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1.
J Immunol ; 209(9): 1635-1651, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36104111

RESUMO

The initiation of CD8+ T cell responses against dead cell-associated Ags is tightly regulated, facilitating adaptive immunity against pathogens and tumors while preventing autoimmunity. It is now well established that dying cells actively regulate the generation of CD8+ T cell responses via the release or exposure of damage-associated molecular patterns. However, it is unclear whether nonproteasomal proteases (activated in stressed and dying cells) can influence the availability of Ags for cross-presentation. Using a mouse model of immunogenic necrosis, we investigated the role of tumor-derived proteases in the priming of CD8+ T cells. We demonstrate that proteases released from necrotic tumor cells can degrade whole-protein Ag, generating proteolytic intermediates that are efficiently cross-presented by dendritic cells and enhance CD8+ T cell cross-priming. We identify a dominant role for calpain proteases, which are activated during necrotic cell death induced by severe heat shock. Mechanistically, proteolytic intermediates generated by tumor-derived proteases associate with necrotic tumor cell debris, which acts as a vehicle for Ag transfer that facilitates highly efficient cross-presentation in dendritic cells. Our results suggest that proteolytic systems activated in Ag donor cells during cell death may influence the availability of antigenic substrates for cross-presentation, thereby regulating the antigenicity of cell death.


Assuntos
Apresentação Cruzada , Neoplasias , Apresentação de Antígeno , Linfócitos T CD8-Positivos , Calpaína/metabolismo , Células Dendríticas , Humanos , Necrose/metabolismo , Neoplasias/metabolismo
2.
Int J Mol Sci ; 23(9)2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35562953

RESUMO

Isocitrate dehydrogenase (IDH)-wildtype glioblastoma (GBM) is a fast growing and highly heterogeneous tumor, often characterized by the presence of glioblastoma stem cells (GSCs). The plasticity of GSCs results in therapy resistance and impairs anti-tumor immune response by influencing immune cells in the tumor microenvironment (TME). Previously, ß-catenin was associated with stemness in GBM as well as with immune escape mechanisms. Here, we investigated the effect of ß-catenin on attracting monocytes towards GBM cells. In addition, we evaluated whether CCL2 is involved in ß-catenin crosstalk between monocytes and tumor cells. Our analysis revealed that shRNA targeting ß-catenin in GBMs reduces monocytes attraction and impacts CCL2 secretion. The addition of recombinant CCL2 restores peripheral blood mononuclear cells (PBMC) migration towards medium (TCM) conditioned by shß-catenin GBM cells. CCL2 knockdown in GBM cells shows similar effects and reduces monocyte migration to a similar extent as ß-catenin knockdown. When investigating the effect of CCL2 on ß-catenin activity, we found that CCL2 modulates components of the Wnt/ß-catenin pathway and alters the clonogenicity of GBM cells. In addition, the pharmacological ß-catenin inhibitor MSAB reduces active ß-catenin, downregulates the expression of associated genes and alters CCL2 secretion. Taken together, we showed that ß-catenin plays an important role in attracting monocytes towards GBM cells in vitro. We hypothesize that the interactions between ß-catenin and CCL2 contribute to maintenance of GSCs via modulating immune cell interaction and promoting GBM growth and recurrence.


Assuntos
Neoplasias Encefálicas , Quimiocina CCL2 , Glioblastoma , beta Catenina , Neoplasias Encefálicas/metabolismo , Linhagem Celular Tumoral , Proliferação de Células , Quimiocina CCL2/genética , Quimiocina CCL2/farmacologia , Glioblastoma/genética , Glioblastoma/metabolismo , Humanos , Leucócitos Mononucleares/metabolismo , Monócitos/metabolismo , Microambiente Tumoral , Via de Sinalização Wnt , beta Catenina/genética , beta Catenina/metabolismo
3.
Ann Hematol ; 100(6): 1603-1620, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33846857

