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The last decade has seen a sharp increase in the number of scientific publications describing physiological and pathological functions of extracellular vesicles (EVs), a collective term covering various subtypes of cell-released, membranous structures, called exosomes, microvesicles, microparticles, ectosomes, oncosomes, apoptotic bodies, and many other names. However, specific issues arise when working with these entities, whose size and amount often make them difficult to obtain as relatively pure preparations, and to characterize properly. The International Society for Extracellular Vesicles (ISEV) proposed Minimal Information for Studies of Extracellular Vesicles (“MISEV”) guidelines for the field in 2014. We now update these “MISEV2014” guidelines based on evolution of the collective knowledge in the last four years. An important point to consider is that ascribing a specific function to EVs in general, or to subtypes of EVs, requires reporting of specific information beyond mere description of function in a crude, potentially contaminated, and heterogeneous preparation. For example, claims that exosomes are endowed with exquisite and specific activities remain difficult to support experimentally, given our still limited knowledge of their specific molecular machineries of biogenesis and release, as compared with other biophysically similar EVs. The MISEV2018 guidelines include tables and outlines of suggested protocols and steps to follow to document specific EV-associated functional activities. Finally, a checklist is provided with summaries of key points.
Background: Unlike metastatic colorectal cancer (CRC) there are to date few reports concerning the predictive value of molecular biomarkers on the clinical outcome in stage II/III CRC patients receiving adjuvant chemotherapy. Aim of this study was to assess the predictive value of proteins related with the EGFR- and VEGFR- signalling cascades in these patients.
Methods: The patients' data examined in this study were from the collective of the 5-FU/FA versus 5-FU/FA/irinotecan phase III FOGT-4 trial. Tumor tissues were stained by immunohistochemistry for VEGF-C, VEGF-D, VEGFR-3, Hif-1 α, PTEN, AREG and EREG expression and evaluated by two independent, blinded investigators. Survival analyses were calculated for all patients receiving adjuvant chemotherapy in relation to expression of all makers above.
Results: Patients with negative AREG and EREG expression on their tumor had a significant longer DFS in comparison to AREG/EREG positive ones (p< 0.05). The benefit on DFS in AREG-/EREG- patients was even stronger in the group that received 5-FU/FA/irinotecan as adjuvant treatment (p=0.002). Patients with strong expression of PTEN profited more in terms of OS under adjuvant treatment containing irinotecan (p< 0.05). Regarding markers of the VEGFR- pathway we found no correlation of VEGF-C- and VEGFR-3 expression with clinical outcome. Patients with negative VEGF-D expression had a trend to live longer when treated with 5-FU/FA (p=0.106). Patients who were negative for Hif-1 α, were disease-free in more than 50% at the end of the study and showed significant longer DFS-rates than those positive for Hif-1 α (p=0.007). This benefit was even stronger at the group treated with 5-FU/FA/irinotecan (p=0.026). Finally, AREG-/EREG-/PTEN+ patients showed a trend to live longer under combined treatment combination.
Conclusions: The addition of irinotecan to adjuvant treatment with 5-FU/FA does not provide OS or DFS benefit in patients with stage II/III CRC. Nevertheless, AREG/EREG negative, PTEN positive and Hif-1 α negative patients might profit significantly in terms of DFS from a treatment containing fluoropyrimidines and irinotecan. Our results suggest a predictive value of these biomarkers concerning adjuvant chemotherapy with 5-FU/FA +/− irinotecan in stage II/III colorectal cancer.
