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Der gezielte, effiziente Aufbau komplexer Struktureinheiten, die mehrere Stereozentren besitzen, ist bis heute eine der größten Herausforderungen in der organischen Synthese. Gerade hinsichtlich der Wirkstoffentwicklung ist es von großer Bedeutung alle möglichen Stereoisomere einer Verbindung zugänglich zu machen. Die 1,3-Diamin-Struktureinheit ist Bestandteil interessanter Naturstoffe, biologisch aktiver Substanzen oder chiraler Liganden. Zusammenfassend konnte erfolgreich eine neue hoch modulare, stereokonvergente, Enamid/Acylimin-basierte Methode zur Synthese von 1,3-Diaminen mit drei fortlaufenden Stereozentren entwickelt werden. Diese Route bietet Zugang zur kompletten Tetrade möglicher Diastereomere, ausgehend von einfach zugänglichen Startmaterialien. Die Konfiguration der beiden zuerst gebildeten Stereozentren kann durch die Enamid-Geometrie kontrolliert werden ((E) -> 1,2 anti, (Z) -> 1,2-syn-Konfiguration). Die 2,3 Konfiguration kann hingegen über die geschickte Wahl der Reagenzien und den damit assoziierten Reaktionsbedingungen gesteuert werden. Weiterhin konnte eine Bi(OTf)3-katalysierte Ein-Topf-Sequenz zur diastereoselektiven Synthese von 1,2-anti-2,3-anti-1,3-Diaminen 6 etabliert werden. Darüber hinaus konnte die Synthese der N,O-Acetale, als auch die der Enamide optimiert und bzgl. der Synthesen im Multigrammmaßstab verbessert werden. Die N,O-Acetale konnten erfolgreich aus Amiden, Aldehyden und Alkoholen dargestellt werden. Die Enamide wurden unter Zuhilfenahme luftunempfindlicher Ni-Katalystoren aus Allylamiden mittels Isomerisierung zugänglich gemacht.
In der vorliegenden Studie wurden sieben verschiedene Biomarker (Survivin, Ki-S2, EGFR, Her2/neu, PTEN, p53, OSF-2) von Plattenepithelkarzinomen der Mundhöhle und des anterioren Oropharynx bezüglich ihres Expressionsverhaltens vor und nach Applikation einer intraarteriellen Induktionschemotherapie mit 150mg/m² Cisplatin und im Hinblick auf einen möglichen Zusammenhang des Expressionsverhaltens mit dem Chemotherapieresponse untersucht.
Mit Hilfe der TMA-Technologie wurde in Gewebeproben von 41 Patienten, welche am genannten Krebs erkrankt waren, die Expressionsraten immunhistochemisch bestimmt. Die Behandlung der Patienten erfolgte im Rahmen eines multimodalen Therapiekonzepts in der Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie am Klinikum der Johann Wolfgang Goethe-Universität in Frankfurt am Main. Alle Patienten hatten eine intraarterielle Induktionschemotherapie erhalten gefolgt von einer chirurgischen Intervention. Spätestens nach sechs Wochen erfolgte die adjuvante Bestrahlung beziehungsweise Radiochemotherapie (Maximalvariante). 56% der Patienten erhielten die Maximalvariante.
Die allgemeine pathologische Ansprechrate nach intraarterieller Induktion lag bei 39% (2%= pCR, 37%= pPR). 59% der Patienten zeigten kein Ansprechen auf die Induktion (pSD) und 2% zeigten eine Progression (pPD). Die Expressionsraten der einzelnen Biomarker wurden jeweils vor und nach intraarterieller Induktionschemotherapie bestimmt. Die statistische Analyse erfolgte univariat mittels Wilcoxon-Mann-Whitney-U-Test und Wilcoxon-matched-pairs-Test. Für Survivin, Ki-S2, OSF-2 und EGFR konnten signifikante Unterschiede nach Induktion verzeichnet werden, die Expressionsrate stieg für Survivin Kern (p= 0,0001), OSF-2 (OSF-2 Zytoplasma, p= 0,0067; OSF-2 Membran, p= 0,0001) und EGFR (p= 0,039) signifikant an. Für Ki-S2 nahm die Expressionsrate signifikant ab (p= 0,001).
