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Ein intaktes Arbeitsgedächtnis ermöglicht es, Informationen, z.B. visuellen oder auditorischen Ursprungs temporär zu speichern, zu manipulieren und weiterzuverarbeiten. Es bildet die Grundlage zum Lernen, zum Begreifen und zum Verstehen von Sprache und somit die Grundlage zum tagtäglichen Funktionieren.
Beeinträchtigungen des Arbeitsgedächtnisses sind mit schlechten (Arbeits-) Leistungen, eingeschränkter zwischenmenschlicher Kommunikation, niedrigerem gesellschaftlichem Funktionsniveau und Arbeitslosigkeit vergesellschaftet und somit folgenschwer.
Psychiatrische Erkrankungen aus dem schizophrenen Spektrum, die unipolare Depression oder das Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom (ADHS) gehen gehäuft mit kognitiven Beeinträchtigungen einher. Auch die bipolare affektive Störung zählt zu den psychiatrischen Erkrankungen, die mit kognitiver Beeinträchtigung assoziiert ist.
Das Ziel der Studie war es, darzustellen, dass kognitive Einschränkungen von Patienten, die an einer bipolaren affektiven Störung leiden, unter den exekutiven Funktionen insbesondere das Arbeitsgedächtnis betreffen und diese auch in euthymer Stimmungslage zu erfassen sind.
Hierzu wurde mittels einer Aufgabe zur Farbveränderung vier verschiedener Kreise, die um ein zentral platziertes, schwarzes Kreuz angeordnet waren, das visuelle Arbeitsgedächtnis anhand der Merkfähigkeit der Patienten, deren euthyme Stimmungslage mit den Ratingskalen MADRS und YMRS bestätigt wurde, im Vergleich zu einer Gruppe gesunder Kontrollprobanden, die mit der Patientengruppe in den Faktoren Alter, Geschlechterverteilung, prämorbide Intelligenz, Schulbildung und Händigkeit vergleichbar war, überprüft.
Anhand der erzielten Ergebnisse wurde die Arbeitsgedächtniskapazität K nach Pashler bestimmt. Es ergab sich eine bei mittlerer Effektstärke signifikant geringere Arbeitsgedächtniskapazität in der Gruppe der remittierten Patienten mit bipolarer affektiver Störung im Vergleich zur Kontrollgruppe gesunder Probanden.
Ein Einfluss der zum Zeitpunkt der Testung in der Patientengruppe angewandten Psychopharmaka auf die Arbeitsgedächtniskapazität konnte ausgeschlossen werden, sodass die ermittelten Defizite nicht als eine Form von Medikamentennebenwirkungen erklärt werden konnten. Interessanterweise betrug die mediane Erkrankungsdauer in der Patientengruppe drei Jahre, sodass davon auszugehen ist, dass die Ausprägung von Defiziten des Arbeitsgedächtnisses keinen langen Krankheitsverlauf bedingt, sondern bereits zu Beginn der Erkrankung vorhanden sein könnte.
Somit konnte die Studie darlegen, dass kognitive Defizite, insbesondere Störungen des Arbeitsgedächtnisses mit daraus resultierender signifikant erniedrigter Arbeitsgedächtniskapazität, bei Patienten mit bipolarer affektiver Störung in euthymer Stimmungslage bereits zu einem frühen Zeitpunkt des Krankheitsverlaufs bestehen, die eine Folge der Erkrankung selbst sind und keine Nebenwirkung von psychopharmazeutischer Medikation darstellen. Den Grund für das Auftreten kognitiver Defizite bei Patienten mit bipolarer affektiver Störung liefert diese Studie nicht, sie impliziert dennoch, dass das Verständnis und die Berücksichtigung kognitiver Störungen bei der bipolaren affektiven Störung zukünftig ein wichtiges Therapieziel darstellen sollte um das funktionelle Outcome von Patienten, die an dieser Störung leiden, entscheidend zu verbessern und somit eine Teilnahme am tagtäglichen Funktionieren weiterhin ermöglicht wird.
