TRAIL Deficient Mice Are Protected from Sugen/Hypoxia Induced Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a progressive lung disease diagnosed by an increase in pulmonary arterial blood pressure that is driven by a progressive vascular remodelling of small pulmonary arterioles. We have previously reported that tumor necrosis factor apoptosis-inducing ligand (TRAIL) protein expression is increased in pulmonary vascular lesions and pulmonary artery smooth muscle cells (PASMC) of patients with idiopathic PAH. The addition of recombinant TRAIL induces the proliferation and migration of PASMCs in vitro. TRAIL is required for hypoxia-induced pulmonary hypertension in mice, and blockade of TRAIL prevents and reduces disease development in other rodent models of PAH. Due to the availability of knockout and transgenic mice, murine models of disease are key to further advances in understanding the complex and heterogeneous pathogenesis of PAH. However, murine models vary in their disease severity, and are often criticized for lacking the proliferative pulmonary vascular lesions characteristic of PAH. The murine Sugen-hypoxic (SuHx) mouse model has recently been reported to have a more severe PAH phenotype consisting advanced pulmonary vascular remodelling. We therefore aimed to determine whether TRAIL was also required for the development of PAH in this model. C57BL/6 and TRAIL−/− mice were exposed to normoxia, Sugen5416 alone, hypoxia or both Sugen5416 and hypoxia (SuHx). We report here that SuHx treated C57BL/6 mice developed more severe PAH than hypoxia alone, and that TRAIL−/− mice were protected from disease development. These data further emphasise the importance of this pathway and support the use of the SuHx mouse model for investigating the importance of potential mediators in PAH pathogenesis

Increased expression of 5-hydroxytryptamine(2A/B) receptors in idiopathic pulmonary fibrosis: a rationale for therapeutic intervention

Background Idiopathic pulmonary fibrosis (IPF) has a poor prognosis and limited responsiveness to available treatments. It is characterised by epithelial cell injury, fibroblast activation and proliferation and extracellular matrix deposition. Serotonin (5-hydroxytryptamine; 5-HT) induces fibroblast proliferation via the 5-HTR2A and 5-HTR2B receptors, but its pathophysiological role in IPF remains unclear. A study was undertaken to determine the expression of 5-HT receptors in IPF and experimental lung fibrosis and to investigate the effects of therapeutic inhibition of 5-HTR2A/B signalling on lung fibrosis in vivo and in vitro. Methods and results Quantitative RT-PCR showed that the expression of 5-HTR1A/B and 5-HTR2B was significantly increased in the lungs of patients with IPF (n = 12) and in those with non-specific interstitial pneumonia (NSIP, n = 6) compared with transplant donors (n = 12). The expression of 5-HTR2A was increased specifically in IPF lungs but not in NSIP lungs. While 5-HTR2A protein largely localised to fibroblasts, 5-HTR2B localised to the epithelium. To assess the effects of 5HTR(2A/B) inhibition on fibrogenesis in vivo, mice were subjected to bleomycin-induced lung fibrosis and treated with the 5-HTR2A/B antagonist terguride (or vehicle) in a therapeutic approach (days 14-28 after bleomycin). Terguride-treated mice had significantly improved lung function and histology and decreased collagen content compared with vehicle-treated mice. Functional in vitro studies showed that terguride is a potent inhibitor of transforming growth factor beta(1)- or WNT3a-induced collagen production. Conclusion The studies revealed an increased expression of 5-HTR2A specifically in IPF. Blockade of 5-HTR2A/B signalling by terguride reversed lung fibrosis and is thus a promising therapeutic approach for IPF

Developing an Industrial IoT Platform – Trade-off between Horizontal and Vertical Approaches

Demands for a digitalized, connected, and smart production provide a fertile ground for industrial Internet-of-Things (IIoT) platforms to arise within the manufacturing industry (e.g., Siemens Mind Sphere, AXOOM Smart Enterprise, FORCAM FORCE). Nevertheless, many companies struggle to successfully kick-off platform ecosystems. Information Systems (IS) literature is of limited help, because insights on managing platform ecosystems are mostly derived from successful examples in the business-to-consumer (B2C) context. To better understand the challenging situation of companies in the emerging IIoT environment, we conducted an in-depth case study at a prospective platform provider. Insights gained through interviews and engagement in the field uncovered a tension between a horizontal platform strategy and vertical integrated solutions as a central challenge for companies aiming to launch an IIoT-platform in the market. By conceptualizing this trade-off, its causes along with related benefits and challenges, we add to existing literature on platform governance and launch strategies

