerung erlangen gerontologische Themen immer zentralere Bedeutung. Die Thematik des Dekubitus in der häuslichen Pflege ist durch ihren Bevölkerungsbezug und die Multidisziplinarität der Problemstellung dabei ein wichtiges Praxisfeld. Die vorliegende Arbeit gliedert sich in drei Teile: 1. Zur Anleitung häuslich Pflegender ist ein Ratgeber für pflegende Angehörige entstanden und wird im Schlüter Verlag, Hannover veröffentlicht. 2. Durch die Befragung möglichst repräsentativer Stichproben von niedergelassenen Allgemeinärzten und praktischen Ärzten werden Maßnahmen zu Prävention, Diagnostik und Therapie des Dekubitus in der allgemeinärztlichen Versorgung erfaßt. Alle vertragsärztlich tätigen Allgemeinmediziner und Praktischen Ärzte der Modellregion Stadt und Landkreis Offenbach (mittelgroße Stadt in Hessen, die die hessische Grundgesamtheit widerspiegelt) werden 1993 (N=165) (Dissertation Silke Nowack) und 1998 (N=196) in ein schriftliches postalisches Interview mit 21 überwiegend offenen Fragen in 2 Wellen einbezogen. Die Antworterquote von jeweils 35% (n=58/69) ist im Vergleich zu anderen Studien in dieser schwierigen Befragtengruppe zufriedenstellend, aber vermutlich zugunsten der am Thema Interessierten verzerrt. Der Vergleich der Datenprofile 1993 und 1998 läßt auf eine weitgehend gleiche Antwortergruppe schließen. Die Ergebnisse können allerdings nur zu Tendenzaussagen herangezogen werden. Von den Allgemeinmedizinern und praktischen Ärzten werden 1993 und 1998 durchschnittlich 4 bis 5 Patienten mit Dekubitus jeweils in Alten und Pflegeheimen und zu Hause betreut (Median = 3). Der Altersgipfel der Patienten liegt bei 71 bis über 80 Jahren. Als Grunderkrankung spielen allgemeine Schwäche und Kachexie sowie der cerebrale Insult, als Begleiterkrankung der Diabetes mellitus die führende Rolle. Während 1993 in erster Linie Felle als Antidekubitushilfsmittel genannt werden, treten diese in der Befragung 1998 in den Hintergrund. Antidekubitusmatratzen werden 1998 am häufigsten genannt (1993: 29 von 58 Ärzten; 1998: 42 von 69 Ärzten, Unterschiede nicht signifikant). Zur Prävention und Behandlung von Druckgeschwüren gibt es zahlreiche Literatur. Ein durchgehend positiver Effekt von Publikationen, Fortbildungen oder den beiden deutschsprachigen Leitlinien auf die tatsächliche Versorgung von Patienten mit Dekubitus im allgemeinärztlichen Bereich im Vergleich von 1993 zu 1998 wird in den vorliegenden Daten allerdings nicht sichtbar. So ist z.B. die Auswahl der von den Hausärzten eingesetzten Lokaltherapeutika und lokalen Maßnahmen polypragmatisch, manchmal konfus und aktionistisch und nicht an den wenigen vorhandenen, in ihrem Nutzen belegten Konzepten orientiert. Im Verordnungsbereich der Dermatika ist ein großes Einsparpotential vorhanden, das zugunsten moderner feuchter Wundverbände zu mobilisieren wäre, wie das Verordnungsverhalten der Vertragsärzte zeigt. Von 1992 zu 1997 weisen die Daten des GKVArzneimittelindex zwar einen Rücklauf der Verordnung von Lokalantibiotika auf, er spiegelt sich aber nicht im Antwortverhalten der hier Befragten wider. Zu beobachten ist weiterhin ein deutlicher Anstieg von allgemeinärztlichen Nennungen bei diagnostischen Maßnahmen im Jahre 1998, von denen einige keinen Stellenwert im Umgang mit Dekubituspatienten haben. 