RESUMO

Hematologic and oncologic patients with chemo- or immunotherapy-related immunosuppression are at substantial risk for bacterial infections and Pneumocystis jirovecii pneumonia (PcP). As bacterial resistances are increasing worldwide and new research reshapes our understanding of the interactions between the human host and bacterial commensals, administration of antibacterial prophylaxis has become a matter of discussion. This guideline constitutes an update of the 2013 published guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). It gives an overview about current strategies for antibacterial prophylaxis in cancer patients while taking into account the impact of antibacterial prophylaxis on the human microbiome and resistance development. Current literature published from January 2012 to August 2020 was searched and evidence-based recommendations were developed by an expert panel. All recommendations were discussed and approved in a consensus conference of the AGIHO prior to publication. As a result, we present a comprehensive update and extension of our guideline for antibacterial and PcP prophylaxis in cancer patients.


Assuntos
Antibacterianos/uso terapêutico , Neoplasias Hematológicas/complicações , Pneumocystis carinii/efeitos dos fármacos , Pneumonia por Pneumocystis/prevenção & controle , Antineoplásicos/uso terapêutico , Farmacorresistência Bacteriana , Fluoroquinolonas/uso terapêutico , Alemanha , Neoplasias Hematológicas/tratamento farmacológico , Hematologia , Humanos , Oncologia , Microbiota/efeitos dos fármacos , Pneumonia por Pneumocystis/complicações , Sociedades Médicas
4.
Int J Mol Sci ; 22(16)2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34445503

RESUMO

Obesity is a major risk factor for developing cancer, with obesity-induced immune changes and inflammation in breast (BC) and colorectal cancer (CRC) providing a potential link between the two. This study investigates systemic effects of obesity on adaptive and innate immune cells in healthy and tumour-bearing mice. Immune cells from lean and obese mice were phenotyped prior to implantation of either BC (C57mg and EO771.LMB) or CRC (MC38) cells as tumour models. Tumour growth rate, tumour-infiltrating lymphocytes (TIL) and peripheral blood immune cell populations were compared between obese and lean mice. In vitro studies showed that naïve obese mice had higher levels of myeloid cells in the bone marrow and bone marrow-derived dendritic cells expressed lower levels of activation markers compared to cells from their lean counterparts. In the tumour setting, BC tumours grew faster in obese mice than in lean mice and lower numbers of TILs as well as higher frequency of exhausted T cells were observed. Data from peripheral blood showed lower levels of myeloid cells in tumour-bearing obese mice. This study highlights that systemic changes to the immune system are relevant for tumour burden and provides a potential mechanism behind the effects of obesity on cancer development and progression in patients.


Assuntos
Neoplasias da Mama/patologia , Neoplasias Colorretais/patologia , Linfócitos do Interstício Tumoral/metabolismo , Obesidade/imunologia , Imunidade Adaptativa , Animais , Neoplasias da Mama/imunologia , Linhagem Celular Tumoral , Neoplasias Colorretais/imunologia , Feminino , Humanos , Masculino , Camundongos , Células Mieloides/metabolismo , Transplante de Neoplasias , Microambiente Tumoral
5.
Stroke ; 49(3): 700-709, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29382802

RESUMO

BACKGROUND AND PURPOSE: Human amnion epithelial cells (hAECs) are nonimmunogenic, nontumorigenic, anti-inflammatory cells normally discarded with placental tissue. We reasoned that their profile of biological features, wide availability, and the lack of ethical barriers to their use could make these cells useful as a therapy in ischemic stroke. METHODS: We tested the efficacy of acute (1.5 hours) or delayed (1-3 days) poststroke intravenous injection of hAECs in 4 established animal models of cerebral ischemia. Animals included young (7-14 weeks) and aged mice (20-22 months) of both sexes, as well as adult marmosets of either sex. RESULTS: We found that hAECs administered 1.5 hours after stroke in mice migrated to the ischemic brain via a CXC chemokine receptor type 4-dependent mechanism and reduced brain inflammation, infarct development, and functional deficits. Furthermore, if hAECs administration was delayed until 1 or 3 days poststroke, long-term functional recovery was still augmented in young and aged mice of both sexes. We also showed proof-of-principle evidence in marmosets that acute intravenous injection of hAECs prevented infarct development from day 1 to day 10 after stroke. CONCLUSIONS: Systemic poststroke administration of hAECs elicits marked neuroprotection and facilitates mechanisms of repair and recovery.


