The brain-specific astroglial protein GFAP is a blood biomarker candidate indicative of intracerebral hemorrhage in patients with symptoms suspicious of acute stroke. Comparably little, however, is ...known about GFAP release in other neurological disorders. In order to identify potential "specificity gaps" of a future GFAP test used to diagnose intracerebral hemorrhage, we measured GFAP in the blood of a large and rather unselected collective of patients with neurological diseases.
Within a one-year period, we randomly selected in-patients of our university hospital for study inclusion. Patients with ischemic stroke, transient ischemic attack and intracerebral hemorrhage were excluded. Primary endpoint was the ICD-10 coded diagnosis reached at discharge. During hospital stay, blood was collected, and GFAP plasma levels were determined using an advanced prototype immunoassay at Roche Diagnostics.
A total of 331 patients were included, covering a broad spectrum of neurological diseases. GFAP levels were low in the vast majority of patients, with 98.5% of cases lying below the cut-off that was previously defined for the differentiation of intracerebral hemorrhage and ischemic stroke. No diagnosis or group of diagnoses was identified that showed consistently increased GFAP values. No association with age and sex was found.
Most acute and chronic neurological diseases, including typical stroke mimics, are not associated with detectable GFAP levels in the bloodstream. Our findings underline the hypothesis that rapid astroglial destruction as in acute intracerebral hemorrhage is mandatory for GFAP increase. A future GFAP blood test applied to identify patients with intracerebral hemorrhage is likely to have a high specificity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•The use of CAM for chronic diseases such as multiple sclerosis (MS) is an important issue for those affected.•A structured questionnaire was sent to real and web-based self-help groups for MS in ...Germany.•343 answers could be evaluated; 81.9% said they were using CAM, nearly half (44.8%) used it alternatively.•Patients with MS have a strong interest in CAM.
The use of complementary and alternative medicine (CAM) for chronic diseases such as multiple sclerosis (MS) is becoming an increasingly important issue for those affected. Especially in Germany there are only a few studies dealing with CAM, as yet. The aim of this study was to assess the prevalence, the methods used, the subjective benefits as well as physician/patient communication.
A structured questionnaire including demographic and disease-specific data, CAM use, perceived benefits as well as physician/patient communication was sent to real and web-based self-help groups for MS in Germany.
343 answers could be evaluated. 77.3% of the participants were females. The mean age was 45.0 ± 11.9 years and the duration of the disease was 12.0 ± 9.6 years. 81.9% said they were using CAM, nearly half (44.8%) used it alternatively to conventional medicine. The average number of CAM- methods used were 3.6. The most popular methods were vitamin supplements, Yoga/Thai chi/Qi Gong, relaxation techniques and meditation. Approximately half (139/49.5%) of CAM users disclosed this to their treating neurologist. Yet, 37,6% have doubts on the competence of the respective physician.
Patients with MS have a strong interest in CAM. Usage as alternative therapy is widespread and puts patients at risk of progress of the disease. As patient/physician communication on the topic is increasing, neurologists should be attentive to guiding their patients through safe complementary methods.
The perfect crime? CCSVI not leaving a trace in MS Mayer, Christoph A; Pfeilschifter, Waltraud; Lorenz, Matthias W ...
Journal of neurology, neurosurgery and psychiatry,
04/2011, Letnik:
82, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Multiple sclerosis (MS) is a chronic, inflammatory demyelinating disease of the central nervous system, believed to be triggered by an autoimmune reaction to myelin. Recently, a fundamentally ...different pathomechanism termed 'chronic cerebrospinal venous insufficiency' (CCSVI) was proposed, provoking significant attention in the media and scientific community.
Twenty MS patients (mean age 42.2 ± 13.3 years; median Extended Disability Status Scale 3.0, range 0-6.5) were compared with 20 healthy controls. Extra- and intracranial venous flow direction was assessed by colour-coded duplex sonography, and extracranial venous cross-sectional area (VCSA) of the internal jugular and vertebral veins (IJV/VV) was measured in B-mode to assess the five previously proposed CCSVI criteria. IJV-VCSA ≤ 0.3 cm(2) indicated 'stenosis,' and IJV-VCSA decrease from supine to upright position 'reverted postural control.' The sonographer, data analyser and statistician were blinded to the patient/control status of the participants.
No participant showed retrograde flow of cervical or intracranial veins. IJV-VCSA ≤ 0.3 cm(2) was found in 13 MS patients versus 16 controls (p=0.48). A decrease in IJV-VCSA from supine to upright position was observed in all participants, but this denotes a physiological finding. No MS patient and one control had undetectable IJV flow despite deep inspiration (p=0.49). Only one healthy control and no MS patients fulfilled at least two criteria for CCSVI.
This triple-blinded extra- and transcranial duplex sonographic assessment of cervical and cerebral veins does not provide supportive evidence for the presence of CCSVI in MS patients. The findings cast serious doubt on the concept of CCSVI in MS.
