Refine
Year of publication
- 2013 (152) (remove)
Document Type
- Doctoral Thesis (152) (remove)
Has Fulltext
- yes (152)
Is part of the Bibliography
- no (152) (remove)
Keywords
- UrQMD (2)
- A-Discriminant (1)
- ALICE (1)
- ALICE experiment (1)
- Acculturation (1)
- Adolescence (1)
- Agent (1)
- Akkulturation (1)
- Aktivierungsmethode (1)
- Akustik (1)
Institute
- Biowissenschaften (29)
- Biochemie und Chemie (24)
- Physik (21)
- Medizin (9)
- Pharmazie (8)
- Geowissenschaften (7)
- Informatik (6)
- Informatik und Mathematik (6)
- Psychologie (6)
- Geschichtswissenschaften (4)
Ziel der vorliegenden prospektiven, experimentellen, randomisierten kontrollierten In-vitroStudie war es, zwei Dentinadhäsive, die der sechsten (One-Up-Bond F, Tokuyama) und siebten (G-Bond, GC Tokio) Generation angehören, unter ISO-Bedingungen zu untersuchen und einer Kontrollgruppe (Clearfil SE, Kuraray), die der sechsten Generation zugeordnet wird, gegenüberzustellen. Neunzig unversehrte humane Molaren der zweiten Dentition wurden eingebettet. Das Dentin wurde mit Siliziumcarbidscheiben der Körnung 600 bearbeitet, um eine Schmierschicht zu erhalten. Anschließend wurden die Dentinproben randomisiert in drei Gruppen eingeteilt und die jeweiligen Dentinadhäsive wurden nach Herstellerangaben appliziert. Mittels einer Versuchsapparatur, die in Anlehnung an die ISO/TS 11405:2003 hergestellt wurde, wurde das Kompositmaterial Tetric EvoCeram in der Farbe A2 aufgetragen und lichtgehärtet. Eine Alterung der Proben fand bei 500 Thermocycling-Zyklen bei Temperaturen von 5°C und 55°C statt. Mit einer Universalprüfmaschine Zwicki (Vorschubgeschwindigkeit 0,5 mm/min) wurde die Scherhaftfestigkeit der Proben bestimmt. Anschließend wurden die abgescherten Dentinproben unter dem Rasterelektronenmikroskop bei einer Vergrößerung von 20-fach und 2000-fach bezüglich der auftretenden Frakturmodi untersucht.
Die Haftkraft-Mittelwerte von Clearfil SE betrugen 4,22 MPa, von G-Bond 3,83 MPa und von One-Up-Bond F 7,11 MPa. Bei der statistischen Analyse mittels Kruskal-Wallis-Test wurde die Signifikanz ermittelt. Eine Signifikanz zwischen den Dentinadhäsiven One-UpBond F und G-Bond lag vor. Einzig Clearfil SE war statistisch nicht signifikant gegenüber den anderen Produkten. Die Bruchanalyse ergab, dass G-Bond eine hohe Anzahl (46,7 %) an kohäsiven Frakturen aufwies, Clearfil SE mehr als die Hälfte (66,7 %) gemischte Frakturen und dass One-Up-Bond F kaum adhäsive (3,3 %) Frakturen zeigte, sondern hauptsächlich (80 %) gemischte Brüche. Signifikante Unterschiede waren zwischen dem Bruchverhalten von Clearfil SE und G-Bond sowie zwischen G-Bond und One-Up-Bond F zu beobachten.
Unter der Limitation der vorliegenden In-vitro-Studie erscheint die Anwendung von G-Bond aufgrund der erhaltenen statistisch signifikant niedrigeren Haftwerten als nicht empfehlenswert.
This doctoral thesis is concerned with the development of a method that allows to measure in vivo and non-invasively the mid-infrared absorption spectra of human epidermis, using photoacoustic spectroscopy. The main focus is the monitoring of the glucose level in epidermal interstitial fluid and its correlation with the blood glucose level; which is the most important parameter for the diagnosis and treatment of diabetes mellitus. Most publications in this field have only reported measurements in vitro for the absorption spectra of epidermis in the mid-infrared range. Using the approach presented in this work, it was possible to record in vivo and in situ the absorption spectra of skin of volunteers; and with these spectra, the changing glucose concentration could be monitored. The novelty of the photoacoustic method introduced here is that it operates in acoustic resonance in the ultrasound range. This considerably reduces the signal noise due to the external acoustic background. Although the photoacoustic method reported in this work was used to measure glucose in human epidermis, it can also be applied to other solid samples with relevant absorption bands in the mid-infrared. Furthermore, it can be used in other spectral regions if the laser source covers relevant absorption bands of the sample.