Assuntos
Âmnio/transplante , Células Epiteliais/transplante , Neuroproteção , Acidente Vascular Cerebral/terapia , Animais , Callithrix , Modelos Animais de Doenças , Feminino , Xenoenxertos , Humanos , Masculino , Camundongos , Acidente Vascular Cerebral/metabolismo , Acidente Vascular Cerebral/patologia
6.
Ann Hematol ; 95(9): 1435-55, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27339055

RESUMO

Infectious complications after allogeneic haematopoietic stem cell transplantation (allo-HCT) remain a clinical challenge. This is a guideline provided by the AGIHO (Infectious Diseases Working Group) of the DGHO (German Society for Hematology and Medical Oncology). A core group of experts prepared a preliminary guideline, which was discussed, reviewed, and approved by the entire working group. The guideline provides clinical recommendations for the preventive management including prophylactic treatment of viral, bacterial, parasitic, and fungal diseases. The guideline focuses on antimicrobial agents but includes recommendations on the use of vaccinations. This is the updated version of the AGHIO guideline in the field of allogeneic haematopoietic stem cell transplantation utilizing methods according to evidence-based medicine criteria.


Assuntos
Infecções Bacterianas/prevenção & controle , Transplante de Células-Tronco Hematopoéticas/métodos , Micoses/prevenção & controle , Doenças Parasitárias/prevenção & controle , Viroses/prevenção & controle , Anti-Infecciosos/uso terapêutico , Infecções Bacterianas/etiologia , Alemanha , Hematologia/organização & administração , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Oncologia/organização & administração , Micoses/etiologia , Doenças Parasitárias/etiologia , Guias de Prática Clínica como Assunto , Sociedades Médicas , Transplante Homólogo , Vacinação/métodos , Viroses/etiologia
7.
J Bacteriol ; 197(2): 307-13, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25368302

RESUMO

The bacterial strategy of chemotaxis relies on temporal comparisons of chemical concentrations, where the probability of maintaining the current direction of swimming is modulated by changes in stimulation experienced during the recent past. A short-term memory required for such comparisons is provided by the adaptation system, which operates through the activity-dependent methylation of chemotaxis receptors. Previous theoretical studies have suggested that efficient navigation in gradients requires a well-defined adaptation rate, because the memory time scale needs to match the duration of straight runs made by bacteria. Here we demonstrate that the chemotaxis pathway of Escherichia coli does indeed exhibit a universal relation between the response magnitude and adaptation time which does not depend on the type of chemical ligand. Our results suggest that this alignment of adaptation rates for different ligands is achieved through cooperative interactions among chemoreceptors rather than through fine-tuning of methylation rates for individual receptors. This observation illustrates a yet-unrecognized function of receptor clustering in bacterial chemotaxis.


Assuntos
Adaptação Fisiológica/fisiologia , Quimiotaxia/fisiologia , Escherichia coli/metabolismo , Escherichia coli/fisiologia , Proteínas de Bactérias/metabolismo
8.
EMBO J ; 30(9): 1719-29, 2011 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-21441899

RESUMO

In chemotactic bacteria, transmembrane chemoreceptors, CheA and CheW form the core signalling complex of the chemotaxis sensory apparatus. These complexes are organized in extended arrays in the cytoplasmic membrane that allow bacteria to respond to changes in concentration of extracellular ligands via a cooperative, allosteric response that leads to substantial amplification of the signal induced by ligand binding. Here, we have combined cryo-electron tomographic studies of the 3D spatial architecture of chemoreceptor arrays in intact E. coli cells with computational modelling to develop a predictive model for the cooperativity and sensitivity of the chemotaxis response. The predictions were tested experimentally using fluorescence resonance energy transfer (FRET) microscopy. Our results demonstrate that changes in lateral packing densities of the partially ordered, spatially extended chemoreceptor arrays can modulate the bacterial chemotaxis response, and that information about the molecular organization of the arrays derived by cryo-electron tomography of intact cells can be translated into testable, predictive computational models of the chemotaxis response.


