Analyse der Zielgene von Notch bei der Regulation von Proliferation und Differenzierung myeloischer Stamm- und Vorläuferzellen

Zelllinienentscheidungen in der Hämatopoese werden eingeleitet und sind abhängig von der Aktivierung von Transkriptionsfaktoren. Es ist allerdings bisher nicht geklärt, ob die initiale Aktivierung früher hämatopoetischer Transkriptionsfaktoren durch bisher unbekannte extrinsische Signale oder durch ein zellinternes autonomes Programm erfolgt. Notch Rezeptoren sind evolutionär hoch konservierte Transmembranrezeptoren, die an der Regulation von Zelllinienentscheidungen, Differenzierung und Proliferation in verschiedenen embryonalen und adulten Geweben beteiligt sind. Die Expression von Notch Rezeptoren auf hämatopoetischen Zellen und der dazugehörigen Liganden wie Jagged1 auf Knochenmarksstromazellen deutet auf eine Bedeutung von Notch in der Regulation der Hämatopoese. Vor Kurzem konnte die Induktion der myeloischen Differenzierung von hämatopoetischen Stamm- und Vorläuferzellen durch Notch nachgewiesen werden. Die molekularen Mechanismen dieses Prozesses sind dabei noch völlig unklar. Darin Einblick zu gewinnen wurde im Rahmen dieser Doktorarbeit durch die Suche nach Zielgenen von Notch in der Myelopoese versucht. Dazu wurden die multipotente myeloische Stammzelllinie FDCP-mix und die granulozytäre Vorläuferzelllinie 32D mit einem durch Tamoxifen aktivierbarem Notch als Zellsysteme gewählt. In dieser Arbeit durchgeführte zytokingesteuerte Differenzierungskinetiken konnten bestätigen, dass die verwendeten FDCP-mix Zellen während ihrer Differenzierung in reife Granulozyten, Makrophagen und Erythrozyten auf RNA-Ebene charakteristische Regulationen von wichtigen myeloischen Transkriptionsfaktoren, Zytokinrezeptoren sowie differenzierungsabhängigen Funktionsproteinen durchlaufen. Sie stellen somit ein optimales Zellsystem zur Analyse von Notch-Zielgenen in der Myelopoese dar. Mit dem Tamoxifen induzierbaren System der Notchaktivierung wurden zuerst bekannte, zentrale Regulationsfaktoren der Myelopoese auf eine Induktion durch Notch im Northern Blot untersucht. Dabei stellte sich als entscheidendes Ergebnis sowohl in 32D als auch FDCP-mix Zellen die direkte, spezifische Induktion des frühen myeloischen Transkriptionsfaktors PU.1 heraus, von dem bekannt ist, dass er myeloische Differenzierung initiiert. Außerdem kam es zu einer indirekten Hochregulation des M-CSF-Rezeptors, der als wichtiges Zielgen von PU.1 bekannt ist. Diese Ergebnisse zeigen, dass ein extrinsisches Signal, im Organismus durch den Jagged / Notch Signalweg vermittelt, zu einer Aktivierung eines frühen hämatopoetischen Transkriptionsfaktors führt, welcher Zelllinienentscheidungen in der Hämatopoese bestimmt. In Zusammenschau mit den biologischen Wirkungen von Notch in der Hämatopoese weist dies darauf hin, dass extrinsische Mechanismen eine wichtige Rolle in der Regulation der Hämatopoese spielen dürften. Durch ein neu zu etablierendes cDNA-Filter (cDNA-Microarray) Screening-Verfahren konnten dann als weitere wichtige Zielgene von Notch in der Hämatopoese u.a. der Interferon Regulatory Factor-1 (IRF-1), der Interleukin1-Rezeptor-Antagonist (IL1RA), der Tumornekrosefaktor-Rezeptor 2 (TNFR2), sowie c-myc und myb identifiziert werden

