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Dreyling M, Fowler NH, Dickinson M, Martinez-Lopez J, Kolstad A, Butler J, Ghosh M, Popplewell L, Chavez JC, Bachy E, Kato K, Harigae H, Kersten MJ, Andreadis C, Riedell PA, Ho PJ, Pérez-Simón JA, Chen AI, Nastoupil LJ, von Tresckow B, María Ferreri AJ, Teshima T, Patten PEM, McGuirk JP, Petzer AL, Offner F, Viardot A, Zinzani PL, Malladi R, Paule I, Zia A, Awasthi R, Han X, Germano D, O'Donovan D, Ramos R, Maier HJ, Masood A, Thieblemont C, Schuster SJ. Durable response after tisagenlecleucel in adults with relapsed/refractory follicular lymphoma: ELARA trial update. Blood 2024; 143:1713-1725. [PMID: 38194692 DOI: 10.1182/blood.2023021567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/21/2023] [Accepted: 12/16/2023] [Indexed: 01/11/2024] Open
Abstract
ABSTRACT Tisagenlecleucel is approved for adults with relapsed/refractory (r/r) follicular lymphoma (FL) in the third- or later-line setting. The primary analysis (median follow-up, 17 months) of the phase 2 ELARA trial reported high response rates and excellent safety profile in patients with extensively pretreated r/r FL. Here, we report longer-term efficacy, safety, pharmacokinetic, and exploratory biomarker analyses after median follow-up of 29 months (interquartile range, 22.2-37.7). As of 29 March 2022, 97 patients with r/r FL (grades 1-3A) received tisagenlecleucel infusion (0.6 × 108-6 × 108 chimeric antigen receptor-positive viable T cells). Bridging chemotherapy was allowed. Baseline clinical factors, tumor microenvironment, blood soluble factors, and circulating blood cells were correlated with clinical response. Cellular kinetics were assessed by quantitative polymerase chain reaction. Median progression-free survival (PFS), duration of response (DOR), and overall survival (OS) were not reached. Estimated 24-month PFS, DOR, and OS rates in all patients were 57.4% (95% confidence interval [CI], 46.2-67), 66.4% (95% CI, 54.3-76), and 87.7% (95% CI, 78.3-93.2), respectively. Complete response rate and overall response rate were 68.1% (95% CI, 57.7-77.3) and 86.2% (95% CI, 77.5-92.4), respectively. No new safety signals or treatment-related deaths were reported. Low levels of tumor-infiltrating LAG3+CD3+ exhausted T cells and higher baseline levels of naïve CD8+ T cells were associated with improved outcomes. Tisagenlecleucel continued to demonstrate highly durable efficacy and a favorable safety profile in this extended follow-up of 29 months in patients with r/r FL enrolled in ELARA. This trial was registered at www.clinicaltrials.gov as #NCT03568461.
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Affiliation(s)
- Martin Dreyling
- Department of Medicine, Medical Clinic III, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Nathan Hale Fowler
- The University of Texas MD Anderson Cancer Center, Houston, TX
- BostonGene, Waltham, MA
| | - Michael Dickinson
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Joaquin Martinez-Lopez
- Hospital 12 De Octubre, Complutense University, Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | | | - Jason Butler
- Royal Brisbane Hospital, Herston, QLD, Australia
| | - Monalisa Ghosh
- Division of Hematology/Oncology, Michigan Medicine University of Michigan, Ann Arbor, MI
| | | | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Emmanuel Bachy
- Clinical Hematology, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Lyon, France
| | - Koji Kato
- Department of Hematology, Oncology, and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hideo Harigae
- Department of Hematology, Tohoku University Hospital, Sendai, Japan
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands, on behalf of Stichting Hemato-Oncologie voor Volwassenen Nederland/Lunenburg Lymphoma Phase I/II Consortium
| | - Charalambos Andreadis
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | - Peter A Riedell
- David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - José Antonio Pérez-Simón
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla Consejo Superior de Investigaciones Cientificas, Universidad de Sevilla, Seville, Spain
| | - Andy I Chen
- Oregon Health and Science University, Portland, OR
| | - Loretta J Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bastian von Tresckow
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center and German Cancer Consortium, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andrés José María Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Haematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Piers E M Patten
- Comprehensive Cancer Centre, King's College London, London, United Kingdom
- Department of Haematology, King's College Hospital, London, United Kingdom
| | - Joseph P McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer l Center, Westwood, KS
| | - Andreas L Petzer
- Internal Medicine I, Ordensklinikum Linz Barmherzige Schwestern-Elisabethinen, Linz, Austria
| | | | - Andreas Viardot
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli," Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Ram Malladi
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | - Rakesh Awasthi
- Novartis Institutes for BioMedical Research, East Hanover, NJ
| | - Xia Han
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | - Roberto Ramos
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Aisha Masood
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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Awasthi R, Maier HJ, Zhang J, Lim S. Kymriah® (tisagenlecleucel) - An overview of the clinical development journey of the first approved CAR-T therapy. Hum Vaccin Immunother 2023:2210046. [PMID: 37185251 DOI: 10.1080/21645515.2023.2210046] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
The emergence of cell and gene therapies has dramatically changed the treatment paradigm in oncology and other therapeutic areas. Kymriah® (tisagenlecleucel), a CD19-directed genetically modified autologous T-cell immunotherapy, is currently approved in major markets for the treatment of relapsed/refractory (r/r) pediatric and young adult acute lymphoblastic leukemia, r/r diffuse large B-cell lymphoma, and r/r follicular lymphoma. This article presents a high-level overview of the clinical development journey of tisagenlecleucel, including its efficacy outcomes and safety considerations.
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Affiliation(s)
- Rakesh Awasthi
- Oncology & Hematology, Novartis Institutes for BioMedical Research, East Hanover, NJ, USA
| | - Harald J Maier
- Oncology and Hematology, Global Drug Development, Novartis Pharma AG, Basel, Switzerland
| | - Jie Zhang
- Cell & Gene Unit, Novartis Services Inc, East Hanover, NJ, USA
| | - Stephen Lim
- US Medical Affairs, Oncology, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Pulsipher MA, Han X, Maude SL, Laetsch TW, Qayed M, Rives S, Boyer MW, Hiramatsu H, Yanik GA, Driscoll T, Myers GD, Bader P, Baruchel A, Buechner J, Stefanski HE, Kalfoglou C, Nguyen K, Waldron ER, Thudium Mueller K, Maier HJ, Kari G, Grupp SA. Next-Generation Sequencing of Minimal Residual Disease for Predicting Relapse after Tisagenlecleucel in Children and Young Adults with Acute Lymphoblastic Leukemia. Blood Cancer Discov 2022; 3:66-81. [PMID: 35019853 PMCID: PMC9924295 DOI: 10.1158/2643-3230.bcd-21-0095] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/29/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
We assessed minimal residual disease (MRD) detection and B-cell aplasia after tisagenlecleucel therapy for acute lymphoblastic leukemia (ALL) to define biomarkers predictive of relapse (N = 143). Next-generation sequencing (NGS) MRD detection >0 in bone marrow (BM) was highly associated with relapse. B-cell recovery [signifying loss of functional chimeric antigen receptor (CAR) T cells] within the first year of treatment was associated with a hazard ratio (HR) for relapse of 4.5 [95% confidence interval (CI), 2.03-9.97; P < 0.001]. Multivariate analysis at day 28 showed independent associations of BMNGS-MRD >0 (HR = 4.87; 95% CI, 2.18-10.8; P < 0.001) and B-cell recovery (HR = 3.33; 95% CI, 1.44-7.69; P = 0.005) with relapse. By 3 months, the BMNGS-MRD HR increased to 12 (95% CI, 2.87-50; P < 0.001), whereas B-cell recovery was not independently predictive (HR = 1.27; 95% CI, 0.33-4.79; P = 0.7). Relapses occurring with persistence of B-cell aplasia were largely CD19- (23/25: 88%). Detectable BMNGS-MRD reliably predicts risk with sufficient time to consider approaches to relapse prevention such as hematopoietic cell transplantation (HCT) or second CAR-T cell infusion. SIGNIFICANCE: Detectable disease by BMNGS-MRD with or without B-cell aplasia is highly predictive of relapse after tisagenlecleucel therapy for ALL. Clonotypic rearrangements used to follow NGS-MRD did not change after loss of CD19 or lineage switch. High-risk patients identified by these biomarkers may benefit from HCT or investigational cell therapies.See related commentary by Ghorashian and Bartram, p. 2.This article is highlighted in the In This Issue feature, p. 1.