Assuntos
Proteínas de Bactérias/metabolismo , Quimiotaxia/fisiologia , Escherichia coli/fisiologia , Proteínas de Membrana/metabolismo , Modelos Moleculares , Complexos Multiproteicos/metabolismo , Transdução de Sinais/fisiologia , Western Blotting , Microscopia Crioeletrônica , Escherichia coli/metabolismo , Proteínas de Escherichia coli , Transferência Ressonante de Energia de Fluorescência , Histidina Quinase , Ligantes , Proteínas Quimiotáticas Aceptoras de Metil , Complexos Multiproteicos/fisiologia
9.
Ann Hematol ; 94(9): 1441-50, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26193852

RESUMO

Reactivation of viral infections is common in patients with solid tumour or haematological malignancy. Incidence and severity depend on the extent of cellular immunosuppression. Antiviral prophylaxis may be effective to prevent viral reactivation. In 2006, the Infectious Diseases Working Party of German Society for Hematology and Medical Oncology (DGHO) published guidelines for antiviral prophylaxis in these patient populations. Here, we present an update of these guidelines for patients with solid and haematological malignancies undergoing antineoplastic treatment but not allogeneic stem cell transplantation. Relevant literature for reactivation of different viruses (herpes simplex virus (HSV), varicella zoster virus (VZV), hepatitis B virus (HBV) and respiratory viruses) is discussed to provide evidence-based recommendations for clinicians taking care of this patient population. We recommend a risk-adapted approach with (val)acyclovir against HSV and VZV in patients treated with alemtuzumab, bortezomib or purine analogues. Seasonal vaccination against influenza is recommended for all patients with solid or haematological malignancies regardless of antineoplastic therapy. Hepatitis B screening is recommended in lymphoproliferative disorders, acute leukaemia, and breast cancer, and during treatment with monoclonal anti-B-cell antibodies, anthracyclines, steroids and in autologous stem cell transplantation. In those with a history of hepatitis B prophylactic lamivudine, entecavir or nucleotide analogues as adefovir are recommended to prevent reactivation.


Assuntos
Antivirais/uso terapêutico , Neoplasias da Mama/terapia , Leucemia/terapia , Viroses/prevenção & controle , Doença Aguda , Antineoplásicos/uso terapêutico , Autoenxertos , Feminino , Alemanha , Hematologia , Humanos , Masculino , Oncologia , Guias de Prática Clínica como Assunto , Sociedades Médicas , Transplante de Células-Tronco
10.
PLoS Comput Biol ; 10(10): e1003870, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25340783

RESUMO

Sensory systems have evolved to respond to input stimuli of certain statistical properties, and to reliably transmit this information through biochemical pathways. Hence, for an experimentally well-characterized sensory system, one ought to be able to extract valuable information about the statistics of the stimuli. Based on dose-response curves from in vivo fluorescence resonance energy transfer (FRET) experiments of the bacterial chemotaxis sensory system, we predict the chemical gradients chemotactic Escherichia coli cells typically encounter in their natural environment. To predict average gradients cells experience, we revaluate the phenomenological Weber's law and its generalizations to the Weber-Fechner law and fold-change detection. To obtain full distributions of gradients we use information theory and simulations, considering limitations of information transmission from both cell-external and internal noise. We identify broad distributions of exponential gradients, which lead to log-normal stimuli and maximal drift velocity. Our results thus provide a first step towards deciphering the chemical nature of complex, experimentally inaccessible cellular microenvironments, such as the human intestine.


