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Bruun TH, Dietrich J, Klingseisen A, Bogdahn U. Editorial: Cellular CNS repair strategies, technologies and therapeutic developments. Front Cell Neurosci 2023; 17:1200639. [PMID: 37187608 PMCID: PMC10180015 DOI: 10.3389/fncel.2023.1200639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
| | - Jorg Dietrich
- Harvard Medical School Boston, Boston, MA, United States
| | - Anna Klingseisen
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Ulrich Bogdahn
- Velvio GmbH Regensburg, Regensburg, Germany
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
- *Correspondence: Ulrich Bogdahn
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Kozole J, Heydn R, Wirkert E, Küspert S, Aigner L, Bruun TH, Bogdahn U, Peters S, Johannesen S. Direct Potential Modulation of Neurogenic Differentiation Markers by Granulocyte-Colony Stimulating Factor (G-CSF) in the Rodent Brain. Pharmaceutics 2022; 14:pharmaceutics14091858. [PMID: 36145606 PMCID: PMC9504319 DOI: 10.3390/pharmaceutics14091858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
The hematopoietic granulocyte-colony stimulating growth factor (G-CSF, filgrastim) is an approved drug in hematology and oncology. Filgrastim's potential in neurodegenerative disorders is gaining increasingly more attention, as preclinical and early clinical studies suggest it could be a promising treatment option. G-CSF has had a tremendous record as a safe drug for more than three decades; however, its effects upon the central nervous system (CNS) are still not fully understood. In contrast to conceptual long-term clinical application with lower dosing, our present pilot study intends to give a first insight into the molecular effects of a single subcutaneous (s.c.) high-dose G-CSF application upon different regions of the rodent brain. We analyzed mRNA-and in some instances-protein data of neurogenic and non-neurogenic differentiation markers in different regions of rat brains five days after G-CSF (1.3 mg/kg) or physiological saline. We found a continuous downregulation of several markers in most brain regions. Remarkably, cerebellum and hypothalamus showed an upregulation of different markers. In conclusion, our study reveals minor suppressive or stimulatory effects of a single exceptional high G-CSF dose upon neurogenic and non-neurogenic differentiation markers in relevant brain regions, excluding unregulated responses or unexpected patterns of marker expression.
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Affiliation(s)
- Judith Kozole
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
- Department of Anesthesiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Rosmarie Heydn
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Eva Wirkert
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Sabrina Küspert
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria
| | - Tim-Henrik Bruun
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
- Velvio GmbH, 93053 Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
- Velvio GmbH, 93053 Regensburg, Germany
- Correspondence: or
| | - Sebastian Peters
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
- Department of Neurology, BG Trauma Center, 82418 Murnau (Staffelsee), Germany
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Peters S, Wirkert E, Kuespert S, Heydn R, Johannesen S, Friedrich A, Mailänder S, Korte S, Mecklenburg L, Aigner L, Bruun TH, Bogdahn U. Safe and Effective Cynomolgus Monkey GLP-Tox Study with Repetitive Intrathecal Application of a TGFBR2 Targeting LNA-Gapmer Antisense Oligonucleotide as Treatment Candidate for Neurodegenerative Disorders. Pharmaceutics 2022; 14:200. [PMID: 35057094 PMCID: PMC8780845 DOI: 10.3390/pharmaceutics14010200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
The capability of the adult central nervous system to self-repair/regenerate was demonstrated repeatedly throughout the last decades but remains in debate. Reduced neurogenic niche activity paralleled by a profound neuronal loss represents fundamental hallmarks in the disease course of neurodegenerative disorders. We and others have demonstrated the endogenous TGFβ system to represent a potential pathogenic participant in disease progression, of amyotrophic lateral sclerosis (ALS) in particular, by generating and promoting a disequilibrium of neurodegenerative and neuroregenerative processes. The novel human/primate specific LNA Gapmer Antisense Oligonucleotide "NVP-13", targeting TGFBR2, effectively reduced its expression and lowered TGFβ signal transduction in vitro and in vivo, paralleled by boosting neurogenic niche activity in human neuronal progenitor cells and nonhuman primate central nervous system. Here, we investigated NVP-13 in vivo pharmacology, safety, and tolerability following repeated intrathecal injections in nonhuman primate cynomolgus monkeys for 13 weeks in a GLP-toxicology study approach. NVP-13 was administered intrathecally with 1, 2, or 4 mg NVP-13/animal within 3 months on days 1, 15, 29, 43, 57, 71, and 85 in the initial 13 weeks. We were able to demonstrate an excellent local and systemic tolerability, and no adverse events in physiological, hematological, clinical chemistry, and microscopic findings in female and male Cynomolgus Monkeys. Under the conditions of this study, the no observed adverse effect level (NOAEL) is at least 4 mg/animal NVP-13.
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Affiliation(s)
- Sebastian Peters
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany; (S.P.); (E.W.); (S.K.); (R.H.); (S.J.); (T.-H.B.)
- Velvio GmbH, Am Biopark 11, 93053 Regensburg, Germany
| | - Eva Wirkert
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany; (S.P.); (E.W.); (S.K.); (R.H.); (S.J.); (T.-H.B.)
| | - Sabrina Kuespert
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany; (S.P.); (E.W.); (S.K.); (R.H.); (S.J.); (T.-H.B.)
| | - Rosmarie Heydn
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany; (S.P.); (E.W.); (S.K.); (R.H.); (S.J.); (T.-H.B.)
| | - Siw Johannesen
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany; (S.P.); (E.W.); (S.K.); (R.H.); (S.J.); (T.-H.B.)
- BG Trauma Center, Professor Küntscher Str. 8, 82418 Murnau am Staffelsee, Germany
| | - Anita Friedrich
- Granzer Regulatory Consulting & Services, Kistlerhofstr. 172C, 81379 München, Germany; (A.F.); (S.M.)
| | - Susanne Mailänder
- Granzer Regulatory Consulting & Services, Kistlerhofstr. 172C, 81379 München, Germany; (A.F.); (S.M.)
| | - Sven Korte
- Labcorp Early Development Services GmbH, 48163 Münster, Germany; (S.K.); (L.M.)
| | - Lars Mecklenburg
- Labcorp Early Development Services GmbH, 48163 Münster, Germany; (S.K.); (L.M.)
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
| | - Tim-Henrik Bruun
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany; (S.P.); (E.W.); (S.K.); (R.H.); (S.J.); (T.-H.B.)
- Velvio GmbH, Am Biopark 11, 93053 Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany; (S.P.); (E.W.); (S.K.); (R.H.); (S.J.); (T.-H.B.)
- Velvio GmbH, Am Biopark 11, 93053 Regensburg, Germany
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Bogdahn U, Peters S, Küspert S, Johannesen S, Bruun TH. Comprehensive approach: Neurogenesis, extracellular matrix, autophagy and immune dysfunction as treatment targets in neurodegeneration as in ALS – Reorganizing physiological repair. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Johannesen S, Bogdahn U, Bruun TH, Huie JR, Ferguson A, Budeus B, Peters S, Wirth AM, Iberl S, Kammermaier T, Kobor I, Wirkert E, Küspert S, Tahedl M, Grassinger J, Pukrop T, Armin S, Aigner L, Schulte-Mattler W, Schuierer G, Koch W. Modeling and bioinformatics identify responders to G-CSF in patients with amyotrophic lateral sclerosis. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Peters S, Kuespert S, Wirkert E, Heydn R, Jurek B, Johannesen S, Hsam O, Korte S, Ludwig FT, Mecklenburg L, Mrowetz H, Altendorfer B, Poupardin R, Petri S, Thal DR, Hermann A, Weishaupt JH, Weis J, Aksoylu IS, Lewandowski SA, Aigner L, Bruun TH, Bogdahn U. Reconditioning the Neurogenic Niche of Adult Non-human Primates by Antisense Oligonucleotide-Mediated Attenuation of TGFβ Signaling. Neurotherapeutics 2021; 18:1963-1979. [PMID: 33860461 PMCID: PMC8609055 DOI: 10.1007/s13311-021-01045-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 02/04/2023] Open
Abstract
Adult neurogenesis is a target for brain rejuvenation as well as regeneration in aging and disease. Numerous approaches showed efficacy to elevate neurogenesis in rodents, yet translation into therapies has not been achieved. Here, we introduce a novel human TGFβ-RII (Transforming Growth Factor-Receptor Type II) specific LNA-antisense oligonucleotide ("locked nucleotide acid"-"NVP-13"), which reduces TGFβ-RII expression and downstream receptor signaling in human neuronal precursor cells (ReNcell CX® cells) in vitro. After we injected cynomolgus non-human primates repeatedly i.th. with NVP-13 in a preclinical regulatory 13-week GLP-toxicity program, we could specifically downregulate TGFβ-RII mRNA and protein in vivo. Subsequently, we observed a dose-dependent upregulation of the neurogenic niche activity within the hippocampus and subventricular zone: human neural progenitor cells showed significantly (up to threefold over control) enhanced differentiation and cell numbers. NVP-13 treatment modulated canonical and non-canonical TGFβ pathways, such as MAPK and PI3K, as well as key transcription factors and epigenetic factors involved in stem cell maintenance, such as MEF2A and pFoxO3. The latter are also dysregulated in clinical neurodegeneration, such as amyotrophic lateral sclerosis. Here, we provide for the first time in vitro and in vivo evidence for a novel translatable approach to treat neurodegenerative disorders by modulating neurogenesis.
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Affiliation(s)
- Sebastian Peters
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
- Velvio GmbH, Am Biopark 11, Regensburg, Germany
| | - Sabrina Kuespert
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
- Velvio GmbH, Am Biopark 11, Regensburg, Germany
| | - Eva Wirkert
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
- Velvio GmbH, Am Biopark 11, Regensburg, Germany
| | - Rosmarie Heydn
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
- Velvio GmbH, Am Biopark 11, Regensburg, Germany
| | - Benjamin Jurek
- Institute for Molecular and Cellular Anatomy, University of Regensburg, Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
- Velvio GmbH, Am Biopark 11, Regensburg, Germany
| | - Ohnmar Hsam
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Sven Korte
- Covance Preclinical Services GmbH, Muenster, Germany
| | | | | | - Heike Mrowetz
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University Salzburg, Salzburg, Austria
- Institute of Experimental and Clinical Cell Therapy, Spinal Cord Injury and Tissue Regeneration Center (SCI-TReCS), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University Salzburg, Salzburg, Austria
- Institute of Experimental and Clinical Cell Therapy, Spinal Cord Injury and Tissue Regeneration Center (SCI-TReCS), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Rodolphe Poupardin
- Institute of Experimental and Clinical Cell Therapy, Spinal Cord Injury and Tissue Regeneration Center (SCI-TReCS), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Susanne Petri
- Department of Neurology, University Hospital MHH, Hannover, Germany
| | - Dietmar R Thal
- Department for Imaging and Pathology, Laboratory for Neuropathology, University of Leuven, Leuven, Belgium
- Laboratory of Neuropathology, Institute of Pathology, Ulm University, Ulm, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, and German Center for Neurodegenerative Diseases (DZNE) Rostock, Rostock, Germany
| | - Jochen H Weishaupt
- Department of Neurology, University Hospital Mannheim, Mannheim, Germany
| | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University Medical School, Aachen, Germany
| | - Inci Sevval Aksoylu
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sebastian A Lewandowski
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
- SciLifeLab, School of Biotechnology, Royal Institute of Technology, Stockholm, Sweden
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University Salzburg, Salzburg, Austria
- Institute of Experimental and Clinical Cell Therapy, Spinal Cord Injury and Tissue Regeneration Center (SCI-TReCS), Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim-Henrik Bruun
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
- Velvio GmbH, Am Biopark 11, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany.
- Velvio GmbH, Am Biopark 11, Regensburg, Germany.
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University Salzburg, Salzburg, Austria.
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Aschauer-Wallner S, Leis S, Bogdahn U, Johannesen S, Couillard-Despres S, Aigner L. Granulocyte colony-stimulating factor in traumatic spinal cord injury. Drug Discov Today 2021; 26:1642-1655. [PMID: 33781952 DOI: 10.1016/j.drudis.2021.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022]
Abstract
Granulocyte colony-stimulating factor (G-CSF) is a cytokine used in pharmaceutical preparations for the treatment of chemotherapy-induced neutropenia. Evidence from experimental studies indicates that G-CSF exerts relevant activities in the central nervous system (CNS) in particular after lesions. In acute, subacute, and chronic CNS lesions, G-CSF appears to have strong anti-inflammatory, antiapoptotic, antioxidative, myelin-protective, and axon-regenerative activities. Additional effects result in the stimulation of angiogenesis and neurogenesis as well as in bone marrow stem cell mobilization to the CNS. There are emerging preclinical and clinical data indicating that G-CSF is a safe and effective drug for the treatment of acute and chronic traumatic spinal cord injury (tSCI), which we summarize in this review.