3. Von Mai bis August 1998 werden offene, themenzentrierte, leitfadengestützte, mündliche Interviews mit durch Zufallsstichprobe ermittelten 10 pflegenden Angehörigen (9 Frauen, 1 Mann) von Dekubituspatienten aus Stadt und Landkreis Darmstadt geführt und anhand von Tonbandprotokollen in einem Mehrstufenverfahren ausgewertet. Die Interviews finden im häuslichen Umfeld der pflegenden Angehörigen, in Abwesenheit der Patienten, statt. Die Befragung der pflegenden Angehörigen ergibt als durchschnittliches Lebensalter der Pflegebedürftigen 75 Jahre (Median 79 Jahre), Pflegebedürftigkeit besteht seit durchschnittlich 6 Jahren (Median 3,5 Jahre). Die Dauer der Dekubituserkrankung beträgt durchschnittlich 3 Jahre (Median 2 Jahre). Auch in dieser Befragtengruppe unterstreichen polypragmatische und obsolete Behandlungsmethoden die Forderung nach klaren und einheitlichen Konzepten in der Dekubitusprävention und --therapie. Die Pflegenden sind in der Mehrzahl Töchter/Schwiegertöchter. Soziale und emotionale Belastungssituationen werden thematisiert. Aggressive Verhaltensweisen legen 8 von 10 Befragten dar. Selbsthilfegruppen, Gesprächskreise für pflegende Angehörige oder psychologische Betreuung werden von den pflegenden Angehörigen nicht als Entlastungsmöglichkeit geschätzt und genutzt. Gründe für das Pflegeengagement sind gesellschaftliche Normierung, rollenimmanentes Verhalten, der Generationenvertrag sowie der Gedanke, das Leben des Betroffenen durch die häusliche Pflege erleichtern und verlängern zu können. Mit Einführung der Pflegeversicherung wurde die finanzielle Unterstützung häuslich Pflegender verbessert, die Pflegekompetenz bleibt allerdings weiterhin bei allen befragten Angehörigen autodidaktisch erworben. Häusliche Krankenpflegekurse der Krankenkassen werden nicht besucht, so daß von Seiten der Pflegeversicherung eine Attraktivitätssteigerung der Kurse oder eine eventuelle Einführung einer Teilnahmepflicht wünschenswert ist. Zur systematischen Verhütung und Behandlung eines Dekubitus im hausärztlichen Bereich ist die Entwicklung und Verbreitung einer Leitlinie, entsprechend der amerikanischen Guideline der Agency for Health Care Policy and Research anzustreben. Dem Hausarzt als zentraler Koordinationsstelle zwischen Patient und Pflegenden obliegt ferner die Aufgabe auch auf die Gesundheit der Pflegeperson zu achten, um Überlastungssituationen rechtzeitig diagnostizieren und therapieren zu können.
Osteoarthrose ist eine degenerative Gelenkerkrankung, die in einem schleichenden Prozeß zur Zerstörung des Knorpels in den gewichttragenden Gelenken insbesondere der Hüfte und des Knies führt. Chronische Behinderungen sind die Folge. Die hohe Prävalenz in der vorwiegend älteren Bevölkerung hat zur Bezeichnung als Volkskrankheit geführt. Die genauen Ursachen der Osteoarthrose sind weitgehend unbekannt, jedoch wird davon ausgegangen, daß eine Verschiebung des Gleichgewichts zwischen anabolen und katabolen Prozessen, die am normalen Knorpelmetabolismus beteiligt sind, zugunsten des Katabolismus stattfindet. Ein Charakteristikum der Krankheit ist die verstärkte Degradation des Proteoglykans Aggrekan, einem der Hauptbestandteile der Knorpelmatrix. Dafür verantwortlich ist besonders im frühen Krankheitsstadium die Enzymaktivität ''Aggrekanase", in späteren Phasen sind auch verschiedene MatrixMetalloproteasen (MMPs) beteiligt. Die Enzymaktivität Aggrekanase blieb lange Zeit unentdeckt und wurde unter den Mitgliedern der MMPFamilie vermutet. Jedoch weisen MMPs und Aggrekanase eine unterschiedliche Spezifität für Aggrekan auf, da MMPs die interglobuläre Domäne des Aggrekans bevorzugt zwischen N 341 und F 342 spalten (MMPSchnittstelle), Aggrekanase dagegen nur zwischen E 373 und A 374 (Aggrekanase Schnittstelle). Daß es sich bei MMPs und Aggrekanase um