Factors contributing to conductance and outcome of specific immunotherapy: Data from the German National Health Interview and Examination Survey 1998

Background: Allergies are an increasingly relevant public health problem. Specific immunotherapy (sIT) is presently the only causal treatment option. This study aimed to assess the frequency and determinants of sIT use and factors associated with treatment outcome. Methods: A cross-sectional analysis based on data from the German National Health Interview and Examination Survey 1998. Results: 2727 (39.2%) of study participants reported physician-diagnosed allergic disease. Among these, 16.5% (n ¼ 296) stated to have undergone sIT. In this subset 43.4% (n ¼ 129) reported improvement of symptoms, 21.9% (n ¼ 65) had not changed, and 34.6% (n ¼ 102) had discontinued treatment. The majority of patients treated with sIT showed multiple allergic symptoms and sensitisations. Factors significantly correlated with sIT treatment in multivariable analyses included rhinitis, asthma, several sensitisations, higher social status and residence in larger cities. Rhinitis and neurodermatitis were positively, and food allergy was negatively associated with the completion of sIT. No factors predicting improvement due to sIT could retrospectively be identified. Conclusion: Treatment with sIT under ‘real life’ conditions does not exactly follow current clinical guideline recommendations. In addition, patients may be selected for IT by socio-demographic factors. Whether this contributes to considerable discontinuation rates and limited effectiveness as observed here, needs further investigation.Peer Reviewe

GLRB allelic variation associated with agoraphobic cognitions, increased startle response and fear network activation : a potential neurogenetic pathway to panic disorder

The molecular genetics of panic disorder (PD) with and without agoraphobia (AG) are still largely unknown and progress is hampered by small sample sizes. We therefore performed a genome-wide association study with a dimensional, PD/AG - related anxiety phenotype based on the Agoraphobia Cognition Questionnaire (ACQ) in a sample of 1,370 healthy German volunteers of the CRC TRR58 MEGA study wave 1. A genome-wide significant association was found between ACQ and single non-coding nucleotide variants of the GLRB gene (rs78726293, p=3.3x10-8; rs191260602, p=3.9x10-8). We followed up on this finding in a larger dimensional ACQ sample (N=2,547) and in independent samples with a dichotomous AG phenotype based on the Symptoms Checklist (SCL-90; N=3,845) and a case control sample with the categorical phenotype PD/AG (Ncombined =1,012) obtaining highly significant p-values also for GLRB single nucleotide variants rs17035816 (p=3.8x10-4) and rs7688285 (p=7.6x10-5). GLRB gene expression was found to be modulated by rs7688285 in brain tissue as well as cell culture. Analyses of intermediate PD/AG phenotypes demonstrated increased startle reflex and increased fear network as well as general sensory activation by GLRB risk gene variants rs78726293, rs191260602, rs17035816 and rs7688285. Partial Glrb knockout-mice demonstrated an agoraphobic phenotype. In conjunction withthe clinical observation that rare coding GLRB gene mutations are associated with the neurological disorder hyperekplexia characterized by a generalized startle reaction and agoraphobic behavior, our data provide evidence that non-coding, though functional GLRB gene polymorphisms may predispose to PD by increasing startle response and agoraphobic cognitions.PostprintPeer reviewe

Modulation of the rectification properties of GIRK channels by G Protein subunits

