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Institute
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Evaluating frequency, diagnostic quality, and cost of Lyme borreliosis testing in Germany: a retrospective model analysis
(2011)
- Background. Data on the economic impact of Lyme borreliosis (LB) on European health care systems is scarce. This project focused on the epidemiology and costs for laboratory testing in LB patients in Germany. Materials and Methods. We performed a sentinel analysis of epidemiological and medicoeconomic data for 2007 and 2008. Data was provided by a German statutory health insurance (DAK) company covering approx. 6.04 million members. In addition, the quality of diagnostic testing for LB in Germany was studied. Results. In 2007 and 2008, the incident diagnosis LB was coded on average for 15,742 out of 6.04 million insured members (0.26%). 20,986 EIAs and 12,558 immunoblots were ordered annually for these patients. For all insured members in the outpatient sector, a total of 174,820 EIAs and 52,280 immunoblots were reimbursed annually to health care providers (cost: 2,600,850€). For Germany, the overall expected cost is estimated at 51,215,105€. However, proficiency testing data questioned test quality and standardization of diagnostic assays used. Conclusion. Findings from this study suggest ongoing issues related to care for LB and may help to improve future LB disease management.
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Molekulare und zelluläre Analyse der Proteinkinase B/Akt und ihrer funktionellen Verknüpfung zu Insulin in Keratinozyten und während der Wundheilung in gesunden sowie insulinresistenten Mäusen
(2007)
- Die Verbreitung westlicher Verhaltens- und Lebensmuster im Rahmen der Globalisierung führt zu einer dramatischen Zunahme des Typ 2 Diabetes. Eine schwerwiegende Komplikation der diabetischen Erkrankung ist die Wundheilungsstörung, deren molekulare Pathophysiologie noch weitgehend unverstanden ist. Voraussetzung für einen koordinierten Wundheilungsprozess ist die ausgewogene Interaktion wundheilungsrelevanter Faktoren, die eine Vielfalt an Signaltransduktionskaskaden induzieren und somit zu einem streng kontrollierten Heilungsprozess beitragen. Darüber hinaus scheint auch die Insulinsensitivität der Haut für den Heilungsverlauf eine essentielle Rolle zu spielen. Da die Proteinkinase B/Akt nicht nur ein zentrales Molekül der Insulin-Signaltransduktion ist, sondern als Knotenpunkt vieler Signalkaskaden im Mittelpunkt zellulärer Ereignisse steht, sollte in der vorliegenden Arbeit die Rolle und Funktion der Proteinkinase Akt in der kutanen Wundheilung untersucht werden. Sowohl in der Haut als auch im Wundgewebe konnte Akt1 als dominante Isoform identifiziert werden. Die Verletzung des Hautgewebes induzierte einen Anstieg der Akt1-Expression und -Phosphorylierung in der Epidermis akut heilender Wunden. Insbesondere die am Wundrand gelegenen Keratinozyten waren durch eine starke Expression der Akt1-Kinase gekennzeichnet. Die Phosphorylierung und somit Aktivierung der Akt1-Kinase stieg im Verlauf der Wundheilung stetig an und erreichte ihr Maximum in der Endphase des Heilungsprozesses. Begleitet wurde die Aktivierung dieser Kinase von einer Phosphorylierung des eIF4E-BP1 und einer starken VEGF-Sekretion. Dagegen konnte in diabetisch chronischem Wundgewebe weder eine Aktivierung der Akt1-Kinase noch eine Phosphorylierung des eIF4E-BP1 nachgewiesen werden, was mit einer deutlich verminderten VEGF-Sekretion einherging. Um nun zu untersuchen, ob im Prozess der Wundheilung die VEGF-Sekretion in einem funktionellen Zusammenhang zur Akt1-Aktivierung steht, wurde in vitro der Einfluss wundheilungsrelevanter Faktoren, wie EGF, einer Kombination proentzündlicher Zytokine oder Insulin auf die Aktivierung der Akt1-Kinase und VEGF-Biosynthese untersucht. Obwohl alle Faktoren sowohl eine Aktivierung der Akt1-Kinase als auch VEGF-Sekretion induzierten, wurde ausschließlich die Insulininduzierte VEGF-Biosynthese über den PI3-Kinase/Akt-Signalweg vermittelt. Die Regulation der Insulin-induzierten VEGF-Biosynthese erfolgte posttranskriptionell aus einem gleichbleibenden Pool an VEGF-mRNA über die Phosphorylierung des eIF4E-BP1. Durch die Überexpression einer konstitutiv aktiven Akt1-Mutante und die Verwendung des mTOR-Inhibitors Rapamycin konnte mTOR als Mediator der Akt1-vermittelten Phosphorylierung des eIF4E-BP1 und somit der VEGF-Biosynthese identifiziert werden. In vitro-Lokalisationsexperimente zeigten, dass eine vollständig phosphorylierte und somit aktive Akt1-Kinase nach Insulinstimulation im Zytoplasma lokalisiert ist - exakt dort, wo die Regulation der Translation stattfindet. Zusammenfassend weisen diese Ergebnisse darauf hin, dass Insulin im kutanen Heilungsverlauf die VEGF-Biosynthese posttranskriptionell über eine Akt1-vermittelte Phosphorylierung des eIF4E-BP1 induzieren kann. Eine ausbleibende Akt-Aktivierung in insulinresistenten Keratinozyten könnte somit zu einer verminderten VEGF Sekretion und folglich zu einer verzögerten Angiogenese in chronisch diabetischen Wunden beitragen.
