Adipositas definiert durch ein Übermaß an Körperfett. Die Anzahl der Betroffenen hat sich über die letzten 4 Dekaden weltweit verdreifacht. Nicht nur Erwachsene, zunehmend auch Kinder und Jugendliche sind betroffen. Dieser Artikel liefert eine Zusammenfassung über Aktuelle Forschung zu Grundlagen und Therapie.

Identifying factors associated with appropriate and inappropriate therapies in patients with implantable cardioverter-defibrillator (ICD) could help to identify those at risk and reduce the incidence of this emergency situation which has detrimental effect on mortality and morbidity in patients with ICD. These studies were designed to find the prevalence and factors associated with appropriate and inappropriate therapies in patients with ICD.

Identifying factors associated with appropriate and inappropriate therapies in patients with implantable cardioverter-defibrillator (ICD) could help to identify those at risk and reduce the incidence of this emergency situation which has detrimental effect on mortality and morbidity in patients with ICD. These studies were designed to find the prevalence and factors associated with appropriate and inappropriate therapies in patients with ICD.

Multiple sclerosis (MS) is the most common chronic autoimmune neurological disease. Its therapeutic management has drastically evolved in the recent years with the development of specific disease-modifying therapies (DMTs). Together with the established injectables, oral and intravenous alternatives are now available for MS patients with significant benefits to modulate the disease course. Certain drugs present with a higher efficacy than the others, profiles and frequencies of adverse events differentiate as well. Thus due to the several and different treatment alternatives, the therapeutic approach adopted by neurologists requires a tactical focus for a targeted, timed, and meaningful treatment decision. An integration of rational and emotional control with proper communication skills is necessary for shared decision-making with patients. In this perspective paper, we reinforce the necessary concept of strategic MS treatment approach using all available therapies based on scientific evidence and current experience. We apply a didactic analogy to the strategic game chess. The opening with oriented attack (i.e. already in early disease stages as clinical isolated syndrome), a correct choice of chess pieces to move (i.e. among the several DMTs), a re-assessment reaction to different scenarios (e.g. sustained disease activity, adverse events, and family planning) and the advantage of real-world data are discussed to try the best approach to ultimately successfully approach the best personalized MS treatment.