In die Zukunft blickend sollten unsere Ergebnisse mithilfe weiterer Untersuchungen validiert werden, insbesondere in Bezug auf genetische Komponenten, die die Arbeitsgedächtniskapazität regulieren. Es sollten Faktoren identifiziert werden, die eine reduzierte Arbeitsgedächtniskapazität bei Patienten mit bipolarer affektiver Störung bedingen. Die vorliegende Studie beantwortet nämlich nicht die Frage, wie genetische Faktoren und Umweltfaktoren die Arbeitsgedächtniskapazität auf kognitiver und neurophysiologischer Ebene beeinflussen könnten.
Angesichts der erwähnten Relevanz eines intakten Arbeitsgedächtnisses für die Funktionsfähigkeit der Patienten sollten zukünftige Studien prüfen, ob prokognitive Interventionen wie die kognitive Remediation oder sogar medikamentöse Therapieoptionen diese Defizite verbessern könnten.
In der vorliegenden Arbeit wurden die Proteine Vlp15/16 und GlpQ aus B. miyamotoi hinsichtlich ihrer Eigenschaft, mit Plasminogen zu interagieren, charakterisiert.
Da einige Fälle von ZNS-Beteiligungen bei B. miyamotoi-Infektionen berichtet wurden, ist anzunehmen, dass diese Borrelienspezies über molekulare Mechanismen zur Überwindung der Blut-Hirn-Schranke verfügt. Eine solche Strategie könnte die Bindung wirtseigener Proteasen wie z.B. Plasminogen sein, um Komponenten der extrazellulären Matrix zu degradieren und dadurch die Dissemination des Erregers zu erleichtern.
Während Vmps, zu welchen auch Vlp15/16 gehört, als membranständige Proteine durch Variation der antigenen Oberflächenmatrix zur Immunevasion des Erregers beitragen, ist GlpQ bei der Hydrolyse von Phospholipiden in den Zellstoffwechsel eingebunden. Trotz dieser unterschiedlichen Funktionen, die den beiden Proteinen zukommen, binden beide Moleküle Plasminogen. Die Eigenschaften dieser Interaktion wurden in dieser Arbeit im Detail untersucht. Die Ergebnisse zeigen, dass Vlp15/16 und GlpQ Plasminogen konzentrationsabhängig binden und die Dissoziationskonstanten (Vlp15/16:Kd = 354 nM ± 62 nM; GlpQ: Kd = 413 nM ± 72 nM) für beide Proteine im Bereich der Serumkonzentration von 2 µM liegen. Darüber hinaus konnte gezeigt werden, dass den beiden Proteinen unterschiedliche Mechanismen zugrunde liegen, Plasminogen zu binden. Während die erhobenen Daten für Vlp15/16 darauf hindeuten, dass Lysin-Reste essenziell für die Interaktion sind, scheinen bei GlpQ ionische Wechselwirkungen von Bedeutung zu sein.
Um die Beteiligung von C-terminal lokalisierten Lysin-Resten für die PlasminogenBindung von GlpQ nachzuweisen, wurden Varianten mit einzelnen Lysin-Substitutionen an zwei unterschiedlichen Positionen (333 und 334) sowie eine Variante mit einer Zweifach-Substitution (GlpQ-K333A-K334A) generiert. Die Bindungsanalysen ergaben, dass insbesondere der Lysin-Rest an Position 334 bei der Interaktion mit Plasminogen beteiligt ist.
Die funktionellen Analysen zeigten, dass das an Vlp15/16 beziehungsweise GlpQ gebundene Plasminogen zu Plasmin aktiviert werden konnte und darüber hinaus dazu in der Lage war, das physiologische Substrat Fibrinogen zu degradieren.
Abschließend wurde die Plasminogen-Bindung an nativen B. miyamotoi-Zellen mittels Immunfluoreszenz-Mikroskopie nachgewiesen.
Die Ergebnisse dieser Arbeit weisen Vlp15/16 und GlpQ als Plasminogen-bindende Proteine aus, mit deren Hilfe B. miyamotoi befähigt ist, Komponenten der extrazellulären Matrix zu degradieren und somit prinzipiell zur Dissemination des Erregers beizutragen.