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A large-scale chemical modification screen identifies design rules to generate siRNAs with high activity, high stability and low toxicity
(2009)
- The use of chemically synthesized short interfering RNAs (siRNAs) is currently the method of choice to manipulate gene expression in mammalian cell culture, yet improvements of siRNA design is expectably required for successful application in vivo. Several studies have aimed at improving siRNA performance through the introduction of chemical modifications but a direct comparison of these results is difficult. We have directly compared the effect of 21 types of chemical modifications on siRNA activity and toxicity in a total of 2160 siRNA duplexes. We demonstrate that siRNA activity is primarily enhanced by favouring the incorporation of the intended antisense strand during RNA-induced silencing complex (RISC) loading by modulation of siRNA thermodynamic asymmetry and engineering of siRNA 3-overhangs. Collectively, our results provide unique insights into the tolerance for chemical modifications and provide a simple guide to successful chemical modification of siRNAs with improved activity, stability and low toxicity.
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Differential utilization of ketone bodies by neurons and glioma cell lines: a rationale for ketogenic diet as experimental glioma therapy
(2011)
- Background: Even in the presence of oxygen, malignant cells often highly depend on glycolysis for energy generation, a phenomenon known as the Warburg effect. One strategy targeting this metabolic phenotype is glucose restriction by administration of a high-fat, low-carbohydrate (ketogenic) diet. Under these conditions, ketone bodies are generated serving as an important energy source at least for non-transformed cells. Methods: To investigate whether a ketogenic diet might selectively impair energy metabolism in tumor cells, we characterized in vitro effects of the principle ketone body 3-hydroxybutyrate in rat hippocampal neurons and five glioma cell lines. In vivo, a non-calorie-restricted ketogenic diet was examined in an orthotopic xenograft glioma mouse model. Results: The ketone body metabolizing enzymes 3-hydroxybutyrate dehydrogenase 1 and 2 (BDH1 and 2), 3-oxoacid-CoA transferase 1 (OXCT1) and acetyl-CoA acetyltransferase 1 (ACAT1) were expressed at the mRNA and protein level in all glioma cell lines. However, no activation of the hypoxia-inducible factor-1alpha (HIF-1alpha) pathway was observed in glioma cells, consistent with the absence of substantial 3-hydroxybutyrate metabolism and subsequent accumulation of succinate. Further, 3-hydroxybutyrate rescued hippocampal neurons from glucose withdrawal-induced cell death but did not protect glioma cell lines. In hypoxia, mRNA expression of OXCT1, ACAT1, BDH1 and 2 was downregulated. In vivo, the ketogenic diet led to a robust increase of blood 3-hydroxybutyrate, but did not alter blood glucose levels or improve survival. Conclusion: In summary, glioma cells are incapable of compensating for glucose restriction by metabolizing ketone bodies in vitro, suggesting a potential disadvantage of tumor cells compared to normal cells under a carbohydrate-restricted ketogenic diet. Further investigations are necessary to identify co-treatment modalities, e.g. glycolysis inhibitors or antiangiogenic agents that efficiently target non-oxidative pathways.
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Wound healing in mice with high-fat diet- or ob gene-induced diabetes-obesity syndromes: a comparative study
(2010)
- In the past, the genetically diabetic-obese diabetes/diabetes (db/db) and obese/obese (ob/ob) mouse strains were used to investigate mechanisms of diabetes-impaired wound healing. Here we determined patterns of skin repair in genetically normal C57Bl/6J mice that were fed using a high fat diet (HFD) to induce a diabetes-obesity syndrome. Wound closure was markedly delayed in HFD-fed mice compared to mice which had received a standard chow diet (CD). Impaired wound tissue of HFD mice showed a marked prolongation of wound inflammation. Expression of vascular endothelial growth factor (VEGF) was delayed and associated with the disturbed formation of wound margin epithelia and an impaired angiogenesis in the reduced granulation tissue. Normal wound contraction was retarded and disordered. Wound disorders in obese C57Bl/6J mice were paralleled by a prominent degradation of the inhibitor of NFκB (IκB-α) in the absence of an Akt activation. By contrast to impaired wound conditions in ob/ob mice, late wounds of HFD mice did not develop a chronic inflammatory state and were epithelialized after 11 days of repair. Thus, only genetically obese and diabetic ob/ob mice finally developed chronic wounds and therefore represent a better suited experimental model to investigate diabetes-induced wound healing disorders.