Humane corneale Endothelzellen (HCEC) bilden einen Monolayer aus differenzierten Zellen an der posterioren Oberfläche der Cornea und sind essenziell für den Erhalt der cornealen Transparenz. HCEC zeigen nahezu keine proliferative Aktivität in vivo und nur eine begrenzte Proliferationsfähigkeit in vitro. Bei übermäßigem Zellverlust aufgrund von Traumata, Erkrankungen oder des Alters kann die Transparenz der Cornea irreversibel beeinträchtigt werden und die Transplantation einer Spenderhornhaut erforderlich sein, um die Hornhauttransparenz und damit die Sehfähigkeit wiederherzustellen. Dabei ist die weltweite Begrenzung der medizinischen Versorgung mit hochwertigen Spenderhornhäuten das derzeit größte Problem für die Therapie von Cornea-assoziierten Erkrankungen. Zellersatzstrategien mit in vitro kultivierten, quantitativ und qualitativ ausreichenden Spenderzellen sollen die weitestgehend ausgereizten logistischen Ansätze zur Verringerung des Spendermangels ergänzen. Die Entwicklung einer abschaltbaren bzw. transienten Methode zur in vitro- und in situ-Vervielfältigung primärer HCEC ohne Verlust ihrer typischen morphologischen Merkmale würde die Herstellung sowie eine detaillierte und umfassende Charakterisierung von Transplantaten aus primären HCEC ermöglichen. In dieser Arbeit sollten daher zunächst verschiedene proliferationsfördernde Faktoren (PF) identifiziert werden, die nach stabilem retroviralen Gentransfer mit Integrations-kompetenten lentiviralen Vektoren (ICLV) in primären HCEC ein starkes proliferationsförderndes Signal provozieren, das eine Immortalisierung der Zellen zur Folge hat. Dabei sollte die Pseudotypisierung der ICLV-Partikel mit alternativen viralen Glykoproteinen zytopathische Effekte verringern und die Transduktionseffizienz steigern. Nachfolgend sollten die identifizierten PF auf ihre Fähigkeit, die Proliferation primärer HCEC transient zu stimulieren, ohne die Zellen dabei zu transformieren, getestet werden. Mit Hilfe verschiedener retroviraler Expressionssysteme sollte ein klinisch anwendbares System entwickelt werden, das eine kontrollierte, zeitlich begrenzte Stimulierung der Proliferation bei gleichzeitiger Unterdrückung eines tumorartigen Zellwachstums ermöglichte. Hierzu dienten 1) Integrase-defiziente lentivirale Vektoren (IDLV), die eine transiente Transgenexpression durch direkte Transkription des episomalen DNA-Vektorgenoms erlauben, und 2) das transiente Foamyvirus-Vektorsystem (TraFo-VS), dass auf der Enkapsidierung und dem Transfer nicht-viraler mRNA in permissiven Zielzellen basiert. Es konnte gezeigt werden, dass ICLV-Pseudotypen, die entweder eine SFVmcy-Glykoproteinvariante (ICLVSFV) oder das VSV-G-Protein enthielten (ICLVVSV), eine signifikante Transduktionseffizienz aufwiesen und dabei keine zytopathischen Effekte in den Zielzellen auslösten, weshalb beide Glykoproteine für weiterführende Experiment genutzt wurden. Unter Verwendung des optimierten ICLV-Systems konnten drei PF identifiziert werden, die eine reproduzierbare Immortalisierung primärer HCEC infolge stabiler Expression durch Transduktion mit den ICLV-Pseudotypen ermöglichten. Dazu zählten der Cyclin D1/CDK4-Proteinkomplex (4D), die SV40 T-Antigene (SV40T) sowie die transformierenden Proteine E6 und E7 (E6/E7) des HPV-16. Es konnte auch gezeigt werden, dass die Proliferation transduzierter primärer HCEC nach stabiler Transduktion mit PF-codierenden ICLV-Partikeln in einer dosisabhängigen Weise signifikant erhöht werden konnte. Untersuchungen mit IDLV-Varianten haben jedoch gezeigt, dass transduzierte HCEC ein vergleichbares proliferatives Verhalten wie ihre stabil transduzierten Äquivalente aufwiesen. Dies demonstrierte die restliche, geringgradige, nicht-kanonische Integrationskapazität von IDLV-Partikeln besonders im Zusammenhang mit der Expression von potenten PF. Nach erfolgter Transduktion mit TraFo-VP konnten die transferierten PF-codierenden mRNA in den Primärzellen nachgewiesen werden. Die Anwendung dieses Systems resultierte jedoch weder in einer nachweisbaren PF-Expression noch konnte eine proliferationsfördernde Wirkung in transduzierten Zellen festgestellt werden. Auch durch sequenzielle Transduktion der Zielzellen konnte keine Steigerung der Proliferationsrate induziert werden. Durch Verwendung von 50 fach konzentrierten SV40T-codierenden TraFo-VP konnte der mRNA-Transfer erhöht werden, wodurch dann auch die SV40T-Proteinexpression in den transduzierten Zellen nachweisbar wurde. Zudem konnte erstmalig gezeigt werden, dass sich im zeitlichen Verlauf sowohl die zellassoziierte SV40T-mRNA als auch die SV40T-Proteinkonzentration verringerte, bis sie nicht mehr nachweisbar war. Dabei konnte jedoch auch mit den konzentrierten TraFo VP keine nachweisbare transiente Immortalisierung primärer HCEC erreicht werden. Zusammenfassend kann festgestellt werden, dass eine permanente genetische Manipulation mit den viralen PF und dem 4D-Komplex eine Verlängerung der replikativen Lebensdauer ermöglichte und damit einhergehend die Immortalisierung primärer HCEC. Obgleich eine transiente Immortalisierung primärer HCEC mit den getesteten Systemen in dieser Arbeit nicht möglich war, ist eine klinische Anwendung des TraFo-VS, nicht aber des IDLV-Systems, in der angewandten Form, vielversprechend, um die Verfügbarkeit von qualitativ geeignetem Spendergewebe für die Transplantation bzw. Zellen für das Bioengineering des Hornhautendothels zu erhöhen. Daneben könnte das TraFo-VS ebenfalls genutzt werden, um andere zelluläre Funktionen in HCEC oder auch anderen Zielzellen transient zu modifizieren, z. B. Ionenfluss, replikative Seneszenz, Phagozytose oder Apoptose. / Human corneal endothelial cells (HCEC) form a monolayer of differentiated cells on the posterior surface of the cornea and are essential for maintaining corneal transparency. HCECs show almost no proliferative activity in vivo and only limited proliferative capacity in vitro. With excessive cell loss due to trauma, disease, or age-related degeneration, corneal transparency may be irreversibly compromised, and donor cornea transplantation may be required to restore vision. In this context, the global limitations in the medical supply of high-quality donor corneas are currently the most significant obstacle to the treatment of cornea-associated diseases. Cell replacement strategies using in vitro cultured donor cells of sufficient quantity and quality could complement the largely exhausted logistic approaches to alleviate donor shortage. The development of a method for strictly transient in vitro and in situ replication of primary HCECs without loss of their natural morphological characteristics would allow the production of well-characterized grafts derived from primary HCECs. To this end, I first aimed to identify different proliferation factors (PF) that provoke a robust proliferation-promoting signal in primary HCECs through stable retroviral gene transfer of candidate PF genes with integration-competent lentiviral vectors (ICLVs). Additionally, the pseudotyping of ICLV particles with alternative viral glycoproteins should reduce cytopathic effects and increase transduction efficiency. Subsequently, it should be clarified to what extent the identified PFs are capable of stimulating the proliferation of primary HCEC for a limited duration in a non-transformed context. Using different retroviral expression systems, I attempted to develop a clinically applicable system that allowed controlled, time-limited stimulation of proliferation while circumventing tumor-like cell growth. For this purpose, 1) integrase-deficient lentiviral vectors (IDLV), which allow transient transgene expression by direct transcription of the episomal DNA vector genome, and 2) the transient foamy virus vector system (TraFo-VS), which is based on encapsidation and transfer of non-viral mRNA in permissive target cells, were used. It was shown that ICLV pseudotypes containing either an SFVmcy glycoprotein variant (ICLVSFV) or the VSV-G protein (ICLVVSV) exhibited significant transduction efficiency without eliciting cytotoxic effects in target cells, highlighting both as viable candidates. Employing the optimized ICLV system, three PFs were identified that enabled reproducible immortalization of primary HCECs through stable expression after transduction with the ICLV pseudotypes. These included the cyclin D1/CDK4 protein complex (4D), the SV40 T antigens (SV40T), and the transforming proteins E6 and E7 (E6/E7) of HPV16. It was also shown that proliferation of transduced primary HCEC could be significantly increased in a dose-dependent manner following stable transduction with PF encoding ICLV particles. However, studies conducted using IDLV variants showed that PF-transduced HCEC exhibited a comparable proliferative behavior to their stably transduced equivalents. This demonstrated the residual, non-canonical integration capacity of IDLV particles especially in the context of potent PF expression. After successful transduction with TraFo-VP, the transferred PF-encoding mRNA could be detected in primary cells. However, application of this system did not result in detectable PF protein expression, nor could a proliferation-promoting phenotype be detected in transduced cells. Sequential transduction of target cells also failed to induce an increased proliferation rate. By using 50-fold concentrated SV40T-encoding TraFo-VPs, mRNA transfer could be increased, enabling detectable SV40T protein expression in transduced cells. In addition, it was shown for the first time that both cell-associated SV40T mRNA and SV40T protein levels decreased over time until they were no longer detectable. No observable transient immortalization of primary HCEC could be achieved even with the concentrated SV40T-encoding TraFo-VP. In conclusion, permanent genetic manipulation with the viral PFs and 4D protein complex allowed the prolonging of the cellular replicative lifespan in vitro and concomitant immortalization of primary HCEC. Although transient immortalization of primary HCECs was not possible with the systems tested in this investigation, clinical application of the TraFo-VS, but not the IDLV system as applied, remains a promising approach to increase the availability of suitable donor tissue for transplantation or cells for corneal endothelial bioengineering. Additionally, the TraFo-VS could also be used to transiently modify other cellular functions in HCEC or other target cells, e.g., ion flux, replicative senescence, phagocytosis, or apoptosis, for further cell biological research approaches.