In der Vergleichsgruppe Responder versus Non-Responder konnten sowohl in der diagnostischen Primärtumorbiopsie als auch im OP-Präparat des Primärtumors nach Induktion keine signifikanten Unterschiede zwischen Respondern und Non-Respondern in den Expressionsraten festgestellt werden. Für Survivin Zytoplasma lagen die Expressionsraten für die Responder-Patienten vor und nach Induktion im oberen Bereich. Für PTEN konnte bei 75% der Patienten ein Expressionsverlust verzeichnet werden. Damit konnte in der hier durchgeführten Studie kein Biomarker detektiert werden, welcher für eine signifikante Vorhersage zur Responserate herangezogen werden könnte.
Die Änderung der Expressionsraten von Biomarkern bei oralen und oropharyngealen Plattenepithelkarzinomen nach intraarterieller Induktionschemotherapie ist ein Befund, der an ähnliche Beobachtungen nach neoadjuvanter Chemotherapie z. B. beim Mammakarzinom anknüpft und darum weiter verfolgt werden sollte.
Background: Minimally invasive coronary artery bypass grafting (MICS CABG) has been introduced to abstain from median sternotomy due to related comorbidities. The aim of this study is to report the long term results of three different MICS CABG strategies: Partial lower sternotomy (PLS), totally endoscopic coronary artery bypass grafting (TECAB) and anterolateral thoracotomy (ALT). Moreover we aimed to compare these surgical approaches in terms of quality of pain and pain intensity.
Methods: From 1997 to 2006, 126 patients underwent MICS CABG surgeries in our department through different surgical approaches: 43 PLS, 63 TECAB and 20 ALT. Preoperative characteristics were similar between groups. There were 90 males (71.4%) and 36 (28.6%) females with a mean age of 62±11 years (Range 36 to 90).
Results: There was no in-hospital mortality. Conversion to minithoracotomy was necessary in 2 (1.6%) patients and conversion to sternotomy was performed in 1 (0.8%) patient. Length of hospital stay was comparable in patients who underwent PLS or TECAB, but both groups had significantly shorter hospital stays than ALT patients (p<0.05). Two patients in group ALT developed temporary neurological complications postoperatively, which was significantly higher than that in groups TECAB (n=0) and PLS (n=0) (p<0.05). Mean follow-up was 12.2±2.1 (range 7.2 to 16.1) years with completed in 81.7 % of the patients. There were 17 late deaths. Freedom from graft problems was 87.5%, 86.5% and 94.7%; freedom from percutaneous coronary interventions (PCI) was 78.1%, 82.7% and 68.4% and freedom from Re-CABG was 100%, 96.1% and 94.7% in PLS, TECAB and ALT group, respectively. Pain intensity was similar between all three groups.
Conclusion: MICS CABG can be performed safely and effectively. Short and long-term outcomes of MICS CABG are comparable with those of the conventional CABG. There were no major differences regarding pain intensity between all three groups, although all three minimally invasive techniques have completely different surgical accesses.
The objectives of this thesis were to understand how distinct classes of cell types interact to shape oscillatory activity in cortical circuits of the turtle. We chose the turtle cortex as a model system for cortical computations for two reasons. One is that the phylogenetic position of turtles makes their cortex functionally and anatomically particularly interesting. The second is that reptilian brains present several unique experimental advantages. Turtles have a three-layered cortex that forms the dorsalmost part of their pallium and receives direct input from visual thalamus. Thus turtle cortex, while sharing several features with mammalian cortices, constitutes a simpler system for studying cortical computations and dynamics. Freshwater turtles are semiaquatic species, that dive for hours and hibernate for months without breathing. Their brains are adapted to these behaviors so that they can operate under severe anoxia. This property allows for ex vivo wholebrain and whole-cortex (”cortical slab”) preparations in vitro, enabling the use of many sophisticated techniques for monitoring activity in parallel.
