Design of a Biohybrid Materials Circuit with Binary Decoder Functionality

Synthetic biology applies concepts from electrical engineering and information processing to endow cells with computational functionality. Transferring the underlying molecular components into materials and wiring them according to topologies inspired by electronic circuit boards has yielded materials systems that perform selected computational operations. However, the limited functionality of available building blocks is restricting the implementation of advanced information-processing circuits into materials. Here, a set of protease-based biohybrid modules the bioactivity of which can either be induced or inhibited is engineered. Guided by a quantitative mathematical model and following a design-build-test-learn (DBTL) cycle, the modules are wired according to circuit topologies inspired by electronic signal decoders, a fundamental motif in information processing. A 2-input/4-output binary decoder for the detection of two small molecules in a material framework that can perform regulated outputs in form of distinct protease activities is designed. The here demonstrated smart material system is strongly modular and can be used for biomolecular information processing for example in advanced biosensing or drug delivery applications.

Reversible Shielding and Immobilization of Liposomes and Viral Vectors by Tailored Antibody-Ligand Interactions

Controlling the time and dose of nanoparticulate drug delivery by administration of small molecule drugs holds promise for efficient and safer therapies. This study describes a versatile approach of exploiting antibody-ligand interactions for the design of small molecule-responsive nanocarrier and nanocomposite systems. For this purpose, antibody fragments (scFvs) specific for two distinct small molecule ligands are designed. Subsequently, the surface of nanoparticles (liposomes or adeno-associated viral vectors, AAVs) is modified with these ligands, serving as anchor points for scFv binding. By modifying the scFvs with polymer tails, they can act as a non-covalently bound shielding layer, which is recruited to the anchor points on the nanoparticle surface and prevents interactions with cultured mammalian cells. Administration of an excess of the respective ligand triggers competitive displacement of the shielding layer from the nanoparticle surface and restores nanoparticle-cell interactions. The same principle is applied for developing hydrogel depots that can release integrated AAVs or liposomes in response to small molecule ligands. The liberated nanoparticles subsequently deliver their cargoes to cells. In summary, the utilization of different antibody-ligand interactions, different nanoparticles, and different release systems validates the versatility of the design concept described herein.

Biosensor-Enabled Multiplexed On-Site Therapeutic Drug Monitoring of Antibiotics

Personalized antibiotherapy ensures that the antibiotic concentration remains in the optimal therapeutic window to maximize efficacy, minimize side effects, and avoid the emergence of drug resistance due to insufficient dosing. However, such individualized schemes need frequent sampling to tailor the blood antibiotic concentrations. To optimally integrate therapeutic drug monitoring (TDM) into the clinical workflow, antibiotic levels can either be measured in blood using point-of-care testing (POCT), or can rely on noninvasive sampling. Here, a versatile biosensor with an antibody-free assay for on-site TDM is presented. The platform is evaluated with an animal study, where antibiotic concentrations are quantified in different matrices including whole blood, plasma, urine, saliva, and exhaled breath condensate (EBC). The clearance and the temporal evaluation of antibiotic levels in EBC and plasma are demonstrated. Influence of matrix effects on measured drug concentrations is determined by comparing the plasma levels with those in noninvasive samples. The system's potential for blood-based POCT is further illustrated by tracking ß-lactam concentrations in untreated blood samples. Finally, multiplexing capabilities are explored successfully for multianalyte/sample analysis. By enabling a rapid, low-cost, sample-independent, and multiplexed on-site TDM, this system can shift the paradigm of "one-size-fits-all" strategy.

Synthetic Biology-Empowered Hydrogels for Medical Diagnostics

Synthetic biology is strongly inspired by concepts of engineering science and aims at the design and generation of artificial biological systems in different fields of research such as diagnostics, analytics, biomedicine, or chemistry. To this aim, synthetic biology uses an engineering approach relying on a toolbox of molecular sensors and switches that endows cellular hosts with non-natural computing functions and circuits. Importantly, this concept is not only limited to cellular approaches. Synthetic biological building blocks have also conferred sensing and switching capability to otherwise inactive materials. This principle has attracted high interest for the development of biohybrid materials capable of sensing and responding to specific molecular stimuli, such as disease biomarkers, antibiotics, or heavy metals. Moreover, the interconnection of individual sense-and-respond materials to complex materials systems has enabled the processing of, for example, multiple inputs or the amplification of signals using feedback topologies. Such systems holding high potential for applications in the analytical and diagnostic sectors will be described in this chapter.

Spatiotemporally confined red light-controlled gene delivery at single-cell resolution using adeno-associated viral vectors

Methodologies for the controlled delivery of genetic information into target cells are of utmost importance for genetic engineering in both fundamental and applied research. However, available methods for efficient gene transfer into user-selected or even single cells suffer from low throughput, the need for complicated equipment, high invasiveness, or side effects by off-target viral uptake. Here, we engineer an adeno-associated viral (AAV) vector system that transfers genetic information into native target cells upon illumination with cell-compatible red light. This OptoAAV system allows adjustable and spatially resolved gene transfer down to single-cell resolution and is compatible with different cell lines and primary cells. Moreover, the sequential application of multiple OptoAAVs enables spatially resolved transduction with different transgenes. The approach presented is likely extendable to other classes of viral vectors and is expected to foster advances in basic and applied genetic research.

