HINTERGRUND: Der brain-derived neurotrophic factor (BDNF) reguliert die synaptische Plastizität und spielt somit eine wichtige Rolle in der Gedächtnisbildung und -erhaltung. Deswegen gibt es eingehende Untersuchungen dieses neurotrophischen Faktors in Bezug auf Demenzerkrankungen, vor allem der Alzheimer Demenz. In dieser Studie wurde nach einem Zusammenhang zwischen BDNF Blutplasmawerten und der Alzheimer Demenz in einer longitudinalen Kohortenstudie, der Vienna-Transdanube-Aging(VITA)-Studie gesucht. METHODEN: Die VITA-Studie ist eine kommunale Kohortenstudie aller 75jährigen Einwohner einer geographischen Region Wiens. Es wurden die BDNF Plasmawerte der Basisuntersuchung und der ersten Folgeuntersuchung 30 Monate später als mögliche Biomarker für die Alzheimer Demenz untersucht. Assoziationen zwischen BDNF Plasmawerten und anderen epidemiologischen Eckdaten wurden ebenfalls analysiert. ERGEBNISSE: Wir konnten keine Assoziation zwischen BDNF Plasmawerten und der Entwicklung oder einer bereits bestehenden Alzheimer Demenz finden. Geschlecht, Body-Maß-Index und Depression stellten sich als Komorbiditäts-Faktoren von Demenz-erkrankungen dar. SCHLUSSFOLGERUNG: BDNF Plasmawerte sind diesen Ergebnissen nach kein so viel versprechender molekularer Marker für Alzheimer Demenz wie erhofft. BDNF wird jedoch weiterhin in vielen interessanten Studienprotokollen untersucht, da es sowohl im Blutserum als auch im Hirngewebe nachgewiesen werden kann und somit viele diagnostische und therapeutische Ansätze inspiriert. / BACKGROUND: Brain-derived neurotrophic factor (BDNF) regulates the plasticity of synapses and plays an important role in developing and sustaining memory. Therefore it is intensely researched with regard to dementia, especially Alzheimer’s disease. In this study, we searched for a relationship between BDNF plasma levels and Alzheimer’s disease in a longitudinal cohort, the Vienna-Transdanube-Aging (VITA)-study. METHODS: The VITA is a prospective community-based cohort study of all 75 years old inhabitants of a geographical region of Vienna. We have investigated the BDNF plasma levels of the baseline and the first follow-up 30 months later as a possible biomarker for Alzheimer’s disease. Associations between BDNF plasma levels and other epidemiologic data were also analyzed. RESULTS: We found no association between BDNF plasma levels and the development or existence of Alzheimer’s disease. Gender, body-mass-index and depression were shown to be co-morbid to dementia. CONCLUSION: According to these results, BDNF plasma levels are not as promising as a molecular marker for Alzheimer’s disease as hoped for. BDNF, though, is still subject to many interesting study protocols, as it can be detected also in blood serum and brain tissue and therefore invites many diagnostic and therapeutic scenarios.