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Affiliation(s)
- Stephanie Aschauer-Wallner
- Department of Orthopedics and Traumatology, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Stefan Leis
- Department of Neurology, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ulrich Bogdahn
- Velvio GmbH, Regensburg, Germany; Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany; Department of Neurology, BG Trauma Center Murnau, Murnau, Germany
| | - Sebastien Couillard-Despres
- Institute of Experimental Neuroregeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
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Johannesen S, Huie JR, Budeus B, Peters S, Wirth AM, Iberl S, Kammermaier T, Kobor I, Wirkert E, Küspert S, Tahedl M, Grassinger J, Pukrop T, Schneider A, Aigner L, Schulte-Mattler W, Schuierer G, Koch W, Bruun TH, Ferguson AR, Bogdahn U. Modeling and Bioinformatics Identify Responders to G-CSF in Patients With Amyotrophic Lateral Sclerosis. Front Neurol 2021; 12:616289. [PMID: 33815246 PMCID: PMC8012841 DOI: 10.3389/fneur.2021.616289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Developing an integrative approach to early treatment response classification using survival modeling and bioinformatics with various biomarkers for early assessment of filgrastim (granulocyte colony stimulating factor) treatment effects in amyotrophic lateral sclerosis (ALS) patients. Filgrastim, a hematopoietic growth factor with excellent safety, routinely applied in oncology and stem cell mobilization, had shown preliminary efficacy in ALS. Methods: We conducted individualized long-term filgrastim treatment in 36 ALS patients. The PRO-ACT database, with outcome data from 23 international clinical ALS trials, served as historical control and mathematical reference for survival modeling. Imaging data as well as cytokine and cellular data from stem cell analysis were processed as biomarkers in a non-linear principal component analysis (NLPCA) to identify individual response. Results: Cox proportional hazard and matched-pair analyses revealed a significant survival benefit for filgrastim-treated patients over PRO-ACT comparators. We generated a model for survival estimation based on patients in the PRO-ACT database and then applied the model to filgrastim-treated patients. Model-identified filgrastim responders displayed less functional decline and impressively longer survival than non-responders. Multimodal biomarkers were then analyzed by PCA in the context of model-defined treatment response, allowing identification of subsequent treatment response as early as within 3 months of therapy. Strong treatment response with a median survival of 3.8 years after start of therapy was associated with younger age, increased hematopoietic stem cell mobilization, less aggressive inflammatory cytokine plasma profiles, and preserved pattern of fractional anisotropy as determined by magnetic resonance diffusion tensor imaging (DTI-MRI). Conclusion: Long-term filgrastim is safe, is well-tolerated, and has significant positive effects on disease progression and survival in a small cohort of ALS patients. Developing and applying a model-based biomarker response classification allows use of multimodal biomarker patterns in full potential. This can identify strong individual treatment responders (here: filgrastim) at a very early stage of therapy and may pave the way to an effective individualized treatment option.
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Affiliation(s)
- Siw Johannesen
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - J. Russell Huie
- Brain and Spinal Cord Injury Center, Weill Institute of Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | | | - Sebastian Peters
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Anna M. Wirth
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Sabine Iberl
- Department of Hematology - Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Tina Kammermaier
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Ines Kobor
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Eva Wirkert
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Sabrina Küspert
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Marlene Tahedl
- Department of Psychiatry and Psychotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Jochen Grassinger
- Department of Hematology - Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Pukrop
- Department of Hematology - Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | | | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Velvio GmbH, Regensburg, Germany
| | | | - Gerhard Schuierer
- Center of Neuroradiology, University Hospital Regensburg & District Medical Center Regensburg, Regensburg, Germany
| | | | - Tim-Henrik Bruun
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
- Velvio GmbH, Regensburg, Germany
| | - Adam R. Ferguson
- Brain and Spinal Cord Injury Center, Weill Institute of Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Velvio GmbH, Regensburg, Germany
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Bede P, Bogdahn U, Lope J, Chang KM, Xirou S, Christidi F. Degenerative and regenerative processes in amyotrophic lateral sclerosis: motor reserve, adaptation and putative compensatory changes. Neural Regen Res 2021; 16:1208-1209. [PMID: 33269779 PMCID: PMC8224145 DOI: 10.4103/1673-5374.300440] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Peter Bede
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland; Biomedical Imaging Laboratory, Sorbonne University, Paris, France
| | - Ulrich Bogdahn
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Jasmin Lope
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Kai Ming Chang
- Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Sophia Xirou
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Christidi
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kandasamy M, Anusuyadevi M, Aigner KM, Unger MS, Kniewallner KM, de Sousa DMB, Altendorfer B, Mrowetz H, Bogdahn U, Aigner L. TGF-β Signaling: A Therapeutic Target to Reinstate Regenerative Plasticity in Vascular Dementia? Aging Dis 2020; 11:828-850. [PMID: 32765949 PMCID: PMC7390515 DOI: 10.14336/ad.2020.0222] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/22/2020] [Indexed: 12/11/2022] Open
Abstract
Vascular dementia (VaD) is the second leading form of memory loss after Alzheimer's disease (AD). Currently, there is no cure available. The etiology, pathophysiology and clinical manifestations of VaD are extremely heterogeneous, but the impaired cerebral blood flow (CBF) represents a common denominator of VaD. The latter might be the result of atherosclerosis, amyloid angiopathy, microbleeding and micro-strokes, together causing blood-brain barrier (BBB) dysfunction and vessel leakage, collectively originating from the consequence of hypertension, one of the main risk factors for VaD. At the histopathological level, VaD displays abnormal vascular remodeling, endothelial cell death, string vessel formation, pericyte responses, fibrosis, astrogliosis, sclerosis, microglia activation, neuroinflammation, demyelination, white matter lesions, deprivation of synapses and neuronal loss. The transforming growth factor (TGF) β has been identified as one of the key molecular factors involved in the aforementioned various pathological aspects. Thus, targeting TGF-β signaling in the brain might be a promising therapeutic strategy to mitigate vascular pathology and improve cognitive functions in patients with VaD. This review revisits the recent understanding of the role of TGF-β in VaD and associated pathological hallmarks. It further explores the potential to modulate certain aspects of VaD pathology by targeting TGF-β signaling.
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Affiliation(s)
- Mahesh Kandasamy
- Laboratory of Stem Cells and Neuroregeneration, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India.
- Faculty Recharge Programme, University Grants Commission (UGC-FRP), New Delhi, India.
| | - Muthuswamy Anusuyadevi
- Molecular Gerontology Group, Department of Biochemistry, School of Life Sciences, Bharathidhasan University, Tiruchirappalli, Tamil Nadu, India.
| | - Kiera M Aigner
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Michael S Unger
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Kathrin M Kniewallner
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Diana M Bessa de Sousa
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Heike Mrowetz
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Ulrich Bogdahn
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
- Velvio GmbH, Regensburg, Germany.
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
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11
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Meyding-Lamadé U, Jacobi C, Martinez-Torres F, Lenhard T, Kress B, Kieser M, Klose C, Einhäupl K, Bösel J, Mackert MB, Homberg V, Koennecke C, Weißheit G, Claus D, Kieseier B, Bardutzky J, Neumann-Haefelin T, Lorenz MW, Steinmetz H, Gerloff C, Schneider D, Grau A, Klein M, Dziewas R, Bogdahn U, Jakob W, Linker R, Fuchs K, Sander A, Luntz S, Hoppe-Tichy T, Hanley DF, von Kummer R, Craemer E. The German trial on Aciclovir and Corticosteroids in Herpes-simplex-virus-Encephalitis (GACHE): a multicenter, randomized, double-blind, placebo-controlled trial. Neurol Res Pract 2019; 1:26. [PMID: 33324892 PMCID: PMC7650106 DOI: 10.1186/s42466-019-0031-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/07/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Comprehensive treatment of Herpes-simplex-virus-encephalitis (HSVE) remains a major clinical challenge. The current therapy gold standard is aciclovir, a drug that inhibits viral replication. Despite antiviral treatment, mortality remains around 20% and a majority of survivors suffer from severe disability. Experimental research and recent retrospective clinical observations suggest a favourable therapy response to adjuvant dexamethasone. Currently there is no randomized clinical trial evidence, however, to support the routine use of adjuvant corticosteroid treatment in HSVE. Methods The German trial of Aciclovir and Corticosteroids in Herpes-simplex-virus-Encephalitis (GACHE) studied the effect of adjuvant dexamethasone versus placebo on top of standard aciclovir treatment in adult patients aged 18 up to 85 years with proven HSVE in German academic centers of Neurology in a randomized and double blind fashion. The trial was open from November 2007 to December 2012. The initially planned sample size was 372 patients with the option to increase to up to 450 patients after the second interim analysis. The primary endpoint was a binary functional outcome after 6 months assessed using the modified Rankin scale (mRS 0-2 vs. 3-6). Secondary endpoints included mortality after 6 and 12 months, functional outcome after 6 months measured with the Glasgow outcome scale (GOS), functional outcome after 12 months measured with mRS and GOS, quality of life as measured with the EuroQol 5D instrument after 6 and 12 months, neuropsychological testing after 6 months, cranial magnetic resonance imaging findings after 6 months, seizures up to day of discharge or at the latest at day 30, and after 6 and 12 months. Results The trial was stopped prematurely for slow recruitment after 41 patients had been randomized, 21 of them treated with dexamethasone and 20 with placebo. No difference was observed in the primary endpoint. In the full analysis set (n = 19 in each group), 12 patients in each treatment arm achieved a mRS of 0-2. Similarly, we did not observe significant differences in the secondary endpoints (GOS, mRS, quality of life, neuropsychological testing). Conclusion GACHE being prematurely terminated demonstrated challenges encountered performing randomized, placebo-controlled trials in rare life threatening neurological diseases. Based upon our trial results the use of adjuvant steroids in addition to antiviral treatment remains experimental and is at the decision of the individual treating physician. Unfortunately, the small number of study participants does not allow firm conclusions. Trial registration EudraCT-Nr. 2005-003201-81.
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Affiliation(s)
- U Meyding-Lamadé
- Department of Neurology, Krankenhaus Nordwest, Frankfurt, Germany.,Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - C Jacobi
- Department of Neurology, Krankenhaus Nordwest, Frankfurt, Germany
| | - F Martinez-Torres
- Department of Neurology, Krankenhaus Nordwest, Frankfurt, Germany.,Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - T Lenhard
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - B Kress
- Department of Neuroradiology, Krankenhaus Nordwest, Frankfurt, Germany
| | - M Kieser
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C Klose
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - K Einhäupl
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J Bösel
- Department of Neurology, Klinikum Kassel, Kassel, Germany
| | - M-B Mackert
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - V Homberg
- Department of Neurology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - C Koennecke
- Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - G Weißheit
- Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - D Claus
- Department of Neurology, Klinikum Darmstadt, Darmstadt, Germany.,Praxis Dr. Meyer & Prof. Claus, Bensheim, Germany
| | - B Kieseier
- Department of Neurology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - J Bardutzky
- Department of Neurology, University of Freiburg, Freiburg, Germany
| | | | - M W Lorenz
- Department of Neurology, Krankenhaus Nordwest, Frankfurt, Germany.,Department of Neurology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - H Steinmetz
- Department of Neurology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - C Gerloff
- Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - D Schneider
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - A Grau
- Department of Neurology, Klinikum der Stadt Ludwigshafen am Rhein, Lugwigshafen, Germany
| | - M Klein
- Department of Neurology, Klinikum der Ludwig-Maximilians- Universität München, Großhadern, Germany
| | - R Dziewas
- Department of Neurology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - U Bogdahn
- Department of Pharmacy Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - W Jakob
- Department of Neurology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - R Linker
- Department of Neurology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - K Fuchs
- Department of Neurology, Universitätsklinikum Regensburg, Regensburg, Germany
| | - A Sander
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - S Luntz
- Koordinierungszentrum für Klinische Studien (KKS), University of Heidelberg, Heidelberg, Germany
| | - T Hoppe-Tichy
- Department of Pharmacy Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - D F Hanley
- Division of Brain Injury Outcomes, John Hopkins University, Baltimore, MD USA
| | - R von Kummer
- Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - E Craemer
- Department of Neurology, Krankenhaus Nordwest, Frankfurt, Germany
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12
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Iberl S, Meyer AL, Müller G, Peters S, Johannesen S, Kobor I, Beier F, Brümmendorf TH, Hart C, Schelker R, Herr W, Bogdahn U, Grassinger J. Effects of continuous high-dose G-CSF administration on hematopoietic stem cell mobilization and telomere length in patients with amyotrophic lateral sclerosis - a pilot study. Cytokine 2019; 120:192-201. [PMID: 31100684 DOI: 10.1016/j.cyto.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/23/2019] [Accepted: 05/05/2019] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of complex and still poorly understood etiology. Loss of upper and lower motoneurons results in death within few years after diagnosis. Recent studies have proposed neuroprotective and disease-slowing effects of granulocyte-colony stimulating factor (G-CSF) treatment in ALS mouse models as well as humans. In this study, six ALS patients were monitored up to 3.5 years during continuous high-dose G-CSF administration. Repetitive analyses were performed including blood count parameters, CD34+ hematopoietic stem and progenitor cell (HSPC) and colony forming cell (CFC) counts, serum cytokine levels and leukocyte telomere length. We demonstrate that continuous G-CSF therapy was well tolerated and safe resulting in only mild adverse events during the observation period. However, no mobilization of CD34+ HSPC was detected as compared to baseline values. CFC mobilization was equally low and even a decrease of myeloid precursors was observed in some patients. Assessment of telomere length within ALS patients' leukocytes revealed that G-CSF did not significantly shorten telomeres, while those of ALS patients were shorter compared to age-matched healthy controls, irrespective of G-CSF treatment. During G-CSF stimulation, TNF-alpha, CRP, IL-16, sVCAM-1, sICAM-1, Tie-2 and VEGF were significantly increased in serum whereas MCP-1 levels decreased. In conclusion, our data show that continuous G-CSF treatment fails to increase circulating CD34+ HSPC in ALS patients. Cytokine profiles revealed G-CSF-mediated immunomodulatory and proteolytic effects. Interestingly, despite intense G-CSF stimulation, telomere length was not significantly shortened.