Synthetic Biology: Emerging Concepts to Design and Advance Adeno-Associated Viral Vectors for Gene Therapy

Three recent approvals and over 100 ongoing clinical trials make adeno-associated virus (AAV)-based vectors the leading gene delivery vehicles in gene therapy. Pharmaceutical companies are investing in this small and nonpathogenic gene shuttle to increase the therapeutic portfolios within the coming years. This prospect of marking a new era in gene therapy has fostered both investigations of the fundamental AAV biology as well as engineering studies to enhance delivery vehicles. Driven by the high clinical potential, a new generation of synthetic-biologically engineered AAV vectors is on the rise. Concepts from synthetic biology enable the control and fine-tuning of vector function at different stages of cellular transduction and gene expression. It is anticipated that the emerging field of synthetic-biologically engineered AAV vectors can shape future gene therapeutic approaches and thus the design of tomorrow's gene delivery vectors. This review describes and discusses the recent trends in capsid and vector genome engineering, with particular emphasis on synthetic-biological approaches.

Design of a Human Rhinovirus-14 3C Protease-Inducible Caspase-3

The engineering of enzymes for the purpose of controlling their activity represents a valuable approach to address challenges in both fundamental and applied research. Here, we describe and compare different design strategies for the generation of a human rhinovirus-14 (HRV14) 3C protease-inducible caspase-3 (CASP3). We exemplify the application potential of the resulting protease by controlling the activity of a synthetic enzyme cascade, which represents an important motif for the design of artificial signal transduction networks. In addition, we use our engineered CASP3 to characterize the effect of aspartate mutations on enzymatic activity. Besides the identification of mutations that render the enzyme inactive, we find the CASP3-D192E mutant (aspartate-to-glutamate exchange at position 192) to be inaccessible for 3C protease-mediated cleavage. This indicates a structural change of CASP3 that goes beyond a slight misalignment of the catalytic triad. This study could inspire the design of additional engineered proteases that could be used to unravel fundamental research questions or to expand the collection of biological parts for the design of synthetic signaling pathways.

Biofunctionalized Materials Featuring Feedforward and Feedback Circuits Exemplified by the Detection of Botulinum Toxin A

Feedforward and feedback loops are key regulatory elements in cellular signaling and information processing. Synthetic biology exploits these elements for the design of molecular circuits that enable the reprogramming and control of specific cellular functions. These circuits serve as a basis for the engineering of complex cellular networks, opening the door for numerous medical and biotechnological applications. Here, a similar principle is applied. Feedforward and positive feedback circuits are incorporated into biohybrid polymer materials in order to develop signal-sensing and signal-processing devices. This concept is exemplified by the detection of the proteolytic activity of the botulinum neurotoxin A. To this aim, site-specific proteases are incorporated into receiver, transmitter, and output materials, and their release, diffusion, and/or activation are wired according to a feedforward or a positive feedback circuit. The development of a quantitative mathematical model enables analysis and comparison of the performance of both systems. The flexible design could be easily adapted to detect other toxins or molecules of interest. Furthermore, cellular signaling or gene regulatory pathways could provide additional blueprints for the development of novel biohybrid circuits. Such information-processing, material-embedded biological circuits hold great promise for a variety of analytical, medical, or biotechnological applications.

Characterization of the synthetic biology-inspired implementation of a materials-based positive feedback loop

The translation of engineering designs to materials sciences by means of synthetic biological tools represents a novel concept for the development of information-processing materials systems. Here, we provide data on the mathematical model-guided implementation of a biomaterials-based positive feedback loop for the detection of proteolytic activities. Furthermore, we present data on an extended system design for the detection of the antibiotic novobiocin. This work is related to the research article "Synthetic biology-inspired design of signal-amplifying materials systems" (Wagner et al., 2018) [1].

Upgrading biomaterials with synthetic biological modules for advanced medical applications

One key aspect of synthetic biology is the development and characterization of modular biological building blocks that can be assembled to construct integrated cell-based circuits performing computational functions. Likewise, the idea of extracting biological modules from the cellular context has led to the development of in vitro operating systems. This principle has attracted substantial interest to extend the repertoire of functional materials by connecting them with modules derived from synthetic biology. In this respect, synthetic biological switches and sensors, as well as biological targeting or structure modules, have been employed to upgrade functions of polymers and solid inorganic material. The resulting systems hold great promise for a variety of applications in diagnosis, tissue engineering, and drug delivery. This review reflects on the most recent developments and critically discusses challenges concerning in vivo functionality and tolerance that must be addressed to allow the future translation of such synthetic biology-upgraded materials from the bench to the bedside.

Engineering bacterial microcompartments with heterologous enzyme cargos

Bacterial microcompartments (BMCs) are intracellular proteinaceous organelles devoid of a lipid membrane that encapsulates enzymes of metabolic pathways. Salmonella enterica synthesizes propanediol-utilization BMCs containing enzymes involved in the degradation of 1,2-propanediol. BMCs can be designed to enclose heterologous proteins, paving the way to engineered catalytic microreactors. Here, we investigate broader applicability of this design principle by directing three different enzymes to the BMC. We demonstrate that β-galactosidase, esterase Est5, and cofactor-dependent glycerol dehydrogenase can be directed to the BMC and copurified with the microcompartment shell in a catalytically active form. We show that the BMC shell protects enzymes from pH-dependent but not from temperature stress. Moreover, we provide evidence that the heterologously expressed BMCs act as a moderately selective diffusion barrier for lipophilic small molecules.