Current Concepts of Hyperinflammation in Chronic Granulomatous Disease

Chronic granulomatous disease (CGD) is the most common inherited disorder of phagocytic functions, caused by genetic defects in the leukocyte nicotinamide dinucleotide phosphate (NADPH) oxidase. Consequently, CGD phagocytes are impaired in destroying phagocytosed microorganisms, rendering the patients susceptible to bacterial and fungal infections. Besides this immunodeficiency, CGD patients suffer from various autoinflammatory symptoms, such as granuloma formation in the skin or urinary tract and Crohn-like colitis. Owing to improved antimicrobial treatment strategies, the majority of CGD patients reaches adulthood, yet the autoinflammatory manifestations become more prominent by lack of causative treatment options. The underlying pathomechanisms driving hyperinflammatory reactions in CGD are poorly understood, but recent studies implicate reduced neutrophil apoptosis and efferocytosis, dysbalanced innate immune receptors, altered T-cell surface redox levels, induction of Th17 cells, the enzyme indolamine-2,3-dioxygenase (IDO), impaired Nrf2 activity, and inflammasome activation. Here we discuss immunological mechanisms of hyperinflammation and their potential therapeutic implications in CGD

Pathogenic Fungi Regulate Immunity by Inducing Neutrophilic Myeloid-Derived Suppressor Cells

Peer reviewedPublisher PD

Acellular Pertussis Booster in Adolescents Induces Th1 and Memory CD8+ T Cell Immune Response

In a number of countries, whole cell pertussis vaccines (wcP) were replaced by acellular vaccines (aP) due to an improved reactogenicity profile. Pertussis immunization leads to specific antibody production with the help of CD4+ T cells. In earlier studies in infants and young children, wcP vaccines selectively induced a Th1 dominated immune response, whereas aP vaccines led to a Th2 biased response. To obtain data on Th1 or Th2 dominance of the immune response in adolescents receiving an aP booster immunization after a wcP or aP primary immunization, we analyzed the concentration of Th1 (IL-2, TNF-α, INF-γ) and Th2 (IL-4, IL-5, IL-10) cytokines in supernatants of lymphocyte cultures specifically stimulated with pertussis antigens. We also investigated the presence of cytotoxic T cell responses against the facultative intracellular bacterium Bordetella pertussis by quantifying pertussis-specific CD8+ T cell activation following the aP booster immunization. Here we show that the adolescent aP booster vaccination predominantly leads to a Th1 immune response based on IFNgamma secretion upon stimulation with pertussis antigen, irrespective of a prior whole cell or acellular primary vaccination. The vaccination also induces an increase in peripheral CD8+CD69+ activated pertussis-specific memory T cells four weeks after vaccination. The Th1 bias of this immune response could play a role for the decreased local reactogenicity of this adolescent aP booster immunization when compared to the preceding childhood acellular pertussis booster. Pertussis-specific CD8+ memory T cells may contribute to protection against clinical pertussis

Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany

Background: Systemic juvenile idiopathic arthritis (SJIA) is an autoinflammatory disease associated with chronic arthritis. Early diagnosis and effective therapy of SJIA is desirable, so that complications are avoided. The PRO-KIND initiative of the German Society for Pediatric Rheumatology (GKJR) aims to define consensus-based strategies to harmonize diagnostic and therapeutic approaches in Germany. Methods: We analyzed data on patients diagnosed with SJIA from 3 national registries in Germany. Subsequently, via online surveys and teleconferences among pediatric rheumatologists with a special expertise in the treatment of SJIA, we identified current diagnostic and treatment approaches in Germany. Those were harmonized via the formulation of statements and, supported by findings from a literature search. Finally, an in-person consensus conference using nominal group technique was held to further modify and consent the statements. Results: Up to 50% of patients diagnosed with SJIA in Germany do not fulfill the International League of Associations for Rheumatology (ILAR) classification criteria, mostly due to the absence of chronic arthritis. Our findings suggest that chronic arthritis is not obligatory for the diagnosis and treatment of SJIA, allowing a diagnosis of probable SJIA Malignant, infectious and hereditary autoinflammatory diseases should be considered before rendering a diagnosis of probable SJIA There is substantial variability in the initial treatment of SJIA. Based on registry data, most patients initially receive systemic glucocorticoids, however, increasingly substituted or accompanied by biological agents, i.e. interleukin (IL)-1 and IL-6 blockade (up to 27.2% of patients). We identified preferred initial therapies for probable and definitive SJIA, including step-up patterns and treatment targets for the short-term (resolution of fever, decrease in C-reactive protein by 50% within 7 days), the mid-term (improvement in physician global and active joint count by at least 50% or a JADAS-10 score of maximally 5.4 within 4 weeks) and the long-term (glucocorticoid-free clinically inactive disease within 6 to 12 months), and an explicit treat-to-target strategy. Conclusions: We developed consensus-based strategies regarding the diagnosis and treatment of probable or definitive SJIA in Germany

Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies

Objectives: The purpose of this document is to make the output of the International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT) Standardization and Validation available to medical and scientific communities, through a peer-reviewed publication, in the interest of improving the diagnosis and treatment of patients with atherosclerosis, including coronary artery disease. Background: Intravascular optical coherence tomography (IVOCT) is a catheter-based modality that acquires images at a resolution of ∼10 μm, enabling visualization of blood vessel wall microstructure in vivo at an unprecedented level of detail. IVOCT devices are now commercially available worldwide, there is an active user base, and the interest in using this technology is growing. Incorporation of IVOCT in research and daily clinical practice can be facilitated by the development of uniform terminology and consensus-based standards on use of the technology, interpretation of the images, and reporting of IVOCT results. Methods: The IWG-IVOCT, comprising more than 260 academic and industry members from Asia, Europe, and the United States, formed in 2008 and convened on the topic of IVOCT standardization through a series of 9 national and international meetings. Results: Knowledge and recommendations from this group on key areas within the IVOCT field were assembled to generate this consensus document, authored by the Writing Committee, composed of academicians who have participated in meetings and/or writing of the text. Conclusions: This document may be broadly used as a standard reference regarding the current state of the IVOCT imaging modality, intended for researchers and clinicians who use IVOCT and analyze IVOCT data

The German National Registry of Primary Immunodeficiencies (2012-2017)

Introduction: The German PID-NET registry was founded in 2009, serving as the first national registry of patients with primary immunodeficiencies (PID) in Germany. It is part of the European Society for Immunodeficiencies (ESID) registry. The primary purpose of the registry is to gather data on the epidemiology, diagnostic delay, diagnosis, and treatment of PIDs. Methods: Clinical and laboratory data was collected from 2,453 patients from 36 German PID centres in an online registry. Data was analysed with the software Stata® and Excel. Results: The minimum prevalence of PID in Germany is 2.72 per 100,000 inhabitants. Among patients aged 1–25, there was a clear predominance of males. The median age of living patients ranged between 7 and 40 years, depending on the respective PID. Predominantly antibody disorders were the most prevalent group with 57% of all 2,453 PID patients (including 728 CVID patients). A gene defect was identified in 36% of patients. Familial cases were observed in 21% of patients. The age of onset for presenting symptoms ranged from birth to late adulthood (range 0–88 years). Presenting symptoms comprised infections (74%) and immune dysregulation (22%). Ninety-three patients were diagnosed without prior clinical symptoms. Regarding the general and clinical diagnostic delay, no PID had undergone a slight decrease within the last decade. However, both, SCID and hyper IgE- syndrome showed a substantial improvement in shortening the time between onset of symptoms and genetic diagnosis. Regarding treatment, 49% of all patients received immunoglobulin G (IgG) substitution (70%—subcutaneous; 29%—intravenous; 1%—unknown). Three-hundred patients underwent at least one hematopoietic stem cell transplantation (HSCT). Five patients had gene therapy. Conclusion: The German PID-NET registry is a precious tool for physicians, researchers, the pharmaceutical industry, politicians, and ultimately the patients, for whom the outcomes will eventually lead to a more timely diagnosis and better treatment