Assuntos
Microambiente Celular/fisiologia , Quimiotaxia/fisiologia , Biologia Computacional/métodos , Escherichia coli/fisiologia , Modelos Biológicos , Simulação por Computador , Teoria da Informação , Modelos Químicos
11.
Proc Natl Acad Sci U S A ; 109(30): 12159-64, 2012 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-22778402

RESUMO

Chemotaxis allows bacteria to follow gradients of nutrients, environmental stimuli, and signaling molecules, optimizing bacterial growth and survival. Escherichia coli has long served as a model of bacterial chemotaxis, and the signal processing by the core of its chemotaxis pathway is well understood. However, most of the research so far has focused on one branch of chemotactic signaling, in which ligands bind to periplasmic sensory domains of transmembrane chemoreceptors and induce a conformational change that is transduced across the membrane to regulate activity of the receptor-associated kinase CheA. Here we quantitatively characterize another, receptor-independent branch of chemotactic signaling that is linked to the sugar uptake through a large family of phosphotransferase systems (PTSs). Using in vivo characterization of intracellular signaling and protein interactions, we demonstrate that signals from cytoplasmic PTS components are transmitted directly to the sensory complexes formed by chemoreceptors, CheA and an adapter protein CheW. We further conclude that despite different modes of sensing, the PTS- and receptor-mediated signals have similar regulatory effects on the conformation of the sensory complexes. As a consequence, both types of signals become integrated and undergo common downstream processing including methylation-dependent adaptation. We propose that such mode of signaling is essential for efficient chemotaxis to PTS substrates and may be common to most bacteria.


Assuntos
Proteínas de Bactérias/metabolismo , Metabolismo dos Carboidratos/fisiologia , Quimiotaxia/fisiologia , Escherichia coli/enzimologia , Proteínas de Membrana/metabolismo , Fosfotransferases/metabolismo , Transdução de Sinais/fisiologia , Proteínas de Escherichia coli/metabolismo , Transferência Ressonante de Energia de Fluorescência , Histidina Quinase , Immunoblotting , Proteínas Quimiotáticas Aceptoras de Metil , Modelos Biológicos
12.
Int J Mol Sci ; 16(12): 29029-46, 2015 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-26690125

RESUMO

Stroke is one of the leading causes of death and long-term disability, with limited treatment options available. Inflammation contributes to damage tissue in the central nervous system across a broad range of neuropathologies, including Alzheimer's disease, pain, Schizophrenia, and stroke. While the immune system plays an important role in contributing to brain damage produced by ischemia, the damaged brain, in turn, can exert a powerful immune-suppressive effect that promotes infections and threatens the survival of stroke patients. Recently the cholinergic anti-inflammatory pathway, in particular its modulation using α7-nicotinic acetylcholine receptor (α7-nAChR) ligands, has shown potential as a strategy to dampen the inflammatory response and facilitate functional recovery in stroke patients. Here we discuss the current literature on stroke-induced inflammation and the effects of α7-nAChR modulators on innate immune cells.


Assuntos
Imunidade Inata , Inflamação/etiologia , Inflamação/imunologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/imunologia , Receptor Nicotínico de Acetilcolina alfa7/imunologia , Animais , Humanos , Imunidade Inata/efeitos dos fármacos , Inflamação/tratamento farmacológico , Inflamação/patologia , Células Mieloides/efeitos dos fármacos , Células Mieloides/imunologia , Células Mieloides/patologia , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/patologia , Receptor Nicotínico de Acetilcolina alfa7/agonistas
13.
EMBO J ; 29(20): 3484-95, 2010 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-20834231

RESUMO

In chemotaxis of Escherichia coli and other bacteria, extracellular stimuli are perceived by transmembrane receptors that bind their ligands either directly, or indirectly through periplasmic-binding proteins (BPs). As BPs are also involved in ligand uptake, they provide a link between chemotaxis and nutrient utilization by cells. However, signalling by indirectly binding ligands remains much less understood than signalling by directly binding ligands. Here, we compared intracellular responses mediated by both types of ligands and developed a new mathematical model for signalling by indirectly binding ligands. We show that indirect binding allows cells to better control sensitivity to specific ligands in response to their nutrient environment and to coordinate chemotaxis with ligand transport, but at the cost of the dynamic range being much narrower than for directly binding ligands. We further demonstrate that signal integration by the chemosensory complexes does not depend on the type of ligand. Overall, our data suggest that the distinction between signalling by directly and indirectly binding ligands is more physiologically important than the traditional distinction between high- and low-abundance receptors.


