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Die vorliegende Dissertation berichtet über eine Serie von Verhaltens- und funktionellen Bildgebungsstudien zu experimentalpsychologischen Paradigmata, die eine räumliche Analyse und Koordinatentransformation von Material der visuellen Wahrnehmung oder Vorstellung beinhalten. Nach einer Einführung in die Prinzipien und Techniken der funktionellen Kernspintomographie, der hier benutzten Methode für die Messung von Gehirnaktivität, werden die Versuche einer Replikation des berühmten Stratton'schen Umkehrbrillen-Experiments dargestellt (Kapitel 1). Unsere vier Probanden zeigten zwar eine zügige Anpassung der visuomotorischen Funktionen an die neue visuelle Umwelt, berichteten aber, anders als Stratton, nicht, daß sie die Welt nach einigen Tagen mit der Umkehrbrille wieder normal sähen. Diese Persistenz des umgekehrten Bildes wurde durch eine psychphysische Testbatterie bestätigt. Des weiteren ergaben die funktionellen Kernspinmessungen, daß sich die kortikale retinotope Organisation im Verlaufe des Experiments nicht geändert hat. Da sich also Strattons Haupteffekt, das Aufrechtsehen durch die Umkehrbrille nach einwöchiger Adaptation, nicht replizieren ließ, werden andere Möglichkeiten der Interpretation der verschiedenen Umkehrexperimente der letzten hundert Jahre vorgeschlagen. Dieses Ergebnis einer funktionellen Anpassung ohne größere Änderungen der visuellen Wahrnehmung (und ohne Veränderungen der Repräsentation der Netzhautareale in der Sehrinde) führte zu der Hypothese, daß die erforderlichen Transformationen auf einer höheren Stufe der kortikalen Hierarchie der visuellen Verarbeitung erfolgen. Zur Testung dieser Hypothese wurde eine funktionelle Kernspinstudie des Umkehrlesens durchgeführt (Kapitel 2). Hierbei lasen die Probanden Wörter und Sätze in Spiegelschrift oder auf dem Kopf. Der neuronale Mechanismus der räumlichen Transformationen, die zur Bewältigung dieser Aufgabe nötig sind, konnte in bestimmten Regionen des Parietallappens, die zwischen den Probanden sehr konstant waren, lokalisiert werden. Weiterhin fand sich eine Koaktivierung okzipitootemporaler Objekterkennungs-Areale. Die Spezifizität der parietalen Aktivierungsfoci wurde durch ein Kontrollexperiment bestätigt, in welchem das kortikale System für räumliche Transformationen von den Netzwerken der allgemeinen visuellen Aufmerksamkeit und der Augenbewegungskontrolle unterschieden werden konnte. In einem weiteren Experiment wurden die räumlichen Funktionen des Parietallappens unter dem Vorzeichen der visuellen Vorstellung untersucht. Als Paradigma wurde der "mental clock" - Test verwendet, bei welchem die Probanden die Winkel der Zeiger zweier Uhren vergleichen müssen, deren Zeiten nur akustisch vorgegeben werden (Kapitel 3). Diese Aufgabe erfordert die Generierung eines entsprechenden Vorstellungsbildes und dessen räumliche Analyse, stellt also sowohl ein kontrolliertes Vorstellungs-Paradigma als auch einen Test räumlicher Funktionen dar, der nicht auf visuell präsentiertem Material beruht. Das parietale Aktivierungsmuster, das der Analyse der Winkel dieser vorgestellten Uhren zugeschrieben werden konnte, entsprach weitgehend demjenigen, das mit der räumlichen Transformation von Buchstaben verbunden war. Es handelt sich also wahrscheinlich um ein kortikales System für räumliche Analyse und Koordinatentransformationen, das nicht auf eine visuelle Stimulation angewiesen ist, sondern auch bei bloßer visueller Vorstellung aktiv werden kann. Die vorgelegten Resultate werden im Kontext neuerer neuropsychologischer Befunde zu Defiziten räumlicher Analyse und Vorstellung bei Läsionen des Parietallappens diskutiert (Kapitel 4). Auch die methodologischen Probleme der kognitiven Subtraktion, die in unseren Studien teilweise benutzt wurde, werden behandelt. Dabei wird erläutert, inwiefern diese für die Beurteilung der vorgelegten Studien nur von untergeordneter Bedeutung sind. Nichtsdestoweniger schlagen wir Modifikationen der experimentellen Paradigmata im Sinne des parametrischen Designs und des "event-related functional magnetic resonance imaging" vor, die bei zukünftigen Studien einen vollständigen Verzicht auf die kognitive Subtraktion ermöglichen dürften. Schließlich wird die Bedeutung der vorgelegten Ergebnisse für die Erforschung der Anpassungsfähigkeit des menschlichen Gehirns und des Verhältnisses von Vorstellung und visueller Wahrnehmung dargelegt.
Removal of apoptotic cells by macrophages or resident semi-professional phagocytes is a prominent principle with important implications for the pathophysiology of chronic inflammatory diseases, viral infections, or cancer. To characterize mechanisms which may determine the fate of apoptotic cells, I investigated chemokine expression in apoptotic promonocytic U-937 cells or PBMC. Exposure of U-937 cells to the anti-cancer drug etoposide (VP-16), an inducer of apoptosis in these cells, was associated with increased expression of the chemokines IL-8 and macrophage inflammatory protein 1alpha (MIP-1alpha). Upregulation of IL-8 mRNA expression by VP-16 was observed as early as 4 h after onset of treatment and was still detectable after 19h of exposure. A serine protease inhibitor prevented both VP-16-induced apoptosis and release of IL-8, whereas inhibition of p38 MAP-kinases reduced IL-8 secretion only. Moreover, I observed that incubation with 2-chlorodeoxyadenosine (CdA) upregulated release of IL-8 from adherent PBMC in parallel to induction of apoptosis. In these cells a modest but significant induction of TNF-alpha release by CdA was also detected. In addition, CdA augmented release of IL-8 from whole blood cultures. By facilitating adequate recruitment of phagocytes to sites of cell death, stress-induced upregulation of chemokines associated with apoptosis may contribute to mechanisms aiming at efficient removal of apoptotic cells.