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Affiliation(s)
- Michael A. Pulsipher
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Disease Institute, USC Keck School of Medicine, Los Angeles, California.,Corresponding Author: Michael A. Pulsipher, Huntsman Cancer Institute at the University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112. Phone: 323-361-8840; Fax: 323-361-8068; E-mail:
| | - Xia Han
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Shannon L. Maude
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Oncology, Center for Childhood Cancer Research and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Theodore W. Laetsch
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Oncology, Center for Childhood Cancer Research and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Muna Qayed
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Healthcare of Atlanta, Atlanta, Georgia
| | - Susana Rives
- Pediatric Hematology, Hospital Sant Joan de Déu de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain
| | - Michael W. Boyer
- Department of Pediatrics and Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Hidefumi Hiramatsu
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto City, Japan
| | - Gregory A. Yanik
- Michigan Medicine Bone Marrow Transplant and Leukemia, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Tim Driscoll
- Pediatric Blood and Marrow Transplant, Duke University Medical Center, Durham, North Carolina
| | - G. Doug Myers
- Pediatric Hematology and Oncology, Children's Mercy Hospital; University of Missouri—Kansas City School of Medicine, Kansas City, Missouri
| | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine Hospital for Children and Adolescents University Hospital Frankfurt, Frankfurt, Germany
| | - Andre Baruchel
- Pediatric Hemato-Immunology Department, Hôpital Universitaire Robert Debré (APHP), Paris, France.,Université de Paris et Institut de Recherche Saint-Louis (EA3518), Paris, France
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Heather E. Stefanski
- Department of Pediatrics, The University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Kevin Nguyen
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | | | | | - Gabor Kari
- Novartis Pharmaceuticals Corporation, Basel, Switzerland
| | - Stephan A. Grupp
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Oncology, Center for Childhood Cancer Research and Cancer Immunotherapy Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Tsesmelis M, Tiwary K, Steiger K, Sperb N, Gerstenlauer M, Manfras U, Maier HJ, Hermann PC, Chan LK, Wirth T. Deletion of NEMO Inhibits EMT and Reduces Metastasis in KPC Mice. Cancers (Basel) 2021; 13:4541. [PMID: 34572768 PMCID: PMC8471477 DOI: 10.3390/cancers13184541] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/04/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains a largely incurable cancer type. Its high mortality is attributed to the lack of efficient biomarkers for early detection combined with its high metastatic properties. The aim of our study was to investigate the role of NF-κB signaling in the development and metastasis of PDAC. We used the well-established KPC mouse model, and, through genetic manipulation, we deleted NF-κB essential modulator (NEMO) in the pancreata of KPC mice. Interestingly, NEMO deletion altered the differentiation status of the primary tumor but did not significantly affect its development. However, in the absence of NEMO, the median survival of the mice was prolonged by 13.5 days (16%). In addition, examination of the liver demonstrated that, whereas KPC mice occasionally developed liver macro-metastasis, NEMO deletion completely abrogated this outcome. Further analysis of the tumor revealed that the expression of epithelial-mesenchymal transition (EMT) transcription factors was diminished in the absence of NEMO. Conclusively, our study provides evidence that NF-κB is dispensable for the progression of high-grade PanINs towards PDAC. In contrast, NF-κB signaling is essential for the development of metastasis by regulating the gene expression program of EMT.
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Affiliation(s)
- Miltiadis Tsesmelis
- Institute of Physiological Chemistry, University of Ulm, 89081 Ulm, Germany; (M.T.); (N.S.); (M.G.); (U.M.); (H.J.M.)
| | - Kanishka Tiwary
- Department of Internal Medicine I, University of Ulm, 89081 Ulm, Germany; (K.T.); (P.C.H.)
| | - Katja Steiger
- Department of Pathology, School of Medicine, Technical University of Munich, 81675 Munich, Germany;
| | - Nadine Sperb
- Institute of Physiological Chemistry, University of Ulm, 89081 Ulm, Germany; (M.T.); (N.S.); (M.G.); (U.M.); (H.J.M.)
| | - Melanie Gerstenlauer
- Institute of Physiological Chemistry, University of Ulm, 89081 Ulm, Germany; (M.T.); (N.S.); (M.G.); (U.M.); (H.J.M.)
| | - Uta Manfras
- Institute of Physiological Chemistry, University of Ulm, 89081 Ulm, Germany; (M.T.); (N.S.); (M.G.); (U.M.); (H.J.M.)
| | - Harald J. Maier
- Institute of Physiological Chemistry, University of Ulm, 89081 Ulm, Germany; (M.T.); (N.S.); (M.G.); (U.M.); (H.J.M.)
- Novartis Pharma AG, 4056 Basel, Switzerland
| | - Patrick C. Hermann
- Department of Internal Medicine I, University of Ulm, 89081 Ulm, Germany; (K.T.); (P.C.H.)
| | - Lap Kwan Chan
- Institute of Physiological Chemistry, University of Ulm, 89081 Ulm, Germany; (M.T.); (N.S.); (M.G.); (U.M.); (H.J.M.)
- Institute of Molecular Cancer Research, University of Zurich, 8057 Zurich, Switzerland
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Thomas Wirth
- Institute of Physiological Chemistry, University of Ulm, 89081 Ulm, Germany; (M.T.); (N.S.); (M.G.); (U.M.); (H.J.M.)