Establishment of an in vitro culture system for Marek’s Disease Virus infection of B- and T-cells

Die Marek’sche Erkrankung (MD) ist weltweit eines der bedeutendsten Probleme in der Geflügelindustrie und verantwortlich für erhebliche wirtschaftliche Schäden. Die MD wird durch ein lymphotropes und strikt zell-assoziiertes α-Herpesvirus (MDV) verursacht, das immunsuppressiv wirkt und regelmäßig T Zelltumore induziert. B- und T-Zellen sind die primären Zielzellen des MDV in vivo. In B-Zellen kommt es zu einer lytischen Infektion und zum massiven Untergang der infizierten Zellen. Dagegen wird eine latente Infektion primär in CD4+ αβTCR+ T-Zellen beobachtet, welche nach Reaktivierung des Virus auch transformieren und Lymphome bilden können. Bis heute basieren alle Untersuchungen zur MD Pathogenese entweder auf in vivo Versuchen oder aber auf Zellkultursystemen, die mit Fibroblasten oder Nierenzellen arbeiten. Ein in vitro Infektionssystem für B- und T-Zellen, den primären Zielzellen des Virus, konnte bis heute nicht etabliert werden. Ursächlich hierfür war das Fehlen geeigneter Zellkultursysteme für diese Zellen, die ex vivo nur eine sehr kurze Überlebenszeit und einen schnellen apoptotischen Zelltod zeigen. Fortschritte in der aviären Immunologie haben zur Charakterisierung zahlreicher Zytokinen und Wachstumsfaktoren geführt, die B- und T-Zellen in vitro aktivieren, zur Proliferation anregen und erhöhte Überlebensraten induzieren. Diese Zytokine wurden in der vorliegenden Arbeit genutzt, um neue Kultursysteme für Hühner-Lymphozyten zu etablieren, mit deren Hilfe in vitro MDV Infektionsmodelle für B- und T Zellen aufgebaut werden konnten. Die erfolgreiche Infektion der Zellen wurde mit Hilfe genetisch modifizierten MDV-Reporterviren (MDV RB-1B UL47GFP und RB-1B MeqGFP-UL47RFP) nachgewiesen. Die aus der Milz, dem Blut und der Bursa Fabricii isolierten B-Zellen wurden mit löslichem chCD40L stimuliert und mit MDV RB-1B UL47GFP infizierten Fibroblasten co-kultiviert. Zu verschiedenen Zeitpunkten nach der Infektion konnten infizierte B-Zellen durch die Expression von UL47GFP durchflusszytometrisch identifiziert werden. Die Infektion wurde zusätzlich durch die zytoplasmatische Färbung der MDV-Proteine ICP4 und gB bestätigt. Der Anteil infizierter Bursa-B-Lymphozyten stieg von 2,5% am ersten Tag nach der Infektion (p.i.) bis auf ca. 15% an Tag 4 p.i. Vergleichbare Werte wurden auch für B-Zellkulturen aus der Milz und dem Blut gefunden. Die durchflusszytometrische Charakterisierung der infizierten Zellpopulation erfolgte mit Hilfe zahlreicher Hühner-spezifischer monoklonaler Antikörper. Infizierte B-Zellen sind chBu1+ und zeigen einen distinkten Phänotyp sowie eine intermediäre Zellgröße. Für die weitere Charakterisierung wurden infizierte und nicht infizierte Bursa-B-Zellen durchflusszytometrisch sortiert (> 95% Reinheit) und Mikroarray basierten Genexpressionsanalysen unterzogen. Auch T-Zellen aus der Milz, dem Blut und dem Thymus konnten nach αVβ1-TCR (TCR-2) Stimulation auf dieselbe Weise mit RB-1B MeqGFP-UL47RFP infiziert werden. Der Hauptteil der infizierten T-Zellen zeigte einen CD4+ αVβ1-TCR+ Phänotyp, allerdings fanden sich auch einige infizierte CD8+ T-Zellen. Durch die alleinige Expression von MeqGFP oder die gleichzeitige Expression von UL47RFP und MeqGFP konnten die infizierten Thymozyten in eine latent und eine zytolytisch infizierte Population unterteilt werden. Während die zytolytisch infizierte Population primär aus B-Zellen und CD8+ T-Zellen bestand, waren die latent infizierten T-Zellen zum Großteil CD4+ T Zellen. Erstmals gelang es in dieser Arbeit die Übertragung des Virus von der B-Zelle auf die T Zellen durch Co-Kultivierung mit durchflusszytometrisch sortierten infizierten B Zellen direkt nachzuweisen. Darüber hinaus konnten aus Langzeitkulturen infizierter Thymozyten vier lymphoblastoide Zelllinien (JS1 –JS4) isoliert werden. Alle vier Linien zeigten ein homogenes, lymphoblastoides Erscheinungsbild und waren CD4+, αVβ1-TCR+, MHC I+ und MHC II+. Dieser Phänotyp entspricht exakt dem von in vivo transformierten T Zelllymphomen. Das in