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Affiliation(s)
- Sabine Iberl
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.
| | - Anne-Louise Meyer
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Gunnar Müller
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Sebastian Peters
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Ines Kobor
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Fabian Beier
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, RWTH Aachen University Medical School, Aachen, Germany
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, RWTH Aachen University Medical School, Aachen, Germany
| | - Christina Hart
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Roland Schelker
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Jochen Grassinger
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany; Department of Oncology and Hematology, St. Elisabeth Hospital, Straubing, Germany
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13
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Beier D, Proescholdt M, Reinert C, Pietsch T, Jones DTW, Pfister SM, Hattingen E, Seidel C, Dirven L, Luerding R, Reijneveld J, Warmuth-Metz M, Bonsanto M, Bremer M, Combs SE, Rieken S, Herrlinger U, Kuntze H, Mayer-Steinacker R, Moskopp D, Schneider T, Beringer A, Schlegel U, Stummer W, Welker H, Weyerbrock A, Paulsen F, Rutkowski S, Weller M, Wick W, Kortmann RD, Bogdahn U, Hau P. Multicenter pilot study of radiochemotherapy as first-line treatment for adults with medulloblastoma (NOA-07). Neuro Oncol 2019; 20:400-410. [PMID: 29016837 DOI: 10.1093/neuonc/nox155] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Medulloblastoma in adult patients is rare, with 0.6 cases per million. Prognosis depends on clinical factors and medulloblastoma entity. No prospective data on the feasibility of radiochemotherapy exist. The German Neuro-Oncology Working Group (NOA) performed a prospective descriptive multicenter single-arm phase II trial to evaluate feasibility and toxicity of radio-polychemotherapy. Methods The NOA-07 trial combined craniospinal irradiation with vincristine, followed by 8 cycles of cisplatin, lomustine, and vincristine. Adverse events, imaging and progression patterns, histological and genetic markers, health-related quality of life (HRQoL), and cognition were evaluated. Primary endpoint was the rate of toxicity-related treatment terminations after 4 chemotherapy cycles, and the toxicity profile. The feasibility goal was reached if at least 45% of patients received at least 4 cycles of maintenance chemotherapy. Results Thirty patients were evaluable. Each 50% showed classic and desmoplastic/nodular histology. Sixty-seven percent were classified into the sonic hedgehog (SHH) subgroup without TP53 alterations, 13% in wingless (WNT), and 17% in non-WNT/non-SHH. Four cycles of chemotherapy were feasible in the majority (n = 21; 70.0%). Hematological side effects and polyneuropathy were prevalent toxicities. During the active treatment period, HRQoL and verbal fluency improved significantly. The 3-year event-free survival rate was 66.6% at the time of databank lock. Conclusions Radio-polychemotherapy did lead to considerable toxicity and a high amount of dose reductions throughout the first 4 chemotherapy cycles that may affect efficacy. Thus, we propose frequent patient surveillance using this regimen. Modifications of the regimen may increase feasibility of radio-polychemotherapy of adult patients with medulloblastoma.
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Affiliation(s)
- Dagmar Beier
- Department of Neurology, University Hospital Odense and Clinical Institute, University of Southern Denmark, Odense, Denmark.,Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Martin Proescholdt
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Christiane Reinert
- Wilhelm Sander Neuro-Oncology Unit and Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, Brain Tumor Reference Center of the Society for Neuropathology and Neuroanatomy, University of Bonn Medical Center, Bonn, Germany
| | - David T W Jones
- Division of Pediatric Neuro-oncology, German Cancer Research Center, Heidelberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neuro-oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Elke Hattingen
- Department of Radiology, Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Clemens Seidel
- Department of Radiotherapy and Radio-oncology, University Hospital Leipzig, Leipzig, Germany
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ralf Luerding
- Wilhelm Sander Neuro-Oncology Unit and Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Jaap Reijneveld
- Brain Tumor Center Amsterdam and Department of Neurology, VU University Medical Center and Academic Medical Center, Amsterdam, the Netherlands
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Matteo Bonsanto
- Department of Neurosurgery, University Hospital, Lübeck, Germany.,Department of Radiation Oncology, Medical School Hannover, Hannover, Germany
| | | | - Stephanie E Combs
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrich Herrlinger
- Division of Neuro-oncology, University of Bonn Medical Center, Bonn, Germany
| | - Holger Kuntze
- Department of Neurology, University Hospital Mainz, Mainz, Germany
| | | | - Dag Moskopp
- Department of Neurosurgery, Vivantes Klinikum am Friedrichshain, Berlin, Germany
| | - Thomas Schneider
- Department of Neurosurgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Andreas Beringer
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Uwe Schlegel
- Department of Neurology, Knappschaftskrankenhaus, University of Bochum, Bochum, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Helmut Welker
- Department of Radiation Oncology, Klinikum Stuttgart, Stuttgart, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Weller
- Department of Neurology, Universitätsspital Zurich, Zurich, Switzerland, and Department of Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Wolfgang Wick
- Department of Neurology, University Hospital Heidelberg, and Neuro-oncology Program at the National Center for Tumor Diseases, Heidelberg, Germany
| | - Rolf-Dieter Kortmann
- Department of Radiotherapy and Radio-oncology, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich Bogdahn
- Wilhelm Sander Neuro-Oncology Unit and Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Peter Hau
- Wilhelm Sander Neuro-Oncology Unit and Department of Neurology, University of Regensburg, Regensburg, Germany
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14
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Wirth AM, Johannesen S, Khomenko A, Baldaranov D, Bruun TH, Wendl C, Schuierer G, Greenlee MW, Bogdahn U. Value of fluid-attenuated inversion recovery MRI data analyzed by the lesion segmentation toolbox in amyotrophic lateral sclerosis. J Magn Reson Imaging 2018; 50:552-559. [PMID: 30569457 PMCID: PMC6767504 DOI: 10.1002/jmri.26577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022] Open
Abstract
Background MRI fluid‐attenuated inversion recovery (FLAIR) studies reported hyperintensity in the corticospinal tract and corpus callosum of patients with amyotrophic lateral sclerosis (ALS). Purpose To evaluate the lesion segmentation toolbox (LST) for the objective quantification of FLAIR lesions in ALS patients. Study Type Retrospective. Population Twenty‐eight ALS patients (eight females, mean age: 50 range: 24–73, mean ALSFRS‐R sum score: 36) were compared with 31 age‐matched healthy controls (12 females, mean age: 45, range: 25–67). ALS patients were treated with riluzole and additional G‐CSF (granulocyte‐colony stimulating factor) on a named patient basis. Field Strength/Sequence 1.5 T, FLAIR, T1‐weighted MRI. Assessment The lesion prediction algorithm (LPA) of the LST enabled the extraction of individual binary lesion maps, total lesion volume (TLV), and number (TLN). Location and overlap of FLAIR lesions across patients were investigated by registration to FLAIR average space and an atlas. ALS‐specific functional rating scale revised (ALSFRS‐R), disease progression, and survival since diagnosis served as clinical correlates. Statistical Tests Univariate analysis of variance (ANOVA), repeated‐measures ANOVA, t‐test, Bravais‐Pearson correlation, Chi‐square test of independence, Kaplan–Meier analysis, Cox‐regression analysis. Results Both ALS patients and healthy controls exhibited FLAIR alterations. TLN significantly depended on age (F(1,54) = 24.659, P < 0.001) and sex (F(1,54) = 5.720, P = 0.020). ALS patients showed higher TLN than healthy controls depending on sex (F(1, 54) = 5.076, P = 0.028). FLAIR lesions were small and most pronounced in male ALS patients. FLAIR alterations were predominantly detected in the superior and posterior corona radiata, anterior capsula interna, and posterior thalamic radiation. Patients with pyramidal tract (PT) lesions exhibited significantly inferior survival than patients without PT lesions (P = 0.013). Covariate age exhibited strong prognostic value for survival (P = 0.015). Data Conclusion LST enables the objective quantification of FLAIR alterations and is a potential prognostic biomarker for ALS. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:552–559.
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Affiliation(s)
- Anna M Wirth
- Department of Neurology, University Hospital of Regensburg, Germany.,Department of Experimental Psychology, University of Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital of Regensburg, Germany
| | - Andrei Khomenko
- Department of Neurology, University Hospital of Regensburg, Germany
| | - Dobri Baldaranov
- Department of Neurology, University Hospital of Regensburg, Germany
| | - Tim-Henrik Bruun
- Department of Neurology, University Hospital of Regensburg, Germany
| | - Christina Wendl
- Center of Neuroradiology, University Hospital and District Medical Hospital of Regensburg, Germany
| | - Gerhard Schuierer
- Center of Neuroradiology, University Hospital and District Medical Hospital of Regensburg, Germany
| | - Mark W Greenlee
- Department of Experimental Psychology, University of Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital of Regensburg, Germany
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15
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Johannesen S, Budeus B, Peters S, Iberl S, Meyer AL, Kammermaier T, Wirkert E, Bruun TH, Samara VC, Schulte-Mattler W, Herr W, Schneider A, Grassinger J, Bogdahn U. Biomarker Supervised G-CSF (Filgrastim) Response in ALS Patients. Front Neurol 2018; 9:971. [PMID: 30534107 PMCID: PMC6275232 DOI: 10.3389/fneur.2018.00971] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/29/2018] [Indexed: 01/16/2023] Open
Abstract
Objective: To evaluate safety, tolerability and feasibility of long-term treatment with Granulocyte-colony stimulating factor (G-CSF), a well-known hematopoietic stem cell factor, guided by assessment of mobilized bone marrow derived stem cells and cytokines in the serum of patients with amyotrophic lateral sclerosis (ALS) treated on a named patient basis. Methods: 36 ALS patients were treated with subcutaneous injections of G-CSF on a named patient basis and in an outpatient setting. Drug was dosed by individual application schemes (mean 464 Mio IU/month, range 90-2160 Mio IU/month) over a median of 13.7 months (range from 2.7 to 73.8 months). Safety, tolerability, survival and change in ALSFRS-R were observed. Hematopoietic stem cells were monitored by flow cytometry analysis of circulating CD34+ and CD34+CD38− cells, and peripheral cytokines were assessed by electrochemoluminescence throughout the intervention period. Analysis of immunological and hematological markers was conducted. Results: Long term and individually adapted treatment with G-CSF was well tolerated and safe. G-CSF led to a significant mobilization of hematopoietic stem cells into the peripheral blood. Higher mobilization capacity was associated with prolonged survival. Initial levels of serum cytokines, such as MDC, TNF-beta, IL-7, IL-16, and Tie-2 were significantly associated with survival. Continued application of G-CSF led to persistent alterations in serum cytokines and ongoing measurements revealed the multifaceted effects of G-CSF. Conclusions: G-CSF treatment is feasible and safe for ALS patients. It may exert its beneficial effects through neuroprotective and -regenerative activities, mobilization of hematopoietic stem cells and regulation of pro- and anti-inflammatory cytokines as well as angiogenic factors. These cytokines may serve as prognostic markers when measured at the time of diagnosis. Hematopoietic stem cell numbers and cytokine levels are altered by ongoing G-CSF application and may potentially serve as treatment biomarkers for early monitoring of G-CSF treatment efficacy in ALS in future clinical trials.