Modularized CRISPR/dCas9 effector toolkit for target-specific gene regulation

The ability to control mammalian genes in a synergistic mode using synthetic transcription factors is highly desirable in fields of tissue engineering, stem cell reprogramming and fundamental research. In this study, we developed a standardized toolkit utilizing an engineered CRISPR/Cas9 system that enables customizable gene regulation in mammalian cells. The RNA-guided dCas9 protein was implemented as a programmable transcriptional activator or repressor device, including targeting of endogenous loci. For facile assembly of single or multiple CRISPR RNAs, our toolkit comprises a modular RNAimer plasmid, which encodes the required noncoding RNA components.

Optogenetic control of protein kinase activity in mammalian cells

Light-dependent dimerization is the basis for recently developed noninvasive optogenetic tools. Here we present a novel tool combining optogenetics with the control of protein kinase activity to investigate signal transduction pathways. Mediated by Arabidopsis thaliana photoreceptor cryptochrome 2, we activated the protein kinase C-RAF by blue light-dependent dimerization, allowing for decoupling from upstream signaling events induced by surface receptors. The activation by light is fast, reversible, and not only time but also dose dependent as monitored by phosphorylation of ERK1/2. Additionally, light-activated C-RAF controls serum response factor-mediated gene expression. Light-induced heterodimerization of C-RAF with a kinase-dead mutant of B-RAF demonstrates the enhancing role of B-RAF as a scaffold for C-RAF activity, which leads to the paradoxical activation of C-RAF found in human cancers. This optogenetic tool enables reversible control of protein kinase activity in signal duration and strength. These properties can help to shed light onto downstream signaling processes of protein kinases in living cells.

Modular adeno-associated virus (rAAV) vectors used for cellular virus-directed enzyme prodrug therapy

The pre-clinical and clinical development of viral vehicles for gene transfer increased in recent years, and a recombinant adeno-associated virus (rAAV) drug took center stage upon approval in the European Union. However, lack of standardization, inefficient purification methods and complicated retargeting limit general usability. We address these obstacles by fusing rAAV-2 capsids with two modular targeting molecules (DARPin or Affibody) specific for a cancer cell-surface marker (EGFR) while simultaneously including an affinity tag (His-tag) in a surface-exposed loop. Equipping these particles with genes coding for prodrug converting enzymes (thymidine kinase or cytosine deaminase) we demonstrate tumor marker specific transduction and prodrug-dependent apoptosis of cancer cells. Coding terminal and loop modifications in one gene enabled specific and scalable purification. Our genetic parts for viral production adhere to a standardized cloning strategy facilitating rapid prototyping of virus directed enzyme prodrug therapy (VDEPT).

Comparison of six different specimen types for Epstein-Barr viral load quantification in peripheral blood of pediatric patients after heart transplantation or after allogeneic hematopoietic stem cell transplantation

BACKGROUND

Epstein-Barr Virus (EBV) a gamma-herpes virus is associated with a spectrum of lymphoid and epithelial malignancies including posttransplant lymphoproliferative disorders (PTLD). EBV-load measurement has been shown to be important for the monitoring of these patients. However, in contrast to the viral quantification of human immunodeficiency virus or human hepatitis C virus, the EBV-load measurement has not been completely standardized as yet.

OBJECTIVES

In this study, we compared the EBV DNA levels in whole blood (WB), plasma, peripheral mononuclear cells (PBMC) and B-cells (BC) in children and adolescents after heart transplantations (HTx) and allogeneic hematopoietic stem cell transplantations (HSCT).

STUDY DESIGN

In a period of 2 years (from May 2007 to May 2009) we collected 547 samples of 96 cardiac transplant recipients and 248 samples of 37 patients who underwent HSCT. For EBV DNA quantification we used a duplex real-time PCR (ABI Prism 7500, Applied Biosystems). Additionally, EBV-load of PBMC and BC were normalized with respect to endogenous cell DNA.

RESULTS

In both patient populations we found no significant difference of test sensitivity for the EBV detection. In PBMC as well as BC, there was a high correlation between the analysis of cells with and without normalization in both populations. Spearman's correlation coefficient ρ between PBMC without and PBMC with normalization was ρ=0.98 (P<0.0001) in patients after HTx and ρ=0.99 (P<0.0001) in patients after HSCT. Correlation between BC with and without normalization was ρ=0.98 (P<0.0001) in patients after HTx and ρ=0.995 (P<0.0001) in patients after HSCT. When comparing the different blood compartments for EBV quantification in both populations, the strongest correlations were found between the EBV DNA levels in WB and PBMC (HTx: ρ=0.93, P<0.0001; HSCT: ρ=0.81, P<0.0001) followed by PBMC and BC (HTx: ρ=0.87, P<0.0001; HSCT: ρ=0.81, P<0.0001) as well as WB and BC (HTx: ρ=0.86, P<0.0001; HSCT: ρ=0.75, P<0.0001). In contrast, the correlation coefficients between plasma and the other blood compartments (WB as well as PBMC or BC) were lower. Six patients developed seven episodes of PTLD (five patients after HTx and one after renal transplantation). Analyzing the different blood compartments, we found that a threshold of WB ≥20,000EBV-copies/ml and plasma ≥1000EBV-copies/ml had the highest sensitivities and specificities (WB: sensitivity 100%, specificity 87% and plasma: sensitivity 88%, specificity 98%).