Retroviral vectors are powerful tools in clinical gene therapy as they integrate permanently into the target cell genome and thus guarantee long-term expression of transgenes. Therefore, they belong to the most frequently used application platforms in clinical gene therapy involving a broad range of different target cells and tissues. However, stable genomic integration of retroviral vectors can be oncogenic, as reported in several animal models and in clinical trials. In particular, γ-retroviral vectors, which derive from naturally mutagenic γ-retroviruses, integrate semirandomly into the host genome with regard to the target sequence, but have a preference for regions of active transcription and regulatory elements of transcriptionally active genes. The integration can result in overexpression of adjacent genes or disruption of ‘target’ gene expression. Moreover, γ-retroviral integration can cause modified transcripts and proteins through alternative or aberrant splicing or through premature termination of transcription.
Initially, the event of insertional mutagenesis and subsequent induction of leukemia by the genotoxicity of a γ-retroviral vector was described in a mouse model after genetic modification of hematopoietic stem cells (HSCs). Vector-related activation and overexpression of the oncogene ecotropic viral integration site-1 (Evi1) fostered clonal outgrowth and leukemogenesis. Additional genotoxic events of γ-retroviral vectors were observed in clinical HSC gene therapy trials for X-linked severe combined immune deficiency (SCID-X1), chronic granulomatous disease (X-CGD), and Wiskott-Aldrich Syndrome (WAS). But, genotoxicity induced by γ-retroviral vectors has never been described in clinical gene therapy trials involving adoptive transfer of genetically modified mature T lymphocytes. This fact is surprising, since T cells are long-lived and have a high capacity of self-renewal.
In a previous study, the susceptibility towards oncogenic transformation of mature T cells and HSCs after genetic modification was compared. It could be demonstrated that T-cell receptor (TCR)-polyclonal mature T cells are far less prone to transformation after γ-retroviral transfer of (proto-)oncogenes in vivo than HSCs. Additional experiments revealed that TCR-oligoclonal (OT-I and P14) mature T cells are transformable in the same setting and give rise to mature T-cell lymphomas (MTCLs).
In the present thesis, the susceptibility of mature T cells towards insertional mutagenesis was investigated. Within the first part of the thesis, retroviral integration sites (RISs) from 33 murine MTCLs were retrieved and subsequently analyzed in terms of integration pattern, detection of common integration sites (CIS) and gene ontology (GO). As these bioinformatic results demonstrated that insertional mutagenesis most likely contributed to mature T-cell lymphomagenesis, the susceptibility of mature T cells was directly assessed in a mouse model. Therefore, murine TCR-oligoclonal OT-I T cells were transduced with an enhanced green fluorescent protein (EGFP) encoding γ-retroviral vector and gene-modified T cells were transplanted into RAG1-/- mice. After 16 months, including one round of serial transplantation, a case of MTCL emerged. Tumor cells were characterized by CD3, CD8, TCR and ICOS expression. Integration site analysis via ligation-mediated polymerase chain reaction (LM-PCR) revealed a proviral insertion in the Janus kinase 1 (Jak1) gene. Subsequent overexpression of Jak1 could be demonstrated on transcriptional and protein level. Furthermore, T-cell lymphoma cells were characterized by an activated Jak/STAT-pathway as signal transducer and activator of transcription 3 (STAT3) was highly phosphorylated. The overexpression of Jak1 was causally implicated in tumor growth promotion as specific pharmacological inhibition of Jak1 using Ruxolitinib significantly prolonged survival of mice transplanted with these Jak1-activated tumor cells. A concluding systematic metaanalysis of available gene expression data on human mature T-cell lymphomas/leukemias confirmed the relevance of Jak/STAT overexpression in sporadic human T-cell tumorigenesis.
This was the first reported case of an insertional mutagenesis event in mature T cells in vivo. Thus, the results obtained in this thesis underline the importance of long-term monitoring of genetically modified T cells in vivo and the evaluation of vector toxicology and safety in T-cell based gene therapies. In particular, the transduction of T cells with a recombinant TCR or CAR (chimeric antigen receptor) bears a risk enhancement, as normal T-cell homeostasis is perturbed besides the general risk of insertional mutagenesis.
