V‐ATPase inhibition overcomes trastuzumab resistance in breast cancer

The HER2 oncogene targeting drug trastuzumab shows remarkable efficacy in patients overexpressing HER2. However acquired or primary resistance develops in most of the treated patients why alternative treatment strategies are strongly needed. As endosomal sorting and recycling are crucial steps for HER2 activity and the vacuolar H+‐ATPase (V‐ATPase) is an important regulator of endocytotic trafficking, we proposed that targeting V‐ATPase opens a new therapeutic strategy against trastuzumab‐resistant tumor cells in vitro and in vivo. V‐ATPase inhibition with archazolid, a novel inhibitor of myxobacterial origin, results in growth inhibition, apoptosis and impaired HER2 pro‐survival signaling of the trastuzumab‐resistant cell line JIMT‐1. This is accompanied by a decreased expression on the plasma membrane and accumulation of HER2 in the cytosol, where it colocalizes with endosomes, lysosomes and autophagosomes. Importantly, microscopic analysis of JIMT‐1 xenograft tumor tissue of archazolid treated mice confirms the defect in HER2‐recycling which leads to reduced tumor growth. These results suggest that V‐ATPase inhibition by archazolid induces apoptosis and inhibits growth of trastuzumab‐resistant tumor cells by retaining HER2 in dysfunctional vesicles of the recycling pathway and consequently abrogates HER2‐signaling in vitro as well as in vivo. V‐ATPase inhibition is thus suggested as a promising strategy for treatment of trastuzumab‐resistant tumors.     

N-terminal domain of alphaB-crystallin provides a conformational switch for multimerization and structural heterogeneity

The small heat shock protein (sHSP) αB-crystallin (αB) plays a key role in the cellular protection system against stress. For decades, high-resolution structural studies on heterogeneous sHSPs have been confounded by the polydisperse nature of αB oligomers. We present an atomic-level model of full-length αB as a symmetric 24-subunit multimer based on solid-state NMR, small-angle X-ray scattering (SAXS), and EM data. The model builds on our recently reported structure of the homodimeric α-crystallin domain (ACD) and C-terminal IXI motif in the context of the multimer. A hierarchy of interactions contributes to build multimers of varying sizes: Interactions between two ACDs define a dimer, three dimers connected by their C-terminal regions define a hexameric unit, and variable interactions involving the N-terminal region define higher-order multimers. Within a multimer, N-terminal regions exist in multiple environments, contributing to the heterogeneity observed by NMR. Analysis of SAXS data allows determination of a heterogeneity parameter for this type of system. A mechanism of multimerization into higher-order asymmetric oligomers via the addition of up to six dimeric units to a 24-mer is proposed. The proposed asymmetric multimers explain the homogeneous appearance of αB in negative-stain EM images and the known dynamic exchange of αB subunits. The model of αB provides a structural basis for understanding known disease-associated missense mutations and makes predictions concerning substrate binding and the reported fibrilogenesis of αB.     

Role of age and uncoupling protein-2 in oxidative stress, RAGE/AGE interaction and inflammatory liver injury

The objective of this study is to clarify whether age-related oxidative stress enhances hepatic vulnerability via increased interaction of advanced glycation endproducts (AGE) with their receptor RAGE. To further address the role of uncoupling of mitochondrial respiration, mitochondrial uncoupling protein-2 wild-type (UCP2+/+) and knock out (UCP2−/−) mice were used and studied at an age of 8 (young), 38 (adult) and 76 weeks (senescent). First, we could show that UCP2 protein expression increased with age in UCP2+/+ mice. Second, in both mouse strains oxidative stress, as measured by malondialdehyde concentrations and the ratio of glutathione to glutathione disulfide, as well as hepatic RAGE expression and highly modified AGE accumulation significantly increased with age. This, however, was far more pronounced in UCP2−/− mice, in particular at the young age of 8 wk. In addition, the hepatic activity of the AGE precursor detoxifying enzyme glyoxalase-I was significantly decreased in 8 wk old UCP2−/− animals and concomitantly caused 2-fold higher levels of methylglyoxal-modified AGE in these animals. We further showed that the numbers of hepatic cells expressing sRAGE which acts as a decoy for RAGE ligands decreased with age and were markedly lower in the UCP2−/− than the UCP2+/+ mice. As a consequence, young 8 wk old UCP2−/− mice benefited from treatment with recombinant mouse RAGE to block the RAGE/AGE interaction, when challenged with galactosamine/lipopolysaccharide for the induction of acute liver injury. They showed less pronounced tissue damage and slightly lower mortality rate, while older UCP2+/+ and UCP2−/− mice revealed comparably high mortality rates and extent of liver injury, irrespective of their treatment with rRAGE. Taken together, the present study underlines the role of UCP2 in the age-related increase of oxidative stress and the oxidative stress-related RAGE/AGE interaction. In young animals, blockade of the RAGE/AGE interaction is of benefit, while in older animals, this protective effect is lost, supposedly due to the fact that with age other factors than enhanced hepatic glycation products predominantly determine liver injury and injury-related mortality rate.     