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Kleer-Reiter N, Julmi S, Feichtner F, Waselau AC, Klose C, Wriggers P, Maier HJ, Meyer-Lindenberg A. Biocompatibility and degradation of the open-pored magnesium scaffolds LAE442 and La2. Biomed Mater 2021; 16. [PMID: 33827052 DOI: 10.1088/1748-605x/abf5c5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 04/07/2021] [Indexed: 11/11/2022]
Abstract
Porous magnesium implants are of particular interest for application as resorbable bone substitutes, due to their mechanical strength and a Young's modulus similar to bone. The objective of the present study was to compare the biocompatibility, bone and tissue ingrowth, and the degradation behaviour of scaffolds made from the magnesium alloys LAE442 (n= 40) and Mg-La2 (n= 40)in vivo. For this purpose, cylindrical magnesium scaffolds (diameter 4 mm, length 5 mm) with defined, interconnecting pores were produced by investment casting and coated with MgF2. The scaffolds were inserted into the cancellous part of the greater trochanter ossis femoris of rabbits. After implantation periods of 6, 12, 24 and 36 weeks, the bone-scaffold compounds were evaluated usingex vivo µCT80 images, histological examinations and energy dispersive x-ray spectroscopy analysis. The La2 scaffolds showed inhomogeneous and rapid degradation, with inferior osseointegration as compared to LAE442. For the early observation times, no bone and tissue could be observed in the pores of La2. Furthermore, the excessive amount of foreign body cells and fibrous capsule formation indicates insufficient biocompatibility of the La2 scaffolds. In contrast, the LAE442 scaffolds showed slow degradation and better osseointegration. Good vascularization, a moderate cellular response, bone and osteoid-like bone matrix at all implantation periods were observed in the pores of LAE442. In summary, porous LAE442 showed promise as a degradable scaffold for bone defect repair, based on its degradation behaviour and biocompatibility. However, further studies are needed to show it would have the necessary mechanical properties required over time for weight-bearing bone defects.
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Affiliation(s)
- N Kleer-Reiter
- Clinic of Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Veterinärstr. 13, München 80539, Germany
| | - S Julmi
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, Garbsen 30823, Germany
| | - F Feichtner
- Clinic of Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Veterinärstr. 13, München 80539, Germany
| | - A-C Waselau
- Clinic of Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Veterinärstr. 13, München 80539, Germany
| | - C Klose
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, Garbsen 30823, Germany
| | - P Wriggers
- Institute of Continuum Mechanics, Leibniz Universität Hannover, Appelstr. 11, Hannover 30167, Germany
| | - H J Maier
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, Garbsen 30823, Germany
| | - A Meyer-Lindenberg
- Clinic of Small Animal Surgery and Reproduction, Ludwig-Maximilians-Universität, Veterinärstr. 13, München 80539, Germany
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Vaughan MW, Karayan AI, Srivastava A, Mansoor B, Seitz JM, Eifler R, Karaman I, Castaneda H, Maier HJ. The effects of severe plastic deformation on the mechanical and corrosion characteristics of a bioresorbable Mg-ZKQX6000 alloy. Mater Sci Eng C Mater Biol Appl 2020; 115:111130. [PMID: 32600727 DOI: 10.1016/j.msec.2020.111130] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/07/2020] [Accepted: 05/26/2020] [Indexed: 01/29/2023]
Abstract
In this work, a bioresorbable Mg-ZKQX6000 (Mg-6Zn-0.6Zr-0.4Ag-0.2Ca (wt%)) alloy was severely plastically deformed via equal channel angular pressing (ECAP) according to three unique hybrid routes at low temperatures (200 °C to 125 °C). The roles of ECAP processing on microstructure, and ensuing mechanical properties and corrosion rates, are assessed. Microstructurally, ECAP induces a complex plethora of features, especially variations in grain sizes and precipitates' sizes, distributions, and morphologies for individual cases. Mechanically, ECAP generally refined grain size, resulting in ultra-high strength levels of about 400 MPa in ultimate tensile strength for several cases; however, deformation via ECAP of precipitates induced embrittlement and low elongation to failure levels. Corrosion testing, conducted in simulated bodily fluid at bodily pH levels to mimic conditions in the human body, revealed consistent corrosion rates across several techniques (mass loss, hydrogen evolution, and electrochemical impedance spectroscopy (EIS)), showing that severe plastic deformation deteriorates corrosion resistance for this material. In-situ corrosion monitoring explained that corrosion accelerated after ECAP due to the creation of heterogeneous, anodic shear zones, which exhibited dense regions of refined grains and fine precipitates. Suggestions for future design and thermomechanical processing of Mg alloys for bioresorbable orthopedic implants are provided.
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Affiliation(s)
- M W Vaughan
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX, USA
| | - A I Karayan
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX, USA
| | - A Srivastava
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX, USA
| | - B Mansoor
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX, USA; Mechanical Engineering Program, Texas A&M University at Qatar, Doha, Qatar.
| | - J M Seitz
- Institut für Werkstoffkunde (IW), Leibniz Universität Hannover, An der Universität 2, 30823 Hannover, Germany
| | - R Eifler
- Institut für Werkstoffkunde (IW), Leibniz Universität Hannover, An der Universität 2, 30823 Hannover, Germany
| | - I Karaman
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX, USA
| | - H Castaneda
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX, USA
| | - H J Maier
- Institut für Werkstoffkunde (IW), Leibniz Universität Hannover, An der Universität 2, 30823 Hannover, Germany
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He J, Gerstenlauer M, Chan LK, Leithäuser F, Yeh MM, Wirth T, Maier HJ. Block of NF-kB signaling accelerates MYC-driven hepatocellular carcinogenesis and modifies the tumor phenotype towards combined hepatocellular cholangiocarcinoma. Cancer Lett 2019; 458:113-122. [PMID: 31128214 DOI: 10.1016/j.canlet.2019.05.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 12/12/2022]
Abstract
Primary liver cancer ranks among the leading causes of cancer death worldwide. Risk factors are closely linked to inflammation, such as viral hepatitis and alcoholic as well as non-alcoholic steatohepatitis. Among the pathways involved in the pathogenesis of malignant liver tumors, dysregulation of NF-κB signaling plays a prominent role. It provides a link between inflammation and cancer. To examine the role of NF-κB in a MYC-induced model of hepatocellular carcinoma we deleted NEMO (IKKγ) specifically from hepatocytes. NEMO deletion accelerated tumor development and shortened survival, suggesting a tumor-suppressive function of NF-κB signaling. We observed increased proliferation, inflammation and fibrosis, as well as activation of MAPK and STAT signaling. Importantly, deletion of NEMO modified the tumor phenotype from hepatocellular carcinoma to combined hepatocellular cholangiocarcinoma. The intrahepatic cholangiocarcinoma tumor component showed increased expression of progenitor markers such as Sox9 and reduced expression of mature hepatic markers such as CPS1. In both cases tumorigenesis was reversible by turning off MYC expression. To our knowledge this is the first mouse model of combined hepatocellular cholangiocarcinoma and may provide insights into the development of this rare malignant tumor.