Die Diskussion über die zeitgenössische Globalethik im Kontext von Hans Küng und Iḫwān aṣ-ṣafāʾ
(2013)
Die Menschheit befindet sich in einer globalen Krise, die sich nicht nur im wirtschaftlichen, politischen und ökologischen Bereich zeigt. Auch Religion und Moral sind davon betroffen. Die Modernisierung führt zunehmend dazu, dass menschliche Werte wie bedingungslose Solidarität, Aufrichtigkeit, Hilfsbereitschaft und Großzügigkeit immer mehr durch Geldgier und Ausbeutung der Umwelt ersetzt werden. Man beschwert sich oft über die Kriegsgefahren, über die Probleme des Bevölkerungswachstums, die Umweltverschmutzung und die Vergiftung von Gewässern sowie über die Gefahr des globalen Terrors. Viele dieser Probleme berühren Religion und Moral, die nicht unabhängig von modernen Problemen denkbar sind. Globaler Terror hat beispielsweise neben vielen anderen Faktoren auch religiös begründete Motive.
In dieser Arbeit wurde das Protein OR1 ausführlich charakterisiert und die Grundlage für weitere Studien an diesem Protein gelegt. Die Zielsetzung dieser Arbeit bestand primär in der biophysikalischen Analyse eines eukaryotischen Proteorhodopsins, da bislang keine Daten zu diesen vorlagen. Dieser Ansatz ist vergleichbar mit der Studie am BR ähnlichen Rhodopsin aus dem Pilz Leptosphaeria maculans (Waschuk et al. 2005). Auch wenn man aus den Eigenschaften von OR1 keine Signatur für eukaryotische PRs herausfiltern kann, so weist OR1 eine Reihe von Charakteristika auf, die es wert sind weiterbearbeitet zu werden. Zu den hervorzuhebenden Ergebnissen dieser Arbeit zählen:
(1) OR1 zeigte in der methylotrophen Hefe Pichia pastoris ein hohes Expressionsniveau weit über der gewohnten Ausbeute bei Membranproteinen.
(2) OR1 offenbarte sich als Proteorhodopsin mit BR ähnlichen Eigenschaften wie dem niedrigen pKs-Wert des Protonenakzeptors und damit guten Protonenpumpeigenschaften über einen großen pH-Bereich. Auch bindet OR1 keinen zweiten Chromophor, was die nahen Verwandten GR und XR hingegen tun.
(3) OR1 demonstriert, dass die Konfiguration des komplexen Gegenions von Proteorhodopsinen stark variiert und sich anscheinend flexibel den physiologischen Erfordernissen des jeweiligen Organismus anpasst. In diesem Zusammenhang spielt auch das konservierte Histidin eine Rolle, da es den primären Protonenakzeptor beeinflusst. Bei OR1 stellte sich heraus, dass das Histidin den pKs Wert der D100 Position nicht signifikant beeinflusst.
(4) OR1 wurde mit 13C und 15N Atomen erfolgreich markiert und das entwickelte Protokoll für die Rekonstitution bewährte sich. Die Proteoliposomen des Wildtyps gaben sehr gut aufgelöste Festkörper-NMR Spektren. In Zukunft sind somit ausführliche NMR Studien an OR1 möglich.
In this work the main emphasis is put on the investigation of relativistic shock waves and Mach cones in hot and dense matter using the microscopic transport model BAMPS, based on the relativistic Boltzmann equation. Using this kinetic approach we study the complete transition from ideal-fluid behavior to free streaming. This includes shock-wave formation in a simplified (1+1)-dimensional setup as well as the investigation of Mach-cone formation induced by supersonic projectiles and/or jets in (2+1)- and (3+1)-dimensional static and expanding systems. We further address the question whether jet-medium interactions inducing Mach cones can contribute to a double-peak structure observed in two-particle correlations in heavy-ion collision experiments. Furthermore, BAMPS is used as a benchmark to compare kinetic theory to several relativistic hydrodynamic theories in order to verify their accuracy and to find their limitations.
The prevalence of food allergies has increased in the westernized countries during the past decades. Clinical manifestations of food allergies involve the skin (e.g. atopic dermatitis), the respiratory tract (e.g. rhinitis, and asthma), the ocular area (e.g. conjunctivitis), the gastrointestinal tract (e.g. food-protein-induced enterocolitis syndrome, food-induced proctocolitis, and eosinophilic gastroenteropathies), and the cardiovascular system (e.g. anaphylaxis). A curative treatment of these diseases has not been established yet. Oral immunotherapy (OIT) has gained attention as a potential therapy for food allergies. Continuous feeding of allergenic diet applied in the model described here mirrors to a certain extent an OIT treatment. It might be therefore useful to investigate efficacy and safety of OIT pre-clinically.