Die 4. Fassung der Roten Liste der Brutvögel Deutschlands wurde durch das "Nationale Gremium Rote Liste Vögel" erarbeitet, in dem die wissenschaftlichen Institutionen der Ornithologie und Avifaunistik in Deutschland vertreten sind. Die Rote Liste ersetzt die 3. Fassung aus dem Jahr 2002 (BAUER et al. 2002); sie wurde erstmalig nach dem für alle Tier- und Pflanzenartengruppen sowie den Pilzen in Deutschland entwickelten Kriterienschema (5. LUDWIG et al. 2007) erarbeitet. Somit wird ein direkter Vergleich der Gefährdungssituation zwischen diesen Gruppen ermöglicht. Bestandsgröße, kurzfristiger (25 Jahre) und langfristiger (50-150 Jahre) Bestandstrend sind die wichtigsten Parameter zur Gefahrdungseinstufung der einzelnen Arten. Zusätzlich wurde jeweils die Wirksamkeit von Risikofaktoren artspezifisch identifiziert und berücksichtigt. Alle Einstufungen werden transparent vorgenommen und in der Anhangsliste publiziert. Der Dachverband Deutscher Avifaunisten (DDA) hat zur Erstellung der Datengrundlagen mit Stand 2005 für die Gefahrdungseinstufung ein neues Abfrageschema entwickelt, in dem die relevanten Informationen aus den nationalen Vogelmonitoring-Programmen aufgearbeitet und als Hintergrunddaten für die Einschätzungen von Bestandstrend und -größe auf Landesebene bereitgestellt wurden. Dadurch gewinnen die Einstufungen an Verlässlichkeit und Nachvollziehbarkeit. Der langfristige Trend wurde vom "Nationalen Gremium Rote Liste Vogel" ermittelt. Vor der Einstufung der Brutvogelarten wurde je Art eine Statuszuordnung vorgenommen, von denen nur die regelmäßig brütenden einheimischen Arten den weiteren Weg der Rote Liste-Erstellung durchlaufen. In der Roten Liste 2007 werden insgesamt 260 regelmäßige einheimische Brutvogelarten in Deutschland berücksichtigt, 25 weitere Arten brüteten nur unregelmäßig ('vermehrungsgäste': Status II), zudem wurden 29 Neozoen-Arten ermittelt (Status III), von denen 20 regelmäßig brüten. Dies ergibt zusammen 314 Arten, die höchste Zahl an Brutvogelarten, die je für eine Rote Liste zu Grunde gelegt wurde. Insgesamt befinden sich 110 regelmäßige Brutvogelarten in den Kategorien der Roten Liste 2007 (0 = ausgestorben, 1 = vom Aussterben bedroht, 2 :: stark gefährdet, 3 :: gefährdet und R = extrem selten), das entspricht 42,3 % der Arten, was einer minimal geringeren Gefahrdungsquote gegenüber der Vorgängerliste entspricht. Erfreulich ist, dass mit dem Bruchwasserläufer und dem Steinrötel zwei ehemals in Deutschland ausgestorbene Arten zwischen 2000 und 2005 wieder regelmäßig gebrütet haben. Dem entgegen ist mit der Blauracke eine weitere Art ausgestorben. Schwarzstorch, Wanderfalke, Seeadler und Uhu sind hier erstmals seit der ersten deutschen Roten Liste 1971 nicht mehr aufgeführt - ein Erfolg jahrzehntelanger direkter Schutzmaßnahmen der ehrenamtlichen und amtlichen Vogelschützer und gleichzeitig ein Beweis, dass sich Vogelschutz bei stark gefährdeten Arten lohnen kann. Andererseits sind mit Schreiadler, Zwergseeschwalbe oder Großem Brachvogel Alien in die höchste Gefährdungskategorie eingestuft worden, die zwar auch im Fokus des Vogelschutzes standen und stehen, bei denen aber bislang Maßnahmen nicht ausreichend erfolgreich umgesetzt werden konnten. Gerade die Kategorie "vom Aussterben bedroht" umfasst mit nunmehr 30 Arten den