Assuntos
Proteínas de Bactérias/metabolismo , Quimiotaxia/fisiologia , Proteínas de Escherichia coli/metabolismo , Escherichia coli/fisiologia , Ligantes , Proteínas de Membrana/metabolismo , Transdução de Sinais/fisiologia , Proteínas de Bactérias/genética , Fatores Quimiotáticos/farmacologia , Quimiotaxia/efeitos dos fármacos , Relação Dose-Resposta a Droga , Escherichia coli/efeitos dos fármacos , Proteínas de Escherichia coli/genética , Humanos , Proteínas de Membrana/genética , Proteínas Quimiotáticas Aceptoras de Metil , Modelos Teóricos , Transdução de Sinais/efeitos dos fármacos
14.
Immunol Cell Biol ; 92(6): 535-42, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24687021

RESUMO

Particulate vaccine formulations, designed to improve the delivery of antigens to antigen-presenting cells (APCs) and to stimulate an immune response, have been shown to activate the NLRP3 inflammasome. This leads to the processing and secretion of interleukin (IL)-1ß, which supports the recruitment of pro-inflammatory immune cells into the tissue and can therefore be beneficial for vaccine potency. Recent work suggested that this may be a common mechanism of action for all particulate formulations. The aim of this study was to investigate whether the activation of the NLRP3 inflammasome was common to many delivery systems. We prepared polymer-based chitosan nanoparticles (CNPs), lipid-based cubosomes, a water in oil emulsion of incomplete Freund's adjuvant (IFA) and alum formulations and examined inflammasome activation in vitro using murine bone-marrow-derived dendritic cells and human peripheral blood mononuclear cells and in vivo in mice. The formulations differed in their morphology, size and zeta-potential. Only the positively charged particles (CNPs and alum) were able to activate the inflammasome and increase the secretion of IL-1ß. A decrease in the activation of the inflammasome with these particulates was observed when cathepsin B-mediated effects were blocked, implying a role of lysosomal rupture in the activation process. These findings demonstrate a role for the surface charge of particulates in the activation of the NLRP3 inflammasome, which should be considered when designing a novel vaccine formulation.


Assuntos
Adjuvantes Imunológicos/farmacologia , Proteínas de Transporte/imunologia , Inflamassomos/imunologia , Compostos de Alúmen/farmacologia , Animais , Catepsina B/imunologia , Quitosana/farmacologia , Feminino , Adjuvante de Freund/farmacologia , Humanos , Interleucina-1beta/imunologia , Masculino , Camundongos , Proteína 3 que Contém Domínio de Pirina da Família NLR , Nanopartículas
15.
Ann Hematol ; 93(9): 1449-56, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24951122

RESUMO

Invasive fungal infections cause substantial morbidity and mortality in immunocompromised patients, particularly in those with haematological malignancies and recipients of allogeneic haematopoietic stem cell transplantation. Difficulties in diagnosing invasive fungal infections and subsequent delays in treatment initiation lead to unfavourable outcomes and emphasise the importance of prophylaxis. Since the recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology in 2009, results of 14 additional clinical studies have been published comprising 2,899 patients and initiating this update. Key recommendations for adult patients are as follows: Posaconazole remains the drug of choice during remission-induction chemotherapy in acute myeloid leukaemia, myelodysplastic syndrome and allogeneic haematopoietic stem cell transplantation with graft versus host disease (AI). In the pre-engraftment period of allogeneic transplantation, several antifungals are appropriate and can be recommended with equal strength: voriconazole (BI), micafungin (BI), fluconazole (BI) and posaconazole (BII). There is poor evidence regarding antifungal prophylaxis in the post-engraftment period of allogeneic haematopoietic stem cell transplantation if no steroids for treatment of graft versus host disease are required. Aerosolised liposomal amphotericin B inhalation in conjunction with fluconazole can be used in patients with prolonged neutropenia (BII).