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Affiliation(s)
- Siw Johannesen
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | | | - Sebastian Peters
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Sabine Iberl
- Department of Hematology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Anne-Louise Meyer
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Tina Kammermaier
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Eva Wirkert
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Tim-Henrik Bruun
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Verena C Samara
- Stanford Neuroscience Health Center, Palo Alto, CA, United States
| | | | - Wolfgang Herr
- Department of Hematology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | | | - Jochen Grassinger
- Department of Hematology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
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16
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Seliger C, Luber C, Gerken M, Schaertl J, Proescholdt M, Riemenschneider MJ, Meier CR, Bogdahn U, Leitzmann MF, Klinkhammer-Schalke M, Hau P. Use of metformin and survival of patients with high-grade glioma. Int J Cancer 2018; 144:273-280. [PMID: 30091464 DOI: 10.1002/ijc.31783] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/03/2018] [Accepted: 07/25/2018] [Indexed: 12/12/2022]
Abstract
High-grade glioma (HGG) is associated with poor prognosis. Drug repurposing evolves as new modality to improve standard therapy. The antidiabetic drug metformin has been found to inhibit glioma cell growth in vitro and in vivo. The aim of the present retrospective cohort study was to evaluate the survival of patients with HGG with or without treatment with metformin, based on a large cohort of a cancer registry. The analysis included 1,093 patients with HGG diagnosed between 1998 and 2013 from the population-based clinical cancer registry Regensburg (Germany), which covers 2.1 Mio inhabitants and 98% of all cancer diagnoses. We performed multivariable adjusted Cox-regression analyses. Hazard Ratios (HRs) with 95% Confidence Intervals (CIs) for overall survival (OS) and progression-free survival (PFS) of patients with HGG with or without treatment with metformin were obtained. Use of metformin was associated with a significantly better overall and progression-free survival of patients with WHO grade III glioma (HR for OS = 0.30; 95% CI = 0.11-0.81, HR for PFS = 0.29; 95% CI = 0.11-0.78), while there were no significant relations with OS (HR = 0.83; 95% CI = 0.57-1.20) or PFS (HR = 0.85; 95% CI = 0.59-1.22) in patients with WHO grade IV glioma. In conclusion, use of metformin is associated with better overall and progression-free survival of patients with WHO grade III. Possible underlying mechanisms include the higher prevalence of IDH mutations in WHO grade III glioma, which might sensitize to the metabolic drug metformin.
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Affiliation(s)
- Corinna Seliger
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Christian Luber
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Michael Gerken
- Institute for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Julia Schaertl
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Martin Proescholdt
- Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany
| | | | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of CIinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Switzerland.,Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Boston University, USA.,Department of Pharmaceutical Sciences, Hospital Pharmacy, University Hospital Basel, Switzerland
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Institute for Quality Assurance and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
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17
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Wirth AM, Khomenko A, Baldaranov D, Kobor I, Hsam O, Grimm T, Johannesen S, Bruun TH, Schulte-Mattler W, Greenlee MW, Bogdahn U. Combinatory Biomarker Use of Cortical Thickness, MUNIX, and ALSFRS-R at Baseline and in Longitudinal Courses of Individual Patients With Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:614. [PMID: 30104996 PMCID: PMC6077217 DOI: 10.3389/fneur.2018.00614] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/09/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative process affecting upper and lower motor neurons as well as non-motor systems. In this study, precentral and postcentral cortical thinning detected by structural magnetic resonance imaging (MRI) were combined with clinical (ALS-specific functional rating scale revised, ALSFRS-R) and neurophysiological (motor unit number index, MUNIX) biomarkers in both cross-sectional and longitudinal analyses. Methods: The unicenter sample included 20 limb-onset classical ALS patients compared to 30 age-related healthy controls. ALS patients were treated with standard Riluzole and additional long-term G-CSF (Filgrastim) on a named patient basis after written informed consent. Combinatory biomarker use included cortical thickness of atlas-based dorsal and ventral subdivisions of the precentral and postcentral cortex, ALSFRS-R, and MUNIX for the musculus abductor digiti minimi (ADM) bilaterally. Individual cross-sectional analysis investigated individual cortical thinning in ALS patients compared to age-related healthy controls in the context of state of disease at initial MRI scan. Beyond correlation analysis of biomarkers at cross-sectional group level (n = 20), longitudinal monitoring in a subset of slow progressive ALS patients (n = 4) explored within-subject temporal dynamics of repeatedly assessed biomarkers in time courses over at least 18 months. Results: Cross-sectional analysis demonstrated individually variable states of cortical thinning, which was most pronounced in the ventral section of the precentral cortex. Correlations of ALSFRS-R with cortical thickness and MUNIX were detected. Individual longitudinal biomarker monitoring in four slow progressive ALS patients revealed evident differences in individual disease courses and temporal dynamics of the biomarkers. Conclusion: A combinatory use of structural MRI, neurophysiological and clinical biomarkers allows for an appropriate and detailed assessment of clinical state and course of disease of ALS.
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Affiliation(s)
- Anna M Wirth
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany.,Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Andrei Khomenko
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Dobri Baldaranov
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Ines Kobor
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Ohnmar Hsam
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Thomas Grimm
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Tim-Henrik Bruun
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | | | - Mark W Greenlee
- Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
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18
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Leidgens V, Proske J, Rauer L, Moeckel S, Renner K, Bogdahn U, Riemenschneider MJ, Proescholdt M, Vollmann-Zwerenz A, Hau P, Seliger C. Stattic and metformin inhibit brain tumor initiating cells by reducing STAT3-phosphorylation. Oncotarget 2018; 8:8250-8263. [PMID: 28030813 PMCID: PMC5352398 DOI: 10.18632/oncotarget.14159] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/21/2016] [Indexed: 01/03/2023] Open
Abstract
Glioblastoma (GBM) is the most common and malignant type of primary brain tumor and associated with a devastating prognosis. Signal transducer and activator of transcription number 3 (STAT3) is an important pathogenic factor in GBM and can be specifically inhibited with Stattic. Metformin inhibits GBM cell proliferation and migration. Evidence from other tumor models suggests that metformin inhibits STAT3, but there is no specific data on brain tumor initiating cells (BTICs). We explored proliferation and migration of 7 BTICs and their differentiated counterparts (TCs) after treatment with Stattic, metformin or the combination thereof. Invasion was measured in situ on organotypic brain slice cultures. Protein expression of phosphorylated and total STAT3, as well as AMPK and mTOR signaling were explored using Western blot. To determine functional relevance of STAT3 inhibition by Stattic and metformin, we performed a stable knock-in of STAT3 in selected BTICs. Inhibition of STAT3 with Stattic reduced proliferation in all BTICs, but only in 4 out of 7 TCs. Migration and invasion were equally inhibited in BTICs and TCs. Treatment with metformin reduced STAT3-phosphorylation in all investigated BTICs and TCs. Combined treatment with Stattic and metformin led to significant additive effects on BTIC proliferation, but not migration or invasion. No additive effects on TCs could be detected. Stable STAT3 knock-in partly attenuated the effects of Stattic and metformin on BTICs. In conclusion, metformin was found to inhibit STAT3-phosphorylation in BTICs and TCs. Combined specific and unspecific inhibition of STAT3 might represent a promising new strategy in the treatment of glioblastoma.
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Affiliation(s)
- Verena Leidgens
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Judith Proske
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Lisa Rauer
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Sylvia Moeckel
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Kathrin Renner
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | | | - Martin Proescholdt
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Arabel Vollmann-Zwerenz
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Corinna Seliger
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
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19
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Seliger C, Meier CR, Becker C, Jick SS, Proescholdt M, Bogdahn U, Hau P, Leitzmann MF. Metabolic syndrome in relation to risk of meningioma. Oncotarget 2018; 8:2284-2292. [PMID: 27903988 PMCID: PMC5356799 DOI: 10.18632/oncotarget.13667] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 11/21/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Meningioma is a frequent primary intracranial tumor, the etiology of which is potentially related to adiposity. Metabolic syndrome (MetS) is an increasingly common disease characterized by having at least three of the following conditions: central adiposity, arterial hypertension, dyslipidemia, and insulin resistance. Only one prior study investigated MetS in relation to meningioma risk and found a positive association between the two. RESULTS Among 2,027 cases and 20,269 controls, body mass index was positively associated with meningioma (p-value for trend < 0.0001). Arterial hypertension was also associated with an increased risk of meningioma (OR = 1.34; 95% CI = 1.20- 1.49). By comparison, high-density lipoprotein, triglycerides, fasting serum glucose, and use of ACE-inhibitors, AT-II inhibitors, beta-blockers, diuretics, calcium antagonists, nitrates, or statins were not associated with risk of meningioma. MATERIALS AND METHODS We conducted a matched case-control analysis using data from the U.K.-based Clinical Practice Research Datalink (CPRD) to analyse medical conditions and treatments related to MetS in cases with meningioma and meningioma-free controls. We identified all cases with an incident diagnosis of meningioma between 1995 and 2015 and matched each to ten controls on age, sex, calendar time, general practice, and number of years of active history in the CPRD prior to the index date. Exposures were assessed using computerised records. We conducted conditional logistic regression analysis to determine relative risks, estimated as odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for confounding factors. CONCLUSIONS Obesity and arterial hypertension are positively associated with risk of meningioma. Further studies are needed to better understand potential underlying biologic mechanisms.
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Affiliation(s)
- Corinna Seliger
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Boston University, MA, USA.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Claudia Becker
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Susan S Jick
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Boston University, MA, USA
| | - Martin Proescholdt
- Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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20
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Peters S, Zitzelsperger E, Kuespert S, Iberl S, Heydn R, Johannesen S, Petri S, Aigner L, Thal DR, Hermann A, Weishaupt JH, Bruun TH, Bogdahn U. The TGF-β System As a Potential Pathogenic Player in Disease Modulation of Amyotrophic Lateral Sclerosis. Front Neurol 2017; 8:669. [PMID: 29326641 PMCID: PMC5736544 DOI: 10.3389/fneur.2017.00669] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/27/2017] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) represents a fatal orphan disease with high unmet medical need, and a life time risk of approx. 1/400 persons per population. Based on increasing knowledge on pathophysiology including genetic and molecular changes, epigenetics, and immune dysfunction, inflammatory as well as fibrotic processes may contribute to the heterogeneity and dynamics of ALS. Animal and human studies indicate dysregulations of the TGF-β system as a common feature of neurodegenerative disorders in general and ALS in particular. The TGF-β system is involved in different essential developmental and physiological processes and regulates immunity and fibrosis, both affecting neurogenesis and neurodegeneration. Therefore, it has emerged as a potential therapeutic target for ALS: a persistent altered TGF-β system might promote disease progression by inducing an imbalance of neurogenesis and neurodegeneration. The current study assessed the activation state of the TGF-β system within the periphery/in life disease stage (serum samples) and a late stage of disease (central nervous system tissue samples), and a potential influence upon neuronal stem cell (NSC) activity, immune activation, and fibrosis. An upregulated TGF-β system was suggested with significantly increased TGF-β1 protein serum levels, enhanced TGF-β2 mRNA and protein levels, and a strong trend toward an increased TGF-β1 protein expression within the spinal cord (SC). Stem cell activity appeared diminished, reflected by reduced mRNA expression of NSC markers Musashi-1 and Nestin within SC—paralleled by enhanced protein contents of Musashi-1. Doublecortin mRNA and protein expression was reduced, suggesting an arrested neurogenesis at late stage ALS. Chemokine/cytokine analyses suggest a shift from a neuroprotective toward a more neurotoxic immune response: anti-inflammatory chemokines/cytokines were unchanged or reduced, expression of proinflammatory chemokines/cytokines were enhanced in ALS sera and SC postmortem tissue. Finally, we observed upregulated mRNA and protein expression for fibronectin in motor cortex of ALS patients which might suggest increased fibrotic changes. These data suggest that there is an upregulated TGF-β system in specific tissues in ALS that might lead to a “neurotoxic” immune response, promoting disease progression and neurodegeneration. The TGF-β system therefore may represent a promising target in treatment of ALS patients.
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Affiliation(s)
- Sebastian Peters
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Eva Zitzelsperger
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Sabrina Kuespert
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Sabine Iberl
- Department of Hematology, University Hospital Regensburg, Regensburg, Germany
| | - Rosmarie Heydn
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Susanne Petri
- Department of Neurology, University Hospital MHH, Hannover, Germany
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Dietmar R Thal
- Department for Neuroscience, Laboratory for Neuropathology, University of Leuven, Leuven, Belgium
| | - Andreas Hermann
- Department of Neurology, Technische Universität Dresden and German Center for Neurodegenerative Diseases (DZNE), Research Site Dresden, Dresden, Germany
| | | | - Tim-Henrik Bruun
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
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21
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Baldaranov D, Khomenko A, Kobor I, Bogdahn U, Gorges M, Kassubek J, Müller HP. Longitudinal Diffusion Tensor Imaging-Based Assessment of Tract Alterations: An Application to Amyotrophic Lateral Sclerosis. Front Hum Neurosci 2017; 11:567. [PMID: 29259550 PMCID: PMC5723297 DOI: 10.3389/fnhum.2017.00567] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/07/2017] [Indexed: 12/03/2022] Open
Abstract
Objective: The potential of magnetic resonance imaging (MRI) as a technical biomarker for cerebral microstructural alterations in neurodegenerative diseases is under investigation. In this study, a framework for the longitudinal analysis of diffusion tensor imaging (DTI)-based mapping was applied to the assessment of predefined white matter tracts in amyotrophic lateral sclerosis (ALS), as an example for a rapid progressive neurodegenerative disease. Methods: DTI was performed every 3 months in six patients with ALS (mean (M) = 7.7; range 3 to 15 scans) and in six controls (M = 3; range 2–5 scans) with the identical scanning protocol, resulting in a total of 65 longitudinal DTI datasets. Fractional anisotropy (FA), mean diffusivity (MD), axonal diffusivity (AD), radial diffusivity (RD), and the ratio AD/RD were studied to analyze alterations within the corticospinal tract (CST) which is a prominently affected tract structure in ALS and the tract correlating with Braak’s neuropathological stage 1. A correlation analysis was performed between progression rates based on DTI metrics and the revised ALS functional rating scale (ALS-FRS-R). Results: Patients with ALS showed an FA and AD/RD decline along the CST, while DTI metrics of controls did not change in longitudinal DTI scans. The FA and AD/RD decrease progression correlated significantly with ALS-FRS-R decrease progression. Conclusion: On the basis of the longitudinal assessment, DTI-based metrics can be considered as a possible noninvasive follow-up marker for disease progression in neurodegeneration. This finding was demonstrated here for ALS as a fast progressing neurodegenerative disease.