distinkte Aktivitäten handelt, zeigt die jüngste Klonierung zweier Aggrekanasen, die der Familie der ADAMTSProteasen angehören. Trotz der Identifikation dieser zwei Aggrekanasen, die über eine Metalloprotease, Disintegrin und ThrombospondinDomäne verfügen, sind viele EnzymCharakteristika noch ungeklärt, und auch die Frage, welches dieser beiden Enzyme oder welches noch unentdeckte Enzym in der Pathophysiologie der Osteoarthrose die bedeutendste Rolle spielt, ist noch offen. Der Fokus dieser Arbeit lag auf der Untersuchung der noch weitgehend ungeklärten Substratspezifität der Aggrekanase. Besonderes Interesse bestand in der Frage, welche minimalen Anforderungen ein Substrat erfüllen muß, um von Aggrekanase als solches akzeptiert zu werden, da Hinweise existieren, daß kurze Peptide, die die Schnittstelle in nativem Aggrekan repräsentieren, nicht als AggrekanaseSubstrat erkannt und gespalten werden. In dieser Arbeit wird gezeigt, daß tatsächlich Sequenzbereiche des Aggrekans distal zur AggrekanaseSchnittstelle für eine effiziente Spaltung durch Aggrekanase notwendig sind. Durch Mutations und Deletionsstudien mit einem funktionalen rekombinanten Substrat, das die gesamte interglobuläre Domäne des Aggrekans mit der AggrekanaseSchnittstelle beinhaltet, wird gezeigt, daß die Substratregion der MMPSchnittstelle, insbesondere deren N terminale Hälfte, wichtig ist für eine effiziente Spaltung an der AggrekanaseSchnittstelle 32 Aminosäuren weiter Cterminal. Dieses Ergebnis weist auf die Möglichkeit hin, Aggrekanase trete über eine zweite, von der eigentlichen Schnittstelle distinkten Interaktionsstelle mit dem Substrat in Wechselwirkung. Diese Substratspezifität ist in verschiedenen zellulären und nicht zellulären sowie rekombinanten AggrekanaseSystemen reproduzierbar und somit für Aggrekanase charakteristisch. Die membrangebundene MMP14, die unter bestimmten Bedingungen in der Lage ist, eine Proteolyse der AggrekanaseSchnittstelle zu erzeugen, teilt diese Eigenschaft nicht und ist deshalb als Kandidat für die pathologische Aggrekanase Aktivität unwahrscheinlich. Desweiteren wurde die Rolle der Substratglykosylierung für die Degradation durch Aggrekanase untersucht. Die Ergebnisse zeigen, daß die N und OGlykosylierungen des rekombinanten Substrats dessen Spaltung durch Aggrekanase negativ beeinflussen. Einen zusätzlichen Aspekt der AggrekanaseCharakterisierung stellt die Inhibition der Enzymaktivität durch das Mukopolysaccharid Heparin dar. Heparin bindet vermutlich an Enzymdomänen außerhalb der katalytischen Domäne und hemmt so die für eine effiziente Spaltung nötigen Interaktionen zwischen diesen Domänen und dem Substrat. Die Charakterisierung der Enzymaktivität Aggrekanase, die in dieser Arbeit beschrieben ist, führt zu einem besseren Verständnis der molekularen Mechanismen der Aggrekan Degradation und kann zur Entwicklung neuer Ansätze zur Inhibition des Enzyms im Zuge der Osteoarthrosebekämpfung beitragen.
1. Die Membran des SR besitzt mehrere unterscheidbare Transportsysteme für organische und anorganische Anionen. Diese Transportsysteme lassen sich durch Anionenfluxmessungen mit der FilterassayMethode und durch Einzelkanalmessungen mit der Planarmembrantechnik charakterisieren. Der Vergleich der mit beiden Methoden ermittelten Daten ergibt, dass der 35 SO 4 2 Flux unter Standardbedingungen durch den als BCl (Big Chloride Channel) bezeichneten Chloridkanal bewerkstelligt wird und eine Steigerung der Effluxrate im Vesikelfluxexperiment auf die zusätzliche Aktivierung des als SCl (Small Chloride Channel) bezeichneten Chloridkanals zurückzuführen ist. 2. Neben Chlorid und Sulfat werden auch andere organische und anorganische Anionen wie Jodid, Pyrophosphat, Oxalat und Nukleotide transportiert. 