The substantia nigra is not the induction site in the brain of the neurodegenerative process that underlies Parkinson’s disease. Instead, the results of this semiquantitative study of 30 autopsy cases with incidental Lewy body pathology indicate that Parkinson’s disease in the brain commences with the formation of the very first immunoreactive Lewy neurites and Lewy bodies in noncatecholaminergic visceromotor neurons of the dorsal glossopharyngeusvagus complex, in projection neurons of the intermediate reticular zone, and in specific nerve cell types of the gain setting system (coeruleussubcoeruleus complex, caudal raphe nuclei, gigantocellular reticular nucleus), olfactory bulb, olfactory tract, and/or anterior olfactory nucleus in the absence of nigral involvement. The topographical parcellation of the nuclear grays described here is based upon known architectonic analyses of the human brain stem and takes into consideration the pigmentation properties of a few highly susceptible nerve cell types involved in Parkinson’s disease. In this sample and in all 58 ageand gendermatched controls, Lewy bodies and Lewy neurites do not occur in any of the known telencephalic Parkinson’s disease predilection sites (hippocampal formation, temporal mesocortex, proneocortical cingulate areas, amygdala, basal nucleus of Meynert, interstitial nucleus of the diagonal band of Broca, hypothalamic tuberomamillary nucleus).
Hepatitis E virus (HEV) is a positive-stranded RNA virus with a 7.2 kb genome that is capped and polyadenylated. The virus is currently unclassified : the organisation of the genome resembles that of the Caliciviridae but sequence analyses suggest that it is more closely related to the Togaviridae. HEV is an enterically transmitted virus that causes both epidemics and sporadic cases of acute hepatitis in many countries of Asia and Africa but only rarely causes disease in more industrialised countries. Initially the virus was believed to have a limited geographical distribution. However, serological studies suggest that that HEV may be endemic also in the United states and Europe even though it infrequently causes overt disease in these countries. Many different animal species worldwide recently have been shown to have antibodies to HEV suggesting that hepatitis E may be zoonotic. Although two related strains have been experimentally transmitted between species, direct transmission from animal to a human has not been documented. Our main objective in this study is to evaluate the suitability of current available HEV antibody assays for use in low-endemicity areas such as in Germany. Methods: We selected sera on the basis of at least borderline reactivity in the routinely used Abbot EIA. Most were tested as part of routine screening of long-term expatriates in endemic countries. The following assays (recombinant antigens : ORF2 and ORF3) were used: Abbot EIA, Genelabs ELISA, Mikrogen recomBlot and a 'Prototype' DSL-ELISA. We observed a wide range of sensitivity ( average of 56.8%) and specificity ( an average of 61.4%) in these used assays. These results implies that , these assays might be unreliable for detection of HEV infection in areas where hepatitis E is not endemic. However, most anti- HEV assays have not been correlated with the HEV RNA determined by reverse transcription. Many of these unexpected results and discrepancies can be alluded to the following reasons: I. The choice and the size of the HEV antigen. II. Duration of the antibody persistence III. A cross reactivity with different agent IV. Due to geographic species V. A low sensitivity of the available assays. VI. And infection with non-pathogenic HEV strain. (zoonotic strain?). We therefore suggest that, further studies will be required to improve the sensitivity and specificity of the available commercial assays on the market.
Spontaneous carotid artery dissection-associated medial changes in a selected autopsy population
(2006)
Spontaneous carotid artery dissection (SCAD) is a major cause of stroke in young adults, yet its pathogenesis remains unclear. Hereditary connective tissue diseases, hormonal influences, sympathomimetic drugs or upper respiratory tract infections may predispose to dissection. Mechanical stress or minimal trauma may also act as a trigger. Various lesions of the arterial wall have been described in association with SCAD, but no prospective autopsy study to evaluate the presence of these lesions in normal controls was found. We performed a histologic evaluation of the carotid bifurcation and the aortic arch in an autopsy series to establish a baseline anatomy of the bifurcation and to determine whether similar lesions could be observed. In seven of 54 (12.96%) selected cases we observed isolated changes closely resembling those described for medionecrosis, fibromuscular dysplasia, mucoid degeneration and elastinolysis; and in one case, prior carotid artery dissection and coiling with a patent false lumen. Generally, vascular microanatomy in the carotid bifurcation can be highly variable. Lesions similar to those associated with spontaneous dissection are present in controls and appear non-specific for spontaneous dissection. They can be explained as reactive changes of smooth muscle cells (SMC) and the vascular wall in response to various stressors. Recent advances in vascular physiology are discussed to illustrate the concept of SMC phenotypic modulation. Forensic pathology can provide a large control population for extensive vascular analyses and further the understanding of normal and pathological vascular wall changes to help elucidate spontaneous arterial dissection.
IL-12-related cytokines produced by dendritic cells are considered to be major inducers of adaptive immune system activation upon innate antigen-sensing. IL-23 specifically is currently being discussed to support the differentiation of potentially auto-aggressive Th17 cells. Prostaglandins as bystander cell products are known to modulate the translation of this process. While previous studies focused therefore on IL-12, ignoring the existence of new IL-12-related cytokines IL-23 and IL-27, this study analysed effects of prostaglandin E2, D2 and 15d-PGJ2 on the secretion pattern of these subunits in the murine immature Langerhans cell line XS52 and the murine immature myeloid dendritic cell line JawsII under TLR4 (LPS) and TLR9 (CpG) stimulation as well as effects of prostaglandins on the murine Th1 cell line IF12 in coculture and upon Con A treatment. In serial semi-quantitative RT-PCR of the IL-12 related cytokines of the XS52 cell line and the JawsII cell line, the p40 subunit was upregulated in both DC cell lines upon TLR-stimulation, the IL-23p19 subunit constantly expressed in XS52 and upregulated in JawsII upon TLR-stimulation, while the IL-27p28 subunit was only weekly expressed under additional stimulating aCD40 Ab treatment. IL-12p35 could only be detected in the immature myeloid cell line. The protein expression of the p40 subunit was measured in Western blot assays following SDS-PAGE under reducing conditions in XS52. The Western blot-based antibody specification allowed the establishment of a p40-specific ELISPOT assays, where overadditive upregulation of the number of LPS-stimulated spot forming XS52 cells was observed under stimulation with PGE2 while PGD2 depressed the number of LPS-stimulated cytokine secreting cells. Contrary IL-12p40 could not be detected in supernatants of the JawsII cell line. Both DC cell lines were further tested for differential response towards different TLR stimulation described as a defining feature of DC subsets. While subunit expression on transcription level did not differ, only LPS-treatment led to constant IL-12p40 expression in supernatants of XS52. CpG-treatment of XS52 cells led to constantly high IL-12p40 levels under additional aCD40 Ab treatment. In IFN-g ELISPOT assays, prostaglandin effects were further analysed in IF12 Th1 cells upon Con A treatment or alternatively upon treatment in a coculture model with the syngeneic cell line XS52 and the T lymphocyte-specific protein ovalbumin. While PGE2 depressed the amount of activated Th1, PGD2 showed no effect. In conclusion, a coculture model has been generated that allows the analysis of DC and TC interactions. The importance of prostaglandins as differential regulators in time- and tissue-dependence in inflammatory processes has been demonstrated. These results accord with recent observations of an upregulation of IL-23 secretion upon PGE2 treatment.