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Affiliation(s)
- Dobri Baldaranov
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Andrei Khomenko
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Ines Kobor
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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22
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Beier D, Proescholdt M, Pietsch T, Jones D, Pfister SM, Hattingen E, Dirven L, Lürding R, Weller M, Kortman RD, Bogdahn U, Hau P. RARE-10. MULTICENTER PILOT STUDY OF RADIO-CHEMOTHERAPY AS FIRST-LINE TREATMENT FOR ADULTS WITH MEDULLOBLASTOMA – THE NOA-07 TRIAL. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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23
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Aguiar de Sousa D, Canhão P, Crassard I, Coutinho J, Arauz A, Conforto A, Béjot Y, Giroud M, Ferro JM, Pinho e Melo T, Pereira L, Costa E, Rodrigues M, Viana Baptista M, Carvalho M, Lopes G, Correia M, Pinto AA, Coelho P, Cunha L, Veiga A, Silva M, Costa MM, Nzwalo H, Ferreira F, Zuurbier Y, Dequatre-Ponchelle N, Leys D, Bejot Y, Ruiz-Sandoval JL, Hacke W, Poli S, Gumbinger C, Nolte CH, Bogdahn U, Schlachetzki F, Gerriets T, Stolz E, Bastos V, Gagliardi R, Diez-Tejedor E, Fuentes B, Casado-Naranjo I, Martinelli I, Scoditti U, de Veber G, Lanthier S. Safety of Pregnancy After Cerebral Venous Thrombosis. Stroke 2017; 48:3130-3133. [DOI: 10.1161/strokeaha.117.018829] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 07/22/2017] [Accepted: 08/10/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Diana Aguiar de Sousa
- From the Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Instituto de Medicina Molecular, Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Department of Neurology, Hôpital Lariboisière, Paris, France (I.C.); Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands (J.C.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia Manuel Velasco Suárez, Mexico City, Mexico (A.A.); Department of Neurology, Hospital
| | - Patrícia Canhão
- From the Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Instituto de Medicina Molecular, Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Department of Neurology, Hôpital Lariboisière, Paris, France (I.C.); Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands (J.C.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia Manuel Velasco Suárez, Mexico City, Mexico (A.A.); Department of Neurology, Hospital
| | - Isabelle Crassard
- From the Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Instituto de Medicina Molecular, Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Department of Neurology, Hôpital Lariboisière, Paris, France (I.C.); Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands (J.C.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia Manuel Velasco Suárez, Mexico City, Mexico (A.A.); Department of Neurology, Hospital
| | - Jonathan Coutinho
- From the Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Instituto de Medicina Molecular, Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Department of Neurology, Hôpital Lariboisière, Paris, France (I.C.); Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands (J.C.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia Manuel Velasco Suárez, Mexico City, Mexico (A.A.); Department of Neurology, Hospital
| | - Antonio Arauz
- From the Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Instituto de Medicina Molecular, Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Department of Neurology, Hôpital Lariboisière, Paris, France (I.C.); Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands (J.C.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia Manuel Velasco Suárez, Mexico City, Mexico (A.A.); Department of Neurology, Hospital
| | - Adriana Conforto
- From the Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Instituto de Medicina Molecular, Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Department of Neurology, Hôpital Lariboisière, Paris, France (I.C.); Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands (J.C.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia Manuel Velasco Suárez, Mexico City, Mexico (A.A.); Department of Neurology, Hospital
| | - Yannick Béjot
- From the Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Instituto de Medicina Molecular, Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Department of Neurology, Hôpital Lariboisière, Paris, France (I.C.); Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands (J.C.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia Manuel Velasco Suárez, Mexico City, Mexico (A.A.); Department of Neurology, Hospital
| | - Maurice Giroud
- From the Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Instituto de Medicina Molecular, Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Department of Neurology, Hôpital Lariboisière, Paris, France (I.C.); Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands (J.C.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia Manuel Velasco Suárez, Mexico City, Mexico (A.A.); Department of Neurology, Hospital
| | - José M. Ferro
- From the Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Instituto de Medicina Molecular, Lisbon, Portugal (D.A.d.S., P.C., J.M.F.); Department of Neurology, Hôpital Lariboisière, Paris, France (I.C.); Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands (J.C.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia Manuel Velasco Suárez, Mexico City, Mexico (A.A.); Department of Neurology, Hospital
| | | | | | | | | | | | | | | | | | | | - Paulo Coelho
- Centro Hospitalar da Universidade de Coimbra, Coimbra, Portugal
| | - Luís Cunha
- Centro Hospitalar da Universidade de Coimbra, Coimbra, Portugal
| | | | | | | | | | | | | | | | - Didier Leys
- Centre Hospitalier Universitaire de Lille, France
| | | | | | | | | | | | | | - Ulrich Bogdahn
- Klinik für Neurologie der Universität Regensburg, Germany
| | | | | | | | - Vanessa Bastos
- Faculdade de Medicina da Santa Casa de São Paulo, Brazil
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Müller H, Kobor I, Bogdahn U, Ludolph A, Khomenko A, Baldaranov D, Kassubek J. PB 1 In vivo assessment of neurodegeneration in the brain by serial longitudinal diffusion tensor imaging – an application to amyotrophic lateral sclerosis. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Blume J, Rothenfusser E, Schlaier J, Bogdahn U, Lange M. Educational attainment and motor burden in advanced Parkinson's disease - The emerging role of education in motor reserve. J Neurol Sci 2017; 381:141-143. [PMID: 28991666 DOI: 10.1016/j.jns.2017.08.3241] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/23/2017] [Accepted: 08/22/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the relationship of motor burden and educational attainment in patients with advanced stage PD. MATERIALS AND METHODS We included 102 consecutive patients who underwent a complete evaluation for DBS surgery, including detailed neuropsychological testing and UPDRSIII in a standardized Levodopa challenge. Years of education (YoE) were calculated as the highest grade attained in secondary school plus years for post-secondary training. RESULTS The OFF medication UPDRS-III score was associated with YoE (p=0.006; t=-2.82) and age (p=0.007; t=-2.75) in our multivariable linear regression model even while including disease duration (p=0.8; t=0.21), presence of mild cognitive impairment (MCI) (p=0.9; t=0.16) or current IQ (p=0.2; t=1.25) as additional covariables. In a subgroup of 60 patients two years after DBS, the ON/ON UPDRS score was associated with YoE (p=0.01; t=-2.42) and diagnosis of PD dementia (p=0.05, t=1.95), while age (p=0.08, t=1.75), disease duration (p=0.6t=0.48) and LEDD (p=0.3; t=1.05) showed no significant association to ON/ON UPDRS score. CONCLUSIONS We found an inverse correlation between years of education and lower (better) UPDRS -III motor score after adjusting for important covariables. Education may lead to an increased ability to compensate disturbances in basal ganglia circuits affecting not only for cognitive, but also for motor aspects of PD. Thus, educational attainment may play an important role in the concept of motor reserve.
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Affiliation(s)
- Josefine Blume
- Department of Neurology, University of Regensburg, Medical Center, Germany.
| | - Eva Rothenfusser
- Department of Neurology, University of Regensburg, Medical Center, Germany
| | - Jürgen Schlaier
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University of Regensburg, Medical Center, Germany
| | - Max Lange
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany
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Hsam NBO, Angstwurm K, Peters S, Fuchs K, Schuierer G, Bogdahn U, Weissert R. Fulminant Acute Ascending Hemorrhagic Myelitis Treated with Eculizumab. Front Neurol 2017; 8:345. [PMID: 28798719 PMCID: PMC5529383 DOI: 10.3389/fneur.2017.00345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/03/2017] [Indexed: 12/24/2022] Open
Abstract
We describe an 18-year-old patient who developed back pain, rapidly ascending sensomotory deficits, bladder dysfunction, Lhermitte’s sign, absent abdominal reflexes of all three levels, brisk tendon reflexes, and positive Babinski’s sign. Magnetic resonance imaging of the spinal cord showed a long segment of cervical and thoracic intramedullary signal hyperintensity suggesting a longitudinally extensive transverse myelitis possibly within the course of a fast progressing ascending immune-mediated hemorrhagic myelopathy. Throughout his illness, the patient deteriorated with tetraplegia, cardiac arrest, and respiratory failure although he received, after exclusion of infective causes, therapy with steroids, immunoglobulins, plasmapheresis, and cyclophosphamide. Interestingly, treatment with the C5-inhibitor eculizumab to prevent complement-mediated spinal cord injury achieved an arrest of clinical deterioration. We propose eculizumab as treatment in fast progressive and potentially fatal immune-mediated spinal cord injury. Furthermore, this case raises awareness for the process of clinical decision-making in severe myelopathies.
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Affiliation(s)
| | - Klemens Angstwurm
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Sebastian Peters
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Kornelius Fuchs
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Gerhard Schuierer
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Robert Weissert
- Department of Neurology, University of Regensburg, Regensburg, Germany
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Seliger C, Meier CR, Becker C, Jick SS, Proescholdt M, Bogdahn U, Hau P, Leitzmann MF. Diabetes, use of metformin, and the risk of meningioma. PLoS One 2017; 12:e0181089. [PMID: 28708856 PMCID: PMC5510861 DOI: 10.1371/journal.pone.0181089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/25/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Metformin is a commonly used oral antidiabetic agent that has been associated with decreased cancer risk. However, data regarding the association between metformin use and the risk of meningioma are unavailable. METHODS We conducted a matched case-control analysis using data from the U.K.-based Clinical Practice Research Datalink (CPRD) to analyse diabetes status, duration of diabetes, glycemic control, and use of metformin, sulfonylureas, and insulin in relation to the risk of meningioma. We conducted conditional logistic regression analyses to determine relative risks, estimated as odds ratios (ORs) with 95% confidence intervals (CIs) and adjusted for body mass index, smoking, history of arterial hypertension, myocardial infarction, and use of estrogens (among women). RESULTS We identified 2,027 meningioma cases and 20,269 controls. For diabetes there was the suggestion of an inverse association with meningioma (OR = 0.89; 95%CI = 0.74-1.07), which was driven by an inverse relation among women (OR = 0.78; 95%CI = 0.62-0.98), in whom we also noted a suggestive inverse association with duration of diabetes (p-value for trend = 0.071). For metformin there was a suggestive positive relation, particularly after matching on duration of diabetes and HbA1c level (OR = 1.64; 95%CI = 0.89-3.04). Sulfonylureas showed no clear association (OR = 0.91; 95%CI = 0.46-1.80). For insulin there was the suggestion of an inverse relation, in particular when comparing a high vs. low number of prescriptions (OR = 0.58; 95%CI = 0.18-1.83). CONCLUSION Further studies are needed to solidify a possible inverse association between diabetes and meningioma risk and to clarify the role of antidiabetics in this context.
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Affiliation(s)
- Corinna Seliger
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
- * E-mail:
| | - Christoph R. Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Boston University, Boston, Massachusetts, United States of America
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Claudia Becker
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Susan S. Jick
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Boston University, Boston, Massachusetts, United States of America
| | - Martin Proescholdt
- Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Michael F. Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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Blume J, Lange M, Rothenfusser E, Doenitz C, Bogdahn U, Brawanski A, Schlaier J. The impact of white matter lesions on the cognitive outcome of subthalamic nucleus deep brain stimulation in Parkinson's disease. Clin Neurol Neurosurg 2017; 159:87-92. [PMID: 28582689 DOI: 10.1016/j.clineuro.2017.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES White Matter lesions (WML) are a risk factor for cognitive impairment in Parkinson's disease. There is no clear evidence of reduced general cognitive function after DBS. However, a subgroup of patients develops dementia rapidly after DBS despite careful patient selection processes. The aim of this study was to evaluate the load of WML as a possible risk factor for cognitive decline following STN DBS. PATIENTS AND METHODS 40 PD-patients receiving bilateral STN-DBS were followed at least three years after surgery to detect dementia. All patients underwent comprehensive neuropsychological assessment and MRI before surgery. The extent of WML was assessed using an automated approach. WML volume was correlated to the onset of dementia and the decline of a cognitive composite score retrospectively. RESULTS Patients with a rapid onset of dementia within one, respective three following DBS showed significant higher WML volumes compared to cognitive normal and MCI patients (55.8cm3±18.836 vs. 9.3cm3±12.2; p=0.002). The same significant association was found in a multivariable model, including the covariables age, gender and PD disease duration (p=0.01). WML volume was associated to the rate of decline in cognitive composite score within three years after DBS surgery (p=0.006; R2=0.40) after correction for age. CONCLUSIONS Damaged white matter may lead to a reduced compensation of disconnections in cognitive circuits caused by the implantation of the DBS electrodes or by chronic stimulation. The role of WML as a prognostic factor for the cognitive outcome after DBS may be underestimated. The WML burden should be taken seriously in preoperative risk stratification.
