ChariteUniversity Medicine Berlin

Berlin, Germany

ChariteUniversity Medicine Berlin

Berlin, Germany
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Thuss-Patience P.C.,ChariteUniversity Medicine Berlin | Shah M.A.,New York Medical College | Ohtsu A.,National Cancer Center Hospital | Van Cutsem E.,Catholic University of Leuven | And 11 more authors.
The Lancet Oncology | Year: 2017

Background Although trastuzumab plus chemotherapy is the standard of care for first-line treatment of HER2-positive advanced gastric cancer, there is no established therapy in the second-line setting. In GATSBY, we examined the efficacy and tolerability of trastuzumab emtansine in patients previously treated for HER2-positive advanced gastric cancer (unresectable, locally advanced, or metastatic gastric cancer, including adenocarcinoma of the gastro-oesophageal junction). Methods This is the final analysis from GATSBY, a randomised, open-label, adaptive, phase 2/3 study, done at 107 centres (28 countries worldwide). Eligible patients had HER2-positive advanced gastric cancer and progressed during or after first-line therapy. In stage one of the trial, patients were randomly assigned to treatment groups (2:2:1) to receive intravenous trastuzumab emtansine (3·6 mg/kg every 3 weeks or 2·4 mg/kg weekly) or physician's choice of a taxane (intravenous docetaxel 75 mg/m2 every 3 weeks or intravenous paclitaxel 80 mg/m2 weekly). In stage two, patients were randomly assigned to treatment groups (2:1) to receive the independent data monitoring committee (IDMC)-selected dose of trastuzumab emtansine (2·4 mg/kg weekly) or a taxane (same regimen as above). We used permuted block randomisation, stratified by world region, previous HER2-targeted therapy, and previous gastrectomy. The primary endpoint (overall survival) was assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01641939. Findings Between Sept 3, 2012, and Oct 14, 2013, 70 patients were assigned to receive trastuzumab emtansine 3·6 mg/kg every 3 weeks, 75 to receive trastuzumab emtansine 2·4 mg/kg weekly, and 37 to receive a taxane in the stage 1 part of the trial. At the pre-planned interim analysis (Oct 14, 2013), the IDMC selected trastuzumab emtansine 2·4 mg/kg weekly as the dose to proceed to stage 2. By Feb 9, 2015, a further 153 patients had been randomly assigned to receive trastuzumab emtansine 2·4 mg/kg weekly and a further 80 to receive a taxane. At data cutoff, median follow-up was 17·5 months (IQR 12·1–23·0) for the trastuzumab emtansine 2·4 mg/kg weekly group and 15·4 months (9·2–18·1) in the taxane group. Median overall survival was 7·9 months (95% CI 6·7–9·5) with trastuzumab emtansine 2·4 mg/kg weekly and 8·6 months (7·1–11·2) with taxane treatment (hazard ratio 1·15, 95% CI 0·87–1·51, one-sided p=0·86). The trastuzumab emtansine 2·4 mg/kg group had lower incidences of grade 3 or more adverse events (134 [60%] of 224 patients treated with trastuzumab emtansine vs 78 [70%] of 111 patients treated with a taxane), and similar incidences of adverse events leading to death (eight [4%] vs four [4%]), serious adverse events (65 [29%] vs 31 [28%]), and adverse events leading to treatment discontinuation (31 [14%] vs 15 [14%]) than did taxane treatment. The most common grade 3 or more adverse events in the trastuzumab emtansine 2·4 mg/kg weekly group were anaemia (59 [26%]) and thrombocytopenia (25 [11%]) compared with neutropenia (43 [39%]), and anaemia (20 [18%]), in the taxane group. The most common serious adverse events were anaemia (eight [4%]), upper gastrointestinal haemorrhage (eight [4%]), pneumonia (seven [3%]), gastric haemorrhage (six [3%]), and gastrointestinal haemorrhage (five [2%]) in the trastuzumab emtansine 2·4 mg/kg weekly group compared with pneumonia (four [4%]), febrile neutropenia (four [4%]), anaemia (three [3%]), and neutropenia (three [3%]) in the taxane group. Interpretation Trastuzumab emtansine was not superior to taxane in patients with previously treated, HER2-positive advanced gastric cancer. There is still an unmet need in this patient group and therapeutic options remain limited. Funding F Hoffmann-La Roche. © 2017 Elsevier Ltd


