Baculovirus-Mediated Expression of Human 65 kDa and 67 kDa Glutamic Acid Decarboxylases in SF9 Insect Cells and Their Relevance in Diagnosis of Insulin-Dependent Diabetes Mellitus

cDNAs coding for the full-length human 65 and 67 kDa glutamic acid decarboxylases (GAD65 and GAD67) were amplified from pancreas and hippocampus cDNA libraries by polymerase chain reaction, respectively. Both cDNAs were inserted into a baculovirus vector which mediated highly efficient expression of the human GAD65 and GAD67 with histidine-hexapeptides as affinity ligands at their C-termini in Spodoptera frugiperda (Sf9) cells. The recombinant GAD proteins were purified to homogeneity by affinity chromatography using a metal-chelating matrix. The infected Sf9 insect cells expressed the recombinant human GAD65 and GAD67 with natural-like conformations, as confirmed by measurement of their enzyme activities as well as their fully restored autoantigenicities. Immunoprecipitation of metabolically labeled infected Sf9 cells demonstrated the autoantigenic potential of the recombinant GAD proteins. The practicability of using recombinant GAD65 and GAD67 derived from the baculovirus expression system for the development of an immunoassay for the diagnosis of insulin-dependent diabetes mellitus is discussed

Recombinant human preproinsulin expression, purification and reaction with insulin autoantibodies in sera from patients with insulin-dependent diabetes mellitus

A novel prokaryotic expression vector pGEX-6T was designed for high-level expression of recombinant fusion protein with a histidine-hexapeptide and glutathione-S-transferase at its N-terminus and the recombinant human preproinsulin at its C-terminus. Efficiency of expression was investigated in the Escherichia coli strain CAG456. The synthesized protein was sequestered in an insoluble form in inclusion bodies and was purified to homogeneity by one-step affinity chromatography based on the specific complex formation of the histidine-hexapeptide and a chelating matrix which was charged with Ni2+ ions. The antigenic nature of the purified recombinant preproinsulin fusion protein was evaluated by ELISA screening for insulin autoantibodies in selected sera from patients with recent-onset type 1 (insulin-dependent) diabetes mellitus classified by the existence of additional autoantibodies reactive against glutamic acid decarboxylase. 14% of the tested sera (n=43) conttained insulin autoantibodies which strongly recognized the recombinant human preproinsulin. Comparable measurements with both recombinant human preproinsulin and mature insulin suggested that the observed autoantigenicity of preproinsulin was mediated by the C-peptide or/and signal peptide

Association between Antibodies to the MR 67,000 Isoform of Glutamate Decarboxylase (GAD) and Type 1 (Insulin-Dependent) Diabetes Mellitus with Coexisting Autoimmune Polyendocrine Syndrome Type II

By using an immunoprecipitation assay, we analysed reactivity of autoantibodies to human recombinant GAD65 and GAD67 in sera from patients with autoimmune polyendocrine syndrome Type II (APS II) with and without Type 1 (insulin-dependent) diabetes mellitus (IDDM) compared to patients with organ-specific autoimmunity. Overall antibodies to GAD65 were correlated with IDDM in all study groups, whereas GAD67 antibodies were associated with IDDM when APS II coexists. Antibodies to GAD65 and GAD67 were detected in 13 (44.8%) and 7 (24.1%) out of 29 APS II patients with IDDM, but in only 4 (13.8%) and 2 (6.9%) out of 29 APS II patients without IDDM, respectively (p < 0.05). In short-standing IDDM (< 1 year), antibodies to GAD67 were significantly more frequent in patients with APS II (5 of 9 [55.6%] subjects) compared to matched diabetic patients without coexisting polyendocrinopathy (1 of 18 [5.6%] subjects) (p < 0.02). The levels of GAD65 (142 ± 90 AU) and GAD67 antibodies (178 ± 95 AU) were significantly higher in patients with polyglandular disease than in patients with isolated IDDM (91 ± 85 AU and 93 ± 57 AU) (p < 0.02). Interestingly, all 11 GAD67 antibody positive subjects also had GAD65 antibodies (p < 0.0001), and in 10 of 11 anti-GAD67 positive sera the GAD67 antibodies could be blocked by either GAD67 or GAD65, suggesting the presence of cross-reactive autoantibodies. No correlation was observed between GAD antibodies and age, sex or any particular associated autoimmune disease, besides IDDM. GAD antibodies were present in only 1 of 6 (16.7%) patients with APS Type I, in 1 of 26 (3.9%) patients with autoimmune thyroid disease but in none of the patients with Addison's disease (n = 16), pernicious anaemia (n = 7) or normal controls (n = 50). Our data suggest distinct antibody specificities reactive to GAD isoforms in APS II and IDDM, which might reflect different mechanisms of autoimmune response in IDDM with coexisting autoimmune polyendocrine autoimmunity