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Affiliation(s)
- Jiajia He
- Institute of Physiological Chemistry, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Melanie Gerstenlauer
- Institute of Physiological Chemistry, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Lap Kwan Chan
- Institute of Physiological Chemistry, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Frank Leithäuser
- Institute of Pathology, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Matthew M Yeh
- Department of Pathology, University of Washington, 1959 NE Pacific St., Seattle, USA
| | - Thomas Wirth
- Institute of Physiological Chemistry, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Harald J Maier
- Institute of Physiological Chemistry, University Hospital of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Meyer P, Maity P, Burkovski A, Schwab J, Müssel C, Singh K, Ferreira FF, Krug L, Maier HJ, Wlaschek M, Wirth T, Kestler HA, Scharffetter-Kochanek K. A model of the onset of the senescence associated secretory phenotype after DNA damage induced senescence. PLoS Comput Biol 2017; 13:e1005741. [PMID: 29206223 PMCID: PMC5730191 DOI: 10.1371/journal.pcbi.1005741] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 11/28/2016] [Revised: 12/14/2017] [Accepted: 08/22/2017] [Indexed: 12/21/2022] Open
Abstract
Cells and tissues are exposed to stress from numerous sources. Senescence is a protective mechanism that prevents malignant tissue changes and constitutes a fundamental mechanism of aging. It can be accompanied by a senescence associated secretory phenotype (SASP) that causes chronic inflammation. We present a Boolean network model-based gene regulatory network of the SASP, incorporating published gene interaction data. The simulation results describe current biological knowledge. The model predicts different in-silico knockouts that prevent key SASP-mediators, IL-6 and IL-8, from getting activated upon DNA damage. The NF-κB Essential Modulator (NEMO) was the most promising in-silico knockout candidate and we were able to show its importance in the inhibition of IL-6 and IL-8 following DNA-damage in murine dermal fibroblasts in-vitro. We strengthen the speculated regulator function of the NF-κB signaling pathway in the onset and maintenance of the SASP using in-silico and in-vitro approaches. We were able to mechanistically show, that DNA damage mediated SASP triggering of IL-6 and IL-8 is mainly relayed through NF-κB, giving access to possible therapy targets for SASP-accompanied diseases.
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Affiliation(s)
- Patrick Meyer
- Department of Dermatology and Allergic Diseases, University of Ulm, Germany
- Aging Research Center (ARC), University of Ulm, Germany
| | - Pallab Maity
- Department of Dermatology and Allergic Diseases, University of Ulm, Germany
- Aging Research Center (ARC), University of Ulm, Germany
| | - Andre Burkovski
- Institute of Medical Systems Biology, University of Ulm, Germany
- International Graduate School in Molecular Medicine, University of Ulm, Germany
| | - Julian Schwab
- Institute of Medical Systems Biology, University of Ulm, Germany
- International Graduate School in Molecular Medicine, University of Ulm, Germany
| | - Christoph Müssel
- Institute of Medical Systems Biology, University of Ulm, Germany
| | - Karmveer Singh
- Department of Dermatology and Allergic Diseases, University of Ulm, Germany
- Aging Research Center (ARC), University of Ulm, Germany
| | - Filipa F. Ferreira
- Department of Dermatology and Allergic Diseases, University of Ulm, Germany
| | - Linda Krug
- Department of Dermatology and Allergic Diseases, University of Ulm, Germany
- Aging Research Center (ARC), University of Ulm, Germany
| | | | - Meinhard Wlaschek
- Department of Dermatology and Allergic Diseases, University of Ulm, Germany
- Aging Research Center (ARC), University of Ulm, Germany
| | - Thomas Wirth
- Institute of Physiological Chemistry, University of Ulm, Germany
| | - Hans A. Kestler
- Aging Research Center (ARC), University of Ulm, Germany
- Institute of Medical Systems Biology, University of Ulm, Germany
| | - Karin Scharffetter-Kochanek
- Department of Dermatology and Allergic Diseases, University of Ulm, Germany
- Aging Research Center (ARC), University of Ulm, Germany
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9
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Eifler R, Seitz JM, Weber CM, Grundke S, Reifenrath J, Kietzmann M, Lenarz TH, Maier HJ, Klose C, Durisin M. MgNd2 alloy in contact with nasal mucosa: an in vivo and in vitro approach. J Mater Sci Mater Med 2016; 27:25. [PMID: 26704542 DOI: 10.1007/s10856-015-5636-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/23/2015] [Indexed: 06/05/2023]
Abstract
Biodegradable and biocompatible magnesium alloys appear to be very promising not only for temporary clinical application but also for developing deformable and degradable medical implants. This study analyzes the in vivo degradation behavior and the impact on the paranasal sinuses of the highly ductile Mg-2 wt%Nd alloy (MgNd2) in order to provide a basis for a satisfying stent system for the therapy of a chronic sinusitis. Moreover, in vitro tests were carried out on primary porcine nasal epithelial cells (PNEC). For the in vivo tests, cylindrical MgNd2 specimens were implanted into the sinus' mucosa of minipigs. During and after a total period of 180 days the long-term biodegradation and biocompatibility properties after direct contact with the physiological tissue were analyzed. Biodegradation was investigated by measuring the mass and volume losses of the MgNd2 specimens as well as by performing element analyses to obtain information about the degradation layer. The influence on the surrounding tissue of paranasal sinuses was evaluated by endoscopic and histopathological examinations of the mucosa. Here, only a locally unspecific chronic infection was found. The degradation rate showed a maximum after 45 days postsurgery and was determined to decrease subsequently. In vitro experiments using PNEC showed adequate biocompatibility of MgNd2. This study demonstrates a good in vivo biocompatibility for MgNd2 in the system of paranasal sinuses and underlines the promising properties of alloy MgNd2 for biodegradable nasal stent applications.
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Affiliation(s)
- R Eifler
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany.
| | - J-M Seitz
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany
- Department of Materials Science and Engineering, Michigan Technological University, 1400 Townsend, Dr., Houghton, MI, 49931, USA
| | - C M Weber
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - S Grundke
- Institute of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hanover, Foundation, Bünteweg 17, 30559, Hanover, Germany
| | - J Reifenrath
- Small Animal Clinic, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany
- Department of Orthopedic Surgery, CrossBIT - Center for Biocompatibility and Implant-Immunology, Hannover Medical School, Feodor-Lynen-Straße 31, 30625, Hannover, Germany
| | - M Kietzmann
- Institute of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hanover, Foundation, Bünteweg 17, 30559, Hanover, Germany
| | - T H Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - H J Maier
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany
| | - C Klose
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany
| | - M Durisin
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
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10
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Uzer B, Toker SM, Cingoz A, Bagci-Onder T, Gerstein G, Maier HJ, Canadinc D. An exploration of plastic deformation dependence of cell viability and adhesion in metallic implant materials. J Mech Behav Biomed Mater 2016; 60:177-186. [PMID: 26807771 DOI: 10.1016/j.jmbbm.2016.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 11/12/2015] [Revised: 12/27/2015] [Accepted: 01/04/2016] [Indexed: 12/18/2022]
Abstract
The relationship between cell viability and adhesion behavior, and micro-deformation mechanisms was investigated on austenitic 316L stainless steel samples, which were subjected to different amounts of plastic strains (5%, 15%, 25%, 35% and 60%) to promote a variety in the slip and twin activities in the microstructure. Confocal laser scanning microscopy (CLSM) and field emission scanning electron microscopy (FESEM) revealed that cells most favored the samples with the largest plastic deformation, such that they spread more and formed significant filopodial extensions. Specifically, brain tumor cells seeded on the 35% deformed samples exhibited the best adhesion performance, where a significant slip activity was prevalent, accompanied by considerable slip-twin interactions. Furthermore, maximum viability was exhibited by the cells seeded on the 60% deformed samples, which were particularly designed in a specific geometry that could endure greater strain values. Overall, the current findings open a new venue for the production of metallic implants with enhanced biocompatibility, such that the adhesion and viability of the cells surrounding an implant can be optimized by tailoring the surface relief of the material, which is dictated by the micro-deformation mechanism activities facilitated by plastic deformation imposed by machining.