Schachtner T.,ChariteUniversity Medicine Berlin | Mu ller K.,ChariteUniversity Medicine Berlin | Stein M.,ChariteUniversity Medicine Berlin | Diezemann C.,ChariteUniversity Medicine Berlin | And 3 more authors.
American Journal of Transplantation | Year: 2011

Impaired BKV-specific immunity is associated with development of BKV-associated nephropathy. Suitable immunological parameters to identify patients at risk, however, are still debated. We monitored 18 kidney-transplant recipients through the course of selflimited BKV-reactivation (n = 11) and BKV-associated nephropathy (n = 7). BKV-specific cellular immunity directed to nonstructural small and Large T-antigen, and structural VP1-3 was analyzed in an interferon-c Elispot assay. BKV-specific IgM and IgGweremeasured using an enzyme-linked immunosorbent assay simultaneously. BKV-specific cellular immunity directed to five BKV-proteins increased significantly from diagnosis to resolution of BKV-reactivation (p < 0.001). Patients with self-limited BKV-reactivation developed BKV-specific T cells without therapeutic interventions, and cleared BKV-reactivation within a median period of 1 month. Patients with BKV-associated nephropathy, however, showed BKV-specific T cells after a median period of 5 months after therapeutic interventions only, and cleared BKV-reactivation after a median period of 8 months. Anti-structural T cells were detected earlier than anti-nonstructural T cells, which coincided with BKV-clearance. Patients with BKV-associated nephropathy showed the highest frequencies of BKV-specific T cells at recovery, the highest increase in BKV-specific IgG and persistence of increased IgM levels (p < 0.05). Our results suggest prognostic values of BKV-specific immune monitoring to identify those patients at risk of BKV-associated nephropathy and to aid in the management of therapeutic interventions. © Copyright 2011 The American Society of Transplantation.


Waterstraat G.,ChariteUniversity Medicine Berlin | Curio G.,ChariteUniversity Medicine Berlin | Nikulin V.V.,ChariteUniversity Medicine Berlin | Nikulin V.V.,Max Planck Institute for Human Cognitive and Brain Sciences | Nikulin V.V.,National Research University Higher School of Economics
NeuroImage | Year: 2017

Introduction Neuronal oscillations synchronize processing in the brain over large spatiotemporal scales and thereby facilitate integration of individual functional modules. Up to now, the relation between the phases of neuronal oscillations and behavior or perception has mainly been analyzed in sensor space of multivariate EEG/MEG recordings. However, sensor-space analysis distorts the topographies of the underlying neuronal sources and suffers from low signal-to-noise ratio. Instead, we propose an optimized source reconstruction approach (Phase Coupling Optimization, PCO). Methods PCO maximizes the ‘mean vector length’, calculated from the phases of recovered neuronal sources and a target variable of interest (e.g., experimental performance). As pre-processing, the signal-to-noise ratio in the search-space is maximized by spatio-spectral decomposition. PCO was benchmarked against several competing algorithms and sensor-space analysis using realistic forward model simulations. As a practical example, thirteen 96-channel EEG measurements during a simple reaction time task were analyzed. After time-frequency decomposition, PCO was applied to the EEG to examine the relation between the phases of pre-stimulus EEG activity and reaction times. Results In simulations, PCO outperformed other spatial optimization approaches and sensor-space analysis. Scalp topographies of the underlying source patterns and the relation between the phases of the source activity and the target variable could be reconstructed accurately even for very low SNRs (−10 dB). In a simple reaction time experiment, the phases of pre-stimulus delta waves (<0.1 Hz) with widely distributed fronto-parietal source topographies were found predictive of the reaction times. Discussion and conclusions From multivariate recordings, PCO can reconstruct neuronal sources that are phase-coupled to a target variable using a data-driven optimization approach. Its superiority has been shown in simulations and in the analysis of a simple reaction time experiment. From this data, we hypothesize that the phase entrainment of slow delta waves (<1 Hz) facilitates sensorimotor integration in the brain and that this mechanism underlies the faster processing of anticipated stimuli. We further propose that the examined slow delta waves, observed to be phase-coupled to reaction times, correspond to the compound potentials typically observed in paradigms of stimulus anticipation and motor preparation. © 2017 Elsevier Inc.


