610 Medizin und Gesundheit
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Institute
- Medizin (732)
- Biochemie, Chemie und Pharmazie (41)
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Aim: Pharmacoresistance is a major burden in epilepsy treatment. We aimed to identify genetic biomarkers in response to specific antiepileptic drugs (AEDs) in genetic generalized epilepsies (GGE). Materials & methods: We conducted a genome-wide association study (GWAS) of 3.3 million autosomal SNPs in 893 European subjects with GGE – responsive or nonresponsive to lamotrigine, levetiracetam and valproic acid. Results: Our GWAS of AED response revealed suggestive evidence for association at 29 genomic loci (p <10-5) but no significant association reflecting its limited power. The suggestive associations highlight candidate genes that are implicated in epileptogenesis and neurodevelopment. Conclusion: This first GWAS of AED response in GGE provides a comprehensive reference of SNP associations for hypothesis-driven candidate gene analyses in upcoming pharmacogenetic studies.
Einleitung: Die akute Tonsillitis gehört zu den Infektionen der oberen Atemwege und ist eine sehr häufige Erkrankung in einer Kinder- und Jugendarztpraxis. Ziel unserer Untersuchung war es, das virale und bakterielle Erregerspektrum der akuten Tonsillitis, ihre saisonale Verteilung, ihre Altersverteilung, die klinische Symptomatik und den Einfluss einer Rauchexposition zu untersuchen. Gleichzeitig sollte erneut die Sensitivität und Spezifität des angewandten StrepA ST überprüft werden.
Methoden: In drei Kinder- und Jugendarztpraxen im Rhein-Main Gebiet wurden zwischen April 2009 und Mai 2010 insgesamt 1720 Patienten mit akuten Halsschmerzen untersucht. Mit einem Anamnesebogen wurden Alter, klinische Symptomatik und die Rauchexposition erfasst. Bei allen Patienten wurde ein StrepA ST durchgeführt. In einer Praxis (Praxis 1) wurden bei 306 Patienten zusätzlich ein Abstrich für eine bakterielle Kultur und für eine Multiplex PCR auf Viren durchgeführt.
Resultate: In 84% der Fälle tritt die GAS Tonsillitis im Alter zwischen 2 und 12 Jahren auf. Es konnte keine saisonale Häufung der GAS nachgewiesen werden. Mit 64 (42%) StrepA ST positiven Patienten von 152 Raucher-Familien und 74 (37%) von 200 Nichtraucher-Raucher-Familien zeigt sich kein signifikant erhöhtes Risiko an einer GAS Tonsillitis zu erkranken, wenn mindestens ein Elternteil raucht. Bei 306 Rachenabstrichen konnten 145 (47,5%) mal Streptokokken nachgewiesen werden. Davon waren mit 133 vorwiegend GAS (92%). Die anderen Streptokokken der Gruppen C (4,8%), G (2,1%) und B (1,4%) kommen deutlich seltener vor und spielen eine untergeordnete Rolle. Die Sensitivität und Spezifität des StrepA ST war mit 89,9% und 94,1% ausgezeichnet. Bei 306 Tonsillitiden gelang bei 110 Patienten (35,8%) ein Virusnachweis. Wie erwartet fanden sich doppelt so viele Virusnachweise (46%) bei Patienten ohne GAS Nachweis als Ko-Infektionen bei einer GAS (24%). Der Anteil der Entero-/Rhinoviren unter den nachgewiesenen Viren war mit 54% am höchsten. Adenoviren waren mit 15% und Influenza- 9% die nächst häufigen Viren, Para- und Coronaviren bildeten kleinere Gruppen. Während Entero-/Rhinoviren ganzjährig vorkommen sind Influenzaviren eher in der kalten Jahreszeit für akute Tonsillitiden verantwortlich. Die Rolle der Ko-Infektion in der Entstehung und im Verlauf der akuten Tonsillitis muss in weiteren Untersuchungen erforscht werden.