Neuromorphic Hardware In The Loop: Training a Deep Spiking Network on the BrainScaleS Wafer-Scale System

Emulating spiking neural networks on analog neuromorphic hardware offers several advantages over simulating them on conventional computers, particularly in terms of speed and energy consumption. However, this usually comes at the cost of reduced control over the dynamics of the emulated networks. In this paper, we demonstrate how iterative training of a hardware-emulated network can compensate for anomalies induced by the analog substrate. We first convert a deep neural network trained in software to a spiking network on the BrainScaleS wafer-scale neuromorphic system, thereby enabling an acceleration factor of 10 000 compared to the biological time domain. This mapping is followed by the in-the-loop training, where in each training step, the network activity is first recorded in hardware and then used to compute the parameter updates in software via backpropagation. An essential finding is that the parameter updates do not have to be precise, but only need to approximately follow the correct gradient, which simplifies the computation of updates. Using this approach, after only several tens of iterations, the spiking network shows an accuracy close to the ideal software-emulated prototype. The presented techniques show that deep spiking networks emulated on analog neuromorphic devices can attain good computational performance despite the inherent variations of the analog substrate.Comment: 8 pages, 10 figures, submitted to IJCNN 201

Pattern representation and recognition with accelerated analog neuromorphic systems

Despite being originally inspired by the central nervous system, artificial neural networks have diverged from their biological archetypes as they have been remodeled to fit particular tasks. In this paper, we review several possibilites to reverse map these architectures to biologically more realistic spiking networks with the aim of emulating them on fast, low-power neuromorphic hardware. Since many of these devices employ analog components, which cannot be perfectly controlled, finding ways to compensate for the resulting effects represents a key challenge. Here, we discuss three different strategies to address this problem: the addition of auxiliary network components for stabilizing activity, the utilization of inherently robust architectures and a training method for hardware-emulated networks that functions without perfect knowledge of the system's dynamics and parameters. For all three scenarios, we corroborate our theoretical considerations with experimental results on accelerated analog neuromorphic platforms.Comment: accepted at ISCAS 201

Strategien und Technologien einer pluralistischen Fern- und Nahwärmeversorgung in einem liberalisierten Energiemarkt unter besonderer Berücksichtigung der Kraft-Wärme-Kopplung und regenerativer Energien : Kurztitel: Pluralistische Wärmeversorgung ; AGFW-Hauptstudie - erster Bearbeitungsabschnitt. Band 1, Grundlagen der Kraft-Wärme-Kopplung, Zertifizierungsverfahren und Fördermodelle