I thus set out to utilize the advantages of our model system, by using optogenetic methods to reliably evoke oscillations in an ex vivo whole-cortex preparation while observing activity in parallel with planar multi-electrode arrays (MEA), linear silicon depth-electrodes and patch-clamp recording techniques. This required several technical aspects to be solved. Prior work in turtle cortex (Prechtl, 1994; Prechtl et al., 1997; Senseman and Robbins, 2002) indicated that visual stimuli evoke complex activity patterns (e. g. wave patterns) in dorsal cortex. The goal was to examine these dynamics in detail and to provide mechanistic explanations for them whenever possible. The recent advent of optogenetics, the development of microelectrode arrays, and the possibility to combine these techniques with classical electrophysiological approaches on a resistant, accessible and stable preparation led me to explore a number of technical avenues.
First I had to establish gene delivery methods in reptiles. I settled on recombinant viruses, and show results from several serotypes of adeno-associated virus (AAV), i lentivirus and rabies virus. I report successful gene expression of genes of interest with several subtypes of AAV, including the commonly used AAV2/1 and AAV2/5 serotypes. Second I had to find promoters enabling global and cell-type specific gene expression in reptiles. Ubiquitous high-yield promoters such as CAG/CB7 or CMV drive high levels of expression in turtles; cell-type specific promoters such as hSyn (expression limited to neurons) and CaMKIIa (expression limited exclusively o mostly to excitatory neurons) appear similarly biased in turtles. Other cell-type specific promoters reported in the literature (fNPY, fPV, fSST) failed to express in turtles.
A second major aspect of my work focused on electrophysiological recordings using microelectrode arrays and the interpretation of extracellular signals recorded from cortex in ex vivo preparations. We observed that spike signals produced by pyramidal and inhibitory neurons were very often followed by a slower potential. We identified these slower potentials as reflections of synaptic currents, and thus of the axonal projections of the neurons, at least within the deep layers of cortex. This also resulted in a means to classify neurons as excitatory or inhibitory with much higher reliability than classical methods (e. g. spike width). The final aspect of my work concerns the use of optogenetics to dissect the mechanisms of cortical oscillations and wave propagation. I show that oscillations can be induced by light in turtle cortex after transfection with AAV2/1 carrying the gene for channelrhodopsin 2 (ChR2). By using the CaMKIIa promoter, ChR2 induced currents are limited to LII/III excitatory cells; we can therefore control excitatory drive to cortical networks. If this drive is strong enough, layer III inhibitory interneurons are recruited and fire in a concerted fashion, silencing the excitatory population. The visually evoked 20 Hz oscillations observed in chronically recorded animals (Schneider, 2015) or in anaesthetized animals (Fournier et al., in press) thus appear to result from a feedback loop between E and I cells within layers II & III. Details of these interactions are being investigated but - layer I interneurons, by contrast, do not seem to be involved. By pulsing light I could control the frequency of the oscillations within a range of several Hz around the natural oscillation frequency. Above this range, cortex could only follow the stimulus at a fraction (1/2, 1/3,...) of the light pulse frequency. Using a digital micromirror device, I limited activation of the cortical networks spatially, enabling the study of wave propagation in this system.
Reptilian cortex offers a relatively simple model system for a reductionist and comparative strategy on understanding cortical computations and dynamics. Turtle dorsal cortex could thus give fundamental insights to the primordial organization tional, computational and functional principles of cortical networks. These insights are relevant to our understanding of mammalian brains and may prove valuable to decipher fundamental questions of modern neuroscience.