Schätzungen zufolge sind weltweit etwa 71 Millionen Menschen chronisch mit dem Hepatitis-C-Virus (HCV) infiziert. Im Jahre 2016 sind rund 400.000 Menschen an einer HCV-bedingten Lebererkrankung gestorben, insbesondere aufgrund der Entwicklung von Leberzirrhose und Lebertumoren. Trotz der großen Unterschiede in den Prävalenzschätzungen und der Qualität der epidemiologischen Daten zeigt die jüngste weltweite Bewertung, dass die virämische Ausbreitung der HCV-Infektion (Prävalenz der HCV-RNA) in den meisten Industrieländern, einschließlich der USA, weniger als 1,0% beträgt (www .cdc.gov / Hepatitis / HCV). In einigen osteuropäischen Ländern wie Lettland (2,2%) oder Russland (3,3%) und bestimmten Ländern in Afrika, Ägypten (6,3%) und Gabun (7,0%) oder im Nahen Osten Syriens (3,0%) ist die Prävalenz bemerkenswert höher. In den USA und den am weitesten entwickelten Ländern gilt die gemeinsame Nutzung von Werkzeugezur Herstellung von Arzneimitteln und zur Injektion von Medikamenten (Nadeln) als die häufigste derzeitige Übertragungsart. Die vorherrschende Übertragungsart in Ländern, in denen die Ausbreitung von HCV-Infektionen im Vergleich zu den Industrieländern höher ist, beruht jedoch auf schlechten Methoden zur Infektionskontrolle und unsicherer Handhabung von Injektionsnadeln.
Wenn die chronische Infektion unbehandelt bleibt, kann sich im fortschreitenden Verlauf eine Zirrhose oder ein hepatozelluläres Karzinom bilden (Alter H. J. und Seef L. B. 2000). Die Doppeltherapie, bei der es sich um eine Kombination aus pegyliertem Interferon-α (PEG IFNα) und Ribavirin (riba) handelt, war in einigen Ländern der Dritten Welt bis vor kurzem der goldene Standard für die Behandlung von Patienten mit chronischer Hepatitis C und hat eine anhaltende virologische Reaktion erzielt. Mit nur 50% der mit HCV-Genotyp 1 infizierten Patienten (der häufigere) im Vergleich zu 80% mit Genotyp 2 oder 3, obwohl sie kostspielig und langwierig sind (z. B. 24-48 Wochen) und zahlreiche harte Nebenwirkungen aufweisen, die schwer zu bekämpfen sind tolerieren (Erklärung der National Institutes of Health Consensus Development Conference: Management von Hepatitis C: 2002 - 10.-12. Juni 2002 2002). Die Identifizierung des JFH1 (japanische fulminante Hepatitis Typ 1) -Isolats wurde in einigen in vitro-Studien zu HCV als wichtiger Durchbruch bei der HCV-Behandlung angesehen. Die Verwendung dieses Isolats führte nachfolgend zu einem besseren Verständnis des HCV-Lebenszyklus und der 3D-Strukturen der viralen Proteine. Basierend auf dieser Erkenntnis konnten die ersten direkt wirkenden antiviralen Mittel (DAAs) entwickelt werden, die spezifisch virale Proteine beeinflussen. Die beiden Proteasehemmer (PI) Telaprevir und Boceprevir hemmen die virale NS3-4A-Protease und wurden 2011 als Kombinationstherapie mit PEG IFNα und Ribavirin zugelassen, was die anhaltende virologische Reaktion auf 67-75% erhöhte (Pawlotsky et al. 2015).
Die Optimierung der gegenwärtigen Arzneimittelregime, die Einschränkung des Problems der Mutationsresistenz, die Gestaltung einer individualisierten Therapie, der Zugang zu diesen therapeutischen antiviralen Arzneimitteln und ihr hoher Preis bleiben weiterhin eine Herausforderung (Pawlotsky 2016; Pawlotsky et al. 2015; Sarrazin 2016). Die Entwicklung eines Impfstoffs wird jedoch als größte Herausforderung für die weltweite Kontrolle von HCV angesehen (Bukh 2016). Aus diesem Grund ist es wichtig, weiterhin mehr über den HCV-Lebenszyklus und die Faktoren zu erfahren, die sich auf die Replikation und den gesamten Lebenszyklus auswirken können, um effiziente, qualitativ hochwertige und vor allem leicht zugängliche Behandlungen für alle Menschen weltweit zu entwickeln.
Der Lipidstoffwechsel und insbesondere das Cholesteringleichgewicht werden durch die HCV-Infektion beeinflusst. Die Korrelation zwischen Lipidstoffwechsel und HCV wurde klinisch seit langem beobachtet. In den Leberbiopsien von mit HCV infizierten Patienten wurde ein Anstieg der in den Lipidtröpfchen im Cytosol akkumulierten neutralen Lipide festgestellt (Dienes et al. 1982). Das Hepatitis-C-Virus wurde auch von Hypobetalipoproteinämie, Hypocholesterinämie und Lebersteatose begleitet (Schaefer und Chung 2013). Die Leber ist der primäre Ort für die Synthese, Speicherung und Oxidation von Lipiden und anderen Makromolekülen. Daher ist der Fettstoffwechsel in der Leber für die Aufrechterhaltung der systemischen Nährstoffhomöostase von wesentlicher Bedeutung. Eine Dysregulation des Leberlipidstoffwechsels ist ein Kennzeichen mehrerer Krankheiten wie Diabetes, alkoholische und nichtalkoholische Fettlebererkrankungen sowie parasitäre und virale Infektionen, einschließlich einer HCV-Infektion. (Erklärung der National Institutes of Health Consensus Development Conference: Management von Hepatitis C: 2002 - 10.-12. Juni 2002 2002; Fon Tacer und Rozman 2011; Chen et al. 2013; Reddy und Rao 2006; Visser et al. 2013; Wu und Parhofer 2014)
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Characteristics and clinical outcome of breast cancer patients with asymptomatic brain metastases
(2020)
Simple Summary: The prognosis for patients with breast cancer that has spread to the brain is poor, and survival for these women hasn’t improved over the last few decades. We do not currently test for asymptomatic brain metastases in breast cancer patients, although this does happen in some other types of cancer. In this study we wanted to find out more about breast cancer that has spread to the brain and in particular to see whether there might be any advantage to spotting brain metastases before the development of neurological symptoms. Overall, our results suggest that women could be better off if their brain metastases are diagnosed before they begin to cause symptoms. We now need to carry out a clinical trial to see what happens if we screen high-risk breast cancer patients for brain metastases. This will verify whether doing so could increase survival, symptom control or quality of life.
Abstract: Background: Brain metastases (BM) have become a major challenge in patients with metastatic breast cancer. Methods: The aim of this analysis was to characterize patients with asymptomatic BM (n = 580) in the overall cohort of 2589 patients with BM from our Brain Metastases in Breast Cancer Network Germany (BMBC) registry. Results: Compared to symptomatic patients, asymptomatic patients were slightly younger at diagnosis (median age: 55.5 vs. 57.0 years, p = 0.01), had a better performance status at diagnosis (Karnofsky index 80–100%: 68.4% vs. 57%, p < 0.001), a lower number of BM (>1 BM: 56% vs. 70%, p = 0.027), and a slightly smaller diameter of BM (median: 1.5 vs. 2.2 cm, p < 0.001). Asymptomatic patients were more likely to have extracranial metastases (86.7% vs. 81.5%, p = 0.003) but were less likely to have leptomeningeal metastasis (6.3% vs. 10.9%, p < 0.001). Asymptomatic patients underwent less intensive BM therapy but had a longer median overall survival (statistically significant for a cohort of HER2-positive patients) compared to symptomatic patients (10.4 vs. 6.9 months, p < 0.001). Conclusions: These analyses show a trend that asymptomatic patients have less severe metastatic brain disease and despite less intensive local BM therapy still have a better outcome (statistically significant for a cohort of HER2-positive patients) than patients who present with symptomatic BM, although a lead time bias of the earlier diagnosis cannot be ruled out. Our analysis is of clinical relevance in the context of potential trials examining the benefit of early detection and treatment of BM.