Este trabalho de mestrado teve como objetivo o desenvolvimento de uma metodologia analítica focada no preparo de amostra protéica. O objeto de estudo foram os fragmentos solúveis das isoformas da proteína precursora do amilóide (APPs) presentes no plasma rico em plaquetas. As APPs têm sido amplamente estudadas em diversos grupos de pesquisa no Brasil e em outros no mundo como possíveis biomarcadores para a doença de Alzheimer. O preparo de amostra é a etapa fundamental que influencia significativamente nos resultados seguintes, especialmente quando se trata de amostras protéicas que exigem maiores cuidados. Para a avaliação dos melhores preparos de amostra para as APPs, foi utilizado SDS-PAGE e eletrotransferências de proteínas por Western Blotting. A eficiência dos preparos foi avaliada baseando-se nos resultados de revelação com anticorpos específicos para APP e medidas de densitometria de bandas. Após a escolha do melhor preparo de amostra utilizando SDS-PAGE e Western Blotting, as isoformas da APP foram separadas por eletroforese bidimensional (2DE). Durante a etapa de preparo de amostra, os resultados inesperados de massa molecular, o que indicou possível biodegradação das APPs. A identificação da fonte de interferência foi realizada estudando as variáveis dos preparos de amostra. Com isso foi possível determinar a fonte de interferência, mas uma avaliação mais detalhada das isoformas (como utilização de espectrometria de massas) não foi possível. / The goal of this Master\'s work was to develop an analytical methodology focused on protein sample preparation. The analyte studied were soluble amyloid precursor protein isoforms (APPs) which has been studied in many groups in Brazil and around the world as a possible biomarker for Alzheimer\'s disease. Sample preparation is a crucial step that influence significantly on next results, especially about biological samples which require more attention. For the best sample preparation for APPs, was used SDS-PAGE and protein electrotransference by Western Blotting techniques. The efficiency of the sample preparations was evaluated based on specific antibody reactions and densitometry measures of these interactions. After that, the APP isoforms were analyzed by two dimensional electrophoresis (2DE). During the sample preparation, were obtained unexpected molecular mass results, which indicated some APPs biodegradation. For the determination of the interference source, the variants steps of the sample preparation were analyzed. The sample preparation interference source was identified, but a more detailed study of the isoforms (by mass spectrometry) was not possible as well as the analysis of the identity of the possible fragmented isoforms.

O objetivo desta tese é avaliar a expressão do miRNA-423-5p, em diferentes sítios, em modelo experimental de remodelamento cardíaco após insulto isquêmico em ratos. Os animais foram randomizados em grupos SHAM (cirurgia sem oclusão da artéria coronária descendente anterior esquerda) ou IAM (cirurgia com ligadura da artéria coronária descendente anterior esquerda) e acompanhados por 1, 7, 28 e 90 dias. Após o tempo de seguimento, os animais foram submetidos ao ecocardiograma e eutanasiados. Foi retirado sangue do plexo retroorbital, sangue venoso e arterial e coletado tecido do músculo gastrocnêmio e do ventrículo esquerdo separando as áreas remota (REM), infartada (INF) e peri-infartada (PERI). A partir da homogeneização dos tecidos, foi realizada a extração de miRNA e sua expressão quantificada pelo método de PCR em tempo real. Também foi mensurado os níveis plasmáticos do peptídeo natriurético cerebral (BNP). Os dados foram analisados pela teste de ANOVA de uma e duas vias e correlações através do programa estatístico SPSS 21.0. Quanto a caracterização do modelo utilizado, podemos verificar que a fração de ejeção do ventrículo esquerdo dos ratos IAM foram menores que os do grupo SHAM e os percentuais de área acinética foram iguais em todos os grupos IAM, como esperado. Também observamos que o miRNA-423-5p é expresso no coração, nos diferentes segmentos analisados, apresentando variação significativa nos tempos avaliados, correlacionado-se positivamente com o tamanho do infarto e negativamente com a fração de ejeção do ventrículo esquerdo. Diante deste cenário, nossos achados solidificam o conceito de que a expressão do miRNA-423-p se altera ao longo do tempo após insulto isquêmico e pode ter papel relevante no remodelamento cardíaco de origem isquêmica. / The objective of this project was to evaluate the expression of miRNA-423-5p in an experimental model of cardiac remodeling after ischemic injury in rats. Animals were randomized to SHAM group (surgery without occlusion of the left anterior descending coronary artery) or acute myocardial infaction (AMI) group (surgery with ligation of the left anterior descending coronary artery) and followed for 1, 7, 28 and 90 days. After the follow-up period, the animals were submitted to echocardiography and euthanized. Blood from the retroorbital plexus, venous and arterial blood was collected; and gastrocnemius and left ventricle tissue was collected, separating the remote (REM), infarcted (INF) and peri-infarcted (PERI) areas. From the homogenization of tissues, miRNA was extracted and its expression quantified by real-time PCR. Plasma levels of brain natriuretic peptide (BNP) were also measured by ELISA. Data were analyzed by one-way and two-way ANOVA and coefficient correlations were calculated using the statistical package SPSS 21.0. Regarding the experimental model, we could verify that the left ventricular ejection fraction of the AMI rats were reduced compared to the SHAM group and the percentages of akinetic area were the same in all AMI groups, as expected. We also observed that miRNA-423-5p is expressed in the heart in the different segments analyzed, showing significant variation in the different periodos that were evaluated, is positively correlated with infarct size and negatively with left ventricular ejection fraction. In this scenario, our findings solidify the concept that miRNA-423-p expression changes over time after an ischemic insult and may play a relevant role in the cardiac remodeling of ischemic origin.