Bei Knochendefekten kritischer Größe gestaltet sich die selbstständige Regeneration als nahezu unmöglich, weshalb es nötig ist die Therapie zu optimieren. Die Verwendung autologer Spongiosatransplantate stellt den aktuellen Goldstandard dar, was jedoch mit einer Reihe von Komplikationen, beispielsweise Schmerzen an der Entnahmestelle oder Wundheilungsstörungen verbunden ist. Das Knochen Tissue Engineering repräsentiert eine aussichtsreiche Alternative. Die Kombination eines osteokonduktiven Gerüststoffes mit regenerativen Zellen, wie zum Beispiel mononukleäre Zellen des Knochenmarks (BMC), stellt einen vielversprechenden Ansatz dar. Die BMCs haben im Vergleich zu anderen verwendbaren Zelltypen, z.B. mesenchymale Stammzellen (MSCs) oder endothelialen Vorläuferzellen (EPCs), den entscheidenden Vorteil einer kurzen Aufbereitungszeit, wodurch die definitive Frakturversorgung beschleunigt wird.
Mittels Inhibierung von MicroRNAs (miRNAs) mit Einfluss auf das osteogene und angiogene Potenzial der BMCs soll dieses System weiter verbessert werden. MiRNAs umfassen eine Gruppe kurzer, nicht-codierender RNAs die an der Steuerung grundlegender biologischer Prozesse beteiligt sind. Im Rahmen dieser Studie sind die MIR92A sowie MIR335 von besonderem Interesse. MIR92A blockiert die Angiogenese durch Verringerung der Expression des pro-angiogenen Proteins Integrin alpha 5 (ITGA5, CD51) sowie durch die Aktivierung des Notch-Signalweges um die Vascular endothelial growth factor (VEGF)-induzierte Blutgefäßbildung zu reduzieren. MIR335 hemmt über die Verringerung der Proteinkonzentration des Runt-related transcription factor 2 (RUNX2) die Proliferation und Differenzierung von humanen mesenchymalen Stammzellen (hMSCs) zu osteogenen Zellen. Aufgrund der erläuterten Erkenntnisse sollte in dieser Arbeit überprüft werden, ob die Neutralisation von MIR92A (Vaskularisierung) und MIR335 (osteogene Differenzierung) in BMCs mittels spezifischer antiMIR zu einer weiteren Verbesserung der BMC gestützten Therapie großer Knochendefekte führt.
Im ersten Teil der Versuche wurde das Prinzip der Lipotransfektion, zur Einbringung der Antikörper gegen die miRNAs in BMCs, optimiert und die Transfektionseffizenz bestimmt. In Abhängigkeit von der Zellsorte wurden mit 30 % - 69 % ausreichend hohe Transfektionseffizenzen erzielt, um jeweils 24 h nach Transfektion einen signifikanten Rückgang der Target-miRNA-Konzentrationen zu erreichen.
Nachdem die Wirksamkeit der Transfektion nachgewiesen war, wurden im zweiten Teil der Experimente die spezifischen Effekte der antiMIR auf die Zielgene überprüft. Der Einsatz von antiMIR92A führte nach 72 h zu einer erhöhten Genexpression von ITGA5 sowie VEGFA, zwei für die Angiogenese entscheidende Proteine. Zusätzliche konnte mittels FACS-Analyse eine signifikant gesteigerte CD51-Oberflächenexpression dokumentiert werden. Bei der Verwendung von antiMIR335 konnte eine verstärkte Expression der für die osteogene Differenzierung entscheidenden Indikatoren RUNX2 und BMP2 nachgewiesen werden. Die additionale Gabe von VEGFA (MIR92A) oder BMP2 (MIR335) konnte nach 48 h einen Trend zu verstärkter ITGA5 und VEGFA, beziehungsweise RUNX2 und BMP2 Expression erkennen lassen.
Zusammenfassend hat diese Studie verdeutlicht, dass die Inhibierung der MIR92A und MIR335 eine vielversprechende Möglichkeit bietet, das BMC gestützte Knochen Tissue Engineering weiter zu optimieren.