3. Der stärkste Hemmstoff von 35 SO 4 2 und NukleotidTransport ist der PurinozeptorAntagonist Suramin mit einer I 50 von 0.91.16 µM. 4. Eine Stimulation des 35 SO 4 2 Transports kann durch die Kationen Calcium, Magnesium und Cholin erreicht werden. Ebenso wirken Hemmstoffe des RyR wie Ryanodin und Atractylosid stimulierend bzw. aktivierend. 5. 35 SO 4 2 Influx und Efflux werden durch Nukleotide unterschiedlich beeinflusst. Der Efflux wird in Abhängigkeit von Nukleotidbase, Anzahl der Phosphatreste und der Ladung gehemmt. Unter Magnesiumeinwirkung ist der Hemmeffekt verstärkt und auch das als nicht hydrolysierbar geltende ATP Analogon AMPPNP wirkt inhibierend. Der maximale 35 SO 4 2 Influx hingegen ist in Anwesenheit von ATP erhöht. Die ATPAnaloga AMPPNP und AMP PCP zeigen diesen stimulierenden Effekt nicht. 6. ATP und GTP werden in Anwesenheit von SRProtein schnell ab und umgebaut. Dieser Umbau lässt sich durch Magnesium und verschiedene Hemmstoffe des Anionenfluxes beeinflussen. 7. Der Eintransport von Nukleotiden in das Lumen des SR lässt sich durch Hemmstoffe des Anionenfluxes inhibieren. Die zusätzliche Hemmbarkeit durch Atractylosid, einen Inhibitor des mitochondrialen ATP/ADP Translokators (AAT), impliziert die Möglichkeit einer Beteiligung dieses Transportproteins am Nukleotidtransport. 8. Inhibitoren der Ca 2 ATPase hemmen auch den Anionenflux. Die Vermittlung des Anionentransports durch die Ca 2 ATPase selbst sowie die Hemmung des Ca 2 Eintransports aufgrund der Inhibition der Anionenkanäle sind ausgeschlossen. Vesikel mit rekonstituierter Ca 2 ATPase weisen keinen Anionen transport auf, obwohl der Ca 2 Eintransport durch Anionenkanalhemmstoffe wie Suramin, DIDS und PPANS inhibiert werden kann. 9. Beim Anionenflux eingesetzt zeigen Aktivatoren und Inhibitoren des Ca 2 ReleaseKanals gegenläufige Effekte. Der Ca 2 ReleaseKanal ist nicht der Vermittler des Anionentransports. Anionentransporter sind im RyRfreien longitudinalen SR ebenso häufig wie in den RyRreichen terminalen SR Zisternen.
g/d TLymphozyten stellen beim Menschen ca. 15% der intestinalen intraepithelialen Lymphozyten. Die physiologische Funktion der g/d TZellpopulation ist ungeklärt. Auf grund ihrer Akkumulation in mukosalen Oberflächen scheinen sie eine Komponente der ''ersten Verteidigungslinie" zu bilden. Das d TZell Rezeptor (TCR) Repertoire gesunder Erwachsener ist oligoklonal, streng individuenspezifisch und zeitlich stabil. Zudem besteht eine charakteristische Kompartimentierung, d.h. im Intestinum liegt ein anderes d TCRRepertoire vor als im peripheren Blut. In der vorliegenden Arbeit wurde untersucht, ob das intestinale d TCRRepertoire einer entwicklungsabhängi gen Dynamik unterliegt. Hierzu wurde die Diversität der antigenbindenden (CDR3) Domäne intestinaler dKettentranskripte von Feten, Neugeborenen, Kindern und Erwachsenen mittels denaturierender PAGE und DNASequenzierung molekular biologisch analysiert. Unsere Studien dokumentieren, daß im Verlauf der Reifung vom Fetus zum adulten Individuum gravierende Veränderungen stattfinden. Das fetale d TCRRepertoire ist stark eingeschränkt und zeichnet sich durch niedrige Komplexität der dKettentrans kripte aus was darauf beruht, daß innerhalb der CDR3Domänen kaum matrizen unabhängige ''N"Nukleotide existieren und zudem homologieabhängige Rekombina tionsereignisse