HELEX Septal Occluder for transcatheter closure of patent foramen ovale : multicenter experience
(2006)
Aims Patients with cryptogenic embolic events and a patent foramen ovale (PFO) are at risk of paradoxical embolism causing recurrent cerebral events; however, transcatheter PFO closure remains controversial. The aim of this multicenter trial was to demonstrate the feasibility and safety of transcatheter closure of PFO with the HELEX Septal Occluder. Methods and results The study enrolled 128 patients (66 female; mean age, 50 years). Mean (± SD) PFO size was 10±3.7 mm; 38 patients also had an atrial septal aneurysm. Device implantation was successful in 127 patients. Device-related events during implantation or follow-up were device embolisation, wire-frame fracture, and retrieval cord breaks (two cases each; no sequelae). Other adverse events included atrial arrhythmia (two patients), migraine, convulsion, and transient ischaemic attack (one case each). There were no recurrent strokes, deaths, perforations, or accumulations of thrombi on the device. Within a mean follow-up period of 21±11 months, complete PFO closure using one device was achieved in 114 patients (90%). Five patients with a moderate to large residual shunt received a second device. Conclusion The HELEX Occluder can be used for PFO closure. Device- and procedure-related complications are rare. The closure procedure appears to reduce recurrence rates of stroke and transient ischaemic attack.
End-stage renal disease has been denominated a vasculopathic state, owing to the accelerated arterial stiffening, which occurs in addition to and independent of atherosclerosis and bears an increased cardiovascular risk. The altered metabolic milieu in uraemia leads to an increased oxidative stress, heightened inflammatory burden, and an abnormal calcium-phosphate metabolism, which are thought to be responsible for the vascular changes. The pulse wave velocity (PWV) is a widely employed surrogate parameter of arteriosclerosis. The purpose of this study was to gain more insight into the pathogenesis of arterial stiffness, by investigating the influence of markers of oxidative stress, procoagulation, and inflammation, and of the calcium-phosphate product on the PWV. We conducted a cross-sectional study in 53 stable patients aged 59 ± 16 years, who had been on haemodialysis for at least 4 months (68 ± 48). Carotid-radial PWV was measured using a semi-automated device, Complior SP (Artech Medical, France). Advanced glycosylation end-products (AGE) and advanced oxidation protein products (AOPP), were quantified according to previously described methods. High sensitive CRP was measured using ELISA, whereas the other biochemical parameters, i.e. fibrinogen, albumin, calcium, phosphate, cholesterol, and triglycerides, were determined using routine methods. For statistical calculations we employed SPSS (Statistical Package of Social Science, 12.0, 2003). The correlations between PWV, as the dependent variable, and many dependent variables were assessed by means of multiple regression analysis, in which we controlled for the influence of the traditional cardiovascular risk factors and some of the patients’ medication (calcium-channel blockers and statins). PWV was found to be significantly correlated to serum CRP (p=0.003), LDLcholesterol (p<0.001), triglycerides (p<0.001), AGE (p=0.002), calcium (p<0.001), phosphate (p=0.001), and fibrinogen (p=0.020). Between PWV and dialysis duration (months) an interesting quadratic relationship (p=0.058) was noted. Against expectation, regression analysis showed a negative correlation between AOPP and PWV (p=0.001). We failed to confirm the correlation between PWV and age, systolic blood pressure, or heart rate. Among traditional cardiovascular risk factors only LDL-cholesterol was positively correlated to PWV. In this cross-sectional analysis we could put forward that PWV correlates positively and significantly with fibrinogen, CRP, AGEs, calcium, phosphate, and LDL-cholesterol in haemodialysis patients. It seems procoagulatory and proinflammatory pathways, oxidative stress, and the calcium-phosphate product exert a synergistic effect on disturbances of vascular architecture in ESRD patients.
Mesenchymal stem cells (MSC), also referred to as marrow stromal cells, maintain the capacity to differentiate into multiple mesenchymal lineages such as osteoblasts, chondrocytes, adipocytes, myoblasts, stromal, neural and endothelial cells. The use of autologous MSC has generated widespread interest due to their developing application in regenerative medicine and tissue engineering in orthopedic surgery. They have become an indispensable cell source for successful implementation in many bone reconstruction procedures. In addition to their multipotency and selfrenewal capacity, they are easily harvested, have demonstrated a homing mechanism and can be efficiently expanded in vitro, thus providing a safe and costefficient tissue replacement for patients with skeletal injury or disease. Little information is currently available concerning donor characteristics for tissue engineering growth of osseous tissue. This study examines the influences of such donor characteristics, including injury pattern, gender, age, and site of harvest on the quantity, quality and osteogenic differentiation of MSC. The goal is to evaluate whether certain patient groups are practically suitable for an ex vivo expansion and therapeutic reimplantation of MSC. The effect of injury pattern on the reservoir and proliferative capacity of MSC in human bone marrow is clearly demonstrated in this analysis. Age and gender were also shown to influence MSC number and proliferation, as in previous studies. A total of 53 participants (46 patients and 7 healthy volunteers ranging from 18 to 64 years of age), who were scheduled to undergo operative procedures on the pelvis, vertebrae, tibia or hip as well as cancellous bone autografts for reconstruction of various bone defects, were included in the study. Participants were divided into 4 groups for each gender: single fracture, multiple trauma, atrophic nonunion and healthy volunteers. A minimum of 6 ml bone marrow samples were aspirated intraoperatively and processed immediately according to protocol. Following cultivation and expansion for 14 days, the cells were then stained for the colony forming unit-fibroblast (CFU-F) assay and each culture flask was photographed, digitized and converted to an 8 bit grey level TIF-format. Using the digitized CFU-F assay, the mean colony number, mean colony area and mean cell number per microscopic field of view (cell density) could be determined. In addition, confirmation of MSC phenotype was established using fluorescent activated cell sorting (FACS). MSC potential for osteogenic differentiation was quantified by von Kossa, alkaline phosphatase and alizarin staining. Furthermore, serum from a total of 39 randomly chosen participants was collected and tested for hormone levels of 17β-estradiol, testosterone and prolactin as well as the cytokine interleukin-6. These analyses demonstrate several significant trauma-related modifications in MSC reservoir and proliferation, in both male and female patients. In multiple trauma patients, the highest MSC frequency was found, independent of gender and age. Proliferative capacity was also highest in male multiple trauma patients. In the case of atrophic nonunion, the lowest MSC reservoir was detected, independent of gender. Furthermore, MSC frequency in male patients was significantly higher than in female, although analyses of hormone and interleukin-6 levels provided no correlation. Agerelated changes in MSC reservoir could also be observed, whereas the proliferative capacity produced only a tendency toward decreasing values with increasing age. Concerning the site of cell harvest, MSC isolated from the proximal extremity of the tibia, greater trochanter and vertebral body did not proliferate sufficiently enough to be included in statistical analysis, supporting the use of the iliac crest for efficient expansion of MSC. This data suggests the interaction of yet to be identified processes in bone marrow in multiple trauma situations which stimulate the activation and mobilization of MSC. Moreover, in the case of atrophic nonunion, the concentration in bone marrow is depleted and the absence of systemic stimulation present in multiple trauma results in reduced activation of proliferative capacity. Such patients, with severe injury or atrophic nonunion, represent a group of patients with an especially acute necessity for effective and successful bone reconstruction. This data can be used to determine the applicability of MSC from various patient groups for osseous tissue replacement procedures. Especially in such medically challenging situations, further research is essential not only to delineate the factors involved in MSC regulation but also to develop methods to stimulate MSC expansion and proliferation.