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Affiliation(s)
- B Uzer
- Koç University, Advanced Materials Group (AMG), Department of Mechanical Engineering, Sarıyer, 34450 İstanbul, Turkey
| | - S M Toker
- Koç University, Advanced Materials Group (AMG), Department of Mechanical Engineering, Sarıyer, 34450 İstanbul, Turkey; California Polytechnic State University, Materials Engineering Department, San Luis Obispo, CA 93407, USA
| | - A Cingoz
- Koç University, School of Medicine, Sarıyer, 34450 İstanbul, Turkey
| | - T Bagci-Onder
- Koç University, School of Medicine, Sarıyer, 34450 İstanbul, Turkey
| | - G Gerstein
- Leibniz Universität Hannover, Institut für Werkstoffkunde (Materials Science), An der Universität 2, 30823 Garbsen, Germany
| | - H J Maier
- Leibniz Universität Hannover, Institut für Werkstoffkunde (Materials Science), An der Universität 2, 30823 Garbsen, Germany
| | - D Canadinc
- Koç University, Advanced Materials Group (AMG), Department of Mechanical Engineering, Sarıyer, 34450 İstanbul, Turkey; Koç University Surface Science and Technology Center (KUYTAM), Sarıyer, 34450 İstanbul, Turkey.
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11
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Kraut B, Maier HJ, Kókai E, Fiedler K, Boettger T, Illing A, Kostin S, Walther P, Braun T, Wirth T. Cardiac-Specific Activation of IKK2 Leads to Defects in Heart Development and Embryonic Lethality. PLoS One 2015; 10:e0141591. [PMID: 26539991 PMCID: PMC4634958 DOI: 10.1371/journal.pone.0141591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 08/21/2015] [Accepted: 10/09/2015] [Indexed: 11/24/2022] Open
Abstract
The transcription factor NF-κB has been associated with a range of pathological conditions of the heart, mainly based on its function as a master regulator of inflammation and pro-survival factor. Here, we addressed the question what effects activation of NF-κB can have during murine heart development. We expressed a constitutively active (CA) mutant of IKK2, the kinase activating canonical NF-κB signaling, specifically in cardiomyocytes under the control of the α-myosin heavy chain promoter. Expression of IKK2-CA resulted in embryonic lethality around E13. Embryos showed defects in compact zone formation and the contractile apparatus, and overall were characterized by widespread inflammation with infiltration of myeloid cells. Gene expression analysis suggested an interferon type I signature, with increased expression of interferon regulatory factors. While apoptosis of cardiomyocytes was only increased at later stages, their proliferation was decreased early on, providing an explanation for the disturbed compact zone formation. Mechanistically, this could be explained by activation of the JAK/STAT axis and increased expression of the cell cycle inhibitor p21. A rescue experiment with an IκBα superrepressor demonstrated that the phenotype was dependent on NF-κB. We conclude that activation of NF-κB is detrimental during normal heart development due to excessive activation of pro-inflammatory pathways.
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Affiliation(s)
- Bärbel Kraut
- Institute of Physiological Chemistry, University of Ulm, Ulm, Germany
| | - Harald J. Maier
- Institute of Physiological Chemistry, University of Ulm, Ulm, Germany
| | - Enikö Kókai
- Institute of Physiological Chemistry, University of Ulm, Ulm, Germany
| | - Katja Fiedler
- Institute of Physiological Chemistry, University of Ulm, Ulm, Germany
| | - Thomas Boettger
- Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Annett Illing
- Institute of Molecular Medicine, University of Ulm, Ulm, Germany
| | - Sawa Kostin
- Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Paul Walther
- Core Facility Electron Microscopy, University of Ulm, Ulm, Germany
| | - Thomas Braun
- Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Thomas Wirth
- Institute of Physiological Chemistry, University of Ulm, Ulm, Germany
- * E-mail:
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12
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Durisin M, Seitz JM, Reifenrath J, Weber CM, Eifler R, Maier HJ, Lenarz T, Klose C. A novel biodegradable frontal sinus stent (MgNd2): a long-term animal study. Eur Arch Otorhinolaryngol 2015; 273:1455-67. [PMID: 26341887 DOI: 10.1007/s00405-015-3774-7] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/28/2015] [Indexed: 12/27/2022]
Abstract
The frontal sinus recess consists of anatomically narrow passages that are prone to stenosis in endonasal frontal sinus surgery for chronic sinus disease. Over the past 100 years, diverse frontal sinus stents have been developed and evaluated in clinical and animal studies. However, superinfection, formation of granulations tissue, stent dislocation and late stenosis of the duct have remained challenges and subject of debate in the literature. Currently developed biodegradable materials, including rare earth-containing magnesium alloys are promising candidates for application as temporary implant materials. The Mg 2 % wt Nd alloy (MgNd2) was used to design a nasal stent that fit the porcine anatomy. In the current study, we evaluate biocompatibility, biodegradation and functionality of a frontal sinus stent in 16 minipigs over 6 months. Intraoperative endoscopy revealed free stent lumen in all cases. Blood examination and clinical examinations indicated no systematic or local inflammation signs. The histopathology and elements analysis showed a very good biocompatibility. The μ-computed tomography-based volumetric analysis showed substantial stent degradation within 6 months. Our MgNd2 based stent appears to be a promising, solid basis for the development of a frontal sinus stent for clinical use.
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Affiliation(s)
- M Durisin
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - J M Seitz
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Hannover, Germany.,Department of Materials Science and Engineering, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA
| | - J Reifenrath
- Department of Orthopedic Surgery, CrossBIT, Center of Biocompatibility and Implant-Immunology, Hannover Medical School, Feodor-Lynen-Straßee 31, 30625, Hannover, Germany
| | - C M Weber
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - R Eifler
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Hannover, Germany
| | - H J Maier
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Hannover, Germany
| | - T Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - C Klose
- Institut für Werkstoffkunde (Materials Science), Leibniz Universität Hannover, An der Universität 2, 30823, Hannover, Germany
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13
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Seitz JM, Eifler R, Weber C, Lenarz TH, Maier HJ, Durisin M. In vivo degradation effects of alloy MgNd2 in contact with mucous tissue. J Biomed Mater Res A 2014; 103:2427-40. [PMID: 25537491 DOI: 10.1002/jbm.a.35382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 10/13/2014] [Revised: 11/17/2014] [Accepted: 12/01/2014] [Indexed: 12/20/2022]
Abstract
Magnesium alloys are currently being investigated for use as resorbable biomaterials. Various applications for magnesium based implant materials have already been presented. Currently, stents and structures that sustain diseased or narrowed vessels seem to be the most promising areas. This study focuses on the use of a magnesium fluoride (MgF2 ) coated magnesium neodymium based alloy (MgNd2 ) and its use as a postsurgery stent material to avoid proliferation in the sinus region. Simple cylindrical shaped specimens were sown to the sinus' mucosa of pigs and left in place for different periods of time to investigate the long-term corrosion resistance of the alloy and its coating during direct contact with physiological tissue. Investigations made within this study explicitly focused on the corrosive behavior of the alloy in the region of a physiological sinus. Thus, losses in mass and volume, and element analyses were considered to obtain information about the specimens' corrosion performance over time. Furthermore, micrographs support the alloy specific corrosion type analyses which focus on grain boundary effects. This study demonstrates the general in vivo applicability of fluoride coated MgNd2 . The progress of corrosion was determined to be adequate and homogeneous over a total period of 180 days.