Die im vorliegenden Band 1 vorgestellten Ergebnisse sollen der Begleitung der anstehenden KWK-Gesetzgebung in technischer und wirtschaftlicher Hinsicht dienen. Das derzeitige KWK-(Vorschalt-)Gesetz, welches durch ein neues mit klareren Kriterien verbundenes Gesetz ersetzt werden soll, ist in mehrfacher Hinsicht problematisch, da es Regelungen zum Auffangen von Stranded Investments mit Regelungen zur Förderung von KWK vermischt, keine klare Definition von KWK enthält, industrielle KWK ausgegrenzt und durch die intransparente Förderstruktur das Mittelaufkommen und die Mittelverwendung nicht nachvollziehbar macht. Ein KWK-Ausbau wird sich in der gegenwärtigen Situation des Strommarktes nur auf der Basis einer Förderung entwickeln können (vgl. Vorstudie). Obwohl neue KWK-Anlagen im Vergleich zu neuen Anlagen der ungekoppelten Erzeugung unter Vollkostenbedingungen meist günstiger abschneiden, benötigen sie vor dem Hintergrund des aktuell auf dem Niveau kurzfristiger Grenzkosten geführten Preiskampfes zusätzliche Deckungsbeiträge. Die Analyse der Vielzahl vorgeschlagener Zertifizierungskriterien hat ergeben, dass definierter KWK-Strom eine geeignete Messgröße darstellt. Ausführliche Analysen zeigen, dass die Bestimmung dieses Stromanteils mit Hilfe einer einmaligen Anlagenzertifizierung relativ unproblematisch ist. Eine weitere Differenzierung des so definierten KWK-Stroms, z. B. hinsichtlich der CO2-Effizienz, birgt dagegen die Gefahr so krasser Fördergegensätze zwischen alten und neuen Anlagen sowie zwischen gas- und kohlegefeuerten Anlagen, dass dadurch vorhandene, für zukünftige Anwendungen prädestinierte Standorte verloren gehen könnten und die sinnvolle Auskopplung großer Wärmemengen aus Steinkohlekraftwerken unterbleibt. Die Bewertung verschiedener Fördermodelle ergibt kein eindeutiges Bild, welches Fördermodell zu bevorzugen wäre. Andererseits zeigt sich, dass sich aus allen Bausteinen von Förderinstrumenten ein sinnvolles Instrumentenmix konstruieren lässt

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Real‐world outcomes using PD‐1 antibodies and BRAF + MEK inhibitors for adjuvant melanoma treatment from 39 skin cancer centers in Germany, Austria and Switzerland

Abstract Background Programmed death‐1 (PD‐1) antibodies and BRAF + MEK inhibitors are widely used for adjuvant therapy of fully resected high‐risk melanoma. Little is known about treatment efficacy outside of phase III trials. This real‐world study reports on clinical outcomes of modern adjuvant melanoma treatment in specialized skin cancer centers in Germany, Austria and Switzerland. Methods Multicenter, retrospective study investigating stage III–IV melanoma patients receiving adjuvant nivolumab (NIV), pembrolizumab (PEM) or dabrafenib + trametinib (D + T) between 1/2017 and 10/2021. The primary endpoint was 12‐month recurrence‐free survival (RFS). Further analyses included descriptive and correlative statistics, and a multivariate linear‐regression machine learning model to assess the risk of early melanoma recurrence. Results In total, 1198 patients from 39 skin cancer centers from Germany, Austria and Switzerland were analysed. The vast majority received anti PD‐1 therapies (n = 1003). Twelve‐month RFS for anti PD‐1 and BRAF + MEK inhibitor‐treated patients were 78.1% and 86.5%, respectively (hazard ratio [HR] 1.998 [95% CI 1.335–2.991]; p = 0.001). There was no statistically significant difference in overall survival (OS) in anti PD‐1 (95.8%) and BRAF + MEK inhibitor (96.9%) treated patients (p > 0.05) during the median follow‐up of 17 months. Data indicates that anti PD‐1 treated patients who develop immune‐related adverse events (irAEs) have lower recurrence rates compared to patients with no irAEs (HR 0.578 [95% CI 0.443–0.754], p = 0.001). BRAF mutation status did not affect overall efficacy of anti PD‐1 treatment (p > 0.05). In both, anti PD‐1 and BRAF + MEK inhibitor treated cohorts, data did not show any difference in 12‐month RFS and 12‐month OS comparing patients receiving total lymph node dissection (TLND) versus sentinel lymph node biopsy only (p > 0.05). The recurrence prediction model reached high specificity but only low sensitivity with an AUC = 0.65. No new safety signals were detected. Overall, recorded numbers and severity of adverse events were lower than reported in pivotal phase III trials. Conclusions Despite recent advances in adjuvant melanoma treatment, early recurrence remains a significant clinical challenge. This study shows that TLND does not reduce the risk of early melanoma recurrence and should only be considered in selected patients. Data further highlight that variables collected during clinical routine are unlikely to allow for a clinically relevant prediction of individual recurrence risk