Discrepancies between knockdown and knockout animal model phenotypes have long stood as a perplexing phenomenon. Several mechanisms explaining such observations have been proposed, namely the toxicity or the off-target effects of the knockdown reagents, as well as, in certain cases, genetic robustness – an organism's ability to maintain its phenotype despite genetic perturbations. In addition to these explanations, transcriptional adaptation (TA), a phenomenon defined as an event whereby a mutation in one gene leads to transcriptional upregulation or downregulation of another, adapting, gene or genes expression, has been recently proposed as an alternative explanation for the conflicting knockdown and knockout phenotype paradox.
Since its discovery in 2015, TA's precise mechanism remains a subject of ongoing research. Majority of evidence suggests that mutant mRNA degradation plays a central in TA. Epigenetic remodeling is also thought to play a role, as evidenced by an increase in active histone marks at the transcription start sites of the adapting genes. Whether mRNA degradation is indeed the key player in TA remains debated. Furthermore, it is still unknown how exactly TA develops, what adapting genes it targets, and whether genomic mutations that render mutant mRNA sensitive to degradation are required for TA to occur.
Throughout the experiments described in this Dissertation, I have designed an inducible TA system where TA can be triggered on demand and its effects on the cell’s transcriptome followed through time. I have demonstrated that degradation-prone transgenes, once induced and expressed, can be efficiently degraded, resulting in the protein loss-independent upregulation of adapting genes via TA. Adapting genes with higher degree of sequence similarity become upregulated faster than genes with lower degree of sequence similarity. Further functionality of this approach to study TA is limited by the leakiness of the inducible gene expression system; however, constitutively expressed degradation-prone transgenes were used to demonstrate TA in human cells.
In addition, I have developed an approach to target wild-type cytoplasmic mRNAs without altering the cell’s genome and reported a TA-like phenomenon, which manifested as adapting gene upregulation not relying on mutations in other genes. Cytoplasmic mRNA cleavage with CRISPR-Cas13d triggered a TA-like response in three different gene models: Actg1 knockdown, Ctnna1 knockdown, and Nckap1 knockdown. After comparing two different modes of triggering TA, CRISPR-Cas9 knockout versus CRISPR-Cas13d knockdown, I reported little overlap between the dysregulated genes and suggested that diverse mRNA degradation modes led to distinct TA responses. In addition, the transcriptional increase of Actg2 caused by CRISPR-Cas13d-mediated Actg1 mRNA cleavage did not require chromatin accessibility changes.
Experiments and genetic tools described in this dissertation investigated how TA develops from its earliest onset, how it affects the global transcriptome of the cell, as well as provided compelling evidence for an mRNA degradation-central TA mechanism. I have created tools to study both direct and indirect TA gene targets and unveiled important insights into the temporal dynamics of TA. Genes with higher sequence similarity were found to be upregulated more rapidly than those with lower similarity. Furthermore, it was revealed that the epigenetic properties of TA responses vary depending on the triggering mechanism. Cas13d-mediated degradation of wild-type mRNAs led to immediate transcriptional enhancement independent of epigenetic changes, which stood in contrast to previously measured alterations in chromatin accessibility in CRISPR-Cas9 mutants. This research has thus significantly advanced our knowledge of TA and provided valuable tools and findings that contribute to the broader understanding of gene expression regulation in response to mRNA degradation.
This thesis provides a detailed derivation of dissipative spin hydrodynamics from quantum field theory for systems composed of spin-0, spin-1/2, or spin-1 particles.
The Wigner function formalism is introduced for quantum fields in the respective representations of the Poincaré group, and the conserved currents, i.e., the energy-momentum tensor and the total angular momentum tensor, in various so-called pseudogauges are derived. An expansion around the semiclassical limit in powers of the Planck constant is performed.
Subsequently, kinetic equations are obtained for binary elastic scattering, using both the de Groot-van Leeuwen-van Weert and Kadanoff-Baym method, with the latter retaining the effect of quantum statistics. The resulting collision term features both local and nonlocal contributions, with the latter providing a relaxation mechanism for the spin degrees of freedom of the quasiparticles. The local-equilibrium distribution function is derived from the requirement that the local part of the collision term vanishes.