Colorectal cancer (CRC) has the third highest incidence and the fourth highest mortality rate worldwide and represents a substantial health care burden and affects the life of millions of people. CRC is a genetic disease caused by the stepwise accumulation of genetic alterations. The initiating event in colorectal carcinogenesis is the aberrant activation of the WNT pathway, but other pathways are also commonly deregulated, including the PI3K/AKT pathway. A number of previous studies using genetically engineered mouse models aimed at dissecting the exact role of PI3K/AKT pathway in CRC, but have yielded in rather conflicting results. Despite the inconsistent results, these studies already put forward the idea that PI3K/AKT signaling in combination with other genetic events might substantially contribute to tumor progression. Since the PI3K/AKT pathway is frequently activated in CRC, it represents an ideal candidate for therapeutic intervention. Although extensive efforts had led to the development of numerous inhibitors targeting the PI3K/AKT pathway, the diversity of genetic alterations can challenge the identification of the most effective therapeutic targets. Therefore, the discovery of shared tumor-promoting mechanisms downstream of these genetic alterations might unravel new biomarkers and druggable targets. The aim of this study was to elucidate the precise role of PI3K/AKT pathway during the course of colorectal carcinogenesis and to decipher novel protumorigenic molecular mechanisms downstream of PI3K/AKT activation that can be used for therapeutic intervention.
To obtain a better insight into the role of the PI3K/AKT pathway during colorectal carcinogenesis, mice expressing an oncogenic variant of AKT1 (AktE17K) specifically in the intestinal epithelial cells (IEC) were used. At the age of 6 months untreated AktE17K mice showed clearly perturbed intestinal homeostasis, but no tumor formation. To induce colonic tumorigenesis, AktE17K mice were subjected to treatment with the colonic carcinogen azoxymethane (AOM). In response to AOM, AktE17K mice developed invasive but non-metastatic tumors, which showed strong nuclear accumulation of TP53. To investigate the role of PI3K/AKT signaling specifically in CRC progression, AktE17K mice were crossed to TP53-deficient mice (Tp53ΔIEC). Unlike AktE17K mice, untreated Tp53ΔIEC; AktE17K, developed highly invasive small
intestinal tumors by the age of 6 months. To investigate the role of AKT hyperactivation in colonic tumor progression, Tp53ΔIEC; AktE17K mice were subjected to AOM treatment. AKT hyperactivation significantly enhanced tumor progression and induced metastatic dissemination.
To get a better insight how AKT signaling can promote tumor progression, whole tumor tissues from AOM-treated Tp53ΔIEC and Tp53ΔIEC; AktE17K mice were subjected to next generation mRNA sequencing and phospho-proteomic analysis by mass spectrometry. Both analyses indicated that AKT hyperactivation expands the inflammatory tumor microenvironment and upregulates pathways associated with invasion and metastasis. Importantly, Gene Set Enrichment Analysis revealed that AOM-induced colon tumors of Tp53ΔIEC; AktE17K animals, are highly similar in their gene expression profile to the CMS4 subtype of human CRC, which is associated with worse overall- and relapse-free survival. Gene expression analysis also suggested elevated NOTCH signaling in the Tp53ΔIEC; AktE17K tumors. Interestingly, while the expression of Notch3 mRNA was increased in the tumors of Tp53ΔIEC; AktE17K mice, the expression of the other NOTCH receptors was unaffected by AKT hyperactivation. In vitro experiments using TP53-deficient mouse tumor organoids with hyperactive AKT signaling confirmed the direct, tumor cell-intrinsic link between AKT activation and increased Notch3 expression. Moreover, inhibition of EZH2 mimicked the effect of AKT hyperactivation on Notch3 expression, suggesting that AKT regulates Notch3 via an epigenetic mechanism.
Knock-down of Notch3 in TP53-deficient mouse tumor organoids with hyperactive AKT signaling resulted in differential regulation of several pathways with potential role in invasion and metastasis and in cell death and survival. Subsequent in vivo experiments confirmed the role of NOTCH3 signaling in CRC progression. Treatment of AOM-induced Tp53ΔIEC; AktE17K mice with a NOTCH3 antagonistic antibody or the γ-secretase inhibitor DAPT significantly reduced invasion and metastasis. Importantly, NOTCH3 expression was also found to be associated with human CRC progression, suggesting that NOTCH3 represent a valid target for the treatment of CRC. This work, using genetically engineered mouse models and advanced in vitro techniques, has demonstrated a strong tumor promoting role for PI3K/AKT signaling in CRC progression and has identified NOTCH3 signaling as a potential therapeutic target downstream of the PI3K/AKT pathway.