Heimesaat M.M.,ChariteUniversity Medicine Berlin | Grundmann U.,ChariteUniversity Medicine Berlin | Alutis M.E.,ChariteUniversity Medicine Berlin | Fischer A.,ChariteUniversity Medicine Berlin | Bereswill S.,ChariteUniversity Medicine Berlin
Frontiers in Cellular and Infection Microbiology | Year: 2017

Human Campylobacter jejuni-infections are progressively increasing worldwide. Despite their high prevalence and socioeconomic impact the underlying mechanisms of pathogen-host-interactions are only incompletely understood. Given that the innate immune receptor nucleotide-oligomerization-domain-2 (Nod2) is involved in clearance of enteropathogens, we here evaluated its role in murine campylobacteriosis. To address this, we applied Nod2-deficient IL-10−/− (Nod2−/− IL-10−/− ) mice and IL-10−/− counterparts both with a depleted intestinal microbiota to warrant pathogen-induced enterocolitis. At day 7 following peroral C. jejuni strain 81–176 infection, Nod2 mRNA was down-regulated in the colon of secondary abiotic IL-10−/− and wildtype mice. Nod2-deficiency did neither affect gastrointestinal colonization nor extra-intestinal and systemic translocation properties of C. jejuni. Colonic mucin-2 mRNA was, however, down-regulated upon C. jejuni-infection of both Nod2−/− IL-10−/− and IL-10−/− mice, whereas expression levels were lower in infected, but also naive Nod2−/− IL-10−/− mice as compared to respective IL-10−/− controls. Remarkably, C. jejuni-infected Nod2−/− IL-10−/− mice were less compromised than IL-10−/− counterparts and displayed less distinct apoptotic, but higher regenerative cell responses in colonic epithelia. Conversely, innate as well as adaptive immune cells such as macrophages and monocytes as well as T lymphocytes and regulatory T-cells, respectively, were even more abundant in large intestines of Nod2−/− IL-10−/− as compared to IL-10−/− mice at day 7 post-infection. Furthermore, IFN-γ concentrations were higher in ex vivo biopsies derived from intestinal compartments including colon and mesenteric lymph nodes as well as in systemic tissue sites such as the spleen of C. jejuni infected Nod2−/− IL-10−/− as compared to IL10−/− counterparts. Whereas, at day 7 postinfection anti-inflammatory IL-22 mRNA levels were up-regulated, IL-18 mRNA was down-regulated in large intestines of Nod2−/− IL-10−/− vs. IL-10−/− mice. In summary, C. jejuni-infection induced less clinical signs and apoptosis, but more distinct colonic pro- and (of note) anti-inflammatory immune as well as regenerative cell responses in Nod2 deficient IL-10−/− as compared to IL-10−/− control mice. We conclude that, even though colonic Nod2 mRNA was down-regulated upon pathogenic challenge, Nod2-signaling is essentially involved in the well-balanced innate and adaptive immune responses upon C. jejuni-infection of secondary abiotic IL-10−/− mice, but does neither impact pathogenic colonization nor translocation. © 2017 Heimesaat, Grundmann, Alutis, Fischer and Bereswill.


Sturm I.,Humboldt University of Berlin | Sturm I.,TU Berlin | Sturm I.,ChariteUniversity Medicine Berlin | Biankertz B.,TU Berlin | And 9 more authors.
Frontiers in Human Neuroscience | Year: 2014

Listening to music moves our minds and moods, stirring interest in its neural underpinnings. A multitude of compositional features drives the appeal of natural music. How such original music, where a composer's opus is not manipulated for experimental purposes, engages a listener's brain has not been studied until recently. Here, we report an in-depth analysis of two electrocorