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Institute
Snake bite envenoming often results in disability or death of breadwinners of poor families in the rural tropics and the subtropics of Nepal. Identification of the medically relevant snake species, circumstances of venomous snake bites, prehospital care of their bites and human responses to snakes and snake bite is, therefore, crucial to enable victims or first aider to select the appropriate first aid measures, physicians to anticipate complications and to use appropriate treatment protocols as well as the local community to implement prevention strategies. Inadequate educational gaps exist in Nepal and hinder identification of snakes involved in bites. To fill this gap, I aim to provide an evidence-based list of medically relevant snake species. Snake specimens brought by patients bitten or their attendants from the tropical and subtropical regions in southeastern, southcentral, and southwestern Nepal to snake bite treatment centres over a period from 2010 through 2014, were taxonomically identified and medical records of envenoming were evaluated.
In Nepal, the epidemiology of snake bite is poorly known. Here I describe the ecological circumstances of proven krait (Bungarus spp.) and Russell´s Viper (Daboia russelii) bites to elucidate and examine, whether environmental circumstances or human behaviour contributed to envenoming. In a cross-sectional study, data about prehospital care, environmental circumstances of 46 krait and 10 Russell´s Viper bites were evaluated. Patients were interviewed using structured interview forms. Snake bite prone communities were surveyed to test people´s knowledge on snakes and their attitude towards venomous snakes in general.
Of 349 snakes involved in bites, 199 (57%) specimens were found to be medically relevant venomous snakes that included 11 species belonging to six genera and two families. Among them, Naja naja (n = 76, 22%), Bungarus caeruleus (n = 65, 19%) and Trimeresusurs albolabris (n = 10, 3%) were the most widely distributed snakes. Daboia russelii (n = 10, 3%) was found to be restricted to the southwestern part of Nepal. For B. walli, a previously poorly known species, 13 voucher specimens represent the first country records of this species as well as the first documented cases of involvement in snake bite envenoming by this species in Nepal.
Numerous snake bites (33%) occurred at night, during the rainy season, and are mainly due to Bungarus species, particularly B. caeruleus. Bites of cobras and Russell’s Vipers are a risk at daytime. Evaluation of data regarding the place where the bite happened, indicates that the snake bite risks appear to be as high in residential areas, in and around houses, as in rural areas. In cases of kraits (n = 46), 61% of the bites occurred while the victim was sleeping indoors, those of Russell´s Vipers mainly during agricultural activities in the fields. Analysis of socio-demographic data revealed that both krait and viper bites predominantly affected farmers or their family members. However, snake bites involved also people of higher socio-economic status, which suggests that it is not a health problem of poor people only living in the rural areas of Nepal.
A small number of snake bite victims (n = 7) sought help from traditional healers, but most patients went to hospitals for medical treatment using motorbikes (65%) or were transferred by ambulance cars (22%). As a first aid measure, most patients (78%) had used a tourniquet, which is of doubtful value and has often severe sequelae, instead of applying the WHO recommended pressure immobilisation bandage or local compression pad. The overall case fatality rate was calculated to be 10%, but up to 17% in cases of Bungarus spp. bites.
Rural community people were found to be extremely afraid of snakes, a major reason for indiscriminate killing of even harmless snakes, e.g., Lycodon aulicus, which were wrongly considered to be venomous. This is mainly due to the poor knowledge on snakes in general and on their role in providing ecological services, which may eventually lead to a decline in snake populations and even the extinction of rare species.
The results of the present study strongly emphasize that snake bite is an important public health issue in Nepal. There is an urgent need to improve the knowledge of people on snakes and to try changing their attitudes towards these reptiles, in addition to documenting the biodiversity and distribution of medically relevant snakes, the epidemiology and circumstances of their bites. Avoiding high-risk behaviour (e.g., killing of snakes), using screened doors and windows are some of the suggested measures preventing snake bite. Early and accurate identification of the snakes involved should help physicians to apply timely treatment, eventually referring the patient to the appropriate hospital. This also has important implications in developing public health and conservation strategies, to the benefit of the people of Nepal.
Human GLUTs represent a family of specialized transporters that facilitate the diffusion of hexoses through membranes along a concentration gradient. The 14 isoforms share high sequence identity but differ in substrate specificity and affinity, and tissue distribution. According to their structure similarity, GLUTs are divided into three classes, with class 1 comprising the most intensively studied isoforms GLUTs1 4. An abnormal function of different GLUT members has been related to the pathogenesis of various diseases, including cancer and diabetes. Hence, GLUTs are the subject of intensive research, and efforts concentrate on identifying GLUT-selective ligands for putative medical purposes and their application in studies aiming to further unravel the metabolic roles of these transporters.