Crystal structures of the endoplasmic reticulum aminopeptidase-1 (ERAP1) reveal the molecular basis for N-terminal peptide trimming

Endoplasmatic reticulum aminopeptidase 1 (ERAP1) is a multifunctional enzyme involved in trimming of peptides to an optimal length for presentation by major histocompatibility complex (MHC) class I molecules. Polymorphisms in ERAP1 have been associated with chronic inflammatory diseases, including ankylosing spondylitis (AS) and psoriasis, and subsequent in vitro enzyme studies suggest distinct catalytic properties of ERAP1 variants. To understand structure-activity relationships of this enzyme we determined crystal structures in open and closed states of human ERAP1, which provide the first snapshots along a catalytic path. ERAP1 is a zinc-metallopeptidase with typical H-E-X-X-H-(X)(18)-E zinc binding and G-A-M-E-N motifs characteristic for members of the gluzincin protease family. The structures reveal extensive domain movements, including an active site closure as well as three different open conformations, thus providing insights into the catalytic cycle. A K(528)R mutant strongly associated with AS in GWAS studies shows significantly altered peptide processing characteristics, which are possibly related to impaired interdomain interactions.     

Bildgebung bei idiopathisch generalisierten Epilepsien

Modern imaging techniques offer refined tools for investigating the pathomechanisms of idiopathic generalized epilepsies (IGE). Studies applying structural MRI techniques, MR spectroscopy, functional MRI and PET are discussed and exemplified by some case studies. Structural and functional changes mainly of thalamic and frontal cortex regions are reported as well as differences related to specific IGE syndromes. The findings suggest a dysfunction within the thalamofrontal-cortical network in IGE and question the traditional syndromatic distinction in focal and generalized epilepsies.     

Quality management in ambulatory care nursing and inpatient nursing in Germany. Specifics and current trends

In principle, quality management in nursing care follows the concepts used in medicine. Occasionally, professionals develop quality requirements and pursue quality improvements by using various tools. Specific features in Germany??s nursing care are related to the binding character of seven so-called expert standards and to mandatory, external quality assessments that began in 2009 and will be conducted and published yearly. Preliminary results of these assessments show that both home health agencies and nursing homes provide on average good quality nursing care. However, assessments also revealed a huge demand for improvements concerning the quality criteria and the procedures used to calculate the results. Currently, nursing scientists, providers of care, and long-term care insurance companies are controversially discussing that matter.     

Hepatic microcirculatory perfusion failure is a determinant of liver dysfunction in warm ischemia-reperfusion.

Hepatic ischemia-reperfusion (I/R) is characterized by circulatory and metabolic derangements, liver dysfunction, and tissue damage. However, little is known about the causative role of I/R-induced microcirculatory disturbance on the manifestation of postischemic reperfusion injury. Therefore, the intention of the study was to assess changes of hepatic microvascular perfusion (intravital fluorescence microscopy) as related to hepatic morphology (light/electron microscopy), hepatocellular integrity (serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities), and excretory function (bile flow). Sprague-Dawley rats were subjected to 20 minutes (group B, n = 9) and 60 minutes (group C, n = 9) of left hepatic lobar ischemia followed by 60 minutes of reperfusion. Sham-operated animals without ischemia served as controls (group A, n = 10). Lobar ischemia for 20 minutes followed by reperfusion resulted in a significant reduction of sinusoidal perfusion rate (93.9 +/- 1.4%; P < 0.05) and a decrease in erythrocyte flux (90.0 +/- 5.6%) when compared with controls (99.4 +/- 0.2 and 97.9 +/- 2.7%). This was accompanied by a significant increase of serum AST and ALT activities (P < 0.05) and a reduction of bile flow (P < 0.05). Prolongation of lobar ischemia (group C, 60 minutes) aggravated postischemic reperfusion injury (sinusoidal perfusion rate: 87.4 +/- 2.9%; erythrocyte flux: 62.1 +/- 8.4%) and was paralleled by severed hepatocellular damage. Electron microscopy of postischemic tissue demonstrated alteration of nonparenchymal cells (swelling of sinusoidal lining cells and widening of Disse's space) and substantial parenchymal cell damage (swelling of mitochondria, disarrangement of rough endoplasmatic reticulum, vacuolization, complete cytoplasmic degeneration). Initial postischemic increase in serum AST and ALT activities and reduction of bile flow directly correlated with the extent of microcirculatory failure (P < 0.01), ie, impairment of sinusoidal perfusion and decrease of erythrocyte flux, indicating the decisive role of microvascular perfusion failure for the manifestation of hepatic tissue damage and liver dysfunction.     