stattfinden. Die Tatsache, daß verschiedene Feten teilweise identi sche dKettentranskripte exprimieren kann jedoch nicht allein auf obige Mechanis men zurückgeführt werden. Somit bleibt unklar, ob das fetale d TCRRepertoire vorprogrammiert ist oder Selektionsprozessen unterliegt. Im Gegensatz zu Feten ist das d TCRRepertoire Neugeborener polyklonal. Wie bei Erwachsenen weisen die CDR3Domänen ihrer dKettentranskripte zahlreiche ''N"Nukleotide auf. Da das d TCRRepertoire bereits im Alter von 14 17 Jahren starke Einschränkungen seiner Diversität zeigt und mit demjenigen siebzigjähriger Personen vergleichbar ist wird angenommen, daß die klonalen Expansionen eine Folge kontinuierlicher Selektions prozesse darstellen, die z.B. durch HSP verwandte Eigenantigene vermittelt werden. Vergleichbar dem Intestinaltrakt bildet auch die Haut eine bedeutende Grenzfläche des Organismus zu seiner Umgebung. Möglicherweise spielen kutane g/d TZellen ebenfalls eine Rolle im Rahmen einer ''ersten Verteidigungslinie". Wir wiesen anhand gesunder Erwachsener nach, daß das kutane d TCRRepertoire analog zum Intesti num oligoklonal ist und sich signifikant vom peripheren d TCRRepertoire unter scheidet. Da in multiplen Hautbiopsien identische dKettentranskripte gefunden wer den, sind dominante g/d TZellklone offenbar weiträumig in der Haut verteilt. Weiterhin wurde untersucht, ob spezifisch aktivierte g/d TLymphozyten an der Patho genese chronisch entzündlicher Darmerkrankungen beteiligt sind. Im Fall der ange nommenen antigenvermittelten Aktivierung müßten klonale Expansionen einzelner g/d TZellpopulationen zu charakteristischen Verschiebungen des d TCRRepertoires innerhalb entzündlich veränderter Darmareale führen. Vergleichende Analysen der läsionalen und nichtläsionalen Darmabschnitte von M.CrohnPatienten lassen jedoch keine krankheitsassoziierten Repertoireverschiebungen erkennen. Vielmehr weisen entzündliche und nichtentzündliche Areale nahezu identische d TCRRepertoires auf. Da dies auch im Fall der bakteriell verursachten Divertikulitis gilt, werden g/d TLym phozyten vermutlich generell indirekt oder über TCRunabhängige Mechanismen (z.B. Zytokine) aktiviert. Alternativ wird eine Erkennung streßinduzierbarer Eigenanti gene durch intestinale g/d TZellen diskutiert. Beide Vorgänge würden zu keiner Beeinflussung des d TCRRepertoires führen und in Einklang mit den nachgewiese nen Expansionen einzelner weniger Rezeptorspezifitäten stehen. Da vermutlich auch die BLymphozyten der intestinalen Lamina propria an der ''ers ten Verteidigungslinie" beteiligt sind nahmen wir an, daß die Ig H Transkripte IgA bzw. IgM exprimierender BZellen ebenfalls Einschränkungen ihres Rezeptor Repertoires aufweisen. Wir fanden, daß die kleinen V H 5, V H 6 und V H 7Familien intestinaler B Zellen oligoklonale Expansionen zeigen, während das Repertoire der dominierenden V H Familien deutlich diverser ausfällt. Durch Subklonierung lassen sich jedoch bei sämtlichen VH Familien klonal verwandte IgATranskripte in weit voneinander ent fernten Darmabschnitten identifizieren. Zudem stellen ~ 75% aller Basensubstitutio nen stille Mutationen dar oder führen zum Ersatz durch Aminosäuren vergleichbarer Eigenschaften, was auf einen starken Selektionsdruck schließen läßt. Da kaum Hin weise auf Isotypwechsel vorliegen, stellen intestinale IgM und IgAImmunozyten ver mutlich divergente Zellinien dar. Das V H Repertoire peripherer BZellen ist stark limitiert, wobei kaum Überlappungen mit intestinalen IgVH Repertoires bestehen. Aufgrund der partiellen Einschränkung