Retreatment for hepatitis C virus direct-acting antiviral therapy virological failure in primary and tertiary settings: The REACH-C cohort

Virological failure occurs in a small proportion of people treated for hepatitis C virus (HCV) with direct-acting antiviral (DAA) therapies. This study assessed retreatment for virological failure in a large real-world cohort. REACH-C is an Australian observational study (n = 10,843) evaluating treatment outcomes of sequential DAA initiations across 33 health services between March 2016 to June 2019. Virological failure retreatment data were collected until October 2020. Of 408 people with virological failure (81% male; median age 53; 38% cirrhosis; 56% genotype 3), 213 (54%) were retreated once; 15 were retreated twice. A range of genotype specific and pangenotypic DAAs were used to retreat virological failure in primary (n = 56) and tertiary (n = 157) settings. Following sofosbuvir/velpatasvir/voxilaprevir availability in 2019, the proportion retreated in primary care increased from 21% to 40% and median time to retreatment initiation declined from 294 to 152 days. Per protocol (PP) sustained virological response (SVR12) was similar for people retreated in primary and tertiary settings (80% vs 81%; p = 1.000). In regression analysis, sofosbuvir/velpatasvir/voxilaprevir (vs. other regimens) significantly decreased likelihood of second virological failure (PP SVR12 88% vs. 77%; adjusted odds ratio [AOR] 0.29; 95%CI 0.11–0.81); cirrhosis increased likelihood (PP SVR12 69% vs. 91%; AOR 4.26; 95%CI 1.64–11.09). Indigenous Australians had lower likelihood of retreatment initiation (AOR 0.36; 95%CI 0.15–0.81). Treatment setting and prescriber type were not associated with retreatment initiation or outcome. Virological failure can be effectively retreated in primary care. Expanded access to simplified retreatment regimens through decentralized models may increase retreatment uptake and reduce HCV-related mortality

Combination of fluorescence microscopy and atomic force microscopy for the investigation of physiological processes in living cells

Innerhalb dieser Doktorarbeit wurde eine neuartige Mikromanipulationstechnik für die lokale Flüssigkeitsabgabe am komplexen Drüsengewebe der Schabe P. americana charakterisiert und für die damit verbundene gezielte Manipulation von einzelnen Zellen in einem Zellkomplex (Gewebe) angewandt. Bei dieser Mikromanipulationstechnik handelt es sich um die seit 2009 bekannte nanofluidische Rasterkraftmikroskopie (FluidFM = fluidic force microscopy). Dabei werden sehr kleine mikrokanälige Rasterkraftspitzen bzw. Mikro-/Nanopipetten mit einer Öffnung zwischen 300 nm und 2 µm verwendet, mit denen es möglich ist, sehr kleine Volumina im Pikoliter- bis Femtoliter-Bereich (10-12 L – 10-15 L) gezielt und ortsgenau abzugeben. Das Ziel dieser Arbeit war die Analyse zellulärer Prozesse, wie z. B. Zell-Zell-Kommunikation oder Signalweiterleitung, zwischen benachbarten Zellen unter Zuhilfenahme der Fluoreszenzmikroskopie. Mit dieser Methode können die Zellen und ihre Bestandteile mittels vorheriger Farbstoffbeladung unter einem Mikroskop mit hohem Kontrast optisch dargestellt werden. Mit Hilfe der Fluoreszenzmikroskopie sollten schlussendlich die zellulären Reaktionen innerhalb des Gewebes nach der lokalen Manipulation visualisiert werden. Zunächst wurde die Anwendung des Systems an Luft und wässriger Umgebung beschrieben. In diesem Zusammenhang wurde eine Reinigungs- und Beladungsmethode entwickelt, mit der es möglich war, die kostspieligen Mikro-/Nanopipetten zu reinigen und anschließend mehrmals wiederzuverwenden. Hierzu wurde eine alternative Methode getestet, mit der das Diffusionsverhalten von Farbstoffmolekülen in unterschiedlichen Medien untersucht werden kann. Des Weiteren wurden die Systemparameter optimiert, welche nötig sind, um zwischen der Probenoberfläche und der Pipette einen guten Pipettenöffnungs-abschluss zu erhalten. Dieser Abschluss ist essentiell, damit die abgegebene Flüssigkeit ausschließlich in der Abgaberegion mit der Probe wechselwirkt und die darauffolgenden Reaktionen nur innerhalb des Gewebes erfolgen, da ansonsten die Zell-Zell-Signalweiterleitung zwischen den Zellen nicht eindeutig nachvollzogen werden kann. Diese interzelluläre Kommunikation wurde anhand zweier sekundärer Botenstoffe (Ca2+ und NO) untersucht. Hierbei war es möglich einzelne lokale Reaktionen zu detektieren, welche sich über weitere Zellen ausbreiteten. Schlussendlich wurde die Fertigung einer speziellen Injektionspipette beschrieben, welche an zwei biologischen Systemen getestet wurde.Within this thesis, a novel micromanipulation technique was characterised for the local liquid delivery at the complex salivary glands tissue of the cockroach P. americana and was applied for the associated targeted manipulation of single cells in a cell complex (tissue). This micromanipulation technique is known since 2009 as the fluidic force microscopy (FluidFM) technique. In this case, very small microchanneled AFM tips or rather micro-/nanopipettes with an opening between 300 nm and 2 μm are used to deliver very small volumes in the picoliter to femtoliter range (10-12 L - 10-15 L) targeted and accurate. The aim of this work was the analysis of cellular processes, such as cell-cell communication or signal transduction, between adjacent cells using fluorescence microscopy. Using this method, the cells and their components can be optically visualised by prior dye loading under a microscope with high contrast. Using fluorescence microscopy, the cellular responses within the tissue were finally visualised after local manipulation. First, the application of the system in air and aqueous environment was described. In this context, a cleaning and loading method was developed which allows the cleaning and the repeated reuse of the expensive micro-/nanopipettes. For this purpose, an alternative method has been tested, with which the diffusion of dye molecules in different media can be examined. Furthermore, the system parameters needed to obtain a good pipette opening sealing between the sample surface and the pipette have been optimised. This sealing is essential to ensure that the delivered liquid interacts only with the sample in the delivery region and that subsequent reactions occur only within the tissue, otherwise cell-cell signaling between the cells can not be clearly understood. This intercellular communication was studied by means of two secondary messengers (Ca2+ and NO). Here it was possible to detect individual local reactions that spread over more cells. Finally, the production of a special injection pipette was described, which was tested on two biological systems