Este trabalho de mestrado teve como objetivo o desenvolvimento de uma metodologia analítica focada no preparo de amostra protéica. O objeto de estudo foram os fragmentos solúveis das isoformas da proteína precursora do amilóide (APPs) presentes no plasma rico em plaquetas. As APPs têm sido amplamente estudadas em diversos grupos de pesquisa no Brasil e em outros no mundo como possíveis biomarcadores para a doença de Alzheimer. O preparo de amostra é a etapa fundamental que influencia significativamente nos resultados seguintes, especialmente quando se trata de amostras protéicas que exigem maiores cuidados. Para a avaliação dos melhores preparos de amostra para as APPs, foi utilizado SDS-PAGE e eletrotransferências de proteínas por Western Blotting. A eficiência dos preparos foi avaliada baseando-se nos resultados de revelação com anticorpos específicos para APP e medidas de densitometria de bandas. Após a escolha do melhor preparo de amostra utilizando SDS-PAGE e Western Blotting, as isoformas da APP foram separadas por eletroforese bidimensional (2DE). Durante a etapa de preparo de amostra, os resultados inesperados de massa molecular, o que indicou possível biodegradação das APPs. A identificação da fonte de interferência foi realizada estudando as variáveis dos preparos de amostra. Com isso foi possível determinar a fonte de interferência, mas uma avaliação mais detalhada das isoformas (como utilização de espectrometria de massas) não foi possível. / The goal of this Master\'s work was to develop an analytical methodology focused on protein sample preparation. The analyte studied were soluble amyloid precursor protein isoforms (APPs) which has been studied in many groups in Brazil and around the world as a possible biomarker for Alzheimer\'s disease. Sample preparation is a crucial step that influence significantly on next results, especially about biological samples which require more attention. For the best sample preparation for APPs, was used SDS-PAGE and protein electrotransference by Western Blotting techniques. The efficiency of the sample preparations was evaluated based on specific antibody reactions and densitometry measures of these interactions. After that, the APP isoforms were analyzed by two dimensional electrophoresis (2DE). During the sample preparation, were obtained unexpected molecular mass results, which indicated some APPs biodegradation. For the determination of the interference source, the variants steps of the sample preparation were analyzed. The sample preparation interference source was identified, but a more detailed study of the isoforms (by mass spectrometry) was not possible as well as the analysis of the identity of the possible fragmented isoforms.