CONCLUSION

Normalization towards an endogenous control does not seem to be necessary for EBV quantification in peripheral blood. The analysis of whole blood correlates well with B-cells and PBMC. Routine screening of EBV DNA in whole blood appeared to be a useful tool supplemented by EBV-load measurement in plasma to discriminate chronic high EBV-load carrier without risk for PTLD from those who are at risk for PTLD. Values in whole blood higher than 20,000EBV-copies/ml WB and plasma values higher than 1000EBV-copies/ml plasma indicated PTLD in our series.

Sarcoidosis following Cushing's syndrome: A report of two cases and review of the literature

Cushing's syndrome is characterized by excessive elevation of glucocorticoid concentrations. In rare cases, the treatment of Cushing's syndrome may result in unmasking or aggravation of diseases responsive to glucocorticoid medication. We report two cases of sarcoidosis following Cushing's syndrome. A 43 year-old male developed cutaneous sarcoidosis and mediastinal lymphadenopathy after resection of an ACTH-secreting pituitary microadenoma. A 32 year-old female showed cutaneous sarcoidosis, arthralgia, mediastinal lymphadenopathy and elevation of angiotensin-converting enzyme and interleukin 2-receptor concentrations after traumatic adrenal bleeding, which ceased formerly undiagnosed hypercortisolism caused by an adrenal adenoma. Sarcoidosis seems to be a rare sequel following the treatment of hypercortisolism. Skin affections were present and suggestive for the diagnosis in all reported cases. As some cases are probably missed when skin affections are lacking, a more frequent evaluation of patients after Cushing's syndrome for the possible diagnosis of sarcoidosis might be necessary.

Palliativtherapie der malignen Ösophagusobstruktion mit selbstexpandierenden Metallendoprothesen

A total of 23 self-expanding metal stents were implanted in 17 patients (12 men, 5 women; mean age 66 [44-83] years) with inoperable malignant obstruction of the oesophagus or the oesophago-gastric junction. A primary success was achieved in all, a good functional result in 16 (94%). There were no complications. In the follow-up period (mean of 15.2 +/- 13 weeks) re-obstruction by the tumour process occurred in three patients. Twelve patients died after a mean survival time of 15.8 +/- 14 weeks. In ten of these the stent was still patent at death, while two had again developed dysphagia. The cumulative patency rate of the stents was 79%. These observations indicate that self-expanding metal stents can achieve satisfactory palliation in dysphagia due to a malignancy. The mortality and morbidity rates of the method seem to be less than those of other palliative measures.

Regulation of intestinal phosphate cotransporter NaPi IIb by ubiquitin ligase Nedd4-2 and by serum- and glucocorticoid-dependent kinase 1

Serum and glucocorticoid-inducible kinase 1 (SGK1) is highly expressed in enterocytes. The significance of the kinase in regulation of intestinal function has, however, remained elusive. In Xenopus laevis oocytes, SGK1 stimulates the epithelial Na(+) channel by phosphorylating the ubiquitin ligase Nedd4-2, which regulates channels by ubiquitination leading to subsequent degradation of the channel protein. Thus the present study has been performed to explore whether SGK1 regulates transport systems expressed in intestinal epithelial cells, specifically type IIb sodium-phosphate (Na(+)-P(i)) cotransporter (NaPi IIb). Immunohistochemistry in human small intestine revealed SGK1 colocalization with Nedd4-2 in villus enterocytes. For functional analysis cRNA encoding NaPi IIb, the SGK isoforms and/or the Nedd4-2 were injected into X. laevis oocytes, and transport activity was quantified as the substrate-induced current (I(P)). Exposure to 3 mM phosphate induces an I(P) in NaPi IIb-expressing oocytes. Coinjection of Nedd4-2, but not the catalytically inactive mutant (C938S)Nedd4-2, significantly downregulates I(P), whereas the coinjection of (S422D)SGK1 markedly stimulates I(P) and even fully reverses the effect of Nedd4-2 on I(P). The effect of (S422D)SGK1 on NaPi IIb is mimicked by wild-type SGK3 but not by wild-type SGK2, constitutively active (T308D,S473D)PKB, or inactive (K127N)SGK1. Moreover, (S422D)SGK1 and SGK3 phosphorylate Nedd4-2. In conclusion, SGK1 stimulates the NaPi IIb, at least in part, by phosphorylating and thereby inhibiting Nedd4-2 binding to its target. Thus the present study reveals a novel signaling pathway in the regulation of intestinal phosphate transport, which may be important for regulation of phosphate balance.

Central venous access catheters: radiological management of complications

A great variety of central venous access devices such as tunneled and non-tunneled central venous catheters (CVC) as well as port systems are implanted by interventional radiologists at an increasing rate. There are some possible immediate, early, and late complications related to the implantation technique, care, and maintenance of CVCs. This review will illustrate possible complications of CVCs and will discuss risk factors. Different strategies will be shown regarding the prevention and treatment of complications.