The hexose transporter deficient (hxt0) yeast strain EBY.VW4000 is devoid of all its endogenous hexose transporters and unable to grow on glucose or related hexoses. This strain has proven to be a valuable platform to investigate heterologous transporters due to its easy handling, increased robustness, and versatile applications. However, the functional expression of GLUTs in yeast requires certain modifications. Single point mutations of GLUT1 and GLUT5 led to their functional expression in EBY.VW4000, whereas the native GLUT1 was actively expressed in EBY.S7, a hxt0 strain carrying the fgy1 mutation that putatively reduces the phosphatidylinositol-4-phosphate (PI4P) content in the plasma membrane. GLUT4 was only actively expressed in the hxt0 strain SDY.022, which also contains the fgy1 mutation and in which ERG4 is additionally deleted. Erg4 is one of the late enzymes in the ergosterol pathway, and therefore SDY.022 probably has an altered sterol composition in its membrane.
The goal of this thesis was to actively express GLUT2 and GLUT3 in a hxt0 yeast strain, providing a convenient system for their ligand screening. A PCR-derived amino acid exchange in the sequence of GLUT3 enabled its functional expression in EBY.VW4000 and the unmodified GLUT3 protein was active in EBY.S7. Functional expression of GLUT2 was achieved by rational design. The extracellular loop between the transmembrane regions 1 and 2 is significantly larger in GLUT2 than in other class 1 GLUTs. By truncating this loop by 34 amino acids and exchanging an alanine for a serine, a GLUT3-like loop was implemented. The resulting construct GLUT2∆loopS was functional in EBY.S7. With an additional point mutation in the transmembrane region 11, GLUT2∆loopS_Q455R was also actively expressed in EBY.VW4000. Inhibition studies with the known GLUT inhibitors phloretin and quercetin showed a reduced transporter activity for GLUT2 and GLUT3 in uptake assays and growth tests when inhibitors were present, demonstrating that both systems are amenable for ligand screening experiments.
The newly established GLUT2 yeast system was then used to screen a library of compounds pre-selected by in silico screening. Thereby, eleven identified GLUT2 inhibitors exhibited strong potencies with IC50 values ranging from 0.61 to 19.3 µM. By employing the other yeast systems, these compounds were tested for their effects on GLUT1, and GLUTs3-5, revealing that nine of the identified ligands were GLUT2-selective. In contrast, one was a pan-class 1 inhibitor (inhibiting GLUTs1-4), and one affected GLUT2 and GLUT5, the two fructose transporting isoforms. These compounds will serve as useful tools for investigations on the role of GLUT2 in metabolic diseases and might even evolve into pharmaceutical agents targeting GLUT2-associated diseases.
Due to the beneficial effect of the putatively changed sterol composition in SDY.022 (by ERG4 deletion) on the functional expression of GLUT4, it was hypothesized that the presence of the human sterol cholesterol, or cholesterol-like sterols, might have a beneficial effect on GLUT expression, too. Thus, it was attempted to generate hxt0 strains that synthesize these sterols by genetic modifications targeting the ergosterol pathway. In the scope of these experiments, several strains with different sterol compositions were generated. Drop tests on glucose medium with the different strains expressing GLUT1 or GLUT4 revealed that the deletion of ERG6 is clearly advantageous for a functional expression of GLUT1 (but not GLUT4). This indicates that the methyl group at the ergosterol side chain (introduced by Erg6 and reduced by Erg4) negatively influences GLUT1 activity. However, this effect on GLUT1 activity was less pronounced than the putative altered PI4P content in EBY.S7.
Additionally, in this thesis, a new tool to measure glucose transport rates of transporters expressed in the hxt0 yeast system was developed to facilitate their kinetic characterization. For this, the pH-sensitive GFP variant pHluorin was employed as a biosensor for the cytosolic pH (pHcyt) by measuring the ratio (R390/470) of emission intensities at 512 nm from two different excitation wavelengths (390 and 470 nm). Sugar-starved cells exhibit a slightly acidic pHcyt because ATP production is depleted, reducing the activity of ATP-dependent proton pumps.
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