Prostate cancer is a leading cause of cancer-related death in men, and while many men diagnosed with the disease will have an indolent clinical course, 20-25% of men will experience disease recurrence which is invariably lethal. There is an urgent need for prognostic biomarkers that will predict disease recurrence and risk-stratify patients upon diagnosis, allowing for personalised therapies. This thesis attempts to identify new prognostic biomarkers for prostate cancer and investigates their patterns of protein expression in human primary prostate tumour tissue. Cancer stem cells are cancer cells thought to be uniquely capable of self-renewal and tumorigenicity, and may have a role in tumour recurrence. Using a literature searching approach, potential biomarkers related to stem cells, cancer stem cells or recurrence in prostate cancer were identified, and ALDH7A1, BMI1, SDC1, MUC1-C, Nestin and ZSCAN4 were chosen for investigation. An in silico approach was also used for biomarker identification, with RS1 and SLC31A1 selected as their mRNA was found to be upregulated in recurrent tumours. The expression patterns of all 7 potential biomarkers were examined by immunohistochemistry on prostate tumour tissue and benign tissue from prostate biopsies and prostatectomies. BMI1, ALDH7A1, MUC1-C and Nestin showed no relationship to recurrence or other clinical features. RS1 protein levels increased in patients with recurrence within 5 years, negatively correlated with AR expression, and a meta-analysis showed that the RS1 gene was amplified in up to 32% of castration-resistant prostate tumours. ZSCAN4 was heterogeneously expressed in a subset of 26% of prostate tumours with unclear characteristics and was not expressed in benign tissue, but was not associated with recurrence. Finally, SDC1 expression was lost in tumour epithelium, but a population of unidentified SDC1-expressing cells were found in the stroma of a third of tumours, and an increased burden of these cells was associated with primary Gleason pattern 5 tumours. These cells do not overlap with common epithelial, mesenchymal or stromal lineages, but may be migratory. In summary, the data presented in this thesis identifies 3 potential new biomarkers for prostate cancer, and provides the basis for future characterisation of their wider roles in the disease.

Hematopoietic stem cell transplant was developed as a curative therapy to treat onco-hematological diseases and recently indications for this therapy have expanded to include solid tumors, hemoglobinopathies and other genetic diseases and disorders. Two major types of hematopoietic stem cell transplant have been developed. Autologous transplants aim to deliver a massive dose of radiation and/or chemotherapy that is capable of ablating the hematopoietic stem cells in the bone marrow. The patient is then "rescued" from this lethal dose of treatment by an infusion of their own hematopoietic stem cells. Allogeneic transplants are designed to either functionally replace a cell class, or an enzyme or biological function absent in the patient, or to consolidate a remission in a onco-hematological disease via the graft-versus-tumor effect . Two of the largest causes of non-relapse mortality from an allogeneic hematopoietic stem cell transplant are acute and chronic graft-versus-host disease, in which immune cells derived from the graft recognize normal host tissue as foreign and attack these tissues. A host of biomarkers for acute graft versus host disease have been identified, but there is almost none for chronic graft versus host disease. Herein, a methodology to discover and validate a biomarker(s) for the most common organ system affected by chronic graft versus host disease is proposed.

Hemorrhagic fever viruses cause severe infections characterized by a hyperactive immune response that often leads to multiorgan failure and death. Current diagnostic tests are based on detecting viral proteins and nucleic acids in the blood. These are late-stage events during infection, which makes it impossible to perform a diagnosis before they are present in the collected sample. In this thesis, I explore an alternative approach using the transcriptional changes of circulating immune cells during the early stages of infection to identify unique markers of viral infection. The main advantage of this method is that it can be used to identify highly pathogenic viruses before standard detection methods become effective. I initially used RNA sequencing data to compare the host patterns of expression of macaques infected with either Lassa virus or Marburg virus, two related hemorrhagic fever viruses. I identified a set of genes that quickly become upregulated after a viral infection and remain highly expressed throughout the entire disease course, irrespective of the specific virus that caused the infection. I was also able to identify a set of biomarker genes that follow unique patterns of expression depending on the type of infection. I used an independent dataset to validate the potential of these genes to be used as biomarkers of infection. Additionally, I compared these results to the patterns of expression of macaques infected with Ebola virus, looking at multiple experimental conditions, tissues and routes of infection. Finally, I validated the host patterns of expression using two independently generated datasets corresponding to infection by different strains of arenaviruses and filoviruses. Studying the host immune response has the potential to improve the diagnosis of viral hemorrhagic fevers and other diseases. It can also accelerate our efforts to understand the underlying molecular mechanisms that lead to pathogenesis and severe disease.