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Affiliation(s)
- J Blume
- Department of Neurology, University of Regensburg, Medical Center, Germany; Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany.
| | - M Lange
- Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - E Rothenfusser
- Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany
| | - C Doenitz
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - U Bogdahn
- Department of Neurology, University of Regensburg, Medical Center, Germany
| | - A Brawanski
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - J Schlaier
- Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Neurosurgery, University of Regensburg, Medical Center, Germany
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Lange M, Mauerer J, Schlaier J, Janzen A, Zeman F, Bogdahn U, Brawanski A, Hochreiter A. Underutilization of deep brain stimulation for Parkinson's disease? A survey on possible clinical reasons. Acta Neurochir (Wien) 2017; 159:771-778. [PMID: 28258308 DOI: 10.1007/s00701-017-3122-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 02/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Only 10% of the up to 15% of patients with advanced Parkinson's disease (PD) eligible for deep brain stimulation (DBS) are referred to specialized centers. This survey evaluated the reasons for the reluctance of patients and referring physicians regarding DBS. METHODS Two different questionnaires containing multiple choice and open verbalized questions were developed, one for neurologists and one for patients with PD. The first questionnaire was sent to 87 neurologists in private practice in the catchment area of the authors' medical center, the second to patient support groups in the same region with the help of the German Parkinson Association. RESULTS Of the addressed neurologists, 56.3% completed the questionnaire; 61.2% of them estimated the risk of intracerebral hemorrhage as the most severe complication at 4.3% on average; 30.6% were concerned about patients developing mood changes or depression after DBS. Only 16.3% felt unable to care for patients after DBS; 61.2% already had personal experience with patients after DBS and reported good clinical outcome in 90.0% of patients. Although 87.8% claimed to know the specific criteria for DBS, only 40.8% could actively describe them. Only 14.0% could state each of the three main criteria. Of the 46 patients, 88.1% completing the questionnaire had obtained information on DBS from regional patient organizations and 54.8% also from a physician; 44.7% assumed the risk of severe complications to be ≥5.0%. Not being satisfied with their medical treatment was reported by 22.2%, of whom more than 70% considered DBS a further treatment option. CONCLUSIONS The latter numbers indicate that treating neurologists tend to overestimate the reluctance of their patients to undergo DBS. Therefore, education of patients and neurologists should be improved and give more realistic figures on the actual outcomes and frequencies of possible complications.
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Affiliation(s)
- Max Lange
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
- Center for Deep Brain Stimulation, University Medical Center Regensburg, Regensburg, Germany.
| | - Josef Mauerer
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Jürgen Schlaier
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
- Center for Deep Brain Stimulation, University Medical Center Regensburg, Regensburg, Germany
| | - Annette Janzen
- Center for Deep Brain Stimulation, University Medical Center Regensburg, Regensburg, Germany
- Department of Neurology, University Medical Center Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Medical Center Regensburg, Regensburg, Germany
| | - Alexander Brawanski
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Andreas Hochreiter
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
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Vollmann-Zwerenz A, Sponton S, Jachnik B, Weigell P, Lorenz J, Schulze M, Bogdahn U, Riemenschneider MJ, Hau P. P01.37 Impact of C/EBPβ isoforms on brain tumor initiating cells. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kirzinger L, Boy S, Marienhagen J, Schuierer G, Neu R, Ried M, Hofmann HS, Wiebe K, Ströbel P, May C, Kleylein-Sohn J, Baierlein C, Bogdahn U, Marx A, Schalke B. Octreotide LAR and Prednisone as Neoadjuvant Treatment in Patients with Primary or Locally Recurrent Unresectable Thymic Tumors: A Phase II Study. PLoS One 2016; 11:e0168215. [PMID: 27992479 PMCID: PMC5161359 DOI: 10.1371/journal.pone.0168215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 11/23/2016] [Indexed: 12/17/2022] Open
Abstract
Therapeutic options to cure advanced, recurrent, and unresectable thymomas are limited. The most important factor for long-term survival of thymoma patients is complete resection (R0) of the tumor. We therefore evaluated the response to and the induction of resectability of primarily or locally recurrent unresectable thymomas and thymic carcinomas by octreotide Long-Acting Release (LAR) plus prednisone therapy in patients with positive octreotide scans. In this open label, single-arm phase II study, 17 patients with thymomas considered unresectable or locally recurrent thymoma (n = 15) and thymic carcinoma (n = 2) at Masaoka stage III were enrolled. Octreotide LAR (30 mg once every 2 weeks) was administered in combination with prednisone (0.6 mg/kg per day) for a maximum of 24 weeks (study design according to Fleming´s one sample multiple testing procedure for phase II clinical trials). Tumor size was evaluated by volumetric CT measurements, and a decrease in tumor volume of at least 20% at week 12 compared to baseline was considered as a response. We found that octreotide LAR plus prednisone elicited response in 15 of 17 patients (88%). Median reduction of tumor volume after 12 weeks of treatment was 51% (range 20%-86%). Subsequently, complete surgical resection was achieved in five (29%) and four patients (23%) after 12 and 24 weeks, respectively. Octreotide LAR plus prednisone treatment was discontinued in two patients before week 12 due to unsatisfactory therapeutic effects or adverse events. The most frequent adverse events were gastrointestinal (71%), infectious (65%), and hematological (41%) complications. In conclusion, octreotide LAR plus prednisone is efficacious in patients with primary or recurrent unresectable thymoma with respect to tumor regression. Octreotide LAR plus prednisone was well tolerated and adverse events were in line with the known safety profile of both agents.
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Affiliation(s)
- Lukas Kirzinger
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Sandra Boy
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Jörg Marienhagen
- Department of Nuclear Medicine, University of Regensburg, Regensburg, Germany
| | | | - Reiner Neu
- Department of Thoracic Surgery, University of Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University of Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University of Regensburg, Regensburg, Germany
| | - Karsten Wiebe
- Department of Cardiac and Thoracic Surgery, University of Muenster, Muenster, Germany
| | - Philipp Ströbel
- Institute of Pathology, University of Goettingen, Goettingen, Germany
| | | | | | | | - Ulrich Bogdahn
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Berthold Schalke
- Department of Neurology, University of Regensburg, Regensburg, Germany
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Seliger C, Meier CR, Becker C, Jick SS, Bogdahn U, Hau P, Leitzmann MF. Reply to Greenland: A serious misinterpretation of a consistent inverse association of statin use with glioma across 3 case-control studies. Eur J Epidemiol 2016; 32:89-90. [PMID: 27896538 DOI: 10.1007/s10654-016-0212-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Corinna Seliger
- Wilhelm Sander-NeuroOncology Unit, Department of Neurology, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Boston University, Boston, MA, USA.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Claudia Becker
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Susan S Jick
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Ulrich Bogdahn
- Wilhelm Sander-NeuroOncology Unit, Department of Neurology, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Peter Hau
- Wilhelm Sander-NeuroOncology Unit, Department of Neurology, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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Seidel C, Reimers C, Beier D, Pietsch T, Warmuth-Metz M, Bogdahn U, Kortmann R, Hau P. OS7.7 Feasibility and toxicity of concomitant radiochemotherapy with vincristine in adult patients with medulloblastoma - results from the NOA-07 trial. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Neumann B, Schulte-Mattler W, Brix S, Pöschl P, Jilg W, Bogdahn U, Steinbrecher A, Kleiter I. Autonomic and peripheral nervous system function in acute tick-borne encephalitis. Brain Behav 2016; 6:e00485. [PMID: 27247855 PMCID: PMC4864130 DOI: 10.1002/brb3.485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/29/2016] [Accepted: 04/01/2016] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Tick-borne encephalitis (TBE) is an emerging flaviviral zoonosis in Central and Eastern Europe. TBE can present as meningitis, meningoencephalitis, or meningoencephalomyelitis. Dysfunction of the autonomic (ANS) and peripheral motoric and sensory nervous system (PNS) might contribute to acute and long-term complications. We aimed to examine, whether the ANS and PNS are affected in acute TBE. METHODS Fourteen patients with acute TBE, 17 with diabetic polyneuropathy (d-PNP), and 30 healthy controls (HC) were examined in our single-center, prospective study. ANS and PNS function was assessed by time- and frequency-domain parameters of the heart rate (HR) variability at rest and deep respiration, and by sural and tibial nerve neurography. Primary endpoint was the HR variability at rest measured by root mean square of the successive differences (RMSSD). Autonomic symptoms and quality of life (QoL) were assessed by questionnaires. RESULTS Tick-borne encephalitis patients had a lower RMSSD at rest (TBE 13.1 ± 7.0, HC 72.7 ± 48.3; P < 0.001) and deep respiration (TBE 42.8 ± 27.0, HC 109.7 ± 68.8; P < 0.01), an increased low-frequency to high-frequency power component ratio at rest (TBE 4.0 ± 4.0, HC 0.8 ± 0.5; P < 0.001), and a higher minimal heart rate at rest (TBE 85.4 ± 7.0, HC 69.5 ± 8.5; P < 0.001), all similar to patients with d-PNP, indicating sympathovagal imbalance with increased sympathetic activation. Compared to HC, sural and tibial nerve conduction velocities and action potential amplitudes were reduced, ANS symptoms were more frequent, and QoL was lower in patients with TBE. CONCLUSIONS The ANS and to a lesser degree the PNS are affected by acute TBE, which could potentially contribute to short- and long-term morbidity.
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Affiliation(s)
- Bernhard Neumann
- Department of Neurology University Medical Centre Regensburg Regensburg Germany
| | | | - Sophie Brix
- Department of Neurology University Medical Centre Regensburg Regensburg Germany
| | - Peter Pöschl
- Department of Neurology Krankenhaus der Barmherzigen Brüder Regensburg Regensburg Germany
| | - Wolfgang Jilg
- Department of Medical Microbiology and Hygiene University Medical Centre Regensburg Regensburg Germany
| | - Ulrich Bogdahn
- Department of Neurology University Medical Centre Regensburg Regensburg Germany
| | - Andreas Steinbrecher
- Department of Neurology University Medical Centre Regensburg Regensburg Germany; Department of Neurology HELIOS Klinikum Erfurt Erfurt Germany
| | - Ingo Kleiter
- Department of Neurology St. Josef-Hospital Ruhr-University Bochum Bochum Germany
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Schömig B, Seliger C, Schulte-Mattler W, Angstwurm K, Fuchs K, Bogdahn U, Schlachetzki F. Clinical Reasoning: Pneumocephalus and pneumorrhachis in a 67-year-old man. Neurology 2016; 86:e218-21. [DOI: 10.1212/wnl.0000000000002693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Seliger C, Meyer AL, Renner K, Leidgens V, Moeckel S, Jachnik B, Dettmer K, Tischler U, Gerthofer V, Rauer L, Uhl M, Proescholdt M, Bogdahn U, Riemenschneider MJ, Oefner PJ, Kreutz M, Vollmann-Zwerenz A, Hau P. Metformin inhibits proliferation and migration of glioblastoma cells independently of TGF-β2. Cell Cycle 2016; 15:1755-66. [PMID: 27163626 DOI: 10.1080/15384101.2016.1186316] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To this day, glioblastoma (GBM) remains an incurable brain tumor. Previous research has shown that metformin, an oral anti-diabetic drug, may decrease GBM cell proliferation and migration especially in brain tumor initiating cells (BTICs). As transforming growth factor β 2 (TGF-β2) has been reported to promote high-grade glioma and is inhibited by metformin in other tumors, we explored whether metformin directly interferes with TGF-β2-signaling. Functional investigation of proliferation and migration of primary BTICs after treatment with metformin+/-TGF-β2 revealed that metformin doses as low as 0.01 mM metformin thrice a day were able to inhibit proliferation of susceptible cell lines, whereas migration was impacted only at higher doses. Known cellular mechanisms of metformin, such as increased lactate secretion, reduced oxygen consumption and activated AMPK-signaling, could be confirmed. However, TGF-β2 and metformin did not act as functional antagonists, but both rather inhibited proliferation and/or migration, if significant effects were present. We did not observe a relevant influence of metformin on TGF-β2 mRNA expression (qRT-PCR), TGF-β2 protein expression (ELISA) or SMAD-signaling (Western blot). Therefore, it seems that metformin does not exert its inhibitory effects on GBM BTIC proliferation and migration by altering TGF-β2-signaling. Nonetheless, as low doses of metformin are able to reduce proliferation of certain GBM cells, further exploration of predictors of BTICs' susceptibility to metformin appears justified.