Mouse models have been widely used to analyse novel treatment approaches. Unfortunately, most of them have focussed on IgE-mediated hyperreactivity. Only a limited number of mouse models presenting mixed IgE- and non-IgE-mediated gastrointestinal symptoms and inflammation upon allergen-challenge are available. To study the mechanisms underlying the induction of food-induced gastrointestinal inflammation and subsequent oral tolerance induction, a mouse model of food-induced gastrointestinal allergy was established. BALB/c mice were sensitised with Ovalbumin (OVA) plus ALUM and subsequently challenged by feeding a diet containing egg white (EW diet). During the first seven days on EW diet, OVA-sensitised mice (OVA/ALUM EW mice) developed gastrointestinal symptoms (e.g. weight loss, ruffed fur, soft stool and less mobility) and inflammation in the small intestines accompanied by a strong induction of OVA-specific IgE antibodies and mouse mast cell protease-1 (mMCP-1). Proliferation of CD4+ T cells from spleen of OVA/ALUM EW mice was reduced compared controls. The result indicated that feeding EW diet induced T cell tolerance systemically. In contrast, CD4+ T cells isolated from MLN of OVA/ALUM EW mice showed stronger proliferation upon OVA stimulation in vitro than mice OVA-sensitised but fed a conventional diet, indicating that tolerance was not induced by short-term EW diet. Histological analysis of the small intestinal tissue of OVA/ALUM EW mice revealed strong inflammation present in the duodenum, jejunum and ileum at this time point.
Interestingly, the observed symptoms in OVA/ALUM EW mice resolved spontaneously after 7 days on EW diet, if the feeding was continued. In the next steps the CD4+ T cell-mediated immune response after 28 days continuous EW diet was assessed and revealed that tolerance was induced systemically as well as locally. This was shown by reduced proliferation and cytokine secretion of CD4+ T cells from MLN of OVA/ALUM EW mice after long-term EW diet. However, the inflammation in the jejunum was aggravated instead of resolved at this time point of allergenic diet. Our results suggest that application of OIT in food-allergic patients with gastrointestinal inflammation may need to be reconsidered, since continuous administration of allergenic food may aggravate inflammation in the local tissue. Interestingly, only the jejunum was affected by a worsened condition, whereas duodenum and ileum resolved inflammation. In accordance to the observed jejunal inflammation mMCP-1 levels in the sera were not changed. Allergen-specific IgE levels did not reach baseline level after long-term EW diet, although they were reduced compared to levels in mice after 7 days on EW diet. This result suggests that residual OVA-specific IgE antibodies would promote the jejunal inflammation by sustained activation of mast cells. Furthermore, our results suggest that IL-4 produced by activated Th2 cells could be an effector molecule to induce intestinal inflammation.
The second part of this thesis was aimed at verifying the hypothesis that IgE-mediated mast cell activation is a major effector mechanism in induction of chronic inflammation induced by long-term EW diet. For that mice deficient for FcεRI, a high affinity IgE receptor, were used. These mice were sensitised with OVA and fed EW diet as described for WT mice. Although FcεRI-deficient mice showed an intact Th2 immunity with IgE production, weight loss in the receptor-deficient mice was moderately induced by EW diet compared to WT mice, suggesting that this clinical symptom during the acute phase of allergic response is associated with IgE-mediated mechanisms. Surprisingly, the deficient mice presented comparable intestinal inflammation on day seven of EW diet as WT mice did. However, if EW diet was continued, recovery of intestinal inflammation was observed in FcεRI-deficient mice in contrast to WT mice. These results suggest that the induction of intestinal inflammation is not IgE-dependent. Nevertheless, this does not rule out a potential role of mast cells in the inflammation, because of their IgE-independent activation pathways. It also suggests the involvement of T cell-mediated mechanisms during induction of jejunal inflammation. Interestingly, the aggravated inflammation seen after long-term EW diet in WT mice seems to be IgE-dependent, considering that it was not observed in FcεRI-deficient mice. The elevated number of mast cells in the intestine of WT mice further led to a hypothesis that their continuous activation might be responsible for the chronification of allergic inflammation observed after long-term EW diet. In the context of OIT it further implies that IgE might be a poor prognostic factor for recovery of intestinal inflammation during and after an OIT treatment. In the third part of this thesis regulatory mechanisms employed by the immune system were analysed. Initial results from CD4+ T cells isolated from MLN from OVA/ALUM EW mice showed elevated IL-10 levels in their supernatants after short-term EW diet. IL-10-deficient mice were used to analyse the effect of this immunosuppressive cytokine in the mouse model presented here. However, IL-10-deficient mice tend to develop a strong Th1-dominated immune response. Nevertheless, an accelerated weight loss and slight inflammation of the jejunum was observed after short-term EW diet. Analysis of OVA-specific proliferation and cytokine production CD4+ T cells from Spleen and MLN of IL-10-deficient mice on EW diet suggested that systemic as well as local tolerance was induced after short-term and long-term EW diet feeding, respectively. The result suggests that IL-10 is dispensable for induction of T cell tolerance in our mouse model.
However, the presence of functionally active Tregs was observed during this study in WT mice fed short-term EW diet, suggesting that Tregs might have an important role in regulating the systemic or local immune response. T cell deletion as an alternative immune regulatory mechanism was also observed. Additionally, the efficacy of continuous EW diet (mirroring to a certain extent an OIT treatment) in induction of permanent tolerance was assessed. In OVA-sensitised WT mice continuous allergenic diet was stopped after resolution of clinical symptoms and reintroduced after a defined period on conventional diet. Evaluating the weight development showed that reintroduction of EW diet induced weight loss again, but not as pronounced as seen after short-term EW diet. Also the CD4+ T cell-mediated response was elevated again upon allergen stimulation in vitro. The results suggested that permanent tolerance was not induced in the chosen feeding regime.
The mouse model established and analysed here was used to investigate inflammatory and regulatory mechanisms underlying food-induced gastrointestinal allergy. It presents clinical symptoms and intestinal inflammation (Burggraf et al., 2011). This model is easy to be reproduced in different laboratories, and is useful for testing novel therapy approaches (Schülke et al., 2011; Bohnen et al., 2013). It further provides an opportunity to investigate basic mechanisms underlying OIT. This therapy approach is currently extensively investigated and our mouse model would help to understand the therapeutic mechanism of OIT.
Channelrhodopsin-2 (ChR2) is a light-gated cation selective channel from the unicellular alga Chlamydomonas reinhardtii, which is involved in phototaxis and photophobic responses. As other rhodopsins, ChR2 comprises a seven-transmembrane helix (TMH) motif and a retinal as the light-sensitive chromophore. The chromophore is covalently attached via a protonated Schiff base to the conserved lysine residue Lys257 located in TMH7. Based on its primary sequence and the all-trans configuration of the retinal in the ground state, ChR2 is assigned to the type I rhodopsins, also referred to as microbial-type rhodopsins. Upon light activation, the retinal isomerizes from the all-trans to the 13-cis form. This photoisomerization, which is accompanied by conformational changes of the protein, eventually leads to the opening of the channel and cation translocation. Cation flux during the conductive state leads to depolarization of the cell membrane and subsequent triggering of action potentials when expressed in neurons. Therefore, ChR2 has become the most versatile optogenetic tool, enabling a non-invasive investigation of neural circuits at high spatial and temporal resolution. With the rapidly increasing importance of ChR2 as a tool in neurobiology and cell biology, structural information is the prerequisite to an unambiguous understanding of the molecular mechanisms of this unique light-activated ion channel. The coupling between isomerization and structural alterations is well understood for other microbial-type rhodopsins, like bacteriorhodopsin (bR), halorhodopsin (HR) and sensory rhodopsin II (SRII). In case of ChR2, the first data on light-induced conformational changes came from spectroscopic studies and structural information is still missing. However, in order to fully understand the mechanism of light transduction by ChR2, it is necessary to determine the changes in the protein structure at specific steps in the photocycle.
By the time I started my PhD thesis, there was no structural information of ChR2 available. Therefore, the objective of this thesis was to obtain structural information of the transmembrane domain containing the first 315 amino acids of ChR2 by cryo electron crystallography. Besides revealing the structure of membrane proteins, cryo-EM of two-dimensional (2D) crystals is ideal for investigating conformational changes in membrane proteins induced by different stimuli. Therefore, the second objective of my thesis was the investigation of light-induced conformational changes in the slow C128T ChR2 mutant. The ~1,000 times longer lifetime of the open state of the C128T mutant compared to the wild-type allowed to trap different intermediates that accumulate during the photocycle.
In 2012, the X-ray structure of a channelrhodopsin-1/channelrhodopsin-2 chimaera (C1C2) at 2.3 Å resolution in the closed dark-adapted state was published (Kato et al., 2012). The structure revealed the essential molecular architecture of C1C2, including the retinal-binding pocket and the putative cation conduction pathway. Together with biochemical, spectroscopic, mutagenesis experiments, and the high-resolution model, some functionally important residues of ChR2 have been identified. However, unambiguous explanation of the molecular determinants that contribute to activation (gating) and transport were still mostly unknown.
RESULTS AND CONCLUSIONS
The first half of my theses dealt with 2D crystallization of ChR2. I succeeded in obtaining 2D crystals of ChR2 of four different types, which differed in size, crystal packing, crystal contacts and resolution, yielding structure factors up to 6 Å resolution. The crystals were grown by reconstituting the protein with different lipids at various lipid-to-protein ratios. The best crystals formed with the synthetic lipid DMPC and EPL upon detergent removal by dialysis. The projection maps calculated from these crystals revealed the overall structure of C128T ChR2 at 6 Å resolution and were published in 2011 (Müller et al., 2011). Surprisingly, ChR2 was found to be a dimer in all crystal types. The ChR2 dimer was stable both in detergent solution and in the presence of lipids for 2D crystallization. The monomers clearly showed the expected densities for the seven TMHs.
The arrangement of the ChR2 dimers on the four 2D lattices was different. However, comparison of the individual rojection maps revealed no significant differences within the ChR2 interface in the four crystal forms. The observation that the structure of the dimer was the same in all four crystal forms and in different lipids suggested strong specific contacts between the two protomers and implied that the protein was also dimeric in the native membrane. These findings were in agreement with Western blot analysis of plasma membranes from oocytes expressing ChR2 and laser-induced liquid bead ion desorption mass spectrometry, which both showed ChR2 as a dimer. The unusual stability of the ChR2 dimer contrasts with other microbial rhodopsins, which exist in different oligomeric states, i.e. monomers, trimers or dimers. These observations raised the question whether the functional unit is the monomer or the dimer.
The comparison of the projection map of the light-driven proton pump bR at the same resolution showed similar overall dimensions. Based on this comparison, the densities which became evident in the ChR2 projection maps could be assigned to the corresponding seven densities in bR. The shape of the densities near the dimer interface suggested that TMHs 2, 3, and 4 are oriented more or less perpendicular to the membrane plane, while the other four helices appear to be more tilted, as in bR.
Based on the high-resolution bR structure and the projection structures obtained, I have built a homology model. On the basis of this homology model, several residues found in the dimer interface were selected for mutational studies in order to disrupt the dimer interface.
The investigation of light-induced conformational changes in C128T ChR2 was the second part of my thesis. I designed an experimental setup for trapping light-induced conformational changes in C128T ChR2. In addition, I optimized the sample preparation in a way that the different illumination conditions did not alter the quality of the crystals. I have trapped two different functional states, namely the conductive open state and the non-conductive closed dark-adapted state.
In order to visualize the location and the extent of conformational changes, projection difference maps were calculated between the open and the closed state. Visual inspection of the difference maps between the open and the two closed states revealed three difference peaks that map to the TMHs 2, 6, and 7, indicating significant and specific rearrangements of these helices. The strong pair of positive/negative peaks at TMH6 suggests an outward tilt movement of approximately 2 Å. Close comparison of similar work on bR revealed that this movement is likely to occur at the cytoplasmic end of TMH6. A second highly significant negative peak is observed at TMH7, indicating a less pronounced tilt compared to TMH6. The third negative peak at TMH2 indicates a loss of density in this region. No significant differences were recorded at the TMH1, 5 and at the dimer interface formed by TMH3 and 4.
I succeeded in trapping and characterizing the open and closed state in the photocycle of ChR2 and could demonstrate that the transition from the closed to the open state is linked to significant light-induced tilt movements of TMH6 and 7, plus a loss of order in TMH2. These conformational changes are likely to create a large water-filled conducting pore, which seems to be required for the conductance of up to 2,000 ions per photocycle. The previously mentioned spectroscopic studies support the difference structures I obtained. This approach sets the stage for studying structural changes accompanying the formation and decay of other photocycle intermediates in ChR2. Future studies will aim at three-dimensional maps of the open and closed state at higher resolution.