Cette recherche retrace l’histoire de la fondation des musées en France englobant les périodes du Directoire, du Consulat et de l’Empire. Cette création des musées se fait à travers des envois gouvernementaux de tableaux à plusieurs villes périphériques. Elle est intimement liée au dit « Décret Chaptal », l’arrêté consulaire du 14 fructidor an IX (1er septembre 1801) qui lance quinze envois dans différentes villes dont Bruxelles, Genève et Mayence, alors considérées comme parties intégrantes du territoire national. Ma thèse est présentée en trois parties, pour valoriser le rôle singulier de Chaptal. Le dépouillement des archives fournit un récit détaillé des prémices de cette politique, de la conception du texte et de la mise en œuvre de cet arrêté avant, pendant et après le Ministère Chaptal. Leur analyse ouvre des perspectives nouvelles sur la politique muséologique initiée par Chaptal dans la continuité des Lumières.
Rhabdomyosarcoma is the most common paediatric soft-tissue sarcoma, and for tumour recurrence, the prognosis is still unfavourable. The current standard therapy consisting of surgery, radiation and combined chemotherapy does not consider the specific biology of this tumour.
Histone deacetylases (HDACs) and the Lysine-specific demethylase-1 (LSD1) are two epigenetic modifiers which are both part of repressor complexes leading to transcriptional silencing of target genes. Whereas HDACs lead to deacetylation of several lysine-residues within the histone tail, LSD1 is specific for demethylation of H3K4me2 and H3K4me1, as well as in a different context for H3K9me2. Rhabdomyosarcoma is reported to harbour high levels of LSD1, but the functional relevance is yet unclear. HDAC inhibition proved to be effective as single agent treatment, however, the proximity of HDAC1/2 and LSD1 in repressor complexes at the DNA implies a suitable rationale for a combination therapy potentially leading to cooperative effects on target gene transcription. In this study, we aimed to evaluate the potential of a combined LSD1 and HDAC inhibition for cell death induction in rhabdomyosarcoma cell lines. Whereas LSD1 inhibitors failed to induce cell death on their own, the combined inhibition of HDACs and LSD1 resulted in highly synergistic cell death induction. This effect extended to several combinations of LSD1 and HDAC inhibitors as well as to four different rhabdomyosarcoma cell lines, two of embryonal and two of alveolar histology.
With the use of the HDAC inhibitor JNJ-26481585 and the reversible LSD1 inhibitor GSK690, we demonstrated that the cell death induced by the combination matches with the details of intrinsic mitochondrial apoptosis. JNJ-26481585/GSK690-induced cell death is partially caspase-dependent and leads to caspase cleavage, followed by substrate cleavage as shown for PARP, as well as loss of the mitochondrial membrane potential.
Furthermore, JNJ-26481585 and GSK690 acted together to transcriptionally upregulate the proapoptotic proteins NOXA, BIM and BMF, which resulted in respective changes on protein level for both cell lines. However, the antiapoptotic BCL-2 family proteins BCL-2, MCL-1 and BCL-xL displayed only minor changes in protein levels upon treatment with GSK690 and JNJ-26481585, which did not rely on transcriptional activity. Therefore, the increase in proapoptotic proteins induces a shift towards proapoptotic signalling at the mitochondrial membrane. This shift is functionally relevant since knockdown of a proapoptotic protein or overexpression of one of the antiapoptotic proteins BCL-2 and MCL-1, as well as a stabilized mutant MCL-1, can significantly protect from GSK690/JNJ-26481585-induced cell death.