G-Protein-gekoppelte einwärtsgleichrichtende Kalium-Kanäle sind durch zwei Eigenschaften gekennzeichnet: (I) Die Leitfähigkeit für K+-Ionen ist positiv des Kalium-Gleichgewichtspotentials reduziert und (II) die Kanal-Aktivität wird durch Bindung von G betagamma-Dimere heterotrimerer Gi/o-Proteine reguliert. In der Literatur wurde die Aktivierung von GIRK-Kanälen als eine Zunahme ihrer Offenwahrscheinlichkeit unabhängig vom Membranpotential beschrieben. Die vorliegenden Untersuchungen zeigten, dass es bei starker Aktivierung des GIRK-Kanals durch G betagamma-Dimere auch zu einer Abschwächung der Einwärtsgleichrichtung kommt. Im heterologen Expressionssystem konnte bei Rezeptor-Stimulation mit Agonist die Einwärtsgleichrichtung von GIRK-Kanälen abhängig von der Stärke der Koexpression von G betagamma-Dimeren geschwächt werden. Dieser Effekt entstand nicht durch eine Veränderung der Affinität, mit der Polyamine und Mg2+-Ionen den GIRK-Kanal membranpotentialabhängig blockieren. Die Kinetik, mit der Polyamine den GIRK-Kanal blockieren, war nicht verändert; eine Erhöhung der intrazellulären Mg2+-Konzentration um den Faktor 20 konnte eine Abschwächung der Einwärtsgleichrichtung nicht mindern. Es wurde vermutet, dass eine Änderung der Konformation von Strukturen nahe des Selektivitätsfilters die Abschwächung der Einwärtsgleichrichtung verursacht. Gestützt wurde diese Vermutung zum einen dadurch, dass Ba2+- und Cs+-Ionen, die von extrazellulärer Seite her den Kanal an Strukturen nahe des Selektivitätsfilters blockieren können, unter schwach einwärtsgleichrichtenden Bedingungen eine geringere Bindungsaffinität hatten und zum anderen dadurch, dass das relative Ausmaß des GIRK-Kanal-Blocks durch Cs+-Ionen mit der Stärke der Einwärtsgleichrichtung korrelierte.G Protein-coupled inwardly rectifying potassium channels (GIRK channels) conduct K+ ions at membrane potentials negative of the potassium reversal potential and are activated by binding of G betagamma subunits of heterotrimeric Gi/o proteins. Activation of GIRK channels was described to be a process, which results in an increase in open probabilty independent of the membrane potential. The investigations of this thesis enhance this modell by supoorting evidence, that the degree of rectification becomes weakened upon strong GIRK channel activation. The weakened inward rectification was not associated with a shift in Mg2+ or polyamine binding affinities towards GIRK. It was concluded, that structeres close to the selectivity filter may be involved in the process, as proposed by the finding, that Cs+ and Ba2+ block (which is considered to take place near the selectivity filter) is less efficient in weakly inward rectifying GIRK channels