Immunotherapy for Hodgkin's disease

EBV proteins present in the malignant Hodgkin Reed-Sternberg (HR-S) cells of about 40% of patients with Hodgkin's Disease (HD) provide targets for immunotherapy with virus-specific cytotoxic T lymphocytes (CTL). However, Hodgkin tumors use multiple strategies to avoid CTL, including down-regulation of immunodominant EBV antigens, and secretion of cytokines and chemokines such as TGF-beta, that inhibit the activation of CTL and professional antigen-presenting cells (APC). To be effective against this tumor, CTL must resist some or all of these strategies. Thirteen patients with multiply-relapsed HD received EBV-specific CTL, generated ex vivo using the autologous EBV-transformed B cells (LCL) as stimulator cells. After CTL infusion, EBV-specific immunity increased, virus load decreased, CTL homed to sites of malignancy and persisted for up to ten months. Clinically, CTL produced resolution of B symptoms and mixed tumor responses including one complete remission of residual disease remaining after autologous bone marrow transplant. However, no complete remission of bulky disease was achieved. Although LMP2-specific CTL activity could be detected in some of the infused CTL lines, they were present in low frequency. In pre-clinical studies, LMP1 and LMP2-specific CTL could be produced by stimulating PBMC from patients and normal donors with autologous dendritic cells expressing LMP1 or LMP2 from adenoviral vectors. Further, CTL could be rendered resistant to the devastating effects of TGF-beta by transduction with a retrovirus vector expressing a dominant-negative TGF-beta receptor, while transgenic IL-12 could increase the expression of Th1 and decrease that of Th2 cytokines. Future clinical studies will test the efficacy of CTL with improved antigen-specificity and resistance to Hodgkin immune evasion strategies.

Rotational digital cholangiography (RDC) and 3D-cholangiography (3DC) for guidance of percutaneous biliary drainage procedures

PURPOSE

To evaluate whether RDC and 3DC help clarifying anatomic details in biliary duct disease and is useful for guidance of drainage procedures.

MATERIALS AND METHODS

RDC was conducted in 11 consecutive patients (8 male, 3 female, mean age 63 years). Nine patients underwent PTBD for malignant biliary duct stenosis, one patient because of ischemic stenosis after hepaticojejunostomy and one patient presented with an infected biloma. Images were obtained after initial bile duct puncture during single breath hold from 120 projection angles using a rotating C-arm. These images were immediately available and evaluated in order to facilitate the definitive drainage procedure. For additional 3D reconstruction, data were sent to a dedicated workstation and judged by a blinded observer.

RESULTS

The availability of a rotating data set of images was judged to be helpful in three patients with complex anatomical situations. Additionally, RDC holds the potential to reduce fluoroscopy time. 3DC allowed analysis of the hepatic bifurcation from different viewing angles in 10 cases with high spatial resolution (mean voxel size 480 micro micro m 3). This may allow a better classification of hilar obstructions according to our preliminary observations.

CONCLUSION

Images from RDC and 3DC are helpful in guiding PTBD procedures and for better diagnosis in selected patients with hilar biliary duct stenoses.

Magnetic resonance phase contrast velocity measurement for non-invasive follow up after percutaneous transluminal angioplasty

BACKGROUND

The aim of this study was to evaluate magnetic resonance phase contrast velocimetry (MRVL) as a non-invasive follow up tool to assess restenosis after percutaneous transluminal angioplasty (PTA).

PATIENTS AND METHODS

We prospectively investigated 51 consecutive patients who underwent PTA of the femoropopliteal region. MRVL was conducted prior, one day, six weeks, twelve weeks and 24 weeks after PTA using a circular polarized extremity coil and a gradient echo sequence (TR/TE 600/6 ms, flip angel 30 degrees, slice thickness 10 mm). Hemodynamic data, derived from the MR phase contrast sequence, allowed to calculate the degree of area stenosis of the lesion treated with PTA. These data were correlated with clinical hemodynamic parameters (ankle-brachial index and walking distance).

RESULTS

The mean grade of area stenosis was 69% +/- 27% before PTA, 30% +/- 20% one day, 29% +/- 23% six weeks, 39% +/- 17% twelve weeks and 42% +/- 18% 24 weeks after PTA and correlated well with clinical data and the post angioplasty clinical course of the patients.

CONCLUSIONS

Follow up measurements using MRVL are suitable to assess restenosis after PTA and allow quantifying the grade of recurrent stenosis as well as the hemodynamic consequences.

Time-resolved, undersampled projection reconstruction imaging for high-resolution CE-MRA of the distal runoff vessels

Imaging of the blood vessels below the knee using contrast-enhanced (CE) MRI is challenging due to the need to coordinate image acquisition and arrival of the contrast in the targeted vessels. Time-resolved acquisitions have been successful in consistently capturing images of the arterial phase of the bolus of contrast agent in the distal extremities. Although time-resolved exams are robust in this respect, higher spatial resolution for the depiction of tight stenoses and the small vessels in the lower leg is desirable. A modification to a high-spatial-resolution T(1)-weighted pulse sequence (projection reconstruction-time resolved imaging of contrast kinetics (PR-TRICKS)) that improves the through-plane spatial resolution by a factor of 2 and maintains a high frame rate is presented. The undersampled PR-TRICKS pulse sequence has been modified to double the spatial resolution in the slice direction by acquiring high-spatial-frequency slice data only after first pass of the bolus of contrast agent. The acquisition reported in the present work (PR-hyperTRICKS) has been used to image healthy volunteers and patients with known vascular disease. The temporal resolution was found to be beneficial in capturing arterial phase images in the presence of asymmetric filling of vessels.

[Current status of endovascular therapy in the femoropopliteal vascular segment in chronic peripheral arterial occlusive disease]

Technical success of endovascular measures in the femoropopliteal region has increased since the introduction of new technology (hydrophilic guide-wires, stents, stent grafts) in the last decade to rates of more than 90%. If the initial revascularization--even of long segment occlusions--is successful, the modern armamentarium of interventional radiology enables to keep the vessel open acutely. Evidence, that the immediate success of revascularization leads to a continuous improvement of the clinical symptoms, measured by clinically relevant end points (e.g. improvement of walking distance, increase of limb salvage, increase of survival), has yet to be shown. Several prospective randomized trials demonstrated improvement of walking distance after one year follow-up, but not after two years follow-up in patients with chronic femoropopliteal obstructions, who were treated with PTA compared to walking exercise only. The only two prospective randomized trials comparing vascular surgery and endovascular therapy for femoropopliteal obstructions could not demonstrate any advantage of one of the two modalities in patients with claudication or critical ischemia. The transatlantic consensus document (TASC) recommends PTA as therapy of choice in the femoropopliteal arteries only for single stenosis < 3 cm and does not recommend primary stenting. In order to evaluate endovascular therapy in the femoropopliteal region outcome studies are needed, which carefully assess clinically relevant end points like improvement of walking distance, limb salvage, and survival, but also disease specific quality of life evaluations. Several meta-analyses, performed in recent years, have demonstrated that endovascular therapy has a definite role in the femoropopliteal segment. However, the particular role has to be evaluated for the individual clinical case in the light of case-specific findings and symptoms.

Magnetic resonance hydrometry: non-invasive quantification of the exocrine pancreatic function

AIMS

To show the ability of magnetic resonance hydrometry (MRH) to quantify the pancreatic secretion after secretin stimulation in order to distinguish between physiological excretion and reduced output in chronic pancreatitis.

METHODS

MRH images were acquired in a 1.0-T-clinical scanner using a body-array coil and a heavily T2-weighted standard single-shot TSE sequence. Thirty-one patients (14 male/17 female) who routinely underwent ERCP for suspected choledocholithiasis (n = 22), recurring abdominal pain (n = 1), icterus (n = 6 and suspected pancreatitis (n = 2) were included. During the investigation 1 CU/kg BW secretin were administered intravenously. Secreted volume of fluid, start of secretion, achievement of a plateau of secretion and a combined score of these parameters (MRH score) were assessed and evaluated. Sensitivity and specificity were calculated for these parameters.

RESULTS

27 patients had no pancreatic pathology, and four suffered from chronic pancreatitis. Patients without pancreatic disorders produced a mean pancreatic fluid volume of 183 plus minus 86 mL, whereas patients with chronic pancreatitis secreted 61 +/- 39 mL. Secretion started after a mean time of 95 +/- 94 seconds (no pancreatic impairment) and 62 +/- 13 seconds (chronic pancreatitis). The MRH score achieved a high accuracy in the detection of chronic pancreatitis.

CONCLUSIONS

Our study demonstrated the feasibility of measuring pancreatic output by MRH after stimulation with secretin. Moreover, a distinction between normal secretion and patients with chronic pancreatitis is possible.

Cerebral localization and regulation of the cell volume-sensitive serum- and glucocorticoid-dependent kinase SGK1

The serum- and glucocorticoid-dependent kinase SGK1 is regulated by alterations of cell volume, whereby cell shrinkage increases and cell swelling decreases the transcription, expression and activity of SGK1. The kinase is expressed in all human tissues studied including the brain. The present study was performed to localize the sites of SGK1 transcription in the brain, to elucidate the influence of the hydration status on SGK1 transcription and to explore the functional significance of altered SGK1 expression. Northern blot analysis of human brain showed SGK1 to be expressed in all cerebral structures examined: amygdala, caudate nucleus, corpus callosum, hippocampus, substantia nigra, subthalamic nucleus and thalamus. In situ hybridization and immunohistochemistry in the rat revealed increased expression of SGK1 in neurons of the hippocampal area CA3 after dehydration, compared with similar slices from brains of euvolaemic rats. Additionally, several oligodendrocytes, a few microglial cells, but no astrocytes, were positive for SGK1. The abundance of SGK1 mRNA in the temporal lobe, including hippocampus, was increased by dehydration and SGK1 transcription in neuroblastoma cells was stimulated by an increase of extracellular osmolarity. Co-expression studies in Xenopus laevis oocytes revealed that SGK1 markedly increased the activity of the neuronal K+ channel Kv1.3. As activation of K+ channels modifies excitation of neuronal cells, SGK1 may participate in the regulation of neuronal excitability.

Pineal organs in deep demersal fish

We studied ten species of demersal fish from depths of 1500-4800 m, i.e. regions of the abyss outside the reach of sunlight. A pineal window in the skin and/or the skull, often found in mesopelagic fish, was never observed in demersal specimens. Nine species had a well-developed pineal organ, with light- and electron-microscopic features, well known in other teleosts living in surface waters, including photoreceptor cells with inner and outer segments, synaptic ribbons, neuronal perikarya, and (radial) glial cells. One species ( Bathypterois dubius) showed signs of regression; it also had reduced eyes. We observed considerable morphological variation in location, size, microscopic structure and ultrastructural organisation, including the frequency of photoreceptor cells, size of outer segments and the number of myelinated and unmyelinated axons. No systematic trend in the sense of an increase of sensitivity with greater depths was observed. Melatonin contents varied between 4 pg and 92 pg per pineal in the grenadier Coryphaenoides ( Nematonurus) armatus and between 2 pg and 70 pg per pineal in the eel Synaphobranchus kaupi. Differences between day and night values and between autumn and spring suggest that pineal melatonin acts as neurochemical signal mediating rhythmic processes and behaviour. The role of an alternative non-solar zeitgeber in the demersal environment is discussed.

Multiplanar reconstructions and three-dimensional imaging (computed rotational osteography) of complex fractures by using a C-arm system: initial results

With use of a calibrated angiographic C-arm system and a postprocessing workstation, the authors acquired volume data sets from two-dimensional digital projection images obtained during a C-arm rotation around the patient axis. Multiplanar reconstruction and three-dimensional images of complex fractures were reconstructed and compared with spiral computed tomographic studies in a cadaveric pig study and in eight patients. Computed rotational osteography provided high-resolution multiplanar reconstruction and three-dimensional images of complex fractures.

[Analysis of the genetic structure of the breeding nucleus of the Russian population of purebred Thoroughbred horses at the Extension locus using molecular DNA typing]

Results of the first in Russia survey of the gene pool of the breeding nucleus of the Russian population of thoroughbred horses by means of PCR analysis of the E (Extension) locus MC1R gene mutations are presented. The data on the structure of breeding populations from the leading stud farms Voskhod and Oros with regard to color phenotypes as well as genotype and allele frequencies are presented. The population structure parameters are discussed with respect to possible specific features of microevolution processes.

Vascular response to gadolinium-containing contrast media in an ex vivo rabbit arterial model

RATIONALE AND OBJECTIVES

To assess the influence of gadolinium-containing magnetic resonance contrast agents on contractility of the arterial vessel wall.

METHODS

Bilateral segments of rabbit carotid arteries were mounted in flow chambers, surrounded by aerated (95% O2, 5% CO2) Krebs' solution, and perfused at a constant rate by separated and aerated Krebs' solution. Therefore, changes in pressure of the circulating Krebs' solution indicated alterations of vessel wall contractility. Viability of the artery was tested by 124 mmol/L KCl, 3 x 10-5 mol/L phenylephrine, and 10-5 mol/L acetylcholine. After a washout phase, gadopentate (n = 10) or gadoteridol (n = 10) was added to the perfusate of one carotid artery in increments of 0.1, 0.3, and 0.6 mmol/L. Concentrations up to 0.9 mmol/L and 1.2 mmol/L were tested, respectively. The contralateral artery served as a control. To assess potential relaxing effects of the media, vessels were brought into a contracted status with 3 x 10-5 mol/L phenylephrine and then received gadolinium chelates.

RESULTS

Potassium chloride and phenylephrine increased and acetylcholine decreased the pressure, indicating vasoconstriction and vasodilatation, respectively. After gadopentate and gadoteridol infusion, no statistically significant pressure changes could be detected, ruling out any vasoconstrictor or vasodilator effect.

CONCLUSIONS

Gadopentetate and gadoteridol in doses of up to 1.2 mmol/L did not alter vessel wall tone. The impact of contrast media on blood pressure, as has been shown in some clinical trials, probably is not due to direct changes in arterial wall tone.

Detection of Epstein-Barr virus DNA in peripheral blood of paediatric patients with Hodgkin's disease by real-time polymerase chain reaction

Hodgkin's disease (HD) is commonly associated with latent Epstein-Barr virus (EBV) infection. The aim of our study was a detailed molecular analysis of the EBV status in the peripheral blood of paediatric patients with HD. Blood samples from HD patients were examined before (n=28) and after treatment (n=12). The control group consisted of 20 healthy children and 10 immunosuppressed children with primary EBV infection. EBV load in plasma and peripheral blood mononuclear cells (PBMC) were determined by real time quantitative polymerase chain reaction (RQ-PCR) as recently described. Before treatment, EBV DNA was detected in the plasma of 13/24 EBV-seropositive HD patients, whereas in plasma of healthy controls no EBV DNA was detectable (P<0.001). After treatment, no EBV genomes were found in the plasma of 6 HD patients in stable and complete remission. In contrast, 2/5 HD patients with relapse of disease were positive for EBV DNA in the plasma. In PBMCs, no differences were found in EBV load measured in HD patients before or after treatment and healthy controls. A high EBV load was found in both the plasma and PBMCs of all immunosuppressed patients with primary EBV infection. Thus, EBV DNA detection in the plasma of paediatric HD patients might be of value for non-invasive diagnostic, prognostic and follow-up tests for HD.

Patients at risk for development of posttransplant lymphoproliferative disorder: plasma versus peripheral blood mononuclear cells as material for quantification of Epstein-Barr viral load by using real-time quantitative polymerase chain reaction

BACKGROUND

Early diagnosis of Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disorder (PTLD) is required to detect a stage of disease that is more likely to respond to treatment. Elevated levels of EBV DNA were found in peripheral blood of patients at the onset of PTLD.

METHODS

To compare plasma and peripheral blood mononuclear cells (PBMCs) as material for real-time quantitative polymerase chain reaction (RQ-PCR) measurement of Epstein-Barr viral load, we used two sets of primers and probes specific for the BAM HI-K or BAM HI-W region of the EBV genome.