Mesothelin is a tumor differentiation antigen frequently overexpressed in tumors such as mesothelioma, ovarian, pancreatic, and lung adenocarcinomas while showing limited expression in nonmalignant ...tissues. Mesothelin is therefore an attractive target for cancer therapy using antibody-drug conjugates (ADC). This study describes the detailed characterization of anetumab ravtansine, here referred to as BAY 94-9343, a novel ADC consisting of a human anti-mesothelin antibody conjugated to the maytansinoid tubulin inhibitor DM4 via a disulfide-containing linker. Binding properties of the anti-mesothelin antibody were analyzed using surface plasmon resonance, immunohistochemistry, flow cytometry, and fluorescence microscopy. Effects of BAY 94-9343 on cell proliferation were first studied in vitro and subsequently in vivo using subcutaneous, orthotopic, and patient-derived xenograft tumor models. The antibody binds to human mesothelin with high affinity and selectivity, thereby inducing efficient antigen internalization. In vitro, BAY 94-9343 demonstrated potent and selective cytotoxicity of mesothelin-expressing cells with an IC(50) of 0.72 nmol/L, without affecting mesothelin-negative or nonproliferating cells. In vivo, BAY 94-9343 localized specifically to mesothelin-positive tumors and inhibited tumor growth in both subcutaneous and orthotopic xenograft models. In addition, BAY 94-9343 was able to induce a bystander effect on neighboring mesothelin-negative tumor cells. Antitumor efficacy of BAY 94-9343 correlated with the amount of mesothelin expressed and was generally superior to that of standard-of-care regimen resulting in complete tumor eradication in most of the models. BAY 94-9343 is a selective and highly potent ADC, and our data support its development for the treatment of patients with mesothelin-expressing tumors.
Highlights • CerS2/C24-ceramides are upregulated in white blood cells of EAE mice and MS patients. • CerS2 deficiency reduces pathology of EAE. • CerS2 deficiency reduces migration capacity of ...neutrophils. • G-CSF induces the expression of CerS2 and C24-ceramides. • G-CSF induced migration of neutrophils is CerS2-dependent regulation via CXCR2 expression.
Blocking pyrimidine de novo synthesis by inhibiting dihydroorotate dehydrogenase is used to treat autoimmunity and prevent expansion of rapidly dividing cell populations including activated T cells. ...Here we show memory T cell precursors are resistant to pyrimidine starvation. Although the treatment effectively blocked effector T cells, the number, function and transcriptional profile of memory T cells and their precursors were unaffected. This effect occurred in a narrow time window in the early T cell expansion phase when developing effector, but not memory precursor, T cells are vulnerable to pyrimidine starvation. This vulnerability stems from a higher proliferative rate of early effector T cells as well as lower pyrimidine synthesis capacity when compared with memory precursors. This differential sensitivity is a drug-targetable checkpoint that efficiently diminishes effector T cells without affecting the memory compartment. This cell fate checkpoint might therefore lead to new methods to safely manipulate effector T cell responses.
Ceramides are mediators of inflammatory processes. In experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis (MS), we observed that CerS6 mRNA expression was ...upregulated 15‐fold in peripheral blood leukocytes before the onset of EAE symptoms. In peripheral blood leukocytes from MS patients, a 3.9‐fold upregulation was found. Total genetic deletion of CerS6 and the selective deletion of CerS6 in peripheral blood leucocytes exacerbated the progression of clinical symptoms in EAE mice. This was associated with enhanced leukocyte, predominantly neutrophil infiltration and enhanced demyelination in the lumbar spinal cord of EAE mice. Interferon‐gamma/tumor necrosis factor alpha (IFN‐γ/TNF‐α) and granulocyte colony‐stimulating factor (G‐CSF) both drive EAE development and induce expression of the integrin CD11b and the chemokine receptor C‐X‐C motif chemokine receptor 2 (CXCR2), and we found they also induce CerS6 expression. In vivo, the genetic deletion of CerS6 enhanced the activation/migration of neutrophils, as reflected by an enhanced upregulation of CD11b and CXCR2. In vitro, the genetic deletion of CerS6 enhanced the activation status of IFN‐γ/TNF‐α‐stimulated neutrophils, as shown by increased expression of nitric oxide and CD11b and an increased adhesion capacity. In G‐CSF‐stimulated neutrophils, the migration status was enhanced, as reflected by an elevated level of CXCR2 and an increased migration capacity. These data suggest that CerS6/C16‐Cer mediates feedback regulation by inhibiting the formation of CD11b and CXCR2, which are induced either by IFN‐γ/TNF‐α or by G‐CSF, respectively. We conclude that CerS6/C16‐Cer mediates anti‐inflammatory effects during the development of EAE and MS possibly by suppressing the migration and deactivation of neutrophils.
BACKGROUND AND PURPOSE
Roscovitine, a cyclin‐dependent kinase (CDK) inhibitor that induces tumour cell death, is under evaluation as an anti‐cancer drug. By triggering leukocyte apoptosis, ...roscovitine can also enhance the resolution of inflammation. Beyond death‐inducing properties, we tested whether roscovitine affects leukocyte‐endothelial cell interaction, a vital step in the onset of inflammation.