Interaction of activated G Protein with activated G Protein coupled receptors

Aktivierte G-Protein gekoppelte Rezeptoren aktivieren heterotrimere GProteine, in dem sie den Austausch von GDP zu GTP am G-Protein katalysieren. Theoretische Untersuchungen mittels eines vereinfachten kinetischen Modells des Gi/o-Protein Zyklus legen nahe, dass nicht nur GDP-,sondern auch GTP-gebundene Gi/o-Proteine mit aktivierten α2A-adrenergen Rezeptoren (α2A-AR) interagieren können. Demgemäß sollten aktivierte Gi/o-Proteine mit aktivierten α2A-AR vermehrt interagieren, wenn mehr α2A-AR aktiviert werden als für eine maximale G-Protein Aktivierung nötig sind. Dies sollte zu einer paradoxen Deaktivierung von Gi/o-Proteinen und deren Effektorproteinen, z.B. dem G-Protein gekoppelten, einwärtsgleichrichtenden Kaliumkanal (GIRK-Kanal) führen. Mittels FRET lässt sich in lebenden und in permeabilisierten Zellen unter Kontrolle der intrazellulären Nukleotide die Aktivierung von α2A-AR, die Interaktion von Gi/o-Proteinen mit α2A-AR und die Aktivierung von Gi/o-Proteinen bestimmen. Die Arbeit zeigt auf mehreren Ebenen, dass Go-Proteine mit aktivierten α2A-AR interagieren und im nukleotidfreiem Zustand sequestriert werden können: (I) Go-Proteine,irreversibel durch GTPγS aktiviert werden abhängig von der Rezeptor Aktivierung in Abwesenheit von Nukleotiden deaktiviert, (II) Go-Proteine interagieren in Gegenwart niedriger Nukleotidkonzentrationen in wesentlich größer Fraktion mit aktivierten α2A-AR als in Gegenwart hoher Nukleotidkonzentrationen, (III) Go Proteine können in Gegenwart niedriger GTP und GTPγS-Konzentrationen bei Aktivierung des α2A-AR inaktiviert werden. Die Arbeit zeigt exemplarisch an der Signalkaskade des α2A-AR und Go, dass der G-Protein Zyklus in lebenden Zellen reversibel ist, woraus eine Deaktivierung aktivierter G-Proteine und aktivierter G-Protein Effektoren resultieren kann. Dies erklärt paradoxe Befunde zur Deaktivierung von GIRK-Kanälen in Myozyten durch A1-Rezeptoren.G protein coupled receptors activate heterotrimeric G proteins by catalyzing the exchange of GDP with GTP at the Gα subunit. Kinetic modelling of the Gi/o protein cycle suggests, that both GDP- and GTP-bound Gi/o proteins interact with activated α2A-adrenergic receptors (α2A-AR). Consequently, upon activating more α2A-AR then required for maximal Gi/o protein activation, the interaction of activated Gi/o proteins with activated α2A-AR will become incresingly prominent and ultimately lead to a paradoxic deactivation of Gi/o proteins and their effectors such as G protein coupled inwardly rectifying potassium channels. Using means of FRET allows the detection of the receptor activation, receptor/G protein interaction and G protein activation in single living cells and in single permeabilized cells while controlling the intracellular nucleotide composition.Data suggest, that activated Go proteins may be sequestrated at activated α2A-AR in their nucleotide-free state: (I) Go proteins irreversibly activated by GTPγS become inactivated upon receptor stimulation in the absence of nucleotides, (II) Go proteins interact with activated α2A-AR to a large extent in the presence of low concentrations of nucleotide, (III) Go proteins may be inactivated upon activation of α2A-AR in the presence of low concentrations of GTP or GTPγS. Taken together, the data demonstrate the reversibility of the G protein cycle in living cells for the paradigm α2A-AR/Go pathway. The data thereby explain the paradoxic inactivation of G protein coupled inwardly rectifying potassium channels in myocytes upon activation of adenosine A1 receptors

Validation of VITEK 2 Version 4.01 Software for Detection, Identification, and Classification of Glycopeptide-Resistant Enterococci

We evaluated the ability of the new VITEK 2 version 4.01 software to identify and detect glycopeptide-resistant enterococci compared to that of the reference broth microdilution method and to classify them into the vanA, vanB, vanC1, and vanC2 genotypes. Moreover, the accuracy of antimicrobial susceptibility testing with agents with improved potencies against glycopeptide-resistant enterococci was determined. A total of 121 enterococci were investigated. The new VITEK 2 software was able to identify 114 (94.2%) enterococcal strains correctly to the species level and to classify 119 (98.3%) enterococci correctly to the glycopeptide resistance genotype level. One Enterococcus casseliflavus strain and six Enterococcus faecium vanA strains with low-level resistance to vancomycin were identified with low discrimination, requiring additional tests. One of the vanA strains was misclassified as the vanB type, and one glycopeptide-susceptible E. facium wild type was misclassified as the vanA type. The overall essential agreements for antimicrobial susceptibility testing results were 94.2% for vancomycin, 95.9% for teicoplanin, 100% for quinupristin-dalfopristin and moxifloxacin, and 97.5% for linezolid. The rates of minor errors were 9% for teicoplanin and 5% for the other antibiotic agents. The identification and susceptibility data were produced within 4 h to 6 h 30 min and 8 h 15 min to 12 h 15 min. In conclusion, use of VITEK 2 version 4.01 software appears to be a reliable method for the identification and detection of glycopeptide-resistant enterococci as well as an improvement over the use of the former VITEK 2 database. However, a significant reduction in the detection time would be desirable

The impact of methylphenidate and its enantiomers on dopamine synthesis and metabolism in vitro