Trotz zunehmender Verbesserungen in der Diagnostik und Therapie von Krebserkrankungen leiden onkologische Patienten häufig unter gravierenden tumorund therapiebedingten Symptomen und Nebenwirkungen wie Fatigue, Reduktion der Leistungsfähigkeit und Lebensqualität (Courneya, 2003a; Crevenna et al., 2002; Ferriset al., 2009). Zahlreiche Untersuchungen und Übersichtsarbeiten zeigen, dass körperliche Aktivität in den verschiedenen Phasen der Krebstherapie möglich ist und zu einer Reduktion der Nebenwirkungen sowie zu einer Verbesserung der Lebensqualität und Leistungsfähigkeit führen kann (Cramp & Byron-Daniel, 2012; Jones & Peppercorn, 2010; Mishra et al., 2012b; Schmitz et al., 2010). In aktuellen Leitlinien wird körperliche Aktivität deshalb als wichtige supportive Therapiemaßnahme während der Akuttherapie und im Rahmen der Nachsorge sowie Rehabilitation empfohlen. Analog der zunehmenden Individualisierung medizinischer Diagnostik- und Therapiestrategien in der Onkologie (z. B. vergleichbare oder sequentielle Therapieregime, targeted therapies, Patientenwunsch), gibt es inzwischen auch im Bereich der Sportmedizin Forderungen nach individuell angepassten, effektiven körperlichen Trainingsprogrammen (Jensen et al., 2011). Bei der Erarbeitung dieser Bewegungsangebote sollten Informationen zur Einschätzung der körperlichen Leistungsfähigkeit sowie zu den individuellen persönlichen und medizinischen Voraussetzungen der Betroffenen berücksichtigt werden. Entsprechend muss bei der Planung der körperlichen Aktivität auch die aktuelle Behandlungsphase im Rahmen der onkologischen Therapien einbezogen werden. Neben der zeitlichen Einteilung der Therapiephasen in Akut- oder Rehabilitationsphase gibt es die Möglichkeit, den Therapieprozess in Abhängigkeit der Heilungsaussicht einzuordnen. Dabei wird die Prognose einer Tumorerkrankung in Abhängigkeit des Tumorstadiums, des Lymphknotenbefalls und der möglichen Metastasierung in einen heilbaren (kurativen) und nicht heilbaren (palliativen) Therapieansatz eingestuft. Während ein Großteil der Studien die Wirkung bewegungstherapeutischer Interventionen bei Patienten mit kurativem Therapieansatz untersucht, gibt es bisher nur sehr wenig Untersuchungen bei unheilbar kranken Tumorpatienten (Albrecht & Taylor, 2012). Infolgedessen sind Aussagen zu prognosebezogenen Informationen über die individuelle Leistungsfähigkeit und zu unterschiedlichen physischen und psychischen Reaktionenaufgrund körperlicher Aktivität bei dieser Patientengruppe bisher nur bedingt möglich und erlauben folglich keine zielgruppenspezifischen Empfehlungen.
Angesichts dieses Forschungsdefizits ist das Kernziel der vorliegenden Arbeit, mögliche Unterschiede von Lebensqualität, Fatigue und aerober Kapazität (VO2peak) in Abhängigkeit der Heilungsaussicht (kurativ/palliativ) initial zu identifizieren und gleichzeitig die jeweiligen Veränderungen im Rahmen der Intervention über den Gesamtuntersuchungszeitraum zu überprüfen.
Initial konnten 300 onkologische Patienten (histologisch gesichertes Malignom) mit unterschiedlichen Krebsentitäten, in verschiedenen Behandlungsphasen, mit bekannter klinischer Heilungsprognose (kurativ/palliativ) und unter Berücksichtigung definierter Ein- und Ausschlusskriterien in die Untersuchung eingeschlossen werden. Mit dem Ziel einer individuellen Sportberatung und Trainingsplangestaltung absolvierten die Studienteilnehmer eine sportmedizinische Gesundheits- und Leistungsdiagnostik zur Ermittlung der Ausdauerleistungsfähigkeit und Bestimmung des Trainingsbereichs. Die Messungen erfolgten auf dem Fahrradergometer (0W; 25W Inkrement; 3 Minuten) und umfassten Herzfrequenz, Blutdruck, maximale Sauerstoffaufnahmefähigkeit (VO2peak), Laktatkonzentration und subjektives Belastungsempfinden (Borg Skala). Baseline- und identische Wiederholungs-untersuchungen nach 4-6 und nach 16-20 Wochen dienten gleichzeitig der Erfassung der subjektiven Parameter Lebensqualität und Fatigue (EORTC QLQ-C30) (Aaronson et al., 1993). Der Trainingsplan wurde unter Einbeziehung persönlicher Präferenzen, individueller Leistungsfähigkeit und Empfehlungen zur Gesundheitsprävention der WHO (als Orientierung für den Trainingsumfang von 150 min/Wo.) erstellt und dem Patienten in einem ca. 20minütigen Beratungsgespräch erläutert. Art, Umfang und Häufigkeit des mindestens mit moderater Intensität absolvierten Ausdauertrainings wurde durch die Patienten in einem Trainingstagebuch dokumentiert. Die Gruppenzuteilung erfolgte in Abhängigkeit der Heilungsprognose (kurativ/palliativ) unter Verwendung des TNM-Systems. Patienten mit der Prognose „heilbar“ wurden der kurativen Stichprobe zugeteilt, während Patienten mit histologisch gesichertem Nachweis von Metastasen (M1) als palliativ eingestuft wurden.
