Vasodilation and Exercise Capacity in Patients with End-Stage Renal Disease: A Prospective Proof-of-Concept Study.

BACKGROUND Previous data have pointed to the fact that vascular function is significantly impaired in patients with end-stage renal disease (ESRD). We aimed to better characterise vasodilation and exercise capacity in both ESRD and chronic heart failure (CHF) patients. METHODS A total of 30 ESRD patients (23 male; mean age 45.7 ± 9.9 years) were included in a prospective proof-of-concept study at a tertiary care academic centre. The patients underwent forearm venous plethysmography with post-ischaemic peak blood flow (PF) and flow-dependent flow (FDF) testing as well as cardiopulmonary exercise testing during the morning of the day following the last haemodialysis. After matching for age, gender, and body mass index, the data were compared to 30 patients with CHF and 20 age-matched healthy controls. RESULTS PF in ESRD patients was reduced when compared to that in CHF patients (12.5 ± 4.2 vs. 15.6 ± 6.9 ml/100 ml/min; p = 0.048) and healthy controls (26.4 ± 9.3 ml/100 ml/min; p < 0.001). When compared to controls, FDF was significantly reduced in ESRD patients (7.6 ± 3.1 vs. 6.0 ± 2.5 ml/100 ml/min; p = 0.03), but not in CHF patients, whereas resting blood flow did not differ between the ESRD, CHF, and healthy control groups. In contrast to indices of vasodilative capacity, maximum exercise capacity (peakVO2) was higher in ESRD when compared to CHF patients (23.8 ± 7.3 vs. 18.8 ± 5.2 ml/min/kg), but significantly impaired when compared to controls (32.8 ± 6.7 ml/min/kg; p < 0.001). CONCLUSION In this proof-of-concept study, exercise capacity was relatively preserved, while vasodilative capacity was substantially impaired in ESRD patients. Additional studies are warranted to examine the underlying mechanisms and potential clinical implications of our findings

[18F]F-DED PET imaging of reactive astrogliosis in neurodegenerative diseases: preclinical proof of concept and first-in-human data

ObjectivesReactive gliosis is a common pathological hallmark of CNS pathology resulting from neurodegeneration and neuroinflammation. In this study we investigate the capability of a novel monoamine oxidase B (MAO-B) PET ligand to monitor reactive astrogliosis in a transgenic mouse model of Alzheimer`s disease (AD). Furthermore, we performed a pilot study in patients with a range of neurodegenerative and neuroinflammatory conditions.MethodsA cross-sectional cohort of 24 transgenic (PS2APP) and 25 wild-type mice (age range: 4.3-21.0 months) underwent 60 min dynamic [F-18]fluorodeprenyl-D2 ([F-18]F-DED), static 18 kDa translocator protein (TSPO, [F-18]GE-180) and beta-amyloid ([F-18]florbetaben) PET imaging. Quantification was performed via image derived input function (IDIF, cardiac input), simplified non-invasive reference tissue modelling (SRTM2, DVR) and late-phase standardized uptake value ratios (SUVr). Immunohistochemical (IHC) analyses of glial fibrillary acidic protein (GFAP) and MAO-B were performed to validate PET imaging by gold standard assessments. Patients belonging to the Alzheimer's disease continuum (AD, n = 2), Parkinson's disease (PD, n = 2), multiple system atrophy (MSA, n = 2), autoimmune encephalitis (n = 1), oligodendroglioma (n = 1) and one healthy control underwent 60 min dynamic [F-18]F-DED PET and the data were analyzed using equivalent quantification strategies.ResultsWe selected the cerebellum as a pseudo-reference region based on the immunohistochemical comparison of age-matched PS2APP and WT mice. Subsequent PET imaging revealed that PS2APP mice showed elevated hippocampal and thalamic [F-18]F-DED DVR when compared to age-matched WT mice at 5 months (thalamus: + 4.3%;p = 0.048), 13 months (hippocampus: + 7.6%, p = 0.022) and 19 months (hippocampus: + 12.3%, p < 0.0001;thalamus: + 15.2%, p < 0.0001). Specific [F-18]F-DED DVR increases of PS2APP mice occurred earlier when compared to signal alterations in TSPO and beta-amyloid PET and [F-18]F-DED DVR correlated with quantitative immunohistochemistry (hippocampus: R = 0.720, p < 0.001;thalamus: R = 0.727, p = 0.002). Preliminary experience in patients showed [F-18]F-DED V-T and SUVr patterns, matching the expected topology of reactive astrogliosis in neurodegenerative (MSA) and neuroinflammatory conditions, whereas the patient with oligodendroglioma and the healthy control indicated [F-18]F-DED binding following the known physiological MAO-B expression in brain.Conclusions[F-18]F-DED PET imaging is a promising approach to assess reactive astrogliosis in AD mouse models and patients with neurological diseases