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Affiliation(s)
- Corinna Seliger
- a Department of Neurology and Wilhelm Sander-NeuroOncology Unit , University Hospital Regensburg , Regensburg , Germany
| | - Anne-Louise Meyer
- a Department of Neurology and Wilhelm Sander-NeuroOncology Unit , University Hospital Regensburg , Regensburg , Germany
| | - Kathrin Renner
- b Department of Internal Medicine III , University Hospital Regensburg , Regensburg , Germany
| | - Verena Leidgens
- a Department of Neurology and Wilhelm Sander-NeuroOncology Unit , University Hospital Regensburg , Regensburg , Germany
| | - Sylvia Moeckel
- a Department of Neurology and Wilhelm Sander-NeuroOncology Unit , University Hospital Regensburg , Regensburg , Germany
| | - Birgit Jachnik
- a Department of Neurology and Wilhelm Sander-NeuroOncology Unit , University Hospital Regensburg , Regensburg , Germany
| | - Katja Dettmer
- c Institute of Functional Genomics, University of Regensburg , Regensburg , Germany
| | - Ulrike Tischler
- a Department of Neurology and Wilhelm Sander-NeuroOncology Unit , University Hospital Regensburg , Regensburg , Germany
| | - Valeria Gerthofer
- a Department of Neurology and Wilhelm Sander-NeuroOncology Unit , University Hospital Regensburg , Regensburg , Germany
| | - Lisa Rauer
- a Department of Neurology and Wilhelm Sander-NeuroOncology Unit , University Hospital Regensburg , Regensburg , Germany
| | - Martin Uhl
- d Department of Neurology , University Hospital Erlangen , Germany
| | - Martin Proescholdt
- e Department of Neurosurgery , University Hospital Regensburg , Regensburg , Germany
| | - Ulrich Bogdahn
- a Department of Neurology and Wilhelm Sander-NeuroOncology Unit , University Hospital Regensburg , Regensburg , Germany
| | | | - Peter J Oefner
- c Institute of Functional Genomics, University of Regensburg , Regensburg , Germany
| | - Marina Kreutz
- b Department of Internal Medicine III , University Hospital Regensburg , Regensburg , Germany
| | - Arabel Vollmann-Zwerenz
- a Department of Neurology and Wilhelm Sander-NeuroOncology Unit , University Hospital Regensburg , Regensburg , Germany
| | - Peter Hau
- a Department of Neurology and Wilhelm Sander-NeuroOncology Unit , University Hospital Regensburg , Regensburg , Germany
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Seliger C, Meier CR, Becker C, Jick SS, Bogdahn U, Hau P, Leitzmann MF. Statin use and risk of glioma: population-based case-control analysis. Eur J Epidemiol 2016; 31:947-52. [PMID: 27041698 DOI: 10.1007/s10654-016-0145-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
Abstract
Statins have been reported to decrease the incidence of cancer, but the risk of glioma among statin users has been investigated in only two prior observational studies, both of them suggesting a modest protective effect of statins. We conducted a matched case-control study using data from the UK-based Clinical Practice Research Datalink to analyse use of statins among 2469 cases with glioma and 24,690 controls. We performed conditional logistic regression analysis to calculate relative risks, estimated as odds ratios (ORs) with 95 % confidence intervals (CIs) adjusting for multiple confounding factors. As compared with non-use of statins, use of statins was not associated with risk of glioma (OR for ≥90 prescriptions=0.75; 95 % CI 0.48-1.17). Our findings do not support previous sparse evidence of a possible inverse association between statin use and glioma risk.
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Affiliation(s)
- Corinna Seliger
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Christoph Rudolf Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4031, Basel, Switzerland.,Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, 715 Albany St., Boston, MA, 02118, USA.,Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, 4031, Basel, Switzerland
| | - Claudia Becker
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Spitalstrasse 26, 4031, Basel, Switzerland
| | - Susan Sara Jick
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, 715 Albany St., Boston, MA, 02118, USA
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Michael Fred Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Moeckel S, Vollmann-Zwerenz A, Proescholdt M, Brawanski A, Riemenschneider MJ, Bogdahn U, Bosserhoff AK, Spang R, Hau P. Validation Study: Response-Predictive Gene Expression Profiling of Glioma Progenitor Cells In Vitro. PLoS One 2016; 11:e0151312. [PMID: 26978262 PMCID: PMC4792439 DOI: 10.1371/journal.pone.0151312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/28/2016] [Indexed: 12/28/2022] Open
Abstract
Background In a previous publication we introduced a novel approach to identify genes that hold predictive information about treatment outcome. A linear regression model was fitted by using the least angle regression algorithm (LARS) with the expression profiles of a construction set of 18 glioma progenitor cells enhanced for brain tumor initiating cells (BTIC) before and after in vitro treatment with the tyrosine kinase inhibitor Sunitinib. Profiles from treated progenitor cells allowed predicting therapy-induced impairment of proliferation in vitro. Prediction performance was validated in leave one out cross validation. Methods In this study, we used an additional validation set of 18 serum-free short-term treated in vitro cell cultures to test the predictive properties of the signature in an independent cohort. We assessed proliferation rates together with transcriptome-wide expression profiles after Sunitinib treatment of each individual cell culture, following the methods of the previous publication. Results We confirmed treatment-induced expression changes in our validation set, but our signature failed to predict proliferation inhibition. Neither re-calculation of the combined dataset with all 36 BTIC cultures nor separation of samples into TCGA subclasses did generate a proliferation prediction. Conclusion Although the gene signature published from our construction set exhibited good prediction accuracy in cross validation, we were not able to validate the signature in an independent validation data set. Reasons could be regression to the mean, the moderate numbers of samples, or too low differences in the response to proliferation inhibition in the validation set. At this stage and based on the presented results, we conclude that the signature does not warrant further developmental steps towards clinical application.
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Affiliation(s)
- Sylvia Moeckel
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Arabel Vollmann-Zwerenz
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Martin Proescholdt
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Alexander Brawanski
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Anja-Katrin Bosserhoff
- Institute of Biochemistry (Emil Fischer-Zentrum), Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rainer Spang
- Institute for Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
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Stein F, Kobor I, Bogdahn U, Schulte-Mattler WJ. Toward the validation of a new method (MUNIX) for motor unit number assessment. J Electromyogr Kinesiol 2016; 27:73-7. [PMID: 26930263 DOI: 10.1016/j.jelekin.2016.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/21/2016] [Accepted: 02/01/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION This prospectively designed study analyzed the correlation of a new, non-invasive neurophysiological method (Motor Unit Number Index - MUNIX) with two established Motor Unit Number Estimation (MUNE) methods. METHODS MUNIX and incremental stimulation MUNE (IS-MUNE) were done in the abductor digiti minimi muscle (ADM), while MUNIX and spike-triggered averaging MUNE (STA-MUNE) were tested in the trapezius muscle. Twenty healthy subjects and 17 patients with amyotrophic lateral sclerosis (ALS) were examined. RESULTS MUNIX and MUNE values correlated significantly (ADM: n=108; Spearman-Rho; r=0.88; p<0.01; trapezius muscle: n=49; Spearman-Rho; r=0.46; p<0.01). DISCUSSION MUNIX indeed reflects the number of motor units in a muscle, and may sensibly be recorded from the trapezius muscle. With MUNIX being both much more patient friendly and much more rapid to assess than MUNE, the results support the use of MUNIX when motor unit number assessment is desired.
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Affiliation(s)
- Franziska Stein
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Ines Kobor
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
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Seliger C, Meier CR, Becker C, Jick SS, Bogdahn U, Hau P, Leitzmann MF. Use of Selective Cyclooxygenase-2 Inhibitors, Other Analgesics, and Risk of Glioma. PLoS One 2016; 11:e0149293. [PMID: 26871579 PMCID: PMC4752241 DOI: 10.1371/journal.pone.0149293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/29/2016] [Indexed: 11/18/2022] Open
Abstract
Background Selective cyclooxygenase-2 (COX-2) inhibitors are analgesic, antipyretic, and anti-inflammatory drugs. They have been found to inhibit the development of glioma in laboratory investigations. Whether these drugs reduce the risk of glioma incidence in humans is unknown. Methods We conducted a matched case-control analysis using the U.K.-based Clinical Practice Research Datalink (CPRD). We identified 2,469 cases matched to 24,690 controls on age, sex, calendar time, general practice, and number of years of active history in the CPRD prior to the index date. We conducted conditional logistic regression analyses to determine relative risks, estimated as odds ratios (ORs) with 95% confidence intervals (CIs) of glioma in relation to use of selective COX-2 inhibitors, adjusted for several confounding variables. Results Use of selective COX-2 inhibitors was unrelated to risk of glioma (adjusted OR for 1–9 versus 0 prescriptions = 1.02; 95% CI = 0.92–1.13, 10–29 versus 0 prescriptions = 1.01; 95% CI = 0.80–1.28, ≥30 versus 0 prescriptions = 1.16; 95% CI = 0.86–1.55). Trends for increasing numbers of prescriptions for other non-steroidal anti-inflammatory drugs (NSAIDs), and non-NSAID analgesics were also not associated with glioma risk. Conclusion Further epidemiologic studies are needed to confirm the null relation of use of selective COX-2 inhibitors to glioma risk and to explain the discrepancy between laboratory investigations and our observational study. Impact: Use of selective COX-2 inhibitors is unrelated to glioma risk.
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Affiliation(s)
- Corinna Seliger
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
- * E-mail:
| | - Christoph R. Meier
- Basel Pharmacoepidemiology Unit, Division of CIinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Claudia Becker
- Basel Pharmacoepidemiology Unit, Division of CIinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Susan S. Jick
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Michael F. Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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Bumes E, Rzonsa S, Hutterer M, Proescholdt M, Bogdahn U, Riemenschneider MJ, Uhl M, Wendl C, Hau P. Adverse event grading following CTCAE v3.0 underestimates hypertensive side effects in patients with glioma treated with Bevacizumab. J Neurooncol 2016; 127:191-200. [PMID: 26721240 DOI: 10.1007/s11060-015-2031-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/25/2015] [Indexed: 10/22/2022]
Abstract
Anti-VEGF therapy with Bevacizumab (BEV) is widely used in cases of relapsed high-grade glioma (HGG). Arterial hypertension is a known side effect of anti-VEGF therapy. 42 Patients with relapsed HGG were treated with BEV 10 mg/kg on days 1 and 15 of 28-day cycles in addition to treatment with 40 mg TMZ daily until disease progression, based on magnetic resonance imaging and/or worsening of clinical status. In a retrospective analysis, hypertensive side effects were evaluated as the primary endpoint, while survival information in addition to toxicity was analyzed as secondary endpoint. Grading which employs the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 detected hypertensive events with a significantly higher sensitivity than CTCAE version 3.0. The rate of severe hypertensive events observed as CTCAE ≥ °3 were 9.5 % in version 3.0 and 45.2 % in version 4.0. The results presented here indicate that CTCAE version 3.0 may underreport the incidence and grade of BEV-induced hypertension within clinical trials. As hypertension has not only long-term, but also severe short-term side effects, we suggest that arterial hypertension under BEV should be scored according to CTCAE version 4.0 to avoid clinically relevant hypertension-related adverse events in these patients.
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Affiliation(s)
- Elisabeth Bumes
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University of Regensburg Medical School, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Sarah Rzonsa
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University of Regensburg Medical School, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Markus Hutterer
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University of Regensburg Medical School, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Martin Proescholdt
- Department of Neurosurgery, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University of Regensburg Medical School, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Markus J Riemenschneider
- Department of Neuropathology, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Martin Uhl
- Department of Neurology, University of Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Christina Wendl
- Department of Radiology, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University of Regensburg Medical School, Universitätsstraße 84, 93053, Regensburg, Germany.
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Blume J, Rothenfußer-Korber E, Janzen A, Bogdahn U, Schlaier J, Lange M. Can intraoperative clinical testing predict stimulation-induced effects of STN-DBS? Parkinsonism Relat Disord 2016. [DOI: 10.1016/j.parkreldis.2015.10.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Blume J, Rothenfußer-Korber E, Janzen A, Bogdahn U, Schlaier J, Lange M. Can intraoperative clinical testing predict stimulation-induced effects of STN-DBS? Parkinsonism Relat Disord 2016. [DOI: 10.1016/j.parkreldis.2015.10.551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Dubinski D, Wölfer J, Hasselblatt M, Schneider-Hohendorf T, Bogdahn U, Stummer W, Wiendl H, Grauer OM. CD4+ T effector memory cell dysfunction is associated with the accumulation of granulocytic myeloid-derived suppressor cells in glioblastoma patients. Neuro Oncol 2015; 18:807-18. [PMID: 26578623 DOI: 10.1093/neuonc/nov280] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/14/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Myeloid-derived suppressor cells (MDSCs) comprise a heterogeneous population of myeloid cells that are significantly expanded in cancer patients and are associated with tumor progression. METHODS Multicolor flow cytometry was used to study the frequency, phenotype, and function of MDSCs in peripheral blood and freshly resected tumors of 52 participants with primary glioblastoma (GBM). RESULTS The frequency of CD14(high)CD15(pos) monocytic and CD14(low)CD15(pos) granulocytic MDSCs was significantly higher in peripheral blood of GBM participants compared with healthy donors. The majority of granulocytic MDSCs consisted of CD14(low)CD15(high) neutrophilic MDSCs with high T-cell suppressive capacities. At the tumor side, we found an increase in CD14(high)CD15(pos) monocytic MDSCs and high frequencies of CD14(low)CD15(pos) granulocytic MDSCs that displayed an activated phenotype with downregulation of CD16 and upregulation of HLA-DR molecules, which did not inhibit T-cell proliferative responses in vitro. However, a strong association between granulocytic MDSCs and CD4(+) effector memory T-cells (TEM) within the tumors was detected. Tumor-derived CD4(+) TEM expressed high levels of PD-1 when compared with their blood-derived counterparts and were functionally exhausted. The respective ligand, PD-L1, was significantly upregulated on tumor-derived MDSCs, and T-cell co-culture experiments confirmed that glioma-infiltrating MDSCs can induce PD-1 expression on CD4(+) TEM. CONCLUSIONS Our findings provide a detailed characterization of different MDSC subsets in GBM patients and indicate that both granulocytic MDSCs in peripheral blood and at the tumor site play a major role in GBM-induced T-cell suppression.