Lung cancer is the leading cause of death from cancer in the world. First, we hypothesized that microRNA expression is altered in the bronchial epithelium of patients with lung cancer and that incorporating microRNA expression into an existing mRNA biomarker may improve its performance. Using bronchial brushings collected from current and former smokers, we profiled microRNA expression via small RNA sequencing for 347 patients with available mRNA data. We found that four microRNAs were under-expressed in cancer patients compared to controls (p<0.002, FDR<0.2). We explored the role of these microRNAs and their gene targets in cancer. In addition, we found that adding a microRNA feature to an existing 23-gene biomarker significantly improves its performance (AUC) in a test set (p<0.05). Next, we generalized the biomarker discovery process, and developed a visualization tool for biomarker selection. We built upon an existing biomarker discovery pipeline and created a web-based interface to visualize the performance of multiple predictors. The “visualization” component is the key to sorting through a thousand potential biomarkers, and developing clinically useful molecular predictors. Finally, we explored the molecular events leading to the development of COPD and ILD, two heterogeneous diseases with high mortality. We hypothesized that integrative genetic and expression networks can help identify drivers and elucidate mechanisms of genetic susceptibility. We utilized 262 lung tissue specimens profiled with microRNA sequencing, microarray gene expression and SNP chip genotyping. Next, we built condition specific integrative networks using a causality inference test for predicting SNP-microRNA-mRNA associations, where the microRNA is a predicted mediator of the SNP’s effect on gene expression. We identified the microRNAs predicted to affect the most genes within each network. Members of miR-34/449 family, known to promote airway differentiation by repressing the Notch pathway, were among the top ranked microRNAs in COPD and ILD networks, but not in the non-disease network. In addition, the miR-34/449 gene module was enriched among genes that increase in expression over time when airway basal cells are differentiated at an air-liquid interface and among genes that increase in expression with the airway wall thickening in patients with emphysema. / 2019-07-31T00:00:00Z

abstract: Valley Fever (VF), is a potentially lethal fungal pneumonia caused by Coccidioides spp., which is estimated to cause ~15-30% of all community-acquired pneumonias in the highly endemic Greater Phoenix and Tucson areas of Arizona. However, an accurate antigen-based diagnostic is still lacking. In order to identify protein and glycan antigen biomarkers of infection, I used a combination of genomics, proteomics and glycomics analyses to provide evidence of genus-specific proteins and glycosylations. The next goal was to determine if Coccidioides-specific glycans were present in biological samples from VF patients. Urine collected from 77 humans and 63 dogs were enriched for glycans and evaluated by mass spectrometry for Coccidioides-specific glycans and evaluated against a panel of normal donor urines, urines from patients infected with other fungi, and fungal cultures from closely related pneumonia-causing fungi. A combination of 6 glycan biomarkers was 100% sensitive and 100% specific in the diagnosis of human VF subjects, while only 3 glycan biomarkers were needed for 100% sensitivity and 100 specificity in the diagnosis of dog VF subject. Additionally, a blinded trial of 23 human urine samples was correctly able to classify urine samples with 93.3% sensitivity and 100% specificity. The results of this research provides evidence that Coccidioides genus-specific glycosylations have potential as antigens in diagnostic assays. / Dissertation/Thesis / Doctoral Dissertation Microbiology 2019