Die Dissertation handelt über die Ergebnisse der Laserinduzierten Thermotherapie bei Lebertumoren aus Februar 2000 mit einem Follow up bis Februar 2002. Dabei wurden 43 Patienten mit 89 Läsionen therapiert. Betrachtet wurden Komplikationen, Liegezeiten, metastasenfreie Intervalle, Stichkanalmetastasen, Auswertungen der bildmorphologischen Ablationskontrollen und die Analyse der klinischen Verläufe. Dabei wurden die Patienten in drei Altersgruppen eingeteilt, so dass man die Ergebnisse auf das Alter beziehen konnte. Zu den Primärtumoren zählten zu 70 Prozent das Kolorektale Karzinom, zu 10 Prozent das HCC und zu 20 Prozent andere Tumoren. Liegezeit und Komplikationen waren in allen Altersklassen gleich. Die komplette Ablationsrate betrug 80 Prozent. Die Liegezeit betrug weniger als 3 Tage im Durchschnitt. Komplikationen, die zur Verlängerung der Liegezeit führten, waren intrathorakale Blutungen, subkapsuläre Hämatome und Fistelbildungen. Es wurde ein durchschnittlich sechsmonatiges metastasenfreies Intervall festgestellt. / The dissertation acts about the results of the Laser-Induced Thermotherapy of manignant liver tumors from February 2000 in follow up to February 2002. 43 patients with 89 lesions became to treat in this case. Were considered complications, time to stay in bed, metastasis-free interval, metastasis from prick in the duct, evaluations of the picture-morphological controls and the analyses of the clinical progresses. The patients were divided into 3 age-groups in this case so that one could get the results on the age. To the primary tumors counted in 70 percent the colorectal cancer, to 10 percent the HCC and to 20 percent other tumors. The time to stay in bed and complications were identical in all age-groups. The complete ablation was 80 percent. The time to stay in bed was on average little as 3 days. Complications which led to the prolongation of the time to stay in bed were pleural effusions, subcapsular hematoma and fistulae. It was found on the average an metastases-free interval for 6 month.