höchsten Wert seit Erscheinen der gesamtdeutschen Roten Liste. Der Analyse der aktuellen deutschen Brutvogelfauna zufolge sind die Boden brütenden Vogelarten, Großinsektenfresser und Langstreckenzieher am stärksten von Gefährdungen betroffen. Vogelgruppen mit einem hohen Anteil gefährdeter Arten sind demzufolge Hühnervögel, Rallen, Limikolen und Würger, während Eulen und Schnäpperverwandte derzeit vergleichsweise wenig gefährdet sind. Zudem erfolgt deutschlandweit ein weiteres Ausdünnen der typischen Vögel in der Normallandschaft, was sich vor allem in den Trendanalysen manifestiert, aber in der Roten Liste noch nicht sehr stark zum Ausdruck kommt. Die Nutzungsintensivierungen von Land- und Forstwirtschaft in jüngster Zeit geben hier großen Anlass zur Sorge in diesen Großlebensräumen. Diese Rote Liste stellt erneut ein kritisches Zeugnis über den Zustand der deutschen Vogelwelt aus. Aufgrund der in jüngster Zeit stark ausgeweiteten Monitoringprogramme wird es in Deutschland zukünftig noch besser möglich sein, die Gefahrdung aufzuzeigen. Um den dauerhaften Rückgang der Vogelbestände zu stoppen oder wenigstens zu verlangsamen, müssen die wirksamen Gefahrdungsfaktoren reduziert und minimiert werden. Dem gezielten Vogelartenschutz stellen sich dabei folgende vordringliche Aufgaben: Erhaltung der offenen Kulturlandschaft, Erhaltung strukturreicher Walder, Erhaltung nährstoffarmer Lebensräume, Sicherung der Schutzgebiete - insbesondere Natura 2000, Stärkung der internationalen Zusammenarbeit im Vogelschutz, Reduktion der Populationsverluste durch Unfälle und menschliche Verfolgung sowie Förderung des vogelkundlichen Nachwuchses.
Background: Transcutaneous auricular vagus nerve stimulation (taVNS) has been investigated regarding its therapeutic properties in several several conditions such as epilepsy, migraine and major depressive disorder and was shown to access similar neural pathways as invasive vagus nerve stimulation. While the vagus nerve's role in gut motility is physiologically established, the effect of taVNS has scarcely been investigated in humans and yielded conflicting results. Real-time gastric magnetic resonance imaging (rtMRI) is an established reproducible method to investigate gastric motility non-invasively. Objective: To investigate the influence of taVNS on gastric motility of healthy participants using rtMRI. Methods: We conducted a randomized, double-blind study using high-frequency (HF) stimulation at 25Hz or low-frequency (LF) taVNS at 1Hz after ingestions of a standardized meal in 57 healthy participants. The gastric motility index (GMI) was determined by measuring the amplitude and velocity of the peristaltic waves using rtMRI. Results: After HF taVNS, GMI was significantly higher than after LF stimulation (p = 0.005), which was mainly attributable to a higher amplitude of the peristaltic waves (p = 0.003). Conclusion: We provide evidence that 4-h of taVNS influences gastric motility in healthy human participants for the first time using rtMRI. HF stimulation is associated with higher amplitudes of peristaltic waves in the gastric antrum compared to LF stimulation. Further studies are needed to investigate the effect of different frequencies of taVNS and its therapeutic properties in conditions with impaired gastric motility.