Background The purpose of the trial was to evaluate the safety and performance of the new Protégé stent in the treatment of common and/or internal carotid artery stenoses. Methods The Protégé® GPS stent is a self-expanding Nitinol stent system. It is mounted on a 6 Fr 0.018” (6-9mm stent) or 7 Fr, 0.035” (10mm stent) over-the-wire-delivery system and includes a new stent release system which allows exact placement of the stent. Seventyseven patients were enrolled in the trial. Study patient assessments were conducted clinically and by duplex scan at baseline, peri-procedure, discharge, one and six months post procedure. Results Seventyseven lesions were treated. Thirtyone lesions were symptomatic, 46 lesions were asymptomatic. The procedure was technically successful in 76 (99%) lesions. The percentage of stenosis was reduced from 86 ± 7 % to 16 ± 8 %. One procedure failed because the embolic protection device could not be retrieved and the patient was sent to surgery. Within 30 days there were 4 (5.2%) Major Adverse Neurological Events (MANEs). Three of the MANEs were major strokes (3.9%), one a minor stroke. The fifth MANE occurred prior to the six month follow-up visit; this patient had a major stroke 75 days after the procedure and died 36 days later. One additional death occurred due to urosepsis. Conclusions The trial shows that the Protégé stent satisfies safety and performance criteria for the treatment of carotid artery stenosis. The complication rate was comparable to the incidence of these events in other recent carotid stent and endarterectomy studies.
Aims: The purpose of this study was to evaluate the feasibility and short-term efficacy of transcatheter paravalvular leak closure using different occlusion devices. Methods and Results: Twenty one patients underwent transcatheter closure of either aortic or mitral paravalvular leak from June 2002 to February 2006 using the Amplatzer PDA, ASD or VSD occluder. All patients had symptoms and signs of haemolysis and/or cardiac decompensation with dyspnoea. Implantation of a device was technically successful in twenty patients (95 %). Immediate residual leak was found in seventeen patients (85 %). Significant shunting persisted in nine cases during follow up (45 %). Permanent leaflet obstruction was observed in one patient. Severe complications during follow up led to early death in one patient and surgical intervention in three. A successful second catheter treatment was performed in another three patients. The event-free survival from reoperation, death and stroke at the end of the observation period was 80 %. Conclusion: Transcatheter closure of paravalvular leaks is a technically feasible, but demanding procedure. Residual leaks are common and may worsen pre-existing haemolysis. Due to the significant ongoing morbidity in this group of patients and the complexity of follow up individual patient results differ considerably. Nevertheless, it is possible to achieve some symptomatic relief, thus an interventional approach should be discussed as a potential treatment option for those patients with a limited defect and who are not deemed suitable for another operation.
The removal of apoptotic cells (AC) can be regarded as an integral component of the program to terminate inflammation. Clearance of AC by professional phagocytes such as macrophages induces an anti-inflammatory phenotype in the latter ones. Anti-inflammatory or M2 polarization is also observed in macrophages infiltrating certain human tumors. These tumor-associated macrophages (TAM) contribute actively to tumor progression by promoting immune evasion, angiogenesis and tumor cell survival. The aim of my Ph.D. thesis was to approach the mechanisms as well as the characteristics of macrophage phenotype alterations induced by AC, and to elucidate a possible connection between tumor cell apoptosis and TAM generation. In the first part of my studies, I investigated the impact of AC on macrophage viability. I could show that macrophage survival against pro-apoptotic agents increased after the interaction with AC. Protection of macrophages against cell death required activation of phosphatidylinositol-3 kinase (PI3K), extracellular signal-regulated kinase 1/2 (ERK1/2) and Ca2+ signaling, and correlated with Bcl-XL and Bcl-2 up-regulation as well as Ser136-Bad phosphorylation. Unexpectedly, neither phagocytosis nor binding of apoptotic debris to the phagocyte was necessary to induce protection. AC released the bioactive lipid sphingosine-1-phosphate (S1P), dependent on sphingosine kinase (SphK) 2, as a survival messenger. These data indicated an active role of AC in preventing cell destruction in their neighborhood. My next aim was to elucidate the mechanism of S1P production by AC. During cell death, SphK 2 was cleaved at its N-terminus by caspase-1. Thereupon, the truncated but enzymatically active fragment of SphK 2 was released from cells. This release was coupled to phosphatidylserine exposure, a hallmark of apoptosis and a crucial signal for the phagocyte/apoptotic cell interaction. Thus, I observed a link between common signaling events during apoptosis and the extracellular production of S1P, which is known to affect immune cell attraction and polarization as well as angiogenesis in cancer. In the next part of my studies, I asked for a correlation between tumor cell apoptosis and TAM polarization. During co-culture of human macrophages with human breast cancer carcinoma cells (MCF-7), the latter ones were killed, while macrophages acquired an alternatively activated phenotype. This was characterized by decreased tumor necrosis factor (TNF)-α; and interleukin (IL)-12-p70 production, but increased formation of IL-8 and IL-10. Alternative macrophage activation required tumor cell death, because a co-culture with apoptosis-resistant colon carcinoma cells (RKO) or Bcl-2-overexpressing MCF-7 cells failed to induce phenotype alterations. These phenotype alterations were also achieved with conditioned media from apoptotic tumor cells, which again argued for a soluble factor being involved. Knock-down of SphK2, but not SphK1, to attenuate S1P formation in MCF-7 cells, repressed the otherwise observed alternative macrophage polarization during co-culture. Furthermore, macrophage polarization achieved by tumor cell apoptosis or substitution of authentic S1P was characterized by suppression of pro-inflammatory nuclear factor (NF)-κB DNA binding. These findings suggested that tumor cell apoptosis-derived S1P contributes to the macrophage polarization present in human tumors. To validate these in vitro data, I used an in vivo tumor model to clarify the relevance of SphK2 and S1P in tumor development. The growth of, as well as blood vessel infiltration into SphK2 knock-down MCF-7 (MCF-7-siSphK2) xenografts in nude mice was markedly decreased in comparison to control MCF-7 xenografts. In contrast, macrophage infiltration was similar or even more pronounced. These data provided a first hint for an in vivo role of SphK2-derived S1P in macrophage polarization associated with tumor promotion. In summary, these data indicate a new mechanism how AC themselves shape macrophage polarization, which results in the termination of inflammatory responses and macrophage survival. Furthermore, my studies present evidence that human tumors may utilize this mechanism to foster growth via increased angiogenesis.