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Affiliation(s)
- J-M Seitz
- Department of Materials Science and Engineering, Michigan Technological University, 1400 Townsend Dr., Houghton, Michigan, 49931.,Institut für Werkstoffkunde, Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany.,Department of Biomedical Engineering, Michigan Technological University, 1400 Townsend Dr., Houghton, Michigan, 49931
| | - R Eifler
- Institut für Werkstoffkunde, Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany
| | - C Weber
- Clinic for Laryngology, Rhinology and Otology, Medical School of Hanover, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - T H Lenarz
- Clinic for Laryngology, Rhinology and Otology, Medical School of Hanover, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - H J Maier
- Institut für Werkstoffkunde, Leibniz Universität Hannover, An der Universität 2, 30823, Garbsen, Germany
| | - M Durisin
- Clinic for Laryngology, Rhinology and Otology, Medical School of Hanover, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
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14
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Salem HH, Trojanowski B, Fiedler K, Maier HJ, Schirmbeck R, Wagner M, Boehm BO, Wirth T, Baumann B. Long-term IKK2/NF-κB signaling in pancreatic β-cells induces immune-mediated diabetes. Diabetes 2014; 63:960-75. [PMID: 24296718 DOI: 10.2337/db13-1037] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Type 1 diabetes is a multifactorial inflammatory disease in genetically susceptible individuals characterized by progressive autoimmune destruction of pancreatic β-cells initiated by yet unknown factors. Although animal models of type 1 diabetes have substantially increased our understanding of disease pathogenesis, heterogeneity seen in human patients cannot be reflected by a single model and calls for additional models covering different aspects of human pathophysiology. Inhibitor of κB kinase (IKK)/nuclear factor-κB (NF-κB) signaling is a master regulator of inflammation; however, its role in diabetes pathogenesis is controversially discussed by studies using different inhibition approaches. To investigate the potential diabetogenic effects of NF-κB in β-cells, we generated a gain-of-function model allowing conditional IKK2/NF-κB activation in β-cells. A transgenic mouse model that expresses a constitutively active mutant of human IKK2 dependent on Pdx-1 promoter activity (IKK2-CA(Pdx-1)) spontaneously develops full-blown immune-mediated diabetes with insulitis, hyperglycemia, and hypoinsulinemia. Disease development involves a gene expression program mimicking virus-induced diabetes and allergic inflammatory responses as well as increased major histocompatibility complex class I/II expression by β-cells that could collectively promote diabetes development. Potential novel diabetes candidate genes were also identified. Interestingly, animals successfully recovered from diabetes upon transgene inactivation. Our data give the first direct evidence that β-cell-specific IKK2/NF-κB activation is a potential trigger of immune-mediated diabetes. Moreover, IKK2-CA(Pdx-1) mice provide a novel tool for studying critical checkpoints in diabetes pathogenesis and mechanisms governing β-cell degeneration/regeneration.
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Affiliation(s)
- Heba H Salem
- Institute of Physiological Chemistry, Ulm University, Ulm, Germany
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15
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Bauer M, Biskup C, Schilling T, Haverich A, Bach FW, Maier HJ, Hassel T. Influence of Shot Peening on Surface Roughness and Invitro Load Cycles of Magnesium Alloys. BIOMED ENG-BIOMED TE 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-C/bmt-2013-4060/bmt-2013-4060.xml. [PMID: 24042742 DOI: 10.1515/bmt-2013-4060] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Schmidt-Strassburger U, Schips TG, Maier HJ, Kloiber K, Mannella F, Braunstein KE, Holzmann K, Ushmorov A, Liebau S, Boeckers TM, Wirth T. Expression of constitutively active FoxO3 in murine forebrain leads to a loss of neural progenitors. FASEB J 2012; 26:4990-5001. [PMID: 22935140 DOI: 10.1096/fj.12-208587] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Inactivation of FoxO proteins by phosphorylation is the result of a number of stimuli, including the insulin/IGF pathway. We were interested in the consequence of blunting this pathway by employing transgenic mice with tetracycline-controllable conditional expression of a constitutively active allele of FOXO3 under the control of the forebrain-specific CaMKIIα promoter. Although transgene-expressing mice were viable, brain weight was reduced by 30% in adult animals. Brains showed an isocortex compression with normal cortical layering, and a size reduction in regions known to depend on adult neurogenesis, i.e., the olfactory bulbs and the dentate gyrus. On postnatal activation of the transgene, adult neurogenesis was also severely affected. Investigating the molecular basis of this phenotype, we observed enhanced apoptosis starting from embryonic day E10.5 and a subsequent loss of progenitors in the ventricular/subventricular zones, but not in the isocortex or the striatum of adult mice. The enhanced apoptosis was accompanied by increased expression of PIK3IP1, which we identified as a direct transcriptional target of FOXO3. Transfection of Pik3ip1 into differentiating neural progenitors resulted in a significant reduction of viable cells. We therefore conclude that neural progenitors are particularly vulnerable to FOXO3-induced apoptosis, which is mediated by PIK3IP1, a negative PI3 kinase regulator.
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Affiliation(s)
- Uta Schmidt-Strassburger
- Institute of Physiological Chemistry, Ulm University, Albert Einstein Allee 11, 89081 Ulm, Germany
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17
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Maier HJ, Wagner M, Schips TG, Salem HH, Baumann B, Wirth T. Requirement of NEMO/IKKγ for effective expansion of KRAS-induced precancerous lesions in the pancreas. Oncogene 2012; 32:2690-5. [PMID: 22751123 DOI: 10.1038/onc.2012.272] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pancreatic carcinoma, a leading cause of cancer death, is thought to develop out of pancreatic intraepithelial neoplasia (PanIN). PanIN lesions have not yet attained the fully malignant phenotype, but show increased proliferation and dysplasia, and frequently bear an oncogenic KRAS mutation. Pancreatic cancer development is associated with increased activity of the transcription factor NF-κB. NEMO (IKKγ) is a subunit of the IKK complex essential for the activation of canonical NF-κB signaling and has been ascribed both oncogenic and tumor-suppressive roles in gastrointestinal tumors. Here, we wanted to address the function of NEMO in pancreatic tumorigenesis. We therefore conditionally ablated NEMO in a mouse model for pancreatic carcinoma based on the expression of oncogenic KRAS in pancreatic precursor cells. Mice were analyzed for PanIN lesions and for the activation of associated signaling pathways. NEMO ablation in the pancreas, while in itself not causing any overt pathology, led to a drastic (>93%) decrease in the prevalence of both low-grade and high-grade PanIN in 10-month-old mice expressing oncogenic KRAS. Also, the inflammatory and fibrotic response associated with KRAS action in the pancreas was virtually abolished, including expression of inflammatory cytokines and activation of the interleukin-6/STAT3 axis. Moreover, the activation of MAPK signaling, Notch and KLF4 signaling normally observed in KRAS-induced PanIN was strongly reduced or absent when NEMO was ablated. Our study suggests that NEMO, an IKK subunit necessary for canonical NF-κB activation, is dispensable for normal pancreatic development and function, but essential for the propagation of KRAS-induced PanIN lesions.