dieser Arbeit etablierte Infektionssystem ist das erste Kultursystem, mit dem eine reproduzierbare und effiziente MDV Infektion von Lymphozyten in vitro erreicht wird. Es spiegelt die verschiedenen Phasen des natürlichen Infektionszyklus wider. Damit eröffnet sich erstmals ein Weg, die Interaktion von B-Zellen und Virus, bzw. T-Zellen und Virus detailliert und zu definierten Zeitpunkten zu analysieren. Hervorzuheben ist, dass die hier beschriebenen Methoden nicht nur verbesserte Untersuchungsmöglichkeiten bieten, sondern auch dazu beitragen können, die Zahl der bisher notwendigen Tierversuche in der MDV-Forschung deutlich zu reduzieren.Marek’s disease (MD) is a leading problem in the poultry industry causing significant economic losses worldwide. MD is caused by the Marek’s disease virus (MDV), an alphaherpesvirus that induces immunosuppression and T-cell lymphomas. B- and T lymphocytes are the primary target cells of the virus in vivo and B-lymphocytes undergo cell death in the early cytolytic phase of infection. Latent MDV infection is primarily established in CD4+ αβTCR T-cells, which can also be transformed after virus reactivation leading to lymphoma formation. MDV research has either used in vivo infections or utilized fibroblast and kidney cell cultures for in vitro studies. Thus far, no in vitro infection systems for B- and T-cells, the primary target cells of MDV have been established due to the rapid apoptotic cell death of cultured primary lymphocytes. Recent progress in avian immunology has led to the identification of numerous cytokines promoting survival, proliferation and activation of cultured chicken B- and T-cells. These cytokines were utilized to establish new lymphocyte culture systems and in vitro B- and T cell infection models using the genetically modified MDV reporter strains MDV RB-1B UL47GFP and RB-1B MeqGFP-UL47RFP. B-cells isolated from spleen, bursa and blood were cultured in the presence of soluble chCD40L for extended periods of time and successfully infected by co-culturing with MDV infected chicken embryo cells (CEC) as demonstrated by GFP expression. Infection was confirmed by cytoplasmic staining with monoclonal antibodies (mabs) to the viral proteins ICP4 and gB. Infection rates increased from 2.5 to 15% in bursal lymphocyte cultures between day one and day four post infection and similarly in blood and spleen derived B cells. Cell surface staining with a range of mabs revealed that infected cells represented a subpopulation of chBu1+ cells with a unique phenotype and an intermediate cell size. Further phenotypic characterization of these cells was achieved by microarray based gene expression analysis on infected and no infected B cells enriched to more than 95% purity by fluorescence activated cell sorting. In addition, T-cells isolated from spleen, blood and thymus activated by cross-linking of the αVβ1-TCR (TCR-2) could be infected in the same way. The vast majority of infected T lymphocytes were CD4+ whereas only a small number of CD8+ cells were positive for viral genes. Expression of MeqGFP or MeqGFP plus UL47RFP indicated that latent and lytic infections occurred in T-cell cultures. T-cell infection was not only achieved with infected CEC but also with infected B-cells enriched through fluorescence activated cell sorting. By maintaining activated thymocytes for up to five weeks without further stimulation, four transformed lymphoblastoid cell lines termed JS1 to JS4 were successfully established in vitro. These cell lines represented CD4+, αVβ1-TCR+, MHC I+ and MHC II+ cells, thus reflecting the typical phenotype of MDV lymphomas observed in chickens. For the first time, this work describes the establishment of a reproducible and efficient in vitro infection system which precisely reflects the in vivo life cycle of MDV. This system will help to shed new light on the interaction between MDV and its target cells by providing lymphocytes at defined stages of infection at high purity. Of equal importance, it should help to reduce the number of animal experiments by providing a reliable in vitro alternative