Background: False aneurysms at the puncture site develop in up to 8 % after catheter procedures. They can be treated surgically or by ultrasound guided manual compression. A new method is to inject thrombin into the aneurysm under ultrasound guidance. We evaluated safety and efficacy of this approach in a multicenter registry. Methods: In 595 consecutive patients (age: 31-94 years, median 70) a pseudoaneurysm (593 femoral arteries, 2 brachial arteries) was diagnosed 0 to 250 days (median 3 days) after a catheter procedure. The diameter of the aneurysm ranged from 0.5 x 0.5 x 0.5 (L x W x D) to 8x11x16 cm (median 2 x 2 x1.6 cm). 20 U to 4000 U of thrombin solution (median 400 U) were injected percutaneously into the aneurysm under ultrasound guidance. Results: The procedure was technically successful in 587/595 (99%) patients. The aneurysms were thrombosed after the first injection in 531 patients (89 %). Thirty-eight (6%) patients needed a second injection and 8 (1%) patients a third injection because residual flow in the aneurysm was visible at follow-up. In 4 additional patients (0.7%) the thrombosis of the aneurysms was delayed and occurred only after 24 hours to 7 days. 6 (1%) patients surgery was performed after successful closure of the aneurysm to remove the resulting haematoma. The overall technical success rate was 99% (587/595) and clinical success was achieved in 572/595 (96%) patients. Eight (1%) other patients underwent surgery due to thrombin injection failure. Complications occurred in 9 patients (1.5%): Intravascular thrombus formation (n=3), deep venous thrombosis (n=3), pulmonary embolism due to deep venous thrombosis (n=1), transient paresthesia in the leg during injection (n=3). Conclusion: Ultrasound guided thrombin injection is a safe, painless, effective and rapid alternative to treat false aneurysms. Complications and recurrent pseudoaneurysms are very rare. It has become the treatment of choice in our institution.
All living organisms exhibit daily fluctuations in biochemical, physiological and behavioural parameters driven by endogenous oscillators, residing in the organism itself. In mammals, the core circadian oscillator is located in the paired suprachiasmatic nuclei (SCN) of the hypothalamus. Circadian rhythm generation in the SCN depends upon the expression of clock genes interacting in positive and negative transcriptional/translational feedback loops. The SCN governs the timing of peripheral circadian oscillators by neuronal pathways and by neuroendocrine mechanisms. An important neuroendocrine hand of the core circadian oscillator is melatonin, which is produced in and secreted from the pineal gland night by night. The adenohypophysis represents a peripheral circadian oscillator and the secretion of one of its hormones, prolactin, is known to be regulated by melatonin. The aim of the present study was to analyze a putative influence of melatonin on the activity state and diurnal variations of identified cell types in the hypophysis. Particular attention was paid to lactotroph, gonadotroph and pars intermedia cells. Experiments were performed with young male mice of different strains: melatonin-proficient C3H, melatonin-deficient C57BL, melatonin-proficient C3H with targeted deletions of the Mel1a receptor (MelaaBB), Mel1b receptor (MelAAbb) or both receptors (Melaabb). Cells producing prolactin (PRL), follicle stimulating hormone (FSH) were immunocytochemically identified and the presence of phosphorylated CREB protein (pCREB) and clock gene protein PER1 was demonstrated by double immunolabeling at different time points during the light/dark cycle in melatonin deficient, melatonin proficient and melatonin receptor knockout mice. Melatonin influence on Prl mRNA levels was investigated by means of in situ hybridization. At night the percentage of lactotroph cells showing a positive nuclear pCREB- and PER1-immunoreaction is significantly smaller in C57BL than in C3H mice. In both mouse strains, the percentage of pCREB –immunoreactive cells is minimal in the early morning and gradually increases to reach a maximum in the late night. PER1 levels show a parallel temporal variation in C3H, but in C57BL, they are drastically reduced in the early afternoon. The percentage of FSH-immunoreactive cells showing pCREB immunoreaction was significantly lower in the melatonin-deficient C57Bl mice than in the melatonin-proficient C3H mice during the second part of the day and during the night. In each strain, the percentage of FSH-immunoreactive cells was lowest at the early morning and gradually increases until the maximum at late night. In wild type (MelAABB) and MelAAbb mice the percentage of lactotroph cells with nuclear pCREB immunoreactions varied significantly over 24 h period, whereas in MelaaBB and Melaabb mice no significant differences were found between the five time points analyzed. The number of Prl mRNA expressing cells was significantly higher in MelaaBB and MelAAbb than in their wild type (MelAABB) littermates. pCREB levels in the pars intermedia did not show rhythmic variation in wild type or Melaabb animals, but wild type mice had higher pCREB levels than Melaabb. The observation that, during darkness, the percentage of lactotroph cells with nuclear pCREB immunoreaction is significantly higher in C3H than in C57BL mice suggests the existence of a distinct cell population that is under the control of melatonin-dependent intrapituitary signaling. Results with melatonin receptor knockout mice indicate that Mel1a and Mel1b melatonin receptors are involved in the control of the activity state of lactotroph cells, but to a differing degree. Analysis of cells expressing Prl mRNA showed that inhibitory action on the Prl expression is mostly mediated through the Mel1a receptor. The significant difference between pCREB immunoreaction in gonadotroph cells of C3H and C57BL mice might suggest that, like lactotrophes, FSH cells represent a heterogeneous population and only a subpopulation is under control of melatonin signaling. The present study is first to show that melatonin signaling also affects pCREB levels in pars intermedia of mice.