Das Studium der Kunstgeschichte an der Friedrich-Wilhelms-Universität um 1900

Peer Reviewe

Cortisol awakening response in mothers of young children with sleep problems. Effects of an internet-based treatment program(Mini-KiSS Online)

Brandhorst I, Bernhardt C, Hautzinger M, Schlarb A. Die Cortisol-Aufwachreaktion bei Müttern junger Kinder mit Schlafproblemen. Effekte eines internetbasierten Behandlungsprogramms (Mini-KiSS Online). Somnologie. 2017;21(1):53-66.Background. Sleep problems in young children are common and provoke clinically significant stress in their parents. Studies indicate that the treatment of the child's sleep problem can simultaneously reduce maternal stress. Objectives. In the present study we aimed to investigate, if maternal stress can be reduced by an Internet-based treatment program for sleep disturbances in young children (Mini-KiSS Online). The research also investigated whether the cortisol awakening response is a suitable tool for the detection of a central nervous stress response to such a change. Materials and methods. Mothers (N = 23) of young children (six months to four years) with sleep problems were randomized to either the treatment or waiting-list control condition. Pre-and post-measurement assessed maternal distress by subjective questionnaires and physiologically by cortisol awakening response. The sleep behaviour of the child was assessed using a sleep-diary and the sleep behaviour of mothers using a questionnaire. Results. Mini-KiSS Online partially reduced stress and improved child and maternal sleep. Reductions in cortisol level did not reach statistical significance. There was an association between reductions in subjective stress and cortisol level. Conclusion. The cortisol awakening response seems to be an appropriatemeasure to detect stress in mothers of sleep-disturbed young children. However, larger sample sizes seem to be necessary to identify changes between measurement points

Angioedemas associated with renin-angiotensin system blocking drugs: Comparative analysis of spontaneous adverse drug reaction reports

INTRODUCTION: Angioedema is a subcutaneous swelling typically affecting the face, larynx or pharynx. It is a known adverse drug reaction (ADR) of ACE inhibitors (ACEi), angiotensin-II-receptor blockers (ARBs) and aliskiren (renin inhibitor). Several studies have reported pathophysiological mechanisms and risk factors of ACEi-associated angioedemas, whereas little is known for ARBs and aliskiren. The aim of the study was to analyze comparatively ACEi versus ARBs and aliskiren angioedema reports contained in the European ADR database EudraVigilance with regard to reported risk factors and clinical phenotypes. METHODS: All spontaneous angioedema reports received between 01/2010-06/2017 reporting either an ACEi, ARB, or aliskiren as "suspected/interacting" drug were identified using the Standardized MedDRA Query "angioedema (narrow)". In order to perform a comparative analysis, odds ratios (ORs) were calculated for angioedema reports of ACEi (n = 3.194) versus ARBs (n = 687) and aliskiren (n = 162). RESULTS: More patients with a history of allergy were included in angioedema reports of ARBs (6.8%) and aliskiren (13.6%) versus ACEi (4.3%). "Urticaria" as an ADR was reported more frequently in angioedema reports of ARBs (18.5%) and aliskiren (9.0%) versus ACEi (5.0%). ACEi-associated angioedemas were more often designated as "life-threatening" compared to ARBs (OR 2.2 [1.6–2.9]) and aliskiren-associated angioedemas (OR 14.2 (3.5–57.4). Concomitant therapy with mTOR inhibitors (OR 4.3 [1.0–17.9]) and fibrinolytics (OR 7.8 [1.1–57.2]) was reported more often in ACEi versus ARBs angioedema reports. CONCLUSION: The reported clinical phenotypes differed between ACEi versus ARBs and aliskiren angioedema reports. Differences between the patient populations as observed in our study or differences with regard to underlying pathomechanisms could account for this finding. Due to the methodological limitations of spontaneous reporting systems, we cannot draw a firm conclusion in this regard. Hence, further research is necessary to confirm our observation and elucidate the underyling causes