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Affiliation(s)
- H J Maier
- Institute of Physiological Chemistry, University of Ulm, Ulm, Germany
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18
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Huber MA, Maier HJ, Alacakaptan M, Wiedemann E, Braunger J, Boehmelt G, Madwed JB, Young ERR, Marshall DR, Pehamberger H, Wirth T, Kraut N, Beug H. BI 5700, a Selective Chemical Inhibitor of IκB Kinase 2, Specifically Suppresses Epithelial-Mesenchymal Transition and Metastasis in Mouse Models of Tumor Progression. Genes Cancer 2011; 1:101-14. [PMID: 21779445 DOI: 10.1177/1947601910361749] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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: 01/14/2023] Open
Abstract
Increasing evidence suggests that processes termed epithelial-mesenchymal transitions (EMTs) play a key role in therapeutic resistance, tumor recurrence, and metastatic progression. NF-κB signaling has been previously identified as an important pathway in the regulation of EMT in a mouse model of tumor progression. However, it remains unclear whether there is a broad requirement for this pathway to govern EMT and what the relative contribution of IKK family members acting as upstream NF-κB activators is toward promoting EMT and metastasis. To address this question, we have used a novel, small-molecule inhibitor of IκB kinase 2 (IKK2/IKKβ), termed BI 5700. We investigated the role of IKK2 in a number of mouse models of EMT, including TGFβ-induced EMT in the mammary epithelial cell line EpRas, CT26 colon carcinoma cells, and 4T1 mammary carcinoma cells. The latter model was also used to evaluate in vivo activities of BI 5700.We found that BI 5700 inhibits IKK2 with an IC(50) of 9 nM and was highly selective as compared to other IKK family members (IKK1, IKKε, and TBK1) and other kinases. BI 5700 effectively blocks NF-κB activity in EpRas cells and prevents TGFβ-induced EMT. In addition, BI 5700 reverts EMT in mesenchymal CT26 cells and prevents EMT in the 4T1 model. Oral application of BI 5700 significantly interferes with metastasis after mammary fat-pad injection of 4T1 cells, yielding fewer, smaller, and more differentiated metastases as compared to vehicle-treated control animals. We conclude that IKK2 is a key regulator of both the induction and maintenance of EMT in a panel of mouse tumor progression models and that the IKK2 inhibitor BI 5700 constitutes a promising candidate for the treatment of metastatic cancers.
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Affiliation(s)
- Margit A Huber
- Research Institute of Molecular Pathology (IMP), Vienna, Austria
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19
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Rubitschek F, Niendorf T, Karaman I, Maier HJ. Corrosion fatigue behavior of a biocompatible ultrafine-grained niobium alloy in simulated body fluid. J Mech Behav Biomed Mater 2011; 5:181-92. [PMID: 22100093 DOI: 10.1016/j.jmbbm.2011.08.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 08/29/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
Abstract
The present study reports on the corrosion fatigue behavior of ultrafine-grained (UFG) Niobium 2 wt-% Zirconium (NbZr) alloy in simulated body fluid (SBF). The alloy was processed using multipass equal channel angular processing at room temperature, resulting in a favorable combination of high strength and ductility along with superior biocompatibility and excellent corrosion resistance. Electrochemical measurements revealed stable passive behavior in SBF saline solutions, similar to conventional Ti-6Al-4V alloy. High-cycle fatigue tests showed no alteration in the crack initiation behavior due to the SBF environment, and an absence of pitting and corrosion products. More severe test conditions were obtained in the fatigue crack growth experiments in saline environments. Crack growth rates in UFG NbZr were marginally increased in SBF as compared to laboratory air at a constant test frequency of 20 Hz. Upon a 100 fold decrease in the test frequency, slightly higher crack growth rates were observed only in the near-threshold region. Such excellent corrosion and corrosion fatigue properties of UFG NbZr recommend it as an attractive new material for biomedical implants.
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Affiliation(s)
- F Rubitschek
- Lehrstuhl für Werkstoffkunde (Materials Science), University of Paderborn, D-33095 Paderborn, Germany.
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Schips TG, Wietelmann A, Höhn K, Schimanski S, Walther P, Braun T, Wirth T, Maier HJ. FoxO3 induces reversible cardiac atrophy and autophagy in a transgenic mouse model. Cardiovasc Res 2011; 91:587-97. [PMID: 21628326 DOI: 10.1093/cvr/cvr144] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS The transcription factor FoxO3 contributes to anti-hypertrophic signalling in the heart presumably by regulating autophagic-lysosomal and ubiquitin-proteasomal pathways. We wanted to study FoxO3 function in the adult heart in vivo by expressing a constitutively active mutant of FoxO3 in transgenic mice. METHODS AND RESULTS We generated transgenic mice in which a tetracycline-regulated constitutively active FoxO3 transgene (FoxO3-CA) is controlled by the heart-specific α-myosin heavy chain promoter. Cardiac-specific expression in adult mice resulted in a decrease in heart weight by 25% and a reduction in stroke volume and cardiac output. The decrease in heart size was due to a reduction in the size of individual cardiomyocytes, whereas there was no evidence for increased cell death. FoxO3 activation was accompanied by the initiation of a foetal gene programme with increased expression of β-myosin heavy chain and natriuretic peptides, and by the activation of AKT and mammalian target of rapamycin signalling. As shown by electron microscopy, FoxO3-CA massively stimulated destruction of sarcomeres and autophagy, and induced expression of LC3-II and BNIP3. When FoxO3-CA expression was shut off in affected mice, cardiac atrophy and dysfunction as well as molecular markers were normalized within 1 month. FoxO3-CA expression did not counteract hypertrophy induced by transverse aortic constriction. CONCLUSION Heart-specific expression of constitutively active FoxO3 leads to reversible heart atrophy. The reversibility of the phenotype suggests a remarkable ability of the adult myocardium to respond to different regulatory cues.