Local tissue manipulation via a force- and pressure-controlled AFM micropipette for analysis of cellular processes

Abstract Local manipulation of complex tissues at the single-cell level is challenging and requires excellent sealing between the specimen and the micromanipulation device. Here, biological applications for a recently developed loading technique for a force- and pressure-controlled fluidic force microscope micropipette are described. This technique allows for the exact positioning and precise spatiotemporal control of liquid delivery. The feasibility of a local loading technique for tissue applications was investigated using two fluorescent dyes, with which local loading behaviour could be optically visualised. Thus, homogeneous intracellular distribution of CellTracker Red and accumulation of SYTO 9 Green within nuclei was realised in single cells of a tissue preparation. Subsequently, physiological micromanipulation experiments were performed. Salivary gland tissue was pre-incubated with the Ca2+-sensitive dye OGB-1. An intracellular Ca2+ rise was then initiated at the single-cell level by applying dopamine via micropipette. When pre-incubating tissue with the nitric oxide (NO)-sensitive dye DAF-FM, NO release and intercellular NO diffusion was observed after local application of the NO donor SNP. Finally, local micromanipulation of a well-defined area along irregularly shaped cell surfaces of complex biosystems was shown for the first time for the fluidic force microscope micropipette. Thus, this technique is a promising tool for the investigation of the spatiotemporal effects of locally applied substances in complex tissues

A Multifunctional Frontloading Approach for Repeated Recycling of a Pressure-Controlled AFM Micropipette.

Fluid force microscopy combines the positional accuracy and force sensitivity of an atomic force microscope (AFM) with nanofluidics via a microchanneled cantilever. However, adequate loading and cleaning procedures for such AFM micropipettes are required for various application situations. Here, a new frontloading procedure is described for an AFM micropipette functioning as a force- and pressure-controlled microscale liquid dispenser. This frontloading procedure seems especially attractive when using target substances featuring high costs or low available amounts. Here, the AFM micropipette could be filled from the tip side with liquid from a previously applied droplet with a volume of only a few μL using a short low-pressure pulse. The liquid-loaded AFM micropipettes could be then applied for experiments in air or liquid environments. AFM micropipette frontloading was evaluated with the well-known organic fluorescent dye rhodamine 6G and the AlexaFluor647-labeled antibody goat anti-rat IgG as an example of a larger biological compound. After micropipette usage, specific cleaning procedures were tested. Furthermore, a storage method is described, at which the AFM micropipettes could be stored for a few hours up to several days without drying out or clogging of the microchannel. In summary, the rapid, versatile and cost-efficient frontloading and cleaning procedure for the repeated usage of a single AFM micropipette is beneficial for various application situations from specific surface modifications through to local manipulation of living cells, and provides a simplified and faster handling for already known experiments with fluid force microscopy

ANG-2 for quantitative Na+ determination in living cells by time-resolved fluorescence microscopy