From quantum kinetic theory, dissipative spin hydrodynamics is then constructed via the method of moments, extended to particles with spin. The system of moment equations is closed via the Inverse-Reynolds Dominance (IReD) approach, resulting in a set of equations of motion describing the evolution of both ideal and dissipative degrees of freedom. The application to polarization phenomena relevant to heavy-ion collisions is discussed.
Upper mantle shear zones are complex systems where deformation is commonly closely interacting with metamorphic (solid-solid) and/or melt/fluid-rock reactions. Here, feedback processes between deformation, reactions, grain size reduction and phase mixing result in strain weakening and the localization of deformation. The expression of these interlinked processes is portrayed by the microfabrics of strained peridotites and pyroxenites. The present thesis is focusing on these processes and their impact on the deformation in three upper mantle shear zones situated in the peridotite massifs of Lanzo (Italian Alps), Erro-Tobbio (Italian Alps) and Ronda (Betic Cordillera, Spain). In all three shear zones, the presence of melt led to phase mixing either by interstitial crystallization of pyroxenes from a Si-saturated and partially also highly evolved melt or by melt-rock reactions of pyroxene porphyroclasts with a Si-undersaturated melt. The effect of melt on the localization of strain is twofold and variable. Enhanced deformation by melt-wetted boundaries is assumed for all shear zones. Additionally, phase mixing by crystallization of interstitial pyroxenes or melt-rock reactions reduce or maintain the grain size by the formation of fine grained neoblasts and secondary phase boundary pinning. In this regard, pre- to early syn-kinematic, map-scale percolation of OH-bearing, evolved melts in the NW Ronda peridotite massif and the associated crystallization of interstitial pyroxenes result in the activation of grain size sensitive deformation mechanisms in the entire melt-effected area. In the rocks collected at Erro-Tobbio, syn-kinematic melt-rock reactions of pyroxene porphyroclasts and Si-undersaturated melt led to the formation of ultramylonitic neoblast tails (grain size ~10 μm). Compared to the adjacent coarser-grained olivine-dominated matrix, the activation of diffusion creep led to an increase in the strain rate by an order of magnitude within interconnected ultramylonitic layers. Strain localization and softening in ultramylonitic layers are also documented in the Lanzo samples. Neoblast tails of pyroxene porphyroclasts were likewise identified as their precursor. The phase assemblage of the tails, including ortho- and clinopyroxene, olivine, plagioclase, and spinel (± amphibole), and their geochemical trends suggest, unlike in Erro-Tobbio, a formation by continuous net-transfer reactions enhanced by the spinel lherzolite to plagioclase lherzolite transition.
The new results obtained from the three studied shear zones underscore the importance of reactions for the interlinked processes of grain size reduction, phase mixing, strain localization and strain softening in upper mantle shear zones. Concerning strain localization, the nature of the reaction (solid-solid, melt/fluid-rock) seems to play a subordinate role compared to its timing. Pre- to early syn-kinematic melt-triggered reactions result in strain localization along map-scale shear zones. Late stage syn-kinematic melt-rock or metamorphic reactions under high stress conditions are capable of localizing the deformation along discrete, sub-centimeter thick ultramylonites.
This thesis aims to investigate the properties of hadronic matter by analyzing fluctuations of conserved charges. A transport model (SMASH) is used for these studies to achieve this. The first part of this thesis focuses on examining transport coefficients, specifically the diffusion coefficients of conserved charges and the shear viscosity. The second part investigates equal-time correlations of particle numbers in the form of cumulants. The last chapter studies different aspects of the isobar collision systems Ru and Zr.