Knockdown of the mitochondrial membrane protein BAK, which is directly guarding the mitochondrial membrane integrity, potently protected from GSK690/JNJ-26481585- induced cell death, directly linking the shift in the BCL-2 family proteins to the observed loss of mitochondrial membrane potential and the further downstream activation of caspases. Furthermore, treatment with JNJ-26481585 and GSK690 resulted in a cell cycle arrest in G2/M phase, indicating additional effects on the tumour cells beside apoptosis induction. Taken together, the combined inhibition of LSD1 and HDACs is a promising strategy for rhabdomyosarcoma treatment.
Gutartige Schilddrüsenknoten stellen ein häufiges klinisches Problem dar, bei dem minimalinvasive, thermoablative Therapien wie die Radiofrequenzablation (RFA), als Alternative zur chirurgischen Behandlung, immer relevanter werden. Da es sich bei den Beschwerden oftmals um Symptome handelt, die von der lokalen Raumforderung und Größe abhängen, ist die Reduktion des Knotenvolumens ein zentraler Bestandteil der Therapie. Hierbei stellt die bipolare RFA eine neuartige Technologie zur minimalinvasiven Behandlung von gutartigen Schilddrüsenknoten dar und soll die Nachteile der monopolaren RFA, die das bislang am häufigsten verwendete System darstellt, überwinden. Jedoch gibt es aktuell keine offiziellen Leitlinien bezüglich der zu verwendenden Ablationstechnik. Aus diesem Grund war die Zielrichtung dieser Arbeit, erstmalig die Behandlung gutartiger Schilddrüsenknoten mittels bipolarer RFA in Kombination mit der sogenannten multiple overlapping shot technique („MOST“) anhand der Volumenreduktion nach 3 Monaten zu untersuchen. Hierzu wurden 18 Patienten (4 männliche, 14 weibliche Patienten; mittleres Alter: 50 Jahre, Altersspannweite: 15–72 Jahre) mit insgesamt 20 gutartigen Schilddrüsenknoten (17 hypofunktionelle und 3 hyperfunktionelle Knoten) behandelt und anschließend sonographisch ausgewertet. Mit einer medianen Volumen-reduktion (ΔV) von 5,3 ml (Spannweite: 0,13– 43,1 ml) nach 3 Monaten, was einer mittleren relativen Volumenreduktion von 56 ± 17,9 % entspricht, ergab sich ein signifikantes (p < 0,0001) Ergebnis. Das mediane Knotenvolumen reduzierte sich von anfangs 8 ml (Spannweite: 0,48– 62 ml) auf 2,3 ml (Spannweite: 0,3–32 ml) bei der Kontrolluntersuchung. Es kam bei allen Knoten zu einer Volumenreduktion, welche in 70 % der Fälle über 50 % betrug. Schwere Komplikationen wie anhaltende Stimmveränderungen, Nervenläsionen, Knoten-rupturen und Infektionen, ebenso wie immunogene Überfunktionen oder persistierende Schmerzen, traten während des Follow-ups nicht auf. Alle Patienten mit hypofunktionellen Knoten (15) blieben euthyreot, während sich Patienten mit hyperfunktionellen Knoten zum Zeitpunkt der Kontrolluntersuchung entweder in einer euthyreoten (2) oder latent hypothyreoten (1) Stoffwechsellage befanden. Ein medikationspflichtiger Hypothyreoidismus entstand bei keinem der Patienten. Daher stellt die bipolare RFA in Kombination mit der angewandten MOST ein effektives und sicheres thermoablatives Verfahren für die Behandlung gutartiger Schilddrüsenknoten dar.
Colorectal cancer (CRC) has the third highest incidence and the fourth highest mortality rate worldwide and represents a substantial health care burden and affects the life of millions of people. CRC is a genetic disease caused by the stepwise accumulation of genetic alterations. The initiating event in colorectal carcinogenesis is the aberrant activation of the WNT pathway, but other pathways are also commonly deregulated, including the PI3K/AKT pathway. A number of previous studies using genetically engineered mouse models aimed at dissecting the exact role of PI3K/AKT pathway in CRC, but have yielded in rather conflicting results. Despite the inconsistent results, these studies already put forward the idea that PI3K/AKT signaling in combination with other genetic events might substantially contribute to tumor progression.