Sodium ions (Na+) play an important role in a plethora of cellular processes, which are complex and partly still unexplored. For the investigation of these processes and quantification of intracellular Na+ concentrations ([Na+](i)), two-photon coupled fluorescence lifetime imaging microscopy (2P-FLIM) was performed in the salivary glands of the cockroach Periplaneta americana. For this, the novel Na+-sensitive fluorescent dye Asante NaTRIUM Green-2 (ANG-2) was evaluated, both in vitro and in situ. In this context, absorption coefficients, fluorescence quantum yields and 2P action cross-sections were determined for the first time. ANG-2 was 2P-excitable over a broad spectral range and displayed fluorescence in the visible spectral range. Although the fluorescence decay behaviour of ANG-2 was triexponential in vitro, its analysis indicates a Na+-sensitivity appropriate for recordings in living cells. The Na+-sensitivity was reduced in situ, but the biexponential fluorescence decay behaviour could be successfully analysed in terms of quantitative [Na+](i) recordings. Thus, physiological 2P-FLIM measurements revealed a dopamine-induced [Na+](i) rise in cockroach salivary gland cells, which was dependent on a Na+-K+-2Cl-cotransporter (NKCC) activity. It was concluded that ANG-2 is a promising new sodium indicator applicable for diverse biological systems

Repeated AFM micropipette usage for antibody spotting.

<p>(a) Bright-field image of a spotted droplet of AlexaFluor647-labeled antibody IgG (10 μg/mL) and (b) the corresponding fluorescence image with an intensity profile plot; scale bar = 50 μm; λ_ex = 640 nm ± 15 nm, λ_em = 700 nm ± 37.5 nm. (c,d) Bright-field image and corresponding fluorescence image of the same spot as shown in (a,b, pos. 1), as well as the subsequently spotted glycerol-water droplet after the cleaning procedure (pos. 2); time period between the delivery of droplets 1 and 2 about 65 min. (e,f) Bright-field image and corresponding fluorescence image with an intensity plot of a spotted antibody droplet (pos. 3) due to repeated frontloading of the same micropipette after several hours of storage. (g,h) Corresponding images with an additional spotted glycerol-water droplet (pos. 4) after a repeated cleaning procedure; time period between the delivery of droplets 3 and 4 about 43 min.</p

A Multifunctional Frontloading Approach for Repeated Recycling of a Pressure-Controlled AFM Micropipette

Fluid force microscopy combines the positional accuracy and force sensitivity of an atomic force microscope (AFM) with nanofluidics via a microchanneled cantilever. However, adequate loading and cleaning procedures for such AFM micropipettes are required for various application situations. Here, a new frontloading procedure is described for an AFM micropipette functioning as a force- and pressure-controlled microscale liquid dispenser. This frontloading procedure seems especially attractive when using target substances featuring high costs or low available amounts. Here, the AFM micropipette could be filled from the tip side with liquid from a previously applied droplet with a volume of only a few μL using a short low-pressure pulse. The liquid-loaded AFM micropipettes could be then applied for experiments in air or liquid environments. AFM micropipette frontloading was evaluated with the well-known organic fluorescent dye rhodamine 6G and the AlexaFluor647-labeled antibody goat anti-rat IgG as an example of a larger biological compound. After micropipette usage, specific cleaning procedures were tested. Furthermore, a storage method is described, at which the AFM micropipettes could be stored for a few hours up to several days without drying out or clogging of the microchannel. In summary, the rapid, versatile and cost-efficient frontloading and cleaning procedure for the repeated usage of a single AFM micropipette is beneficial for various application situations from specific surface modifications through to local manipulation of living cells, and provides a simplified and faster handling for already known experiments with fluid force microscopy

AFM micropipette cleaning procedure when using the organic dye rhodamine 6G.

<p>(a-c) Bright-field images of four sequentially spotted droplets (pos. 1, 3 and 4: glycerol-water; pos. 2: 50 μM rhodamine 6G); micropipette silhouette can be seen in the background; scale bar = 50 μm. (d-f) Corresponding fluorescence images of the identical regions shown in (a-c) with associated intensity profile plots along the red lines; λ_ex = 485 nm ± 15 nm, λ_em = 535 nm ± 25 nm; time periods between the delivery of the individual droplets: 1 to 2 in 12 min, 1 to 3 in 39 min, 1 to 4 in 70 min.</p

Representation of the AFM micropipette frontloading procedure.

<p>Schematic illustration of (a) volume delivery on top of the probe holder by using a pipette, (b) loading position of the AFM scan head in the liquid above a chucked coverslip for frontloading (the lamellar liquid film reduces contamination of the entire clip), (c) zoom-in of (b) illustrating the frontloading process at the micropipette opening using low pressure (the black arrows indicate the running direction of the liquid), (d) dispensing of small liquid droplets onto a glass coverslip surface after successful frontloading procedure.</p

Alternate spotting of water and rhodamine 6G.

<p>(a) Bright-field image of four sequentially spotted droplets within 100 min (pos. 1 and 3: glycerol-water; pos. 2 and 4: 50 μM rhodamine 6G); the silhouette of the micropipette can be seen in the background; scale bar = 50 μm; time periods between the delivery of the individual droplets: 1 to 2 in 27 min, 1 to 3 in 74 min, 1 to 4 in 100 min. (b) Corresponding fluorescence image; λ_ex = 485 nm ± 15 nm, λ_em = 535 nm ± 25 nm. (c) Fluorescence intensity profile plot along the red line indicated in (b).</p