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Affiliation(s)
- Daniel Dubinski
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany (D.D., U.B.); Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany (J.W., W.S.); Institute of Neuropathology, University Hospital of Muenster, Muenster, Germany (M.H.); Department of Neurology, University Hospital of Muenster, Muenster, Germany (T.S.-H., H.W., O.M.G.)
| | - Johannes Wölfer
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany (D.D., U.B.); Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany (J.W., W.S.); Institute of Neuropathology, University Hospital of Muenster, Muenster, Germany (M.H.); Department of Neurology, University Hospital of Muenster, Muenster, Germany (T.S.-H., H.W., O.M.G.)
| | - Martin Hasselblatt
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany (D.D., U.B.); Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany (J.W., W.S.); Institute of Neuropathology, University Hospital of Muenster, Muenster, Germany (M.H.); Department of Neurology, University Hospital of Muenster, Muenster, Germany (T.S.-H., H.W., O.M.G.)
| | - Tilman Schneider-Hohendorf
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany (D.D., U.B.); Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany (J.W., W.S.); Institute of Neuropathology, University Hospital of Muenster, Muenster, Germany (M.H.); Department of Neurology, University Hospital of Muenster, Muenster, Germany (T.S.-H., H.W., O.M.G.)
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany (D.D., U.B.); Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany (J.W., W.S.); Institute of Neuropathology, University Hospital of Muenster, Muenster, Germany (M.H.); Department of Neurology, University Hospital of Muenster, Muenster, Germany (T.S.-H., H.W., O.M.G.)
| | - Walter Stummer
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany (D.D., U.B.); Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany (J.W., W.S.); Institute of Neuropathology, University Hospital of Muenster, Muenster, Germany (M.H.); Department of Neurology, University Hospital of Muenster, Muenster, Germany (T.S.-H., H.W., O.M.G.)
| | - Heinz Wiendl
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany (D.D., U.B.); Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany (J.W., W.S.); Institute of Neuropathology, University Hospital of Muenster, Muenster, Germany (M.H.); Department of Neurology, University Hospital of Muenster, Muenster, Germany (T.S.-H., H.W., O.M.G.)
| | - Oliver M Grauer
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany (D.D., U.B.); Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany (J.W., W.S.); Institute of Neuropathology, University Hospital of Muenster, Muenster, Germany (M.H.); Department of Neurology, University Hospital of Muenster, Muenster, Germany (T.S.-H., H.W., O.M.G.)
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Schulte-Mattler W, Grimm T, Stein F, Kobor I, Bogdahn U. MUNIX – ein viel versprechender Biomarker bei der ALS. KLIN NEUROPHYSIOL 2015. [DOI: 10.1055/s-0041-107641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- W. Schulte-Mattler
- Neurologische Klinik und Poliklinik der Universität Regensburg, Universitätsklinikum Regensburg
| | - T. Grimm
- Neurologische Klinik und Poliklinik der Universität Regensburg, Universitätsklinikum Regensburg
| | - F. Stein
- Neurologische Klinik und Poliklinik der Universität Regensburg, Universitätsklinikum Regensburg
| | - I. Kobor
- Neurologische Klinik und Poliklinik der Universität Regensburg, Universitätsklinikum Regensburg
| | - U. Bogdahn
- Neurologische Klinik und Poliklinik der Universität Regensburg, Universitätsklinikum Regensburg
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Leidgens V, Seliger C, Leukel P, Jachnik B, Vollmann-Zwerenz A, Rauer L, Bogdahn U, Kreutz M, Grauer O, Hau P. CBIO-19IBUPROFEN AND DICLOFENAC INHIBIT MIGRATION AND PROLIFERATION OF HUMAN GLIOMA CELL LINES IN VITRO. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov209.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leidgens V, Lu X, Patwary N, Kerkhoff E, Riemenschneider M, Bogdahn U, Vollmann-Zwerenz A, Klein C, Hau P. CBIO-18ISOLATION OF HUMAN BRAIN TUMOUR INITIATING CELLS LEADING INVASION IN AN IN SITU ORGANOTYPIC SLICE CULTURE MIGRATION MODEL. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov209.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pawar K, Prang P, Müller R, Caioni M, Bogdahn U, Kunz W, Weidner N. Intrinsic and extrinsic determinants of central nervous system axon outgrowth into alginate-based anisotropic hydrogels. Acta Biomater 2015; 27:131-139. [PMID: 26310676 DOI: 10.1016/j.actbio.2015.08.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/12/2015] [Accepted: 08/21/2015] [Indexed: 12/20/2022]
Abstract
Appropriate target reinnervation and functional recovery after spinal cord injury depend on longitudinally directed regrowth of injured axons. Anisotropic alginate-based capillary hydrogels (ACH) support peripheral nervous system derived axon growth, which is accompanied by glial supporting cell migration into the ACH. The aim of the present study was to analyze central nervous system (CNS) derived (entorhinal cortex, spinal cord slice cultures) axon regrowth into ACH containing linearly aligned capillaries of defined capillary sizes without and with gelatin constituent. Anisotropic ACH were prepared by ionotropic gel formation using Ba(2+), Cu(2+), Sr(2+), or Zn(2+) ions resulting in gels with average capillary diameters of 11, 13, 29, and 89μm, respectively. Postnatal rat entorhinal cortex or spinal cord slice cultures were placed on top of 500μm thick ACH. Seven days later axon growth and astroglial migration into the ACH were determined. Axon density within capillaries correlated positively with increasing capillary diameters, whereas longitudinally oriented axon outgrowth diminished with increasing capillary diameter. Axons growing into the hydrogels were always accompanied by astrocytes strongly suggesting that respective cells are required to mediate CNS axon elongation into ACH. Overall, midsize capillary diameter ACH appeared to be the best compromise between axon density and orientation. Taken together, ACH promote CNS axon ingrowth, which is determined by the capillary diameter and migration of slice culture derived astroglia into the hydrogel. STATEMENT OF SIGNIFICANCE Biomaterials are investigated as therapeutic tools to bridge irreversible lesions following traumatic spinal cord injury. The goal is to develop biomaterials, which promote longitudinally oriented regeneration of as many injured axons as possible as prerequisite for substantial functional recovery. Optimal parameters of the biomaterial have yet to be defined. In the present study we show that increasing capillary diameters within such hydrogels enhanced central nervous system axon regeneration at the expense of longitudinal orientation. Axon ingrowth into the hydrogels was only observed in the presence of glial supporting cells, namely astrocytes. This suggests that alginate-based hydrogels need to be colonized with respective cells in order to facilitate axon ingrowth.
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Marschallinger J, Schäffner I, Klein B, Gelfert R, Rivera FJ, Illes S, Grassner L, Janssen M, Rotheneichner P, Schmuckermair C, Coras R, Boccazzi M, Chishty M, Lagler FB, Renic M, Bauer HC, Singewald N, Blümcke I, Bogdahn U, Couillard-Despres S, Lie DC, Abbracchio MP, Aigner L. Structural and functional rejuvenation of the aged brain by an approved anti-asthmatic drug. Nat Commun 2015; 6:8466. [PMID: 26506265 PMCID: PMC4639806 DOI: 10.1038/ncomms9466] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 08/24/2015] [Indexed: 01/19/2023] Open
Abstract
As human life expectancy has improved rapidly in industrialized societies, age-related cognitive impairment presents an increasing challenge. Targeting histopathological processes that correlate with age-related cognitive declines, such as neuroinflammation, low levels of neurogenesis, disrupted blood–brain barrier and altered neuronal activity, might lead to structural and functional rejuvenation of the aged brain. Here we show that a 6-week treatment of young (4 months) and old (20 months) rats with montelukast, a marketed anti-asthmatic drug antagonizing leukotriene receptors, reduces neuroinflammation, elevates hippocampal neurogenesis and improves learning and memory in old animals. By using gene knockdown and knockout approaches, we demonstrate that the effect is mediated through inhibition of the GPR17 receptor. This work illustrates that inhibition of leukotriene receptor signalling might represent a safe and druggable target to restore cognitive functions in old individuals and paves the way for future clinical translation of leukotriene receptor inhibition for the treatment of dementias. The leukotriene receptor antagonist montelukast is an anti-asthmatic drug. Here, the authors show that montelukast reduces neuroinflammation, promotes hippocampal neurogenesis and restores learning and memory in old rats suffering from ageing-associated cognitive dysfunction.
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Affiliation(s)
- Julia Marschallinger
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria
| | - Iris Schäffner
- Institute of Biochemistry, Emil Fischer Center, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Barbara Klein
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria
| | - Renate Gelfert
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria
| | - Francisco J Rivera
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria
| | - Sebastian Illes
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Grassner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria.,Center for Spinal Cord Injuries, BG Trauma Center Murnau, 82418 Murnau am Staffelsee, Germany
| | - Maximilian Janssen
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria
| | - Peter Rotheneichner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria.,Institute of Experimental Neuroregeneration, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Claudia Schmuckermair
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, Leopold-Franzens-University of Innsbruck, 6020 Innsbruck, Austria
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Marta Boccazzi
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
| | | | - Florian B Lagler
- Department for Paediatrics, Institute for Inborn Errors of Metabolism, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Marija Renic
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Hans-Christian Bauer
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria.,Institute of Tendon and Bone Regeneration, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Nicolas Singewald
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, Leopold-Franzens-University of Innsbruck, 6020 Innsbruck, Austria
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Sebastien Couillard-Despres
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria.,Institute of Experimental Neuroregeneration, Paracelsus Medical University, 5020 Salzburg, Austria
| | - D Chichung Lie
- Institute of Biochemistry, Emil Fischer Center, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Maria P Abbracchio
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria
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Leidgens V, Seliger C, Jachnik B, Welz T, Leukel P, Vollmann-Zwerenz A, Bogdahn U, Kreutz M, Grauer OM, Hau P. Ibuprofen and Diclofenac Restrict Migration and Proliferation of Human Glioma Cells by Distinct Molecular Mechanisms. PLoS One 2015; 10:e0140613. [PMID: 26485029 PMCID: PMC4617646 DOI: 10.1371/journal.pone.0140613] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/27/2015] [Indexed: 11/24/2022] Open
Abstract
Background Non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with anti-tumorigenic effects in different tumor entities. For glioma, research has generally focused on diclofenac; however data on other NSAIDs, such as ibuprofen, is limited. Therefore, we performed a comprehensive investigation of the cellular, molecular, and metabolic effects of ibuprofen and diclofenac on human glioblastoma cells. Methods Glioma cell lines were treated with ibuprofen or diclofenac to investigate functional effects on proliferation and cell motility. Cell cycle, extracellular lactate levels, lactate dehydrogenase-A (LDH-A) expression and activity, as well as inhibition of the Signal Transducer and Activator of Transcription 3 (STAT-3) signaling pathway, were determined. Specific effects of diclofenac and ibuprofen on STAT-3 were investigated by comparing their effects with those of the specific STAT-3 inhibitor STATTIC. Results Ibuprofen treatment led to a stronger inhibition of cell growth and migration than treatment with diclofenac. Proliferation was affected by cell cycle arrest at different checkpoints by both agents. In addition, diclofenac, but not ibuprofen, decreased lactate levels in all concentrations used. Both decreased STAT-3 phosphorylation; however, diclofenac led to decreased c-myc expression and subsequent reduction in LDH-A activity, whereas treatment with ibuprofen in higher doses induced c-myc expression and less LDH-A alteration. Conclusions This study indicates that both ibuprofen and diclofenac strongly inhibit glioma cells, but the subsequent metabolic responses of both agents are distinct. We postulate that ibuprofen may inhibit tumor cells also by COX- and lactate-independent mechanisms after long-term treatment in physiological dosages, whereas diclofenac mainly acts by inhibition of STAT-3 signaling and downstream modulation of glycolysis.
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Affiliation(s)
- Verena Leidgens
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Corinna Seliger
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Birgit Jachnik
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Welz
- Department of Neurology, Molecular Cell Biology Laboratory, University Hospital Regensburg, Regensburg, Germany
| | - Petra Leukel
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Arabel Vollmann-Zwerenz
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Marina Kreutz
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany and Regensburg Center for Interventional Immunology (RCI), Regensburg, Germany
| | - Oliver M Grauer
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
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