EXPERIMENTAL APPROACH
Leukocyte‐endothelial cell interactions were evaluated in venules of mouse cremaster muscle, using intravital microscopy. In primary human endothelial cells, we studied the influence of roscovitine on adhesion molecules and on the nuclear factor‐κB (NF‐κB) pathway. A cellular kinome array, in vitro CDK profiling and RNAi methods were used to identify targets of roscovitine.
KEY RESULTS
In vivo, roscovitine attenuated the tumour necrosis factor‐α (TNF‐α)‐induced leukocyte adherence to and transmigration through, the endothelium. In vitro, roscovitine strongly inhibited TNF‐α‐evoked expression of endothelial adhesion molecules (E‐selectin, intercellular cell adhesion molecule, vascular cell adhesion molecule). Roscovitine blocked NF‐κB‐dependent gene transcription, but not the NF‐κB activation cascade inhibitor of κB (IκB) kinase activity, IκB‐α degradation, p65 translocation. Using a cellular kinome array and an in vitro CDK panel, we found that roscovitine inhibited protein kinase A, ribosomal S6 kinase and CDKs 2, 5, 7 and 9. Experiments using kinase inhibitors and siRNA showed that the decreased endothelial activation was due solely to blockade of CDK5 and CDK9 by roscovitine.
CONCLUSIONS AND IMPLICATIONS
Our study highlights a novel mode of action for roscovitine, preventing endothelial activation and leukocyte‐endothelial cell interaction by inhibition of CDK5 and 9. This might expand its usage as a promising anti‐inflammatory compound.
Background & Aims
Decompensation is a hallmark of disease progression in cirrhotic patients. Early detection of a phase transition from compensated cirrhosis to decompensation would enable targeted ...therapeutic interventions potentially extending life expectancy. This study aims to (a) identify the predictors of decompensation in a large, multicentric cohort of patients with compensated cirrhosis, (b) to build a reliable prognostic score for decompensation and (c) to evaluate the score in independent cohorts.
Methods
Decompensation was identified in electronic health records data from 6049 cirrhosis patients in the IBM Explorys database training cohort by diagnostic codes for variceal bleeding, encephalopathy, ascites, hepato‐renal syndrome and/or jaundice. We identified predictors of clinical decompensation and developed a prognostic score using Cox regression analysis. The score was evaluated using the IBM Explorys database validation cohort (N = 17662), the Penn Medicine BioBank (N = 1326) and the UK Biobank (N = 317).
Results
The new Early Prediction of Decompensation (EPOD) score uses platelet count, albumin, and bilirubin concentration. It predicts decompensation during a 3‐year follow‐up in three validation cohorts with AUROCs of 0.69, 0.69 and 0.77, respectively, and outperforms the well‐known MELD and Child‐Pugh score in predicting decompensation. Furthermore, the EPOD score predicted the 3‐year probability of decompensation.
Conclusions
The EPOD score provides a prediction tool for the risk of decompensation in patients with cirrhosis that outperforms well‐known cirrhosis scores. Since EPOD is based on three blood parameters, only, it provides maximal clinical feasibility at minimal costs.
Multiple sclerosis patients are treated with fingolimod (FTY720), a prodrug that acts as an immune modulator. FTY720 is first phosphorylated to FTY720‐P and then internalizes sphingosine‐1‐phosphate ...receptors, preventing lymphocyte sequestration. IL‐33 is released from necrotic endothelial cells and contributes to MS severity by coactivating T cells. Herein we analyzed the influence of FTY720, FTY720‐P, and S1P on IL‐33 induced formation of IL‐2 and IFN‐γ, by using IL‐33 receptor overexpressing EL4 cells, primary CD8+ T cells, and splenocytes. EL4‐ST2 cells released IL‐2 after IL‐33 stimulation that was inhibited dose‐dependently by FTY720‐P but not FTY720. In this system, S1P increased IL‐2, and accordingly, inhibition of S1P producing sphingosine kinases diminished IL‐2 release. In primary CD8+ T cells and splenocytes IL‐33/IL‐12 stimulation induced IFN‐γ, which was prevented by FTY720 but not FTY720‐P, independently from intracellular phosphorylation. The inhibition of IFN‐γ by nonphosphorylated FTY720 was mediated via the SET/protein phosphatase 2A (PP2A) pathway, since a SET peptide antagonist also prevented IFN‐γ formation and the inhibition of IFN‐γ by FTY720 was reversible by a PP2A inhibitor. While our findings directly improve the understanding of FTY720 therapy in MS, they could also contribute to side effects of FTY720 treatment, like progressive multifocal leukoencephalopathy, caused by an insufficient immune response to a viral infection.
Multiple sclerosis patients are treated with FTY720 whose phosphorylated moiety prevents lymphocyte sequestration. Herein we present that (A) FTY720‐P inhibits IL‐33 induced IL‐2 production in EL4‐ST2 cells and (B) nonphosphorylated FTY720 attenuated IFN‐γ production of IL‐33/IL‐12 stimulated CD8+ via SET/PP2A. These results further extend the therapeutic mechanisms of fingolimod in MS.
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