Diversity via datafication? Digital patient records and citizenship for sexuality and gender diverse people

In 2018, the Australian Government adopted an ‘opt-out’ strategy to increase participation in My Health Record (MHR), the national digital patient record system. Opt out was rationalised through discourse on the universal right to health. Media controversy ensued due to privacy fears, security and commercial exploitation of patient information. LGBT community organisations warned that people with complex health needs should consider their privacy and legal situation when deciding whether or not to opt out of MHR. With reference to the health needs of sexuality and gender diverse people, we examine MHR’s rights universalism, possessive individualism, and state-based rationalisation of health governance. MHR hails all but no-one in particular, erasing diversity and straightwashing data medicine. It is a technological solution to state-based imperatives for health governance, an emphasis that does not serve minority communities or address health needs that attract stigma and prejudice. We counterpose these effects with citizenship framings seated in critical approaches to data assemblages and sexuality and gender diversity. We suggest ways in which data medicine, of which MHR is but one example, can be made more relevant and effective for individuals and communities whose healthcare is poorly served by mainstream health systems

Inhaled tolafentrine reverses pulmonary vascular remodeling via inhibition of smooth muscle cell migration

BACKGROUND: The aim of the study was to assess the chronic effects of combined phosphodiesterase 3/4 inhibitor tolafentrine, administered by inhalation, during monocrotaline-induced pulmonary arterial hypertension (PAH) in rats. METHODS: CD rats were given a single subcutaneous injection of monocrotaline to induce PAH. Four weeks after, rats were subjected to inhalation of tolafentrine or sham nebulization in an unrestrained, whole body aerosol exposure system. In these animals (i) the acute pulmonary vasodilatory efficacy of inhaled tolafentrine (ii) the anti-remodeling effect of long-term inhalation of tolafentrine (iii) the effects of tolafentrine on the expression profile of 96 genes encoding cell adhesion and extracellular matrix regulation were examined. In addition, the inhibitory effect of tolafentrine on ex vivo isolated pulmonary artery SMC cell migration was also investigated. RESULTS: Monocrotaline injection provoked severe PAH (right ventricular systolic pressure increased from 25.9 ± 4.0 to 68.9 ± 3.2 after 4 weeks and 74.9 ± 5.1 mmHg after 6 weeks), cardiac output depression and right heart hypertrophy. The media thickness of the pulmonary arteries and the proportion of muscularization of small precapillary resistance vessels increased dramatically, and the migratory response of ex-vivo isolated pulmonary artery smooth muscle cells (PASMC) was increased. Micro-arrays and subsequent confirmation with real time PCR demonstrated upregulation of several extracellular matrix regulation and adhesion genes, such as matrixmetalloproteases (MMP) 2, 8, 9, 10, 11, 12, 20, Icam, Itgax, Plat and serpinb2. When chronically nebulized from day 28 to 42 (12 daily aerosol maneuvers), after full establishment of severe pulmonary hypertension, tolafentrine reversed about 60% of all hemodynamic abnormalities, right heart hypertrophy and monocrotaline-induced structural lung vascular changes, including the proportion of pulmonary artery muscularization. The upregulation of extracellular matrix regulation and adhesion genes was reduced by nearly 80% by inhalation of the tolafentrine. When assessed in vitro, tolafentrine blocked the enhanced PASMC migratory response. CONCLUSION: In conclusion, we demonstrate for the first time that inhalation of combined PDE3/4 inhibitor reverses pulmonary hypertension fully developed in response to monocrotaline in rats. This "reverse-remodeling" effect includes structural changes in the lung vascular wall and key molecular pathways of matrix regulation, concomitant with 60% normalization of hemodynamics

Are serial CA 19-9 kinetics helpful in predicting survival in patients with advanced or metastatic pancreatic cancer treated with gemcitabine and cisplatin?