As a first step, the hadronic medium and interactions between its constituents are introduced, and simultaneously, their impact on transport coefficients is investigated. The methodology is verified by comparing the results of SMASH with Chapman-Enskog calculations, followed by examining 3-to-1 multi-particle reactions, revealing their influence on shear viscosity and electrical diffusion. The analysis of the full hadron gas considers angle-dependent cross-sections and additional elastic cross-sections via the AQM description, showing significant impacts on transport coefficients. The dependency on the number of degrees of freedom is explored, with noticeable effects on diffusion coefficients but a smaller influence on the shear viscosity. At non-zero baryon chemical potential, the diffusion coefficients are strongly influenced, while the shear viscosity remains unaffected. Overall, the study underscores the importance of individual cross-sections and the modeling of interactions on transport coefficients.
The following chapter explores fluctuations of conserved charges, crucial for understanding phase transitions in heavy-ion collision from the quark-gluon plasma to the hadronic phase. Using SMASH, the impact of global charge conservation on particle number cumulants in subvolumes of boxes simulating infinite matter is studied. Comparisons with simpler systems highlights the influence of hadronic interactions on cumulants, especially via charge annihilation processes and the results from SMASH shows agreement with analytical calculations. Calculations at finite baryon chemical potential reveals a transition from a Poisson to Skellam distribution within the net proton cumulants. It is shown that an unfolding procedure to obtain the net baryon fluctuations from the net proton ones deviates from the actual net baryon result, particularly in larger volumes. Finally, net proton correlations at vanishing baryon chemical potential align with ALICE measurements and the net proton cumulants are unaffected by deuteron formation.
In the next step, the goal is to investigate critical fluctuations in the hadronic medium. Therefore, the hadronic system is initialized with critical equilibrium fluctuations by coupling the hadron resonance gas with the 3D Ising model. The single-particle probability distributions are derived from the principle of maximum entropy. Evolving these distributions in SMASH, their development in an expanding sphere adjusted to experimental conditions can be analyzed. It reveals resonance decay and formations as the primary source that affects the particle cumulants. Because of isospin randomization processes, critical fluctuations are better preserved in net nucleon numbers. However, for the strongest coupling investigated in this work, correlations of the critical field are still present in the final state of the evolution in the net proton fluctuations. Examining cumulant dependence on rapidity windows shows a non-monotonic trend.
In the third part, collisions involving the isobars Ru and Zr are studied at a center-of-mass energy of 200 GeV. Initially, SMASH is used to study the initial conditions to hydrodynamical simulations, emphasizing the importance of the nuclear structure of isobars on the geometry of the collision area. It is found that the deformation parameters notably influence the initial state. Correlations between nucleon-nucleon pairs on eccentricity fluctuations yield no significant effect. Subsequently, the hydrodynamic model vHLLE evolves the previously explored initial conditions and for the transition between the hydrodynamic and kinetic descriptions, the Cooper-Frye formula is used. Usage of the canonical ensemble ensures the exact conservation of the conserved charges B, Q, and S. The neutron skin effect, which changes the charge distribution within Ru nuclei, is additionally considered. Fluctuations are assessed, revealing suppression in large rapidity windows due to global charge conservation. The hadronic phase modifies fluctuations of net pions, net kaons, and net protons via annihilation processes, yet fluctuations remain unaffected by the neutron skin effect.