Assuntos
Antifúngicos/uso terapêutico , Quimioprevenção , Neoplasias Hematológicas/tratamento farmacológico , Micoses/prevenção & controle , Guias de Prática Clínica como Assunto , Prevenção Primária/normas , Adulto , Azóis/uso terapêutico , Quimioprevenção/métodos , Quimioprevenção/normas , Alemanha , Humanos , Hospedeiro Imunocomprometido , Infecções Oportunistas/prevenção & controle , Prevenção Primária/métodos , Sociedades Médicas/normas
16.
Ann Hematol ; 93(1): 13-32, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24026426

RESUMO

The Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) here presents its updated recommendations for the treatment of documented fungal infections. Invasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. In recent years, new antifungal agents have been licensed, and agents already approved have been studied in new indications. The choice of the most appropriate antifungal treatment depends on the fungal species suspected or identified, the patient's risk factors (e.g., length and depth of neutropenia), and the expected side effects. This guideline reviews the clinical studies that served as a basis for the following recommendations. All recommendations including the levels of evidence are summarized in tables to give the reader rapid access to the information.


Assuntos
Antifúngicos/uso terapêutico , Micoses/tratamento farmacológico , Neoplasias/complicações , Anfotericina B/administração & dosagem , Anfotericina B/efeitos adversos , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/etiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/prevenção & controle , Neutropenia Febril Induzida por Quimioterapia/complicações , Ensaios Clínicos como Assunto , Terapia Combinada , Monitoramento de Medicamentos , Quimioterapia Combinada , Equinocandinas/administração & dosagem , Equinocandinas/efeitos adversos , Equinocandinas/uso terapêutico , Fungemia/tratamento farmacológico , Fungemia/prevenção & controle , Humanos , Hospedeiro Imunocomprometido , Imunoterapia , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Aspergilose Pulmonar Invasiva/etiologia , Aspergilose Pulmonar Invasiva/cirurgia , Micoses/etiologia , Micoses/cirurgia , Micoses/terapia , Terapia de Salvação , Triazóis/administração & dosagem , Triazóis/efeitos adversos , Triazóis/uso terapêutico
18.
Ther Drug Monit ; 35(1): 63-70, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23318279

RESUMO

BACKGROUND: Meropenem is an effective ß-lactam antibiotic that is frequently used to treat serious infections in both intensive care unit (ICU) and febrile neutropenic hematology/oncology (Hem/Onc) patients. Studies suggest that to be effective, meropenem concentrations must be maintained above the inhibitory concentrations for the majority of a dosing interval. However, the pharmacokinetics (PK) of meropenem seem to differ in critically ill patients compared with healthy or less ill subjects used to select labeled dosing regimens. OBJECTIVES: This study was designed to investigate meropenem PK in critically ill patients and to see how often standard dosing regimens produced adequate plasma concentrations. A secondary objective was to investigate how achieved concentrations were related to outcomes (morbidity and mortality) in these patients. METHODS: Meropenem plasma concentrations over time were measured using a high pressure liquid chromatography assay in febrile Hem/Onc and ICU patients who were treated with standard meropenem dosing schedules. Outcomes such as fever control and survival were assessed in these patients and compared with individual meropenem PK data and with recommended target concentrations. RESULTS: A total of 25 subjects including 10 febrile Hem/Onc and 15 ICU patients with a variety of serious illnesses and baseline renal function were studied. Mean peak concentrations were less variable than were pre-dose concentrations. Post peak and trough concentrations were often below recommended minimum inhibitory concentrations. Both clearance and volumes of distribution were greater than reported in less ill subjects, only in part explained by increased renal clearance. Therefore, serum concentrations often did not exceed recommended concentration targets even for moderately sensitive organisms. Inadequate concentrations were especially common in the mostly ill, febrile neutropenic Hem/Onc subjects and seemed to explain at least some therapeutic failures. Conversely, drug accumulation occurred in ICU subjects with decreased renal function. CONCLUSIONS: Standard meropenem dosing regimens were inadequate in many critically ill febrile, neutropenic Hem/Onc, and septic ICU patients. These data suggest a role for meropenem concentration monitoring in such patients.