Background: Serial kinetics of serum CA 19-9 levels have been reported to reflect response and survival in patients with pancreatic cancer undergoing surgery, radiotherapy, and chemotherapy. We prospectively studied serial kinetics of serum CA 19-9 levels of patients with locally advanced or metastatic disease treated with gemcitabine and cisplatin. Patients and Methods: Enrolled in the study were 87 patients (female/male = 26/61; stage III/IV disease = 24/63). Patients received gemcitabine 1,000 mg/m(2) on days 1, 8, and 15 plus cisplatin 50 mg/m(2) on days 1 and 15, every 4 weeks. Serum samples were collected at the onset of chemotherapy and before the start of a new treatment cycle (day 28). Results: 77 of 87 patients (88.5%) with initially elevated CA 19-9 levels were included for evaluation. According to imaging criteria, 4 (5.2%) achieved a complete remission and 11 (14.3%) achieved partial remission, yielding an overall response rate of 19.5%. 43 (55.8%) patients were CA 19-9 responders, defined by greater than or equal to50% decrease in CA 19-9 serum levels within 2 months after treatment initiation. Except for one, all patients who had responded by imaging criteria (n = 14) fulfilled the criterion of a CA 19-9 responder. Despite being characterized as non-responders by CT-imaging criteria (stable/progressive disease), 29 patients were classified as CA 19-9 responders (positive predictive value 32.5%). Independent of the response evaluation by CT, CA 19-9 responders survived significantly longer than CA 19-9 non-responders (295 d; 95% CI: 285-445 vs. 174 d; 95% CI: 134-198; p = 0.022). Conclusion: CA 19-9 kinetics in serum serve as an early and reliable indicator of response and help to predict survival in patients with advanced pancreatic cancer receiving effective treatment with gemcitabine and cisplatin

Systematische Erfassung von Nebenwirkungen ambulanter Verhaltenstherapie

Psychotherapie ist ein integraler Bestandteil der Behandlung psychischer Störungen. Anders als in anderen Disziplinen der Medizin sind den Nebenwirkungen von Psychotherapie bisher nur wenig Aufmerksamkeit geschenkt worden. Im Zuge dieser Publikationspromotion wurde eine Definition von Psychotherapienebenwirkungen entwickelt und ein Instrument (UE-ATR-Checkliste) zu deren Untersuchung eingeführt. In einer Untersuchung an 100 Psychotherapeuten in Ausbildung (VT) und ihren Behandlungsfällen wurde systematisch nach dem Erfahrungsstand der Ausbildungsteilnehmer gefragt und die Qualität, Quantität sowie der Schweregrad und die Dauer von Nebenwirkungen in ihren Behandlungsfällen mit Hilfe eines halbstandardisierten Interviews erfasst. Es zeigte sich, dass die Therapeuten in Ausbildung mit einer hohen Auftretensrate von Nebenwirkungen rechnen, wenngleich ein positiver Bias vorliegt, was die eigenen Behandlungen betrifft. Bei 100 Behandlungsfällen zeigten sich in 43 % der Fälle Nebenwirkungen, die zu meist Stunden oder Tage dauerten und in mehr als der Hälfte leicht bis mittleren Schweregrades waren. Die Ergebnisse der Studie legen nahe, dass eine systematische Überwachung der Behandlungen sinnvoll sein kann und dem Thema der Psychotherapienebenwirkungen im Rahmen der Ausbildung mehr Raum geschenkt werden sollte.Psychotherapy is an important tool in the treatment of mental disorders. Different from other disciplines in the healthcare system psychotherapy´s potential to cause side effects is not well known and has not drawn much attention in the research community. Aim of the publication based dissertation thesis was to develop a definition and instrument (UE-ATR checklist) to conduct systematic research on psychotherapy side effects in a naturalistic setting. 100 therapists in training conducting CBT participated in the study. With a semi-structured interview based on the UE-ATR checklist therapists were asked about their experiences with and expectations of side effects and reported on 100 of their cases. The checklist allowed to identify several side effects, their severity and duration. Results show that therapists in training expect side effects to occur in about every second case, but they show a positive bias concerning their own work. Utilizing the UE-ATR-checklist side effects were reported in 43 % of cases. Most of them were of mild to moderate impact and lasted for hours to days. The results suggest that a systematic monitoring of SEs is necessary and possible and that information about side effects should be part of the training of therapists