The core of this work is represented by the investigation of the chiral phase transition, using Monte Carlo simulations and unimproved staggered fermions, both in the weak and strong coupling regimes of Quantum Chromodynamics. Based on recent results from Monte Carlo simulations, both using unimproved staggered fermions and Wilson fermions, the chiral phase transition in the continuum and chiral limit shows compatibility with a second-order phase transition for Nf (number of flavours) in range [2:7], at zero baryon chemical potential. This achievement relies on the analytic continuation of Nf to non-integer values on the lattice, which allows to make use of extrapolation techniques to the chiral limit, where simulations are not possible. Furthermore, these results provide a resolution to the ambiguous scenario for Nf = 2 in the chiral limt. The first part of this thesis is devoted to the investigation of the chiral phase transition when a non-zero imaginary baryon chemical potential is involved, whose value corresponds to the 81% of the Roberge-Weiss one. Using the same extrapolation techniques aforementioned, the order of the chiral phase transition in the continuum and chiral limit shows compatibility with a second-order phase transition for Nf in range [2:6], highlighting a lack of dependence of the order of the chiral phase transition on the imaginary baryon chemical potential value. The second part of this thesis is about the study of the extension of the first-order chiral region in the strong coupling regime, at zero baryon chemical potential. Using Monte Carlo techniques, this can be done by investigating the Z2 boundary on a coarse lattice, whose temporal extent reads Nt = 2, and simulations are realised for Nf = 4, 8. The results in the weak coupling regime show, for $Nt = 8, 6, 4 and fixed Nf value, an inflating first-order chiral region. As in the strong coupling limit a second-order chiral phase transition is expected, the first-order chiral region has to shrink as the strong coupling regime is approached, resulting in a non-monotonic behaviour of the Z2 boundary. For Nf = 8, a critical mass on the Z2 boundary has been obtained, confirming the expected non-monotonic behaviour. For Nf = 4 the results do not provide a unique conclusion: Either a Z2 boundary at extremely low bare quark mass or a second-order chiral phase transition in the O(2) universality class in the chiral limit can take place. In addition to the two main topics, the performances of the second-order minimum norm integrator (2MN) and the fourth-order minimum norm integrator (4MN) have been compared, after implementing the 4MN one in the CL2QCD code used to realise our simulations. The 2MN integrator had already been implemented in the code since the first version was released. The two integrators belong to the class of symplectic integrators and represent an essential component of the RHMC algorithm, involved in our investigation. This step is extremely important, in order to guarantee the best quality when collecting data from simulations, and the results of the comparison suggested to favor the 2MN integrator, for both the topics.
Die chronische myeloische Leukämie (CML) ist eine klonale myeloproliferative Neoplasie und hat ihren Ursprung in transformierten pluripotenten Stammzellen im Knochenmark. Der Krankheitsentstehung liegt eine reziproke chromosomale Translokation zugrunde, in deren Folge ein neues Fusionsgen, das sogenannte Philadelphia-Chromosom, entsteht. Das hiervon codierte Genprodukt ist eine Tyrosinkinase mit konstitutiver Aktivität mit resultierender unkontrollierter Signaltransduktion. Gegen diese Tyrosinkinase existiert eine molekular zielgerichtete Therapie, die Tyrosinkinase-Inhibitoren (TKI).
Den Therapiestandard stellt die Behandlung mit einem TKI dar. Seit einigen Jahren existiert jedoch das Therapieziel der therapiefreien Remission (TFR), bei dem CML-Patienten mit einem guten molekularen Ansprechen den TKI nach einiger Zeit absetzen und unter engmaschigen Kontrollen therapiefrei bleiben. Ungefähr die Hälfte dieser Patienten erleidet kein molekulares Rezidiv und bleibt langfristig in TFR. Zu der Thematik der TFR existieren zahlreiche klinische Studien, die die Umsetzbarkeit und die Sicherheit eines Absetzversuchs belegen und Kriterien definiert haben, die für einen Absetzversuch erfüllt sein sollten. In dieser Dissertation wird die Umsetzung der TFR im klinischen Alltag onkologischer Praxen untersucht. Es wird untersucht, ob die Studienergebnisse mit den TFR-Raten und den identifizierten Einflussfaktoren auf den Praxisalltag übertragbar sind und ob das Therapieziel TFR in den klinischen Alltag integrierbar ist. Hierfür werden die Daten von 61 CML-Patienten mit einem Absetzversuch aus fünf onkologischen Praxen retrospektiv ausgewertet. Erhoben werden Parameter der Routineversorgung und die Ergebnisse der Kontrolluntersuchungen während der TFR werden dokumentiert und ausgewertet. Die TFR-Raten von ca. 50%, die in den Absetz-Studien beobachtet wurden, finden sich im hier untersuchten Patientenkollektiv wieder. Mithilfe der binären logistischen Regression wird getestet, ob bestimmte Faktoren, wie die Therapiedauer und das verwendete Medikament vor dem Absetzen, einen signifikanten Einfluss auf den Verlauf der TFR haben. Hier kann kein signifikanter Einflussfaktor identifiziert werden. Es lässt sich eine signifikant längere therapiefreie Überlebensdauer bei den Patienten zeigen, die mit einem TKI der zweiten Generation vor dem Absetzen behandelt wurden.