Despite the progress to understand inflammatory reactions, mechanisms causing their resolution remain poorly understood. Prostanoids, especially prostaglandin E2 (PGE2), are well-characterized mediators of inflammation. PGE2 is produced in an inducible manner in macrophages (Mϕ) by microsomal PGE2-synthase-1 (mPGES-1), with the notion that it also conveys pro-resolving properties. We aimed to characterize the role of mPGES-1 during resolution of acute, zymosan-induced peritonitis. Experimentally, we applied the mPGES-1 inhibitor compound III (CIII) once the inflammatory response was established and confirmed its potent PGE2-blocking efficacy. mPGES-1 inhibition resulted in an incomplete removal of neutrophils and a concomitant increase in monocytes and Mϕ during the resolution process. The mRNA-seq analysis identified enhanced C-X3-C motif receptor 1 (CX3CR1) expression in resident and infiltrating Mϕ upon mPGES-1 inhibition. Besides elevated Cx3cr1 expression, its ligand CX3CL1 was enriched in the peritoneal lavage of the mice, produced by epithelial cells upon mPGES-1 inhibition. CX3CL1 not only increased adhesion and survival of Mϕ but its neutralization also completely reversed elevated inflammatory cell numbers, thereby normalizing the cellular, peritoneal composition during resolution. Our data suggest that mPGES-1-derived PGE2 contributes to the resolution of inflammation by preventing CX3CL1-mediated retention of activated myeloid cells at sites of injury.
There is a need for diagnostic biomarkers of epilepsy and status epilepticus to support clinical examination, electroencephalography and neuroimaging. Extracellular microRNAs may be potentially ideal biomarkers since some are expressed uniquely within specific brain regions and cell types. Cerebrospinal fluid offers a source of microRNA biomarkers with the advantage of being in close contact with the target tissue and sites of pathology. Here we profiled microRNA levels in cerebrospinal fluid from patients with temporal lobe epilepsy or status epilepticus, and compared findings to matched controls. Differential expression of 20 microRNAs was detected between patient groups and controls. A validation phase included an expanded cohort and samples from patients with other neurological diseases. This identified lower levels of miR-19b in temporal lobe epilepsy compared to controls, status epilepticus and other neurological diseases. Levels of miR-451a were higher in status epilepticus compared to other groups whereas miR-21-5p differed in status epilepticus compared to temporal lobe epilepsy but not to other neurological diseases. Targets of these microRNAs include proteins regulating neuronal death, tissue remodelling, gliosis and inflammation. The present study indicates cerebrospinal fluid contains microRNAs that can support differential diagnosis of temporal lobe epilepsy and status epilepticus from other neurological and non-neurological diseases.
Men and women differ substantially regarding height, weight, and body fat. Interestingly, previous work detecting genetic effects for waist-to-hip ratio, to assess body fat distribution, has found that many of these showed sex-differences. However, systematic searches for sex-differences in genetic effects have not yet been conducted. Therefore, we undertook a genome-wide search for sexually dimorphic genetic effects for anthropometric traits including 133,723 individuals in a large meta-analysis and followed promising variants in further 137,052 individuals, including a total of 94 studies. We identified seven loci with significant sex-difference including four previously established (near GRB14/COBLL1, LYPLAL1/SLC30A10, VEGFA, ADAMTS9) and three novel anthropometric trait loci (near MAP3K1, HSD17B4, PPARG), all of which were significant in women, but not in men. Of interest is that sex-difference was only observed for waist phenotypes, but not for height or body-mass-index. We found no evidence for sex-differences with opposite effect direction for men and women. The PPARG locus is of specific interest due to its link to diabetes genetics and therapy. Our findings demonstrate the importance of investigating sex differences, which may lead to a better understanding of disease mechanisms with a potential relevance to treatment options.
Background: The most common spinocerebellar ataxias (SCA)—SCA1, SCA2, SCA3, and SCA6—are caused by (CAG)n repeat expansion. While the number of repeats of the coding (CAG)n expansions is correlated with the age at onset, there are no appropriate models that include both affected and preclinical carriers allowing for the prediction of age at onset.
Methods: We combined data from two major European cohorts of SCA1, SCA2, SCA3, and SCA6 mutation carriers: 1187 affected individuals from the EUROSCA registry and 123 preclinical individuals from the RISCA cohort. For each SCA genotype, a regression model was fitted using a log-normal distribution for age at onset with the repeat length of the alleles as covariates. From these models, we calculated expected age at onset from birth and conditionally that this age is greater than the current age.