Methylphenidate (MPH), a psychostimulant, is an effective first-line treatment for the symptoms associated with Attention-Deficit/Hyperactivity Disorder (ADHD). Although most MPH formulations are composed of the racemic 1:1 mixture of the two enantiomers (d- and l-threo), converging lines of evidence indicate that d-threo MPH seems to be superior to the l-isomer. We aimed to investigate whether MPH racemic mixture or pure enantiomers influence the enzyme activity of tyrosine hydroxylase (TH), monoamine oxidase B (MAO-B), catechol-O-methyltransferase (COMT), and aldehyde dehydrogenase (ALDH) in vitro in homogenates of rat PC12 cells incubated with racemic, d- and l-threo MPH (1nM up to 100μM), or a vehicle for control. We could observe dose dependent enhancement of TH activity with d-threo MPH, probably due to its higher affinity to the enzyme, which we could confirm for d-threo versus l-threo MPH via docking and molecular dynamic simulations analysis. MAO-B enzyme activity was found to be enhanced when incubated with both d- and l-isomers but not with the racemic mixture. This conflicting result was hypothesized to be due to possible aggregation of the two enantiomers or other molecular conformations. Such a possible interaction was observed indirectly, when TH was incubated with constant d-threo MPH while increasing l-isomer (increasing total MPH concentrations). Hence, TH activity was slightly decreased with increased l-isomer. In conclusion, the current in vitro investigation points to the stereoselectivity of the investigated enzymes and pharmacological effects of MPH enantiomers

Rsk2 knockout affects emotional behavior in the IntelliCage

Ribosomal s6 kinase 2 is a growth factor activated serine/threonine kinase and member of the ERK signaling pathway. Mutations in the Rsk2 gene cause Coffin–Lowry syndrome, a rare syndromic form of intellectual disability. The Rsk2 KO mouse model was shown to have learning and memory defects. We focused on the investigation of the emotional behavioral phenotype of Rsk2 KO mice mainly in the IntelliCage. They exhibited an anti-depressive, sucrose reward seeking phenotype and showed reduced anxiety. Spontaneous activity was increased in some conventional tests. However, KO mice did not show defects in place learning, working memory and motor impulsivity. In addition, we found changes of the monoaminergic system in HPLC and qRT-PCR experiments. Taken together, RSK2 not only plays a role in cognitive processes but also in emotional and reward-related behaviors

5-HTT Deficiency in Male Mice Affects Healing and Behavior after Myocardial Infarction

Anxiety disorders and depression are common comorbidities in cardiac patients. Mice lacking the serotonin transporter (5-HTT) exhibit increased anxiety-like behavior. However, the role of 5-HTT deficiency on cardiac aging, and on healing and remodeling processes after myocardial infarction (MI), remains unclear. Cardiological evaluation of experimentally naïve male mice revealed a mild cardiac dysfunction in ≥4-month-old 5-HTT knockout (−/−) animals. Following induction of chronic cardiac dysfunction (CCD) by MI vs. sham operation 5-HTT−/− mice with infarct sizes >30% experienced 100% mortality, while 50% of 5-HTT+/− and 37% of 5-HTT+/+ animals with large MI survived the 8-week observation period. Surviving (sham and MI < 30%) 5-HTT−/− mutants displayed reduced exploratory activity and increased anxiety-like behavior in different approach-avoidance tasks. However, CCD failed to provoke a depressive-like behavioral response in either 5-Htt genotype. Mechanistic analyses were performed on mice 3 days post-MI. Electrocardiography, histology and FACS of inflammatory cells revealed no abnormalities. However, gene expression of inflammation-related cytokines (TGF-β, TNF-α, IL-6) and MMP-2, a protein involved in the breakdown of extracellular matrix, was significantly increased in 5-HTT−/− mice after MI. This study shows that 5-HTT deficiency leads to age-dependent cardiac dysfunction and disrupted early healing after MI probably due to alterations of inflammatory processes in mice