To determine the effects of inhaled IL-10 at different doses and different time points on the pulmonary and systemic inflammatory response during endotoxemia, 48 ventilated, anaesthetized rats (mean body weight ± standard deviation, 500 ± 33g) were randomly assigned to six groups (n = 8, each). Interleukin-10 was nebulised either prior to or following the intravenous injection of LPS (5mg/kg) at two doses (5.0 mycro-g or 0.5 mycro-g) in our groups. Eight rats received the same insult with no further treatment (LPS-only group). Another eight rats served as controls without endotoxemia but with aerosolized phosphate-buffered saline, the solvent of IL-10 (Sham group). Concentrations of TNF-alpha, IL-1beta, IL-6, and IFN-gamma were analyzed in plasma and bronchoalveolar lavage fluid (BALF). In addition, the nitrite release from ex-vivo cultured alveolar macrophages was determined. As compared to the LPS-only group, the concentrations of the proinflammatory cytokines TNF-alpha, IL-1beta, IL-6, and IFN-gamma in plasma were significantly reduced in the group, which inhaled 5 mycro-g IL-10 before LPS injection (p< 0.0125). Spontaneous nitrite release from exvivo cultured alveolar macrophages was suppressed in this group (p< 0.0125). Inhalation of 0.5 mycro-g IL-10 before LPS injection and both dosages of IL-10 inhalation (5 mycro-g or 0.5 mycro-g) after LPS injection did not significantly influence either inflammatory cytokine concentrations in BALF, in plasma or the nitrite release from ex-vivo cultured alveolar macrophages. In this study, inhaled IL-10 only demonstrated anti-inflammatory effects when it was administered at 5 mycro-g prior to the induction of experimental endotoxemia. Interleukin-10 aerosol had no effect when it was given either following induction of endotoxemia or given at a lower dosage (which here was 0.5 mycro-g) either before or following injection of lipopolysaccharide.
Imatinib (GleevecTM; GlivecTM; formerly STI571), a specific inhibitor of Abl tyrosine kinase, is efficacious in treating Philadelphiachromosomepositive (Ph+) leukaemias such as chronic myeloid leukaemia (CML) and Ph+ acute lymphoblastic leukaemia (ALL) (Ottmann, Druker et al. 2002). Within a few years of its introduction to the clinic, Imatinib had dramatically altered the firstline therapy for CML, because it was found that most newly diagnosed CML patients in the chronic phase achieve durable responses when treated with Imatinib (Goldman and Melo 2003). However, a small percentage of these patients, as well as most advancedphase CML and Ph+ ALL patients, relapse on Imatinib therapy (Yokota, Kimura et al. 2006). Several mechanisms of refractoriness and relapse have been reported. These include point mutations within the Abl kinase domain, overexpression of BcrAbl mRNA (Hofmann, Jones et al. 2002), decreased intracellular drug levels mediated by Pglycoprotein (Pgp) (Hegedus, Orfi et al. 2002), and nonBcrAbl dependent mechanisms (activation of the SFKs) (Donato, Wu et al. 2003). In this research work, a possible means of overcoming resistance to Imatinib by the use of the specific dual Src/Abl kinase inhibitor AZD0530 has been investigated. The efficacy of AZD0530 in the treatment of Ph+ leukaemias, sensitive to or resistant to Imatinib, has been tested on cell lines, primary patient material and in vivo in transduction/transplantation mouse model of Imatinib sensitive or resistant BcrAbl dependent CML-like disease. Data with AZD0530 has been compared to cells treated with Imatinib. The potential of inhibiting both Src and Abl kinases while inducing growth arrest and apoptosis has been analysed. AZD0530 specifically inhibited the growth of CML and Ph+ ALL cells in a dosedependent manner, but has shown a marginal effect on Ph- ALL cells. Treatment of p185BcrAbl expressing Ba/F3 cells with AZD0530 has led to apoptosis induction and growth inhibition in these cells, while the untransformed Ba/F3 cells have remained unaffected. Resistance to Imatinib due to mutation in the Ba/F3MutY253F cells has been overcomed by this compound. The growth inhibitory effect of AZD0530 correlates with its induction of apoptosis. Combination of AZD0530 and Imatinib at low concentrations has shown an additive effect on the inhibition of proliferation of BV173 cells. The growth inhibition and apoptosis induction by AZD0530 have shown to be uncoupled to major changes in cell cycle. An exception is the CML blast crisis cell line BV173 which has shown a considerable G0/G1 arrest in the presence of AZD0530 and Imatinib as single agents. Immunoblotting of whole cell lysates from Imatinib or AZD0530 treated BV173, Ba/F3 expressing p185(BcrAbl) MutT253F cells and the WTSupB15 cells, for Src and BcrAbl clearly demonstrates that there is an ongoing transphosphorylation taking place between the SFKs and BcrAbl. This transphosphorylation synergizes and influences the aggressive nature of CML blast crisis and Ph+ ALL. Investigations have been carried out on downstream signaling events to determine how Src family members contribute to BcrAbl signaling. Specifically, Stat, Erk and PI3K/ Akt activation status have been characterised in Imatinib sensitive and resistant Ph+ cells. AZD0530 has significantly downregulated the activation of survival signaling pathways as shown by it’s inhibition of Stat5, Akt and Erk kinases in Ph+ cells, resistant or sensitive to Imatinib. The only exception to this has been the Imatinib resistant cell line RTSupB15, in which activated Akt kinase level has remained unaffected. AZD0530 has shown to be efficient in the treatment of cells isolated from three Ph+ leukaemic patients (resistant or sensitive to Imatinib), and has led to an induction of apoptosis. Equally, in the same patients, growth and survival pathways have been inhibited in vitro in the presence of AZD0530. An overall therapeutic effect of AZD0530 in vivo has been studied in mouse model of Imatinib sensitive and Imatinib resistant, BcrAbldependent desease. Mice with a BcrAbllike disease responded to Imatinib treatment but not to AZD0530. Using the CFU assay, an influence on the differentiation status of primary leukaemic blast stem cells have been tested. The in vivo studies as well as the CFU results have shown discrepancies to the effects of AZD0530 tested so far in this research work. These discrepancies have paralleled with the upregulation of BcrAbl in most AZD0530 treated cells. These are to be further analysed. These data elucidate the role of Src kinases in BcrAbl leukaemogenesis. Results gotten from this research work has shown that AZD0530 targets both Src and BcrAbl kinase activity and reduces the transforming potential of BcrAbl. It also shows that there is an ongoing transphosphorylation between SFKs and BcrAbl kinase. AZD0530 has proven effective in CML cell lines, Ph+ ALL cell lines and patient cells resistant to Imatinib. These have demonstrated that AZD0530 is a potential drug target which can be used to overcome Imatinib resistance.