des V H Repertoires ist anzunehmen, daß Teile der humoralen Immunabwehr konservierte Antigene erkennen, wobei es sich im Gegensatz zu TZellen wahrscheinlich nicht um Eigenantigene, sondern um Oberflächenstrukturen symbiontischer Mikroorganismen handelt. Unsere Resultate zeigen, daß die Begrenzung des Rezeptor Repertoires ein Charak teristikum von B und TLymphozyten darstellt. Übereinstimmend hiermit wurden von anderen Arbeitsgruppen klonale Expansionen auch bei a/b TZellen nachgewiesen. Vermutlich wird die Expansion einzelner Zellklone durch permanente Wechselwirkun gen mit ''Schlüsselantigenen" induziert, wobei es sich um invariante Fremdantigene oder konservierte Eigenantigene handeln dürfte.
Das TumorSuppressorGen wt1 (Wilms Tumor Gen) kodiert ein ZinkFinger DNA bindendes Protein mit vorwiegend Transkriptionshemmenden Eigenschaften. Da wt1 Expression auch in leukämischen Blasten von Patienten mit akuten Leukämien nachgewiesen werden konnte, war das Ziel der Arbeit, das Expressionsmuster von wt1 mRNA in Patienten mit akuter myeloischer Leukämie (AML) mittels der PolymeraseKettenreaktion (PCR) zu untersuchen. Dabei war die Expressionsstärke visuell in negativ (), schwach positiv ( ), mittelgradig positiv ( ) und stark positiv ( ) zu unterteilen. Die Ergebnisse, in ausgesuchten Fällen durch eine kompetitive PCR validiert, sollten mit FABKlassifikation, Karyotyp, OberflächenmarkerExpression, Alter, Geschlecht und klinischem Verlauf verglichen werden, um eine Aussage über die Bedeutung der wt1 Expression für Prognose, Verlaufskontrolle und das Erkennen von Minimal Residual Disease (MRD) zu treffen. Es wurden insgesamt mehr als 500 Proben von Patienten (mononukleäre Zellen (MC) aus Knochenmark (KM) und peripherem Blut (PB)) untersucht. Davon wurden insgesamt 129 Patienten bei Erstdiagnose und 32 Patienten bei 1. Rezidiv untersucht. Bei 77 Patienten konnte die wt1 Expression im Verlauf untersucht werden. wt1 mRNA fand sich bei 124 von 161 (77%) der Patienten bei Erstdiagnose und 1.Rezidiv. Die wt1 Expression war unabhängig vom Alter, vorhergehendem myelodysplastischem Syndrom (MDS), Geschlecht und FABSubtyp mit Ausnahme einer signifikant niedrigeren wt1 Expressionshäufigkeit in FAB M5 Leukämien von nur 40% (P=0,0025). Es fand sich keine Korrelation zwischen wt1 mRNA Expressionsstärke und den durch den Karyotyp definierten prognostischen Gruppen. Die Ansprechrate auf Therapie war zwar umso höher, je niedriger die wt1 Expression lag; es fand sich jedoch kein signifikanter Unterschied zwischen den ExpressionsGruppen. Patienten mit hoher wt1 mRNA Expression ( , ) zeigten eine deutlich schlechtere Gesamt Überlebenswahrscheinlichkeit (OS) als solche mit niedriger Expression (, ). Das 3Jahres OS für alle neu diagnostizierten AMLPatienten lag bei 13% bei starker und 38% bei schwacher wt1 Expression (P=0,038); bei Patienten mit de novo AML bei 12% und 43% (P=0,014). Der Unterschied war bei der Patientengruppe unter 60 Jahren noch stärker ausgeprägt. Im Verlauf ließ sich bei allen Patienten, die eine komplette Remission (CR) erreichten, keine wt1 Transkripte mehr nachweisen. Bei Rezidiv trat in den meisten Fällen erneut erhöhte wt1 Expression auf. In einigen Fällen ging dies dem klinischen Befund eines Rezidivs voraus. Zusammenfassend konnte gezeigt werden, daß wt1 von der Mehrzahl der AMLPatienten exprimiert wird und mittels PCR nachgewiesen werden kann, ein von Karyotyp und Alter unabhängiger prognostischer Faktor ist und sich mit Einschränkung zur Verlaufskontrolle und Detektion von MRD anbietet.