Referenzwerte waren für die VO2peak: alters- und geschlechtsentsprechende Normdaten (Median) des American College of Sports Medicine und für die Daten des EORTCQLQ-C30: das Manual „EORTC QLQ-C30 Reference Values“ einer EORTCArbeitsgruppe (Scott, 2008). Die Dateneingabe und die Aufbereitung der Rohdaten erfolgte mit Hilfe von Microsoft Excel. Für die statistische Auswertung wurden alle statistischen Analysen anschließend mithilfe der Statistikprogramme SPSS 19.0 (SPSS Inc., Chicago, IL, USA) und „BIAS für Windows“, Version 10, 2012, Universität Frankfurt) durchgeführt. Das Signifikanzniveau wurde a priori auf p<0,05 festgelegt.
Insgesamt 158 Patienten (99 kurativ, 59 palliativ; 54,9±11,1 Jahre, 108 ♀, 50 ♂) nahmen an allen drei Untersuchungen teil. Der parameterfreie Mann-Whitney-Test zeigte sowohl für Lebensqualität als auch Fatigue-Symptomatik keine signifikanten Unterschiede bei der Eingangsuntersuchung zwischen kurativen und palliativen Teilnehmern. Für die VO2peak ergab der parametrische T-Test ebenfalls keine Unterschiede bei den Initialwerten. Nach Abschluss der Intervention zeigten sich in beiden Patientengruppen sowohl bei der Lebensqualität als auch der Fatigue-Symptomatik signifikante Verbesserungen über den gesamten Untersuchungszeitraum. Anschließende post-hoc-Tests ergaben keine signifikanten Gruppenunterschiede bezüglich der Entwicklung während der verschiedenen Untersuchungszeiträume und der Differenz von Initial- und Abschlusswert. Die Varianzanalyse mit Messwiederholung (Anova) zeigte sowohl für Kurativ- als auch Palliativpatienten signifikante Veränderungen der VO2peak über die Zeit. Einen Haupteffekt im Bezug auf die Gruppe oder eine Interaktion von Zeit und Gruppe gab es dabei nicht. Folglich entwickelten sich beide Gruppen über den Untersuchungszeitraum vergleichbar.
Die vorliegenden Ergebnisse zeigen, dass die Heilungsprognose, kurativ oder palliativ, keinen unterschiedlichen Einfluss auf die Trainierbarkeit der Betroffenen zu haben scheint. Körperliches Training führte bei beiden Patientengruppen dieser Studie zu signifikanten Verbesserungen der Zielparameter. Ein Vergleich der vorliegenden Daten mit bisherigen Untersuchungsergebnissen ist aufgrund der aktuell geringen Anzahl an Studien mit Palliativpatienten und einer bisher nicht einheitlichen Palliativ-Definition schwierig.
Die sporttherapeutische Beratung, welche neben der Vermittlung von Trainingsumfang und –intensität insbesondere Trainingsziele und deren Wirksamkeit aufzeigen soll, kann Patienten und ihrem Umfeld helfen, den Stellenwert von körperlichem Training zuverstehen und bestenfalls die Compliance erhalten. Darüber hinaus kann die allgemeine Leitlinien-Empfehlung von 150 Minuten moderates Ausdauertraining pro Woche als grober Richtwert bestätigt werden. Unterschiedlich hohe Trainingsumfänge in Abhängigkeit initialer Leistungsfähigkeit weisen indessen darauf hin, dass individuelle Trainingsempfehlungen zu bevorzugen sind. Als Konsequenz aus diesen Ergebnissen ist zu empfehlen, dass sich zukünftig körperliche Aktivität als unverzichtbarer Bestandteil des supportiven Therapieangebotes für Krebspatienten mit fortgeschrittener Erkrankung, speziell bei palliativ eingestuften Patienten, etabliert.
Weitere Untersuchungen zu diesem Thema sollten insbesondere darauf abzielen, Dosis-Wirkungs-Zusammenhänge zu ermitteln und diese in symptom- und entitätsspezifische Empfehlungen zu integrieren.