Results: For SCA2 and SCA3 genotypes, the expanded allele was a significant predictor of age at onset (−0.105±0.005 and −0.056±0.003) while for SCA1 and SCA6 genotypes both the size of the expanded and normal alleles were significant (expanded: −0.049±0.002 and −0.090±0.009, respectively; normal: +0.013±0.005 and −0.029±0.010, respectively). According to the model, we indicated the median values (90% critical region) and the expectancy (SD) of the predicted age at onset for each SCA genotype according to the CAG repeat size and current age.
Conclusions: These estimations can be valuable in clinical and research. However, results need to be confirmed in other independent cohorts and in future longitudinal studies.
Background: Perioperative anaemia leads to impaired oxygen supply with a risk of vital organ ischaemia. In healthy and fit individuals, anaemia can be compensated by several mechanisms. Elderly patients, however, have less compensatory mechanisms because of multiple co-morbidities and age-related decline of functional reserves. The purpose of the study is to evaluate whether elderly surgical patients may benefit from a liberal red blood cell (RBC) transfusion strategy compared to a restrictive transfusion strategy.
Methods: The LIBERAL Trial is a prospective, randomized, multicentre, controlled clinical phase IV trial randomising 2470 elderly (≥ 70 years) patients undergoing intermediate- or high-risk non-cardiac surgery. Registered patients will be randomised only if Haemoglobin (Hb) reaches ≤9 g/dl during surgery or within 3 days after surgery either to the LIBERAL group (transfusion of a single RBC unit when Hb ≤ 9 g/dl with a target range for the post-transfusion Hb level of 9–10.5 g/dl) or the RESTRICTIVE group (transfusion of a single RBC unit when Hb ≤ 7.5 g/dl with a target range for the post-transfusion Hb level of 7.5–9 g/dl). The intervention per patient will be followed until hospital discharge or up to 30 days after surgery, whichever occurs first. The primary efficacy outcome is defined as a composite of all-cause mortality, acute myocardial infarction, acute ischaemic stroke, acute kidney injury (stage III), acute mesenteric ischaemia and acute peripheral vascular ischaemia within 90 days after surgery. Infections requiring iv antibiotics with re-hospitalisation are assessed as important secondary endpoint. The primary endpoint will be analysed by logistic regression adjusting for age, cancer surgery (y/n), type of surgery (intermediate- or high-risk), and incorporating centres as random effect.
Discussion: The LIBERAL-Trial will evaluate whether a liberal transfusion strategy reduces the occurrence of major adverse events after non-cardiac surgery in the geriatric population compared to a restrictive strategy within 90 days after surgery.
Trial registration: ClinicalTrials.gov (identifier: NCT03369210).
HLA-DRB1 and HLA-DQB1 genetic diversity modulates response to lithium in bipolar affective disorders
(2021)
Bipolar affective disorder (BD) is a severe psychiatric illness, for which lithium (Li) is the gold standard for acute and maintenance therapies. The therapeutic response to Li in BD is heterogeneous and reliable biomarkers allowing patients stratification are still needed. A GWAS performed by the International Consortium on Lithium Genetics (ConLiGen) has recently identified genetic markers associated with treatment responses to Li in the human leukocyte antigens (HLA) region. To better understand the molecular mechanisms underlying this association, we have genetically imputed the classical alleles of the HLA region in the European patients of the ConLiGen cohort. We found our best signal for amino-acid variants belonging to the HLA-DRB1*11:01 classical allele, associated with a better response to Li (p < 1 × 10−3; FDR < 0.09 in the recessive model). Alanine or Leucine at position 74 of the HLA-DRB1 heavy chain was associated with a good response while Arginine or Glutamic acid with a poor response. As these variants have been implicated in common inflammatory/autoimmune processes, our findings strongly suggest that HLA-mediated low inflammatory background may contribute to the efficient response to Li in BD patients, while an inflammatory status overriding Li anti-inflammatory properties would favor a weak response.