Loss of serum and glucocorticoid-regulated kinase 3 (SGK3) does not affect proliferation and survival of multiple myeloma cell lines.

Multiple myeloma (MM) is a generally fatal plasma cell cancer that often shows activation of the phosphoinositide 3-kinase/Akt (PI3K/Akt) pathway. Targeted pharmacologic therapies, however, have not yet progressed beyond the clinical trial stage, and given the complexity of the PI3K/Akt signalling system (e.g. multiple protein isoforms, diverse feedback regulation mechanisms, strong variability between patients) it is mandatory to characterise its ramifications in order to better guide informed decisions about the best therapeutic approaches. Here we explore whether serum and glucocorticoid-regulated kinase 3 (SGK3), a potential downstream effector of PI3K, plays a role in oncogenic signalling in MM cells--either in concert with or independent of Akt. SGK3 was expressed in all MM cell lines and in all primary MM samples tested. Four MM cell lines representing a broad range of intrinsic Akt activation (very strong: MM.1s, moderate: L 363 and JJN-3, absent: AMO-1) were chosen to test the effects of transient SGK3 knockdown alone and in combination with pharmacological inhibition of Akt, PI3K-p110α, or in the context of serum starvation. Although the electroporation protocol led to strong SGK3 depletion for at least 5 days its absence had no substantial effect on the activation status of potential downstream substrates, or on the survival, viability or proliferation of MM cells in all experimental contexts tested. We conclude that it is unlikely that SGK3 plays a significant role for oncogenic signalling in multiple myeloma

SGK3 expression in relation to (activated) signalling components of the PI3K/Akt system in MM cell lines.

<p>Shown are Western blots for PI3K pathway-associated signalling proteins or for their phosphorylated forms. Cells from the MM cell lines indicated were harvested from standard cell culture, the signals are thus representative of steady-state levels in culture. One cell lysate per line was used to load multiple gels. The representative β-actin control derives from the same blot on which SGK3 and P-FOXO1/3A were also stained. Note: the strong phospho-STAT3 signal in INA-6 cells results from permanent supplementation of the culture with recombinant human IL-6.</p

SGK3 expression in relation to (activated) signalling components of the PI3K/Akt system in primary MM cells.

<p>Shown are Western blots prepared from frozen pellets of primary MM cells purified by CD138 microbead selection. The material was used to load two gels, with the representative β-actin control belonging to the same blot on which PI3K-p110α, P-FOXO1/3A, P-Akt (Thr308) and pan-Akt were also stained. Of note, the phospho-Akt (Thr308) antibody also stained a slightly larger band in most primary MM samples (marked by "?") that was not visible in any MM cell line. This band runs slightly higher, though, than the SGK3 band as stained on the parallel blot. Staining for P-PRAS40 (CST; no. 2997) was performed after staining for P-GSK-3β. Since both antibodies were raised in rabbit the latter signal reappeared in the P-PRAS40 blot.</p