Since the PI3K/AKT pathway is frequently activated in CRC, it represents an ideal candidate for therapeutic intervention. Although extensive efforts had led to the development of numerous inhibitors targeting the PI3K/AKT pathway, the diversity of genetic alterations can challenge the identification of the most effective therapeutic targets. Therefore, the discovery of shared tumor-promoting mechanisms downstream of these genetic alterations might unravel new biomarkers and druggable targets. The aim of this study was to elucidate the precise role of PI3K/AKT pathway during the course of colorectal carcinogenesis and to decipher novel pro-tumorigenic molecular mechanisms downstream of PI3K/AKT activation that can be used for therapeutic intervention.
To obtain a better insight into the role of the PI3K/AKT pathway during colorectal carcinogenesis, mice expressing an oncogenic variant of AKT1 (AktE17K) specifically in the intestinal epithelial cells (IEC) were used. At the age of 6 months untreated AktE17K mice showed clearly perturbed intestinal homeostasis, but no tumor formation. To induce colonic tumorigenesis, AktE17K mice were subjected to treatment with the colonic carcinogen azoxymethane (AOM). In response to AOM, AktE17K mice developed invasive but nonmetastatic tumors, which showed strong nuclear accumulation of TP53. To investigate the role of PI3K/AKT signaling specifically in CRC progression, AktE17K mice were crossed to TP53- deficient mice (Tp53ΔIEC). Unlike AktE17K mice, untreated Tp53ΔIECAktE17K, developed highly invasive small intestinal tumors by the age of 6 months. To investigate the role of AKT hyperactivation in colonic tumor progression, Tp53ΔIECAktE17K mice were subjected to AOM treatment. AKT hyperactivation significantly enhanced tumor progression and induced metastatic dissemination.
To get a better insight how AKT signaling can promote tumor progression, whole tumor tissues from AOM-treated Tp53ΔIEC and Tp53ΔIECAktE17K mice were subjected to next generation mRNA sequencing and phospho-proteomic analysis by mass spectrometry. Both analyses indicated that AKT hyperactivation expands the inflammatory tumor microenvironment and upregulates pathways associated with invasion and metastasis. Importantly, Gene Set Enrichment Analysis revealed that AOM-induced colon tumors of Tp53ΔIECAktE17K animals, are highly similar in their gene expression profile to the CMS4 subtype of human CRC, which is associated with worse overall- and relapse-free survival7 . Gene expression analysis also suggested elevated NOTCH signaling in the Tp53ΔIECAktE17K tumors. Interestingly, while the expression of Notch3 mRNA was increased in the tumors of Tp53ΔIECAktE17K mice, the expression of the other NOTCH receptors was unaffected by AKT hyperactivation. In vitro experiments using TP53-deficient mouse tumor organoids with hyperactive AKT signaling confirmed the direct, tumor cell-intrinsic link between AKT activation and increased Notch3 expression. Moreover, inhibition of EZH2 mimicked the effect of AKT hyperactivation on Notch3 expression, suggesting that AKT regulates Notch3 via an epigenetic mechanism.
Knock-down of Notch3 in TP53-deficient mouse tumor organoids with hyperactive AKT signaling resulted in differential regulation of several pathways with potential role in invasion and metastasis and in cell death and survival. Subsequent in vivo experiments confirmed the role of NOTCH3 signaling in CRC progression. Treatment of AOM-induced Tp53ΔIECAkt E17K mice with a NOTCH3 antagonistic antibody or the γ-secretase inhibitor DAPT significantly reduced invasion and metastasis. Importantly, NOTCH3 expression was also found to be associated with human CRC progression, suggesting that NOTCH3 represent a valid target for the treatment of CRC. This work, using genetically engineered mouse models and advanced in vitro techniques, has demonstrated a strong tumor promoting role for PI3K/AKT signaling in CRC progression and has identified NOTCH3 signaling as a potential therapeutic target downstream of the PI3K/AKT pathway.