Background Growing evidence emphasizes the relevance of sphingolipids for metabolism and immunity of antigen-presenting cells (APC). APCs are key players in balancing tolerogenic and encephalitogenic responses in immunology. In contrast to the well-known prominent effects of sphingosine-1-phosphate (S1P) on lymphocyte trafficking, modulatory effects on APCs have not been fully characterized. Methods Frequencies and activation profiles of dendritic cell (DC) subtypes, monocytes, and T cell subsets in 35 multiple sclerosis (MS) patients were evaluated prior and after undergoing fingolimod treatment for up to 24 months. Impact of fingolimod and S1P on maturation and activation profile, pro-inflammatory cytokine release, and phagocytotic capacity was assessed in vitro and ex vivo. Modulation of DC-dependent programming of naïve CD4+ T cells, as well as CD4+ and CD8+ T cell proliferation, was also investigated in vitro and ex vivo. Results Fingolimod increased peripheral slanDC count—CD1+ DC, and monocyte frequencies remained stable. While CD4+ T cell count decreased, ratio of Treg/Th17 significantly increased in fingolimod-treated patients over time. CD83, CD150, and HLADR were all inhibited, but CD86 was upregulated in DCs after incubation in the presence of fingolimod. Fingolimod but not S1P was associated with reduced release of pro-inflammatory cytokines from DCs and monocytes in vitro and ex vivo. Fingolimod also inhibited phagocytic capacity of slanDCs and monocytes. After fingolimod, slanDCs demonstrated reduced potential to induce interferon–gamma-expressing Th1 or IL-17-expressing Th17 cells and DC-dependent T cell proliferation in vitro and in fingolimod-treated patients. Conclusions We present the first evidence that S1P-directed therapies can act additionally as immunomodulators that decrease the pro-inflammatory capabilities of APCs, which is a crucial element in DC-dependent T cell activation and programming.