The ecological validity of neuropsychological testing (NT) has been questioned in the sports environment. A frequent criticism is that NT, mostly consisting of pen and paper or digital assessments, lacks relevant bodily movement. This study aimed to identify the determinants of a newly developed testing battery integrating both cognitive and motor demands. Twenty active individuals (25 ± 3 years, 11 males) completed the new motor-cognitive testing battery (MC), traditional NT (Stroop test, Trail Making test, Digit Span test) and isolated assessments of motor function (MF; Y-balance test, 20m-sprint, counter-movement jump). Kendal’s tau and partial Spearman correlations were used to detect associations between MC and NT/MF. Except for two items (Reactive Agility A and counter-movement jump; Run-Decide and sprint time; r = 0.37, p < 0.05), MC was not related to MF. Similarly, MC and NT were mostly unrelated, even when controlling for the two significant motor covariates (p > 0.05). The only MC item with (weak to moderate) associations to NT was the Memory Span test (Digit Span backwards and composite; r = 0.43–0.54, p < 0.05). In sum, motor-cognitive function appears to be largely independent from its two assumed components NT and MF and may represent a new parameter in performance diagnostics.
Background: A large number of idiosyncratic drug induced liver injury (iDILI) and herb induced liver injury(HILI) cases of variable quality has been published but some are a matter of concern if the cases were not evaluated for causality using a robust causality assessment method (CAM) such as RUCAM (Roussel Uclaf Causality Assessment Method) as diagnostiinjuryc algorithm. The purpose of this analysis was to evaluate the worldwide use of RUCAM in iDILI and HILI cases. Methods: The PubMed database (1993–30 June 2020) was searched for articles by using the following key terms: Roussel Uclaf Causality Assessment Method; RUCAM; Idiosyncratic drug induced liver injury; iDILI; Herb induced liver injury; HILI. Results: Considering reports published worldwide since 1993, our analysis showed the use of RUCAM for causality assessment in 95,885 cases of liver injury including 81,856 cases of idiosyncratic DILI and 14,029 cases of HILI. Among the top countries providing RUCAM based DILI cases were, in decreasing order, China, the US, Germany, Korea, and Italy, with China, Korea, Germany, India, and the US as the top countries for HILI. Conclusion: Since 1993 RUCAM is certainly the most widely used method to assess causality in IDILI and HILI. This should encourage practitioner, experts, and regulatory agencies to use it in order to reinforce their diagnosis and to take sound decisions.
Colorectal cancer (CRC) is one of the most frequently diagnosed tumor in humans and one of the most common causes of cancer-related death worldwide. The pathogenesis of CRC follows a multistage process which together with somatic gene mutations is mainly attributed to the dysregulation of signaling pathways critically involved in the maintenance of homeostasis of epithelial integrity in the intestine. A growing number of studies has highlighted the critical impact of members of the tripartite motif (TRIM) protein family on most types of human malignancies including CRC. In accordance, abundant expression of many TRIM proteins has been observed in CRC tissues and is frequently correlating with poor survival of patients. Notably, some TRIM members can act as tumor suppressors depending on the context and the type of cancer which has been assessed. Mechanistically, most cancer-related TRIMs have a critical impact on cell cycle control, apoptosis, epithelial–mesenchymal transition (EMT), metastasis, and inflammation mainly through directly interfering with diverse oncogenic signaling pathways. In addition, some recent publications have emphasized the emerging role of some TRIM members to act as transcription factors and RNA-stabilizing factors thus adding a further level of complexity to the pleiotropic biological activities of TRIM proteins. The current review focuses on oncogenic signaling processes targeted by different TRIMs and their particular role in the development of CRC. A better understanding of the crosstalk of TRIMs with these signaling pathways relevant for CRC development is an important prerequisite for the validation of TRIM proteins as novel biomarkers and as potential targets of future therapies for CRC.