Striated muscle microvascular response to silver implants: A comparative in vivo study with titanium and stainless steel

Local microvascular perfusion is the primary line of defense of tissue against microorganisms and plays a considerable role in reparative processes. The impairment of the microcirculation by a biomaterial may therefore have profound consequences. Silver is known to have excellent antimicrobial activity and, although regional and systemic toxic effects have been described, silver is regularly discussed as an implant material in bone surgery. Because little is known about the influence of silver implants on the adjacent host tissue microvasculature, we studied in vivo nutritive perfusion and leukocytic response, and compared these results with those of the conventionally used materials titanium and stainless steel. Using the hamster dorsal skinfold chamber preparation and intravital microscopy, the implantation of a commercially pure silver sample led to a distinct and persistent activation of leukocytes combined with a marked disruption of the microvascular endothelial integrity, massive leukocyte extravasation, and considerable venular dilation. Whereas animals with stainless-steel implants showed a moderate increase in these parameters with a tendency to recuperate, titanium implants caused only a transient increase of leukocyte-endothelial cell interaction within the first 120 min and no significant change in macromolecular leakage, leukocyte extravasation and venular diameter. After 3 days, five of six preparations with silver samples showed severe inflammation and massive edema. Thus, the use of silver as an implant material should be critically judged despite its bactericidal properties. The implant material titanium seems to be well tolerated by the local vascular system and currently represents the golden standard.     

Lipoaspirate-derived adult mesenchymal stem cells improve functional outcome during intracerebral hemorrhage by proliferation of endogenous progenitor cells: Stem cells in intracerebral hemorrhages

Stem cell therapy seems promising in reducing deficits after focal cerebral ischemia. As stroke may result from intracerebral hemorrhage (ICH) in up to 20% we investigated whether human processed lipoaspirate mesenchymal stem cells (PLA-MSC) influence the functional outcome, migration behavior and the activation of endogenous progenitor cells. Experimental ICH was induced by stereotactic administration of collagenase in rats randomly assigned to the control or treatment group. The latter received 3 × 10⁶ PLA-MSC by intravenous (i.v.) injection 24 h after ICH induction. The outcome was continuously monitored using the RotaRod test over a period of 4 weeks. Morphometric analysis of ICH was performed consecutively by magnetic resonance imaging (MRI) studies and immunohistochemical analysis. The RotaRod test revealed a significant 1.5-fold improvement (p < 0.005) in functional outcome for the PLA-MSC treated group after 4 weeks compared to controls. Histological and MRI assessment of lesion size showed no difference between the two groups. Although i.v. injected human cells could not be detected in the post mortem brain, evaluation of the number of endogenous progenitor cells revealed a twofold increase in the treated animals compared to controls. Treatment with PLA-MSC improved the functional outcome significantly in an experimental ICH model. This effect was achieved by stimulation of endogenous progenitor cells rather than integration and differentiation of the infused PLA-MSC.     

Atrial natriuretic peptide protects against histamine-induced endothelial barrier dysfunction in vivo

Endothelial barrier dysfunction is a hallmark of many severe pathologies, including sepsis or atherosclerosis. The cardiovascular hormone atrial natriuretic peptide (ANP) has increasingly been suggested to counteract endothelial leakage. Surprisingly, the precise in vivo relevance of these observations has never been evaluated. Thus, we aimed to clarify this issue and, moreover, to identify the permeability-controlling subcellular systems that are targeted by ANP. Histamine was used as important pro-inflammatory, permeability-increasing stimulus. Measurements of fluorescein isothiocyanate (FITC)-dextran extravasation from venules of the mouse cremaster muscle and rat hematocrit values were performed to judge changes of endothelial permeability in vivo. It is noteworthy that ANP strongly reduced the histamine-evoked endothelial barrier dysfunction in vivo. In vitro, ANP blocked the breakdown of transendothelial electrical resistance (TEER) induced by histamine. Moreover, as judged by immunocytochemistry and Western blot analysis, ANP inhibited changes of vascular endothelial (VE)-cadherin, beta-catenin, and p120(ctn) morphology; VE-cadherin and myosin light chain 2 (MLC2) phosphorylation; and F-actin stress fiber formation. These changes seem to be predominantly mediated by the natriuretic peptide receptor (NPR)-A, but not by NPR-C. In summary, we revealed ANP as a potent endothelial barrier protecting agent in vivo and identified adherens junctions and the contractile apparatus as subcellular systems targeted by ANP. Thus, our study highlights ANP as an interesting pharmacological compound opening new therapeutic options for preventing endothelial leakage.