Background Growing evidence emphasizes the relevance of sphingolipids for metabolism and immunity of antigen-presenting cells (APC). APCs are key players in balancing tolerogenic and encephalitogenic responses in immunology. In contrast to the well-known prominent effects of sphingosine-1-phosphate (S1P) on lymphocyte trafficking, modulatory effects on APCs have not been fully characterized. Methods Frequencies and activation profiles of dendritic cell (DC) subtypes, monocytes, and T cell subsets in 35 multiple sclerosis (MS) patients were evaluated prior and after undergoing fingolimod treatment for up to 24 months. Impact of fingolimod and S1P on maturation and activation profile, pro-inflammatory cytokine release, and phagocytotic capacity was assessed in vitro and ex vivo. Modulation of DC-dependent programming of naïve CD4+ T cells, as well as CD4+ and CD8+ T cell proliferation, was also investigated in vitro and ex vivo. Results Fingolimod increased peripheral slanDC count—CD1+ DC, and monocyte frequencies remained stable. While CD4+ T cell count decreased, ratio of Treg/Th17 significantly increased in fingolimod-treated patients over time. CD83, CD150, and HLADR were all inhibited, but CD86 was upregulated in DCs after incubation in the presence of fingolimod. Fingolimod but not S1P was associated with reduced release of pro-inflammatory cytokines from DCs and monocytes in vitro and ex vivo. Fingolimod also inhibited phagocytic capacity of slanDCs and monocytes. After fingolimod, slanDCs demonstrated reduced potential to induce interferon–gamma-expressing Th1 or IL-17-expressing Th17 cells and DC-dependent T cell proliferation in vitro and in fingolimod-treated patients. Conclusions We present the first evidence that S1P-directed therapies can act additionally as immunomodulators that decrease the pro-inflammatory capabilities of APCs, which is a crucial element in DC-dependent T cell activation and programming.

Graft-versus-host disease (GvHD) of the skin is a severe allo-immune reaction and complication following allogeneic stem cell transplantation. Over the past years, intensive pre-clinical research has led to an improved understanding of the pathophysiology of acute and to a lesser extend chronic GvHD. This has translated into the approval of several new agents for the treatment of both forms of GvHD. This review summarizes the most recent advances in underlying pathomechanisms, clinical trials and newly approved agents for GvHD, with a special focus on skin involvement.

Background: Sphingosine 1-phosphat receptor modulators (S1PRMs) have been linked to attenuated immune response to SARS-CoV-2 vaccines. Objective: To characterize differences in the immune response to SARS-CoV-2 vaccines in patients on selective versus unselective S1PRMs. Methods: Monocentric, longitudinal study on people with multiple sclerosis (pwMS) on fingolimod (FTY), siponimod (SIP), ozanimod (OZA), or without disease-modifying therapy (DMT) following primary and booster SARS-CoV-2 vaccination. Anti-SARS-CoV-2 antibodies and T-cell response was measured with electro-chemiluminescent immunoassay and interferon-γ release assay. Results: Primary vaccination induced a significant antibody response in pwMS without DMT while S1PRM patients exhibited reduced antibody titers. The lowest antibodies were found in patients on FTY, whereas patients on OZA and SIP presented significantly higher levels. Booster vaccinations induced increased antibody levels in untreated patients and comparable titers in patients on OZA and SIP, but no increase in FTY-treated patients. While untreated pwMS developed a T-cell response, patients on S1PRMs presented a diminished/absent response. Patients undergoing SARS-CoV-2 vaccination before onset of S1PRMs presented a preserved, although attenuated humoral response, while T-cellular response was blunted. Conclusion: Our data confirm differential effects of selective versus unselective S1PRMs on T- and B-cell response to SARS-CoV-2 vaccination and suggest association with S1PRM selectivity rather than lymphocyte redistribution.