Hypertonie stellt in der westlichen Welt die Haupttodesursache dar, obwohl sie im Hinblick auf die pharmakologischen Therapieoptionen gut behandelbar ist. Hauptursächlich ist hierfür eine, vor allem durch eine Non-Adhärenz (u.a. bedingt durch den asymptomatischen Charakter) und in selteneren Fällen eine aufgrund einer therapieresistente Hypertonie (TRH) verursachte, unzureichende Blutdruckkontrolle. Eine Möglichkeit zur Überprüfung der Therapietreue in der antihypertensiven Therapie ist der qualitative Nachweis der Arzneistoffe im Blut oder Urin. Unklar ist, inwiefern die Substanzen in einer biologischen Probe innerhalb des Dosierungsintervalls oder darüber hinaus nachweisbar sind und es zu einer Falschbeurteilung kommen kann.
Daher wurde eine quantitative chromatographisch-tandem-massenspektrometrische Methode für das Therapeutische Drug Monitoring von blutdrucksenkenden Arzneistoffen entwickelt und analytisch vollständig validiert. Bei 38 Patienten mit überwachter Medikamenteneinnahme wurde die Aussagekraft der Methode hinsichtlich der Bestätigung einer Adhärenz zunächst mittels zweier Wirkstoffkonzentrationen im Serum (Tal- und Spitzenspiegel) überprüft. Zur Bewertung der Konzentrationen wurden zwei Konzepte evaluiert. Einerseits wurde die untere Grenze des therapeutischen Referenzbereiches (TRR, Literaturdaten) und andererseits die mittels Rechenmodell (Daten pharmakokinetischer Studien) individuell ermittelte, dosisbezogene Arzneimittelkonzentration (DRC) evaluiert. In einem zweiten Studienansatz wurde diese neue quantitative Methode an einem Kollektiv von 36 ambulanten Patienten (ohne überwachte Medikamenteneinnahme) angewendet und zur Überprüfung der Aussagekraft mit Ergebnissen des etablierten Urinscreenings verglichen.
Die gemessenen Wirkstoffkonzentrationen von Atenolol (64 bis 564 ng/ml), Bisoprolol (2,5 bis 53 ng/ml), Metoprolol (5,8 bis 110 ng/ml), Nebivolol (0,32 bis 3,4 ng/ml), Hydrochlorothiazid (15 bis 606 ng/ml), Furosemid (22 ng/ml), Torasemid (17 bis 1829 ng/ml), Canrenon (25 bis 221 ng/ml), Amlodipin (2,4 bis 35 ng/ml), Lercanidipin (0,24 bis 21 ng/ml), Candesartan (6,0 bis 268 ng/ml), Telmisartan (22 bis 375 ng/ml) und Valsartan (115 bis 7962 ng/ml) haben gezeigt, dass die quantitative Analyse von Antihypertensiva in Serumproben und deren Auswertung auf Basis der individuell berechneten unteren DRC in der Beurteilung einer Adhärenz vielversprechend ist.
Die Auswertung auf Basis der unteren Grenze des TRR signalisierte bei den stationären Patienten (überwachte Einnahme) innerhalb der Substanzklasse der Diuretika (ohne Torasemid) bei 16,7 %, der β-Blocker bei 29,4 %, der Calciumkanal-Blocker bei 14,8 % und der AT1-Antagonisten bei 25 % fälschlicherweise eine Non-Adhärenz.