Zusammenfassend lässt sich sagen, dass die TFR bei geeigneten CML-Patienten in der Praxis umsetzbar und sicher ist und fest im klinischen Alltag onkologischer Praxen verankert sein sollte.
Abdominal aortic aneurysm (AAA) is the most common type of aortic aneurysm, which is defined as a dilation of the abdominal aorta over 3.0 cm or more. Surgical repair is the golden standard for the treatment of AAA, in which open surgical repair (OSR) and endovascular aneurysm repair (EVAR) are the main approaches. Technically speaking, the lesion segment of aueurysm is completely replaced by a graft during OSR, while in EVAR, the lesion is insulated by a stentgraft. EVAR is a less invasive treatment than OSR and shows a lower early mortality rate, although the long-term advantages of EVAR over OSR remain inconclusive.
Endoleak, especially the type II endoleak (T2EL), is a common complication after EVAR. According to research, 16-28% of the patients develop a T2EL after EVAR, and it accounts for nearly three in four of all types of endoleaks. Around 30-50% of the T2EL resolved spontaneously during the follow-up, however, it still causes a secondary intervention in many patients. Therefore, it is critical to monitor endoleaks after repair.
Patent aortic branches in the stent-overlapped area and vasa vasorum have been identified as potential sources of blood flow in T2EL. However, the mechanisms of biological changes or remodeling of the aneurysm sac after the repair are still not clear, but they have been considered to play an important role in the development of endoleaks. Unfortunately, it is impossible to obtain a tissue sample of the aortic wall in patients who underwent EVAR.
MicroRNAs (miRNAs) are a class of small single-stranded non-coding RNAs that inhibit the expression of target message RNA (mRNA). miR-29b/29c, miR-155, and miR-15a are miRNAs associated with regulating extracellular matrix (ECM) components, inflammation, and proliferation, respectively. All four miRNAs have been identified as biomarkers of AAA, not only in aneurysm tissue but also extracellular as circulating miRNAs. However, it is still unknown whether they can reflect the biological changes after AAA repair. Thus, we conducted a prospective study to investigate the changes in expression of circulating miR-29b, miR-29c, miR-155, and miR-15a before (T0), 3 days (T1), and 3 months (T2) after AAA repair.
A total of 39 patients were recruited for this study, 17 of whom were repaired by OSR and 22 of whom were repaired by EVAR. Four patients failed the T2 follow-up due to the Covid-19 pandemic. No significant changes were found in the expression of miR-29b, miR-29c, miR-155, and miR-15a. There were also no obvious differences between OSR and EVAR. However, the T1 expression of miR-15a was significantly lower in patients without endoleak after EVAR than in those who developed endoleak after EVAR and those who were repaired by OSR. Unfortunately, these differences did not persist to the T2 follow-up, and no other differences were found among these patients.
In summary, miR-15a is a miRNA that significantly changes in AAA patients. This study demonstrates that the expression of circulating miR-15a is lower in patients without endoleak three days after EVAR, compared to those who had endoleak after EVAR and those who underwent OSR. The results suggest that miR-15a might be involved in the early aortic remodeling after EVAR as an indicator of endoleak.