RESULTS

Patients with PTLD had a median viral load of 19,200 EBV genomes/microg DNA (n=9) or 3,225 EBV genomes/100 microl plasma (n=5), being significantly higher compared with immunosuppressed patients with primary (n=9) or reactivated (n=20) EBV infection or immunosuppressed patients without serological signs of active EBV infection (n=67) (P<0.001). Hence, a value of greater than 5,000 EBV genomes/microg PBMC DNA was considered as a diagnostic parameter for PTLD with a sensitivity and specificity of 1.00 or 0.89, respectively. When plasma was analyzed, however, a value of greater than 1,000 EBV genomes/100 microl plasma had both a sensitivity and specificity of 1.00 for the diagnosis of PTLD. During remission of PTLD, viral load was more effectively cleared in plasma compared with PBMCs. In plasma of nonimmunosuppressed individuals, even a qualitative detection of EBV-related sequences was sensitive and specific for the diagnosis of primary EBV infection, whereas for analysis of PBMC DNA a quantitative parameter had to be considered to differentiate healthy individuals (< 100 EBV genomes/microg PBMC DNA) from patients with primary EBV infection (>100 EBV genomes/microg PBMC DNA).

CONCLUSION

Although both PBMCs and plasma were useful as material for EBV-specific RQ-PCR in immunosuppressed patients and nonimmunosuppressed individuals, the specificity of analysis seemed to be higher if plasma was taken for analysis.

CT-fluoroscopy: Tool or gimmick?

Recent advances in CT scanner technology and computer hardware have led to the development of CT fluoroscopy (CTF), which allows real-time acquisition and display of cross-sectional images (with a rate of up to 8 frames per second). Since the introduction of the first CT fluoroscopy scanner in 1993, a variety of these scanners have been installed world-wide and many reports on the clinical use of this device have appeared recently. However, use of this new technology for the guidance of interventional radiologic procedures, such as percutaneous biopsy and percutaneous drainage, is not uniformly advocated by interventional radiologists. Concerns have been reported regarding radiation exposure and outcome of the procedures when compared with sequential CT guidance or other alternative guiding modalities. This article is intended to present an overview of CTF technology, to summarize the results of published papers on various interventional applications and to reflect on its specific advantages and disadvantages.

Kinetic evaluation of an i.v. bolus of MR contrast media

Currently, it is assumed that the pharmacokinetic properties of the first minutes of an I.V. MR contrast media bolus are similar to those of an i.v. iodinated contrast media bolus used in CT. Correct timing of an MRA examination is crucial for obtaining sufficient arterial contrast. This study sought to evaluate the temporal change of arterial signal intensity within 150 s after i.v. bolus injection of Gd-DTPA. Thirty consecutive patients (14 women/16 men; mean age: 51 +/- 11 years) were prospectively examined with a 1.0 Tesla clinical scanner. A single axial slice was acquired in 1.25 sec with manufacturer provided gradient echo sequence through the aorta at the level of the renal arteries. Investigation was started simultaneously to the application of contrast media (0.1 mmol/kg bodyweight Gd-DTPA at three different rates 2 mL/sec, 3 mL/sec and 4 mL/sec) and repeated for 2.5 min. An additional echo Doppler examination excluded patients with any cardiac disorders. Maximum signal (1300% increase compared to the basic value) in the aorta was achieved 20 +/- 6 sec after start of bolus injection. Then a plateau phase was maintained for the remaining investigation time (2.5 min). No significant difference was shown for different injection rates. After a bolus injection of Gd-DTPA the arterial contrast remains on a high level for at least 2 min. However, correct timing of the bolus arrival is still crucial to discriminate arteries and veins. An injection rate between 2 mL/sec and 4 mL/sec has no influence on early contrast media dynamics.

Brain areas in abyssal demersal fishes

Four areas of the brain which receive primary projections from chemical senses ([1] olfactory bulb, [2] gustatory area including facial and vagal lobes), the eye ([3] optic tectum), and mechanosensory, and-hair-cell based systems i.e. the lateral line, vestibular and auditory systems ([4] trigeminal and octavolateral regions) have been studied and relative size differences used to make deductions on the sensory preferences of 35 fish species living on or near the bottom of the deep sea. Furthermore the relative volumes of the telencephalon and the corpus cerebelli were determined. Two evaluation modes were applied: (1) the relative mean of each system was calculated and species with above-average areas identified; (2) a cluster analysis established multivariate correlations among the sensory systems. The diversity of sensory brain areas in this population of fish suggests that the benthic and epibenthic environment of the abyss presents a rich sensory environment. Vision seems to be the single most important sense suggesting the presence of relevant bioluminescent stimuli. However, in combination the chemical senses, smell and taste, surpass the visual system; most prominent among them is olfaction. The trigeminal/octavolateral area indicating the role of lateral line input and possibly audition is also well represented, but only in association with other sensory modalities. A large volume telencephalon was often observed in combination with a prominent olfactory system, whereas cerebella of unusually large sizes occurred in species with above-average visual, hair-cell based, but also olfactory systems, confirming their role as multimodal sensorimotor coordination centers. In several species the predictions derived from the volumetric brain analyses were confirmed by earlier observations of stomach content and data obtained by baited cameras.