Die rein qualitative Urinanalyse zeigte im Falle der β-Blocker Atenolol, Bisoprolol und des Diuretikums HCT aufgrund einer hohen Bioverfügbarkeit, einer langen Halbwertszeit oder einer überwiegend renalen Ausscheidung der Muttersubstanz ein Nachweisfenster über das Dosierungsintervall hinaus, was bedingt, dass einige Patienten fälschlicherweise als adhärent gewertet wurden. Ein anderes Problem zeigte sich bei einigen Patienten, die mit dem AT1-Antagonist Candesartan oder dem Calciumkanal-Blocker Lercanidipin behandelt wurden und die als non-adhärent eingestuft wurden. Eine geringe Bioverfügbarkeit, eine hohe Metabolisierungsrate oder geringe renale Ausscheidung der unveränderten Arzneistoffe lies auf eine mangelhafte Nachweisbarkeit innerhalb des Dosierungsintervalls und damit auf eine eingeschränkte Beurteilbarkeit schließen.
Aus den Untersuchungen ergibt sich, dass es bei Anwendung qualitativer Nachweismethoden aufgrund besonderer Pharmakokinetiken einzelner antihypertensiver Wirkstoffe zur Fehleinschätzung der Adhärenz kommen kann. Die neu entwickelte Methodik in Form einer quantitativen Serumanalyse ist unter Verwendung patientenindividueller Bewertungskriterien bei dieser Fragestellung überlegen.
Postoperative thrombotic thrombocytopenic purpura (TTP) shows clinical presentation similar to classical TTP, whereas exact pathophysiological contexts remain unexplained. In this study, we investigated intraoperative and postoperative changes in ADAMTS-13 (a disintegrin and metalloprotease with thrombospondin type 1 motifs, member 13), von Willebrand factor (VWF), large VWF multimers, and interleukin-6 (IL-6) in vascular surgery patients. The objective was to compare the impact of endovascular, peripheral, and aortic surgery on target parameters which are supposed to play a role in surgery-associated TTP. A total of 93 vascular surgery patients were included and divided into 4 groups according to the specific type of intervention they underwent. Blood samples were taken preoperatively, intraoperatively, and postoperatively on days 2 and 4. The ADAMTS-13 activity decreased significantly in 3 of the 4 groups during surgery (from median 81% to 49%, P < .001, in the group undergoing aortoiliacal interventions), whereas the percentage of large VWF multimers increased in all groups of patients. von Willebrand factor antigen increased significantly in all groups on postoperative day 2 and IL-6 increased significantly in the intraoperative and early postoperative period. There was no significant correlation between the intraoperative decrease in ADAMTS-13 and the increase in VWF or IL-6. No patient in this study showed clinical picture of TTP; the precise cause and clinical significance of moderately reduced ADAMTS-13 activity in the perioperative setting have not yet been definitely determined.
Background: Macrophage Migration Inhibitory Factor (MIF) is highly elevated after cardiac surgery and impacts the postoperative inflammation. The aim of this study was to analyze whether the polymorphisms CATT5–7 (rs5844572/rs3063368,“-794”) and G>C single-nucleotide polymorphism (rs755622,-173) in the MIF gene promoter are related to postoperative outcome. Methods: In 1116 patients undergoing cardiac surgery, the MIF gene polymorphisms were analyzed and serum MIF was measured by ELISA in 100 patients. Results: Patients with at least one extended repeat allele (CATT7) had a significantly higher risk of acute kidney injury (AKI) compared to others (23% vs. 13%; OR 2.01 (1.40–2.88), p = 0.0001). Carriers of CATT7 were also at higher risk of death (1.8% vs. 0.4%; OR 5.12 (0.99–33.14), p = 0.026). The GC genotype was associated with AKI (20% vs. GG/CC:13%, OR 1.71 (1.20–2.43), p = 0.003). Multivariate analyses identified CATT7 predictive for AKI (OR 2.13 (1.46–3.09), p < 0.001) and death (OR 5.58 (1.29–24.04), p = 0.021). CATT7 was associated with higher serum MIF before surgery (79.2 vs. 50.4 ng/mL, p = 0.008). Conclusion: The CATT7 allele associates with a higher risk of AKI and death after cardiac surgery, which might be related to chronically elevated serum MIF. Polymorphisms in the MIF gene may constitute a predisposition for postoperative complications and the assessment may improve risk stratification and therapeutic guidance.