Metastatic rhabdomyosarcoma (RMS) is one of the most challenging tumor entities in pediatric oncology caused by treatment resistances and immune escape. Novel chimeric antigen receptor (CAR) immunotherapies as specific, effective and safe treatment provide antitumor cytotoxicity by soluble factors and ligands/receptor signals. Besides its intrinsic potential as innate immune cell the ErbB2-sprecific CAR-engineered natural killer (NK)-92 cell line NK-92/5.28.z also provides CAR-mediated cytotoxicity, resulting in a high lytic capacity against 2D and 3D RMS cell structures in vitro. Also in a xenograft model using immune deficient NOD/Scid/IL2Rγ-/- (NSG) mice inhibited NK-92/5.28.z the tumor growth as long as the cells were administered and therefore prolonged the survival of the animals. The NK-92/5.28.z were distributed by the blood circulation and subsequently infiltrated the tumor tissue. Due to the malignant origin of the NK-92 cell line the cells must be irradiated prior to the use in patients. While the irradiation hampered the proliferation of NK-92/5.28.z cells, the cytotoxicity against RMS cells in vitro is retained for at least 24 hours. In the xenograft model irradiated NK-92/5.28.z cells inhibited the tumor growth but to a lower extent than untreated cells, as irradiated cells have only a limited life span in vivo no durable persistence and remission was achieved. Therefore, combinatorial approaches were focused and while blocking of the PD-1/PD-L1 axis did not resulted in a significantly enhanced tumor cell lysis, the combinatorial treatment with proteasome inhibitor bortezomib exhibited a significant enhanced cytotoxicity against RMS cells at least in vitro. Bortezomib itself induces caspase mediated apoptosis and also the upregulates the expression of TRAIL receptor DR5. The corresponding ligand TRAIL is expressed on the surface of the NK-92/5.28.z and pursuing experiments with purified TRAIL and bortezomib revealed a synergism. NK-92/5.28.z as an off-the-shelf product is therefore feasible for the therapy of metastatic RMS, but it might be necessary to support the cytotoxicity by additive agents like proteasome inhibitor bortezomib to archive durable remission.
Another cell population suitable for RMS CAR-immunotherapy are cytokine induced killer (CIK) cells, a heterogenous cell population generated from autologous PBMCs consisting of T, NK and T-NK cells. Lentivirally transduced ErbB2-specific CAR-CIK cells were previously shown to inhibit the tumor engraftment in a RMS xenograft model. However, lentiviral transduced adoptive immunotherapies bear risks for the transfer in patients, therefore the Sleeping Beauty Transposon System (SBTS) as a non-viral method, which integrates the CAR coding DNA by a cut-and-paste mechanism from a minicircle (MC) into the CIK cells genome is more feasible for the generation of CAR-CIK cells. The Sleeping beauty transposase mRNA and the MC were transferred in the cell by nucleofection, different factors influence the transfection efficiency and viability of the CIK cells in this harsh procedure. In preliminary experiments with MC Venus, a MC encoding eGFP, the highest transfection efficiency with the best proliferative capacity was achieved with cells on day 3 of CIK culture and without the addition of autologous monocytes as feeder cells. For the CAR construct the protocol was further improved by adjusting crucial factors, for this construct the best results were achieved on day 0, without irradiated PBMCs as feeder cells and cultivation in X-Vivo10 medium supplemented with human fresh frozen plasma. The X-Vivo10 medium enhanced the percentage of NK- and T-NK cells significantly compared to CAR-CIK cells cultured in RPMI. Since the gene transfer by SBTS resulted in CAR-CIK cells stably expressing a CAR in all subpopulations, resulting in a significantly enhanced cytotoxicity against RMS cells in vitro, these cells were compared to lentiviral transduced CAR-CIK cells in vitro and in vivo. While the SBTS CAR-CIK cells were superior to viral CAR-CIK cells in 2D short-term assays, the viral cells showed higher lytic capacity in 3D spheroid long-term assays. In a RMS xenograft model lentiviral CAR-CIK cells significantly prolonged the survival of mice and persisted, whereas SBTS CAR-CIKs did not favor the overall survival compared to untreated controls and also did not persist. Phenotypic analysis revealed a highly cytotoxic CD8+ and late effector memory dominant phenotype for SBTS CAR-CIK cells supporting short-term cytotoxicity but also more prone for exhaustion, while viral CAR-CIK cells showed a more balanced phenotype for memory and cytotoxicity. Therefore, the SBTS is feasible for the ErbB2-CAR gene transfer in CAR-CIK resulting in a stable CAR-expression with high short-term cytotoxicity, but these cells are also more prone to exhaustion and the protocol might be adapted further to prevent this limitation for in vivo application.
This work underlines the hard-to-treat characteristics of metastatic RMS, but also shows some approaches for further evaluation like the combination of NK-92/5.28.z cells with bortezomib and the feasibility of the generation of CAR-CIK cells via SBTS.