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Affiliation(s)
- Tobias G Schips
- Institute of Physiological Chemistry, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany
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Maier HJ, Schmidt-Strassburger U, Huber MA, Wiedemann EM, Beug H, Wirth T. NF-kappaB promotes epithelial-mesenchymal transition, migration and invasion of pancreatic carcinoma cells. Cancer Lett 2010; 295:214-28. [PMID: 20350779 DOI: 10.1016/j.canlet.2010.03.003] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 02/26/2010] [Accepted: 03/04/2010] [Indexed: 11/29/2022]
Abstract
The transcription factor NF-kappaB is constitutively active in pancreatic adenocarcinoma. Here we explore the contribution of NF-kappaB to the malignant phenotype of pancreatic cancer cells in addition to its anti-apoptotic role. Block of NF-kappaB signalling by non-destructible IkappaBalpha rendered cells resistant to TGF-beta-induced epithelial-mesenchymal transition (EMT). In contrast, NF-kappaB activation by TNF-alpha or expression of constitutively active IKK2 induced an EMT-phenotype with up-regulation of vimentin and ZEB1, and down-regulation of E-cadherin. EMT could also be induced in cells with defective TGF-beta signalling. Functional assays demonstrated reduced or strongly enhanced migration and invasion upon NF-kappaB inhibition or activation, respectively.
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Affiliation(s)
- Harald J Maier
- Institute of Physiological Chemistry, University of Ulm, Germany
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Niklasch D, Maier HJ, Karaman I. Design and application of a mechanical load frame for in situ investigation of ferromagnetic shape memory alloys by magnetic force microscopy. Rev Sci Instrum 2008; 79:113701. [PMID: 19045889 DOI: 10.1063/1.3010383] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
An in situ mechanical load frame has been developed for a commercially available atomic force microscope. This frame allows examining changes in topography and magnetic domain configuration under a given constant load or strain. First results obtained on Ni-Mn-Ga ferromagnetic shape memory alloy single crystals are presented. The magnetic force microscopy (MFM) measurements under different strain levels confirm the one-to-one correspondence, i.e., the magnetomicrostructural coupling between the martensite twins and the magnetic domains. Additionally, the growth of the twin variant with favorable orientation to the compression axis during martensite detwinning was observed. It will be shown that this load frame can be used for the investigation of the relationship between the microstructure and the magnetic domain structure in ferromagnetic shape memory alloys by MFM.
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Affiliation(s)
- D Niklasch
- Lehrstuhl fur Werkstoffkunde (Materials Science), University of Paderborn, Paderborn, Germany.
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Dendorfer S, Maier HJ, Hammer J. Fatigue damage in cancellous bone: an experimental approach from continuum to micro scale. J Mech Behav Biomed Mater 2008; 2:113-9. [PMID: 19627813 DOI: 10.1016/j.jmbbm.2008.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 03/27/2008] [Accepted: 03/28/2008] [Indexed: 11/30/2022]
Abstract
Repeated loadings may cause fatigue fractures in bony structures. Even if these failure types are known, data for trabecular bone exposed to cyclic loading are still insufficient as the majority of fatigue analyses on bone concentrate on cortical structures. Despite its highly anisotropic and inhomogeneous structure, trabecular bone is treated with continuum approaches in fatigue analyses. The underlying deformation and damage mechanism within trabecular specimens are not yet sufficiently investigated. In the present study different types of trabecular bone were loaded in monotonic and cyclic compression. In addition to the measurement of integral specimen deformations, optical deformation analysis was employed in order to obtain strain distributions at different scale levels, from the specimens' surface to the trabeculae level. These measurements allowed for the possibility of linking the macroscopic and microscopic mechanical behaviour of cancellous bone. Deformations were found to be highly inhomogeneous across the specimen. Furthermore strains were found to already localise at very low load levels and after few load cycles. Microcracks in individual trabeculae were induced in the very early stage of cyclic testing. The results provide evidence of the capability of the method to supply essential data on the failure behaviour of individual trabeculae in future studies.
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Affiliation(s)
- S Dendorfer
- Laboratory for Materials Science, University of Applied Sciences Regensburg, Galgenbergstrasse 30, 93053 Regensburg, Germany.
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Dendorfer S, Maier HJ, Hammer J. Deformation behaviour of bovine cancellous bone. Technol Health Care 2006; 14:549-56. [PMID: 17148868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Repetitive cyclic loading from daily activities is reported to induce fatigue damage and microcracking in bone structures. In terms of osteoporotic structures or in cases of serious damage of skeleton segments and the replacement by metallic implants the degree of damage due to cyclic loading will be even more pronounced. It is generally assumed that fatigue induced cracking and crack propagation essentially act as driving forces for complex physiological phenomena such as remodelling processes of bones and the adaptation to applied loads. In cases where the crack propagation rate exceeds the remodelling velocity, sudden and unexpected fracture of the bone is observed. Especially for implant reinforced structures the deviation in stiffness to the bone material can induce high peak stresses and accelerate crack propagation. Whereas, for cortical bone the mechanical behaviour under cyclic loading is sufficiently described, only rough data are available for trabaecular structures. In this study the deformation behaviour of bovine vertebra trabecular bone specimens is investigated under cyclic compressive loading. A powerlaw relationship was found between the applied load ratio and cycles to failure. A linear decrease of maximum, integral strains at failure with increasing applied load ratio was observed. Optical deformation measurement of the surface strains revealed that low strains (0-1 increasing applied load ratio whereby the higher strains behave directly opposite. This indicates that different failure mechanisms are acting at low cycle and high cycle fatigue, respectively.
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Affiliation(s)
- S Dendorfer
- University of Applied Sciences Regensburg, Regensburg, Germany.
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Maier HJ. Procera: a new concept in crown and bridge. J Can Dent Assoc 1992; 58:985, 988. [PMID: 1458349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- H J Maier
- Aurum Ceramic/Classic Dental Laboratories Ltd
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Maier HJ. The KAL-technique. J Can Dent Assoc 1992; 58:448-9. [PMID: 1633575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Maier HJ. Esthetic resin posterior restorations. J Can Dent Assoc 1991; 57:777. [PMID: 1742660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Maier HJ. The self-sanitizing partial. J Can Dent Assoc 1991; 57:628. [PMID: 1889011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Maier HJ. In-Ceram bridges natural translucence and strength--without metal. J Can Dent Assoc 1991; 57:473. [PMID: 1860086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- H J Maier
- Aurum Ceramic/Classic Dental Laboratories Ltd
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Maier HJ. Natural dentures ... natural smiles. J Can Dent Assoc 1991; 57:289-90. [PMID: 2044001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Maier HJ. The Soft Gingival Model. J Can Dent Assoc 1990; 56:995. [PMID: 2261594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Maier HJ. Quality control goes microscopic. J Can Dent Assoc 1990; 56:581. [PMID: 2397418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Maier HJ. The California Bridge--truly conservative fixed bridgework. J Can Dent Assoc 1990; 56:405. [PMID: 2189530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Maier HJ. New prosthesis eliminates gingival esthetic problems. J Can Dent Assoc 1990; 56:119. [PMID: 2407322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Maier HJ. Porcelain today--a whole new world of possibilities. J Can Dent Assoc 1989; 55:783. [PMID: 2679990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Maier HJ. Willi Glas Crowns eliminate the "blue gums" phenomenon. J Can Dent Assoc 1989; 55:612. [PMID: 2670130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Maier HJ. The dental laboratory and you. New system ensures superior resin/metal bond. J Can Dent Assoc 1989; 55:455. [PMID: 2548685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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