Prostaglandin D2 (PGD2) is involved in a variety of physiological and pathophysiological processes, but its role in fever is poorly understood and the data obtained so far are rather controversial. Here we investigated the effects of central PGD2 delivery and of systemic prostaglandin D synthase (PGDS) or cyclooxygenase (COX) inhibition on core body temperature (TC) and on prostaglandin levels in the cerebrospinal fluid (CSF) of rats. Both PGE2 and PGD2 were detectable in CSF samples from control rats (6.2 ± 1.1 and 17.3 ± 3.1 pg/ml, respectively). Lipopolysaccharide (LPS) injection (50 μg i.p.) induced fever during the 5-hour observation period. Five hours after LPS injection, the levels of PGE2 and PGD2 were increased in the CSF about 90-fold (541.0 ± 47.5 pg/ml) and 5-fold (95.4 ± 23.1 pg/ml), respectively. Administration of PGD2 (50 - 500 ng) into the cisterna magna (i.c.m) evoked a delayed fever response in a dose-dependent manner that was accompanied by increased levels of PGE2 in the CSF. RT-PCR analyses revealed that the increased levels of PGE2 after PGD2 administration were not caused by up-regulation of COX-2 or microsomal prostaglandin E synthase 1 (mPGES-1) in the hypothalamus. Interestingly, i.c.m. pretreatment of animals with PGD2 considerably sustained the pyrogenic effects of i.c.m. administered PGE2. Pretreatment with a novel PGDS inhibitor, EDJ300520 (10 – 40 mg/kg p.o.), 1 h prior to the LPS injection impaired the LPS-induced increase of both PGD2 and PGE2 in the CSF and inhibited the fever response. In contrast, administration of EDJ300520 3 h after LPS injection did not ameliorate the LPS-induced fever. Accordingly, the concentration of PGE2 in the CSF was not decreased after EDJ300520 treatment. However, the CSF levels of PGD2 were reduced after administration of a high dose of EDJ300520 (40 mg/kg). We also investigated the effects of antipyretic drugs on the CSF levels of PGE2 and PGD2 during LPS-induced fever. Four antipyretic drugs with different mechanisms of action were used, including ibuprofen (5 - 20 mg/kg), celecoxib (10 - 50 mg/kg), SC560 5 - 20 mg/kg), and paracetamol (50 - 150 mg/kg). Each drug was used in three different doses and was orally administered 3 h after the LPS injection. All drugs were capable to attenuate the LPS-induced fever. The decrease of TC paralleled the reduction of PGE2 levels in the CSF. Of note, there was a tendency to reduced PGD2 levels in the CSF after treatment with the antipyretic drugs. However, only SC560 and the high dose of celecoxib (50 mg/kg) reduced the PGD2 levels significantly. In summary, our experiments underscore the pivotal role of PGE2 as the principal downstream mediator of fever. Moreover, we demonstrate that PGD2 is also involved in the mechanisms underlying fever. Our data suggest that PGD2 exerts an indirect pyrogenic effect by modulating the availability of PGE2 in the CSF. Additional studies are needed to explore the exact mechanism by
Molecular mechanism of intracellular signal transduction by the angiotensin-converting enzyme
(2007)
The angiotensin converting enzyme (ACE) is an important component of the renin-angiotensin system (RAS) and is crucially involved in the homeostasis of fluid and electrolyte balance and thus in the regulation of blood pressure. The zinc metallopeptidase is involved in the generation of angiotensin II, a potent vasoconstrictor and in the degradation of bradykinin, a potent vasodilator. It is worth noting that ACE more readily hydrolyzes bradykinin than it does angiotensin I thus culminating in the net physiological effect of the production of a vasoconstrictor and the decrease in the availability of a vasodilator. ACE inhibitors have become one of the most successful therapeutic approaches as a first line of therapy in hypertension, and are also widely used in treating heart failure, myocardial infarction, stroke, coronary artery disease and impaired left ventricular function. However, one unexpected clinically relevant finding related to ACE inhibitors is their ability to delay the onset of type II diabetes that was revealed by various large clinical trials. However, the mechanisms underlying these beneficial effects of ACE inhibitor therapy are currently unclear and cannot be explained by the prevention of angiotensin II formation or the attenuated degradation of bradykinin. Thus the potential beneficial effects attributed to ACE inhibitors may occur independent of reductions in blood pressure paving way for new and/or unknown mechanism. Our group has recently redefined ACE as a signal transduction molecule which upon binding to ACE inhibitor turns on a signalling cascade leading to phosphorylation of Ser1270 by CK2, activation of JNK and changes in gene expression in endothelial cells. However the mechanism by which ACE inhibitor initiates the signalling cascade was not clear. It was hypothesized that ACE, which is anchored to the membrane with a single transmembrane domain should dimerize prior to initiating further downstream signalling events in endothelial cells. Therefore, we sought to explore whether or not ACE forms dimers in endothelial cells and whether ACE dimerization is essential for the initiation of ACE signalling in endothelial cells. Using native gel electrophoresis, we found that ACE forms dimers in endothelial cells and that there is an increase in the dimer formation upon treatment of endothelial cells with ACE inhibitors. ACE homodimerization was also demonstrated using the split-ubiquitin system and chemical cross-linking experiments. ACE dimers are also formed in endothelial cells overexpressing the non-phosphorylatable ACE, wherein ACE signalling was abolished indicating that dimerization process is not influenced by the phosphorylation of the serine residue residing in the cytoplasmic tail. Monosaccharides like glucose, galactose and mannitol did not have any influence on ACE-inhibitor induced dimerization. Making use of different monoclonal antibodies directed to the epitopes of N-domain which harbours carbohydrate recognizing domain, also did not affect dimerization. However, inactivation of the C-domain active site by introducing mutation of the key histidine residues in HEMGH consensus sequences, which complexes the zinc ions, abolished enzyme dimerization both in the basal state and in response to ramiprilat. Mutation of the C-domain also resulted in the loss of ACE inhibitor-induced ACE signalling, that is we failed to observe ramiprilat-induced increase in the phosphorylation of the Ser1270 and the subsequent JNK activation. ACE-inhibitor induced dimerization precedes the phosphorylation of Ser1270 and activation of JNK. Thus the ACE-inhibitor induced dimerization via the C-domain of ACE represents the initial step in the ACE signalling pathway which involves the activation of JNK/c-Jun pathway and leading to the changes in the gene expression in endothelial cells. Our group previously identified ACE itself as well as cyclooxygenase-2 (COX-2) as two “ACE signalling-regulated” genes. To screen for additional genes regulated in a similar manner we used DNA microarray technology, to assess ramiprilat-induced changes in the endothelial cell gene expression. 