Tumore der Nebennieren stellen häufige Tumore dar, welche bei mindestens 3 % der Population über 50-Jähriger vorkommen. Im Gegensatz dazu ist das Nebennierenrindenkarzinom mit einer Inzidenz von 1-2 Einwohner pro Million ein sehr seltener Tumor. Da seine Prognose allerdings ungünstig, und diese maßgeblich davon abhängt wie fortgeschritten der Tumor bei Diagnosestellung ist, ist es wichtig, dass die richtige Diagnose frühzeitig gestellt wird. Bis heute ist kein zuverlässiger immunhistochemischer Nebennierenrindenkarzinom-spezifischer Marker etabliert um das Nebennierenrindenkarzinom von anderen retroperitonealen Tumoren zu differenzieren. Sasano et al. schlug bereits 1995 erstmalig den Transkriptionsfaktor Steroidogenic Factor 1 (SF1) als Marker zur Differenzierung von Nebennierenrinden- und Nicht-Nebennierenrindentumoren vor. Allerdings wurde die diagnostische Wertigkeit bisher nur in sehr kleinen Fallserien mit insgesamt nur 17 Nebennierenrindenkarzinomen untersucht. In der vorliegenden Arbeit wurde die SF1 Protein-Expression bei 163 Nebennierenrindenkarzinomen, 52 Nebennierenrinden-Adenomen, 12 normalen steroidogenen Geweben (6 Nebennieren und 6 Ovare), sowie 73 Nicht-Steroidtumoren immunhistochemisch untersucht. Hierbei zeigte sich, das SF1 bei 158 von 161 evaluierbaren Nebennierenrindenkarzinomen und bei allen Proben von normalen und gutartigen Geweben (n=64) nachweisbar war. Im Gegensatz dazu war keine der 73 Nicht-Steroidgeweben SF1 positiv, so dass die diagnostische Genauigkeit extrem gut ist (Sensitivität: 98.6 %, Spezifität: 100 %, positive und negative predictive value jeweils 100 % und 97.3 %). In einem zweiten Schritt wurde untersucht ob die Protein-Expression von SF1 beim Nebennierenrindenkarzinom auch prognostische Bedeutung hat. Hierbei zeigte sich, dass Patienten mit Tumoren mit starker SF1 Färbung (30 %) ein deutlich schlechteres tumorstadium-adjustiertes Rezidiffreies- und Gesamt-Überleben haben als Patienten mit geringer SF1 Expression (hazard ratio: 2.45). Zusätzlich zu den immunhistochemischen Untersuchungen wurden FISH Analysen durchgeführt. Hierbei zeigte sich allerdings keine signifikante Korrelation zwischen SF1 Gendosis und der SF1 Protein-Expression, so dass zu vermuten ist, dass SF1 maßgeblich auf Transkriptions- und Translationsebene reguliert wird. In einem Versuch diese Frage zu beantworten wurden zwei mutmaßliche SF1 Interaktionspartner, FATE1 und DAX1, genauer immunhistochemisch untersucht. Hierbei wurde deutlich, dass FATE1 bei 62 von 141 evaluierbaren Nebenierenrindenkarzinomen und 12 von 62 normalen und gutartigen Geweben nachweisbar war. Im Gegensatz hierzu waren alle 9 Nicht-Steroidgewebe FATE1 negativ. Dies zeigt, das FATE1 nicht zur Diagnostik nutzbar ist (Sensitivität: 61 %, Spezifität: 100 %, positive und negative predictive value 100 % bzw. 14 %). Die DAX1 Analyse zeigte, dass alle 20 normalen und gutartigen Gewebe eine positive DAX1 Färbereaktion zeigten. Von 126 Nebennierenrindenkarzinomen waren 71 DAX1 positiv. Von den 8 untersuchten Nicht-Steroidgeweben waren 6 DAX1 positiv. Diese Ergebnisse belegen, dass auch DAX1 keine diagnostische Genauigkeit besitzt (Sensitivität: 56 %, Spezifität: 25 %, positive und negative predictive value 92 % bzw. 4 %). Die Untersuchung der prognostischen Fähigkeiten von FATE1 und DAX1 zeigte, dass Patienten mit Tumoren mit starker FATE1 Färbung (39 %) ein schlechteres tumorstadium-adjustiertes Gesamt- aber nicht Rezidiffreies-Überleben haben als Patienten mit niedriger FATE1 Protein-Expression (hazard ratio: 2.01). Weiterhin wurde deutlich, dass DAX1 keine deutlichen prognostischen Fähigkeiten besitzt. Zusammenfassend läßt sich aus der vorliegenden Arbeit folgern, das SF1 aktuell der beste diagnostische Marker zur Diagnose von Tumoren der Nebennierenrinde ist und damit Eingang in die histopathologische Routine-Diagnostik von Nebennierentumoren finden wird. Zusätzlich ist die SF1 Expression ein sehr guter prognostischer Marker beim Nebennierenrindenkarzinom, wobei sich die prognostische Aussage durch zusätzliche Färbung von FATE1 und DAX1 nur unwesentlich verbessern läßt. / Adrenal tumors are common tumors which are present in at least 3 % in the human population over their 5th decade. However, adrenocortical carcinoma (ACC) is a rare malignancy which shows an approximate anual incidence of 1-2 per million. Prognosis of ACC is generally poor and depends strongly on the tumor stage. Thus, early and correct diagnosis is important. Until now, no reliable immunohistochemical ACC-specific marker has been established for its differentiation from other retroperitoneal tumors. Already in 1995, Sasano et al. suggested the transcription factor Steroidogenic Factor 1 (SF1) as useful marker for differentiation of adrenocortical and non-adrenocortical tumors. Up to now, SF1's value as diagnostic marker for ACC was investigated only in small series of in a total of 17 samples. In our work, SF1 expression was investigated by immunohistochemistry in 163 ACC, 52 adrenocortical adenomas, 12 normal steroidogenic tissues (6 adrenal glands and 6 ovaries), as well as 73 non-steroidogenic tumors. SF1 protein expression was shown in 158 of a total of 161 evaluable ACC, as well as all normal and benign steroidogenic tissues. In contrast, no SF1 protein was detectable in the non-steroidogenic tumors. Thus, SF1 protein expression is a highly specific diagnostic tool (sensitivity: 98.6 %, specificity: 100 %, positive and negative predictive value: 100 % and 97.3 %, respectively). In a second step, SF1 protein expression was investigated as a prognostic tool in ACC. As shown by us, ACCs presenting strong SF1 immunoreactivity (30 %) showed a strong correlation with overall and recurrence-free patients survival than ACCs presenting low SF1 protein expression (hazard ratio: 2.45). Moreover, FISH analyses were performed which revealed no significant correlation of SF1 gene dosis and SF1 protein expression, suggesting a regulatory mechanism at transcriptional and translational level. To investigate the hypothesis, we investigated two putative interaction partners of SF1, namely FATE1 and DAX1 protein, by immunohistochemistry. FATE1 protein was expressed in 62 of a total of 141 evaluable ACC as well as 12 of a total of 62 normal and benign steroidogenic tissues. In contrast, all non-steroidogenic tissues were FATE1 negative (n=9). Thus, FATE1 is no valuable diagnostic tool (sensitivity: 61 %, specificity: 100 %, positive and negative predictive value: 100 % and 14 %, respectively). DAX1 immunohistochemistry showed that all normal and benign steroidogenic tissues (n=20) were DAX1 positive as well as 71 of a total of 126 ACC samples. Furthermore, 6 out of a total of 8 non-steroidogenic tissues stained DAX1 positive, showing that DAX1 protein is no diagnostic tool (sensitivity: 50 %, specificity: 25 %, positive and negative predictive value: 92 % and 4 %, respectively). Investigation of the prognostic value of FATE1 and DAX1 revealed that patients with tumors characterized by strong FATE1 immunoreactivity (39 %) had a worse outcome in overall but not recurrence-free survival than patients showing low FATE1 expression (hazard ratio: 2.01). DAX1 protein expression has no prognostic value in ACC. In summary, we showed that SF1 is currently the best available diagnostic marker for differentiation of adrenocortical tumors from other retroperitoneal tumors, and that it will be suitable for histopathological diagnostic routine. Furthermore, SF1 expression is a well-suited prognostical tool in adrenocortical carcinoma which is only marginally enhanced by subsequent staining of FATE1 and DAX1 protein.