Assuntos
Antibacterianos/sangue , Antibacterianos/farmacocinética , Infecções/tratamento farmacológico , Infecções/metabolismo , Tienamicinas/sangue , Tienamicinas/farmacocinética , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Estado Terminal , Feminino , Humanos , Infecções/sangue , Unidades de Terapia Intensiva , Masculino , Meropeném , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Tienamicinas/uso terapêutico
19.
Front Immunol ; 14: 1152035, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37153625

RESUMO

Anti-tumour T cell responses play a crucial role in controlling the progression of colorectal cancer (CRC), making this disease a promising candidate for immunotherapy. However, responses to immune-targeted therapies are currently limited to subpopulations of patients and specific types of cancer. Clinical studies have therefore focussed on identifying biomarkers that predict immunotherapy responses and elucidating the immunological landscapes of different cancers. Meanwhile, our understanding of how preclinical tumour models resemble human disease has fallen behind, despite their crucial role in immune-targeted drug development. A deeper understanding of these models is therefore needed to improve the development of immunotherapies and the translation of findings made in these systems. MC38 colon adenocarcinoma is a widely used preclinical model, yet how it recapitulates human colorectal cancer remains poorly defined. This study investigated the tumour-T cell immune landscape of MC38 tumours using histology, immunohistochemistry, and flow cytometry. We demonstrate that early-stage tumours exhibit a nascent TME, lacking important immune-resistance mechanisms of clinical interest, while late-stage tumours exhibit a mature TME resembling human tumours, with desmoplasia, T cell exhaustion, and T cell exclusion. Consequently, these findings clarify appropriate timepoint selection in the MC38 model when investigating both immunotherapies and mechanisms that contribute to immunotherapy resistance. Overall, this study provides a valuable resource that will enable appropriate application of the MC38 model and expedite the development and clinical translation of new immunotherapies.


Assuntos
Adenocarcinoma , Neoplasias do Colo , Humanos , Imunoterapia , Citometria de Fluxo
20.
Food Funct ; 14(15): 7240-7246, 2023 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-37465883

RESUMO

Aims: Recent observational data indicate higher ultra-processed food intakes are associated with a broad range of adverse health outcomes. Experimental studies on why this might be are lacking. We have considered the effects of wholegrain processing on measures of appetite in free-living adults with type 2 diabetes. Materials and methods: Participants were randomised to two interventions of two-weeks duration, separated by washout. Interventions were nutrient-matched wholegrain foods that differed by the amount of processing. Self-reported hunger and satiety were indicated on visual analogue scales before or after meals for four days at baseline and the end of each intervention. Metabolite markers of appetite were measured pre and post intervention in fasting plasma. Results: 31 adults (63 ± 13 years old, BMI 32.4 ± 7, HbA1c 7.5 ± 3.4% (59 ± 14 mmol mol-1)) commenced the trial, 28 (90%) completed both interventions. Wholegrain consumption, as measured by alkylresorcinols, was balanced between interventions. Self-reported pre-meal hunger was consistently lower at breakfast (MD, mean difference 0.49/10 95% CI 0.03 to 0.94), lunch (MD 0.67/10 95% CI 0.09 to 1.25), and dinner (MD -0.71/10 95% CI 0.19 to 1.23) during the intervention of less processed whole grains when compared with pre-intervention measures, however this did not result in a difference between interventions. Change in metabolite markers of appetite did not differ between interventions. Conclusions: A significant difference in hunger or satiety between less and more processed whole grains over intervention periods of two weeks was not detected within the current trial. Further experimental studies are needed to consider the potential effects of food processing on physiological processes such as appetite to provide mechanistic understanding behind observations of highly processed food intakes and adverse health outcomes.


Assuntos
Apetite , Diabetes Mellitus Tipo 2 , Adulto , Humanos , Pessoa de Meia-Idade , Idoso , Grãos Integrais , Estudos Cross-Over , Ingestão de Energia , Fome
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