21 genes were identified to be differentially regulated of which, 7 were upregulated and 14 were downregulated by ramiprilat. However, when screened at the protein level, we found no significant differences between the untreated control cells and those treated with ramiprilat. As several other cells and tissues possess a fully functional RAS we screened plasma samples from healthy volunteers as well as from patients with coronary artery disease for the proteins identified in the microarray. We observed that the cellular retinal binding protein-1 (CRBP-1) was detectable at low levels in plasma from patients and that ramipril markedly increased serum levels of this protein. Endothelial cells overexpressing CRBP-1 demonstrated increased RXRE and PPRE activity when stimulated with 9-cis retinoic acid and rosiglitazone respectively suggesting that CRBP-1 might affect gene expression via heterodimerization of PPAR elements with RXR elements by virtue of its function as a transport protein of retinoic acid. Studies aimed at determining the consequences of elevated CRBP-1 expression on endothelial cell homeostasis are ongoing. Although the RAS has been described in many other tissues apart from endothelial cells, ACE signalling has not yet been addressed in tissues such as monocytes/macrophages, which have an increased ACE expression in an atherosclerotic setting. We observed that upon stimulation of cultured ACE expressing monocytes with ramiprilat, JNK is activated suggesting the occurrence of ACE signalling in human monocytes. It is worth noting that ACE inhibitors delay the onset of type II diabetes in spite of moderate decrease in blood pressure. To further elucidate the mechanism underlying this effect, we found that ACE inhibitors increase the PPARgamma levels in the nuclear extracts of ACE expressing monocytes which were also reproduced in human endothelial cells overexpressing human somatic ACE. However, ramiprilat did not have any direct effect on the activity of a luciferase-coupled promoter containing several copies of the PPRE in human endothelial cells. These results contrasted with the actions of the PPARgamma agonist suggesting that ramiprilat enhances PPARgamma levels through an indirect mechanism. We next hypothesized that ramiprilat might increase the levels of 15-deoxy-D12,14-prostaglandin J2 (15dPGJ2) which is a natural ligand for PPARgamma via COX enzymes in monocytes. We observed that ramiprilat was able to decrease the diminution of COX-2 levels upto 48 hours of treatment but the levels of 15dPGJ2 were too low to be detected by ELISA. However ramiprilat enhanced the plasma levels of adiponectin, a downstream target of PPARgamma, which is a anti-atherogenic and anti-inflammatory adipokine, in patients with coronary artery disease. Though adiponectin is a PPARgamma-regulated gene, the observed increase in adiponectin might be attributed to the increase in RXR rather than via PPARgamma. Taken together, the results of this investigation have revealed that ACE inhibitors initiate ACE signalling by eliciting the dimerization of the enzyme, more specifically via its C-domain active centers. The ACE signalling cascade when activated leads to the enhanced expression of ACE, COX-2 and CRBP-1 which in turn favours the heterodimerization of PPARgamma with RXR and thus results in the increased expression of “PPARgamma regulated” genes such as adiponectin. The latter results provide a molecular basis for the observation that ACE inhibitors can delay the onset of type 2 diabetes in as much as it was possible to link ramipril with CRBP-1, RXR activity and the expression of adiponectin, an adipokine associated with improved insulin sensitivity. Further work is however required to elucidate the consequences of ACE inhibitors in monocytes and adipocytes as well as in intact animals.
Transcranial magnetic stimulation (TMS) is a non-invasive technique which can be used to study different intracortical excitatory and inhibitory neuronal circuits in the intact human being. In the primary motor cortex, there are essentially three different TMS measures of inhibitory neuronal circuits as determined by paired-pulse TMS: short-interval intracortical inhibition (SICI), long-interval intracortical inhibition (LICI) and interhemispheric inhibition (IHI). It was hypothesized that SICI is a GABAA receptor mediated inhibition (Ilic et al., 2002) whereas LICI and IHI are mediated by GABAB receptors (Daskalakis et al., 2002; McDonnell et al., 2006). Additionally, it was shown that these inhibitory circuits interact negatively, possible due to presynaptic GABAB receptor mediated inhibition (Sanger et al., 2001; Daskalakis et al., 2002). Which neuronal populations exactly underlie SICI, LICI and IHI, is not completely clear and by which mechanism these inhibitory circuits interact has never been tested pharmacologically so far. Thus, the effects of a single oral dose of Diazepam (DZP), a specific positive allosteric modulator at the GABAA receptor, and of Baclofen (BAC), a specific GABAB receptor agonist, on SICI, LICI and IHI as well as their interactions were tested here in a randomized, placebo controlled, double-blinded crossover study. SICI significantly increased after intake of DZP whereas BAC did not change SICI. Conversely, LICI significantly increased after intake of BAC but did not change after intake of DZP. IHI showed only a trend towards a decrease after intake of DZP but no change after intake of BAC. The interactions IHI-SICI, LICI-IHI and LICI-SICI were all negative at baseline. SICI and IHI were partially suppressed in the presence of IHI and LICI, respectively, and SICI in the presence of LICI was almost completely blocked. BAC did not change any of these interactions, whereas DZP significantly increased SICI in the presence of LICI. This study is the first to examine by means of pharmacological testing the complex interactions between different inhibitory circuits in the human motor cortex. The effects of DZP and BAC on SICI and LICI confirmed the notion that SICI is a GABAA receptor mediated intracortical inhibition whereas LICI depends on GABAB receptor mediated neurotransmission. The pharmacology of IHI at short interstimulus intervals of < 20 ms (12 ms in this study) remains still inconclusive and warrants further investigation. Findings further suggest that SICI, LICI and IHI represent three different inhibitory neuronal circuits which can be tested non-invasively by means of paired-pulse TMS. Furthermore, the data support the idea that the negative interactions IHI-SICI, LICI-IHI and LICI-SICI are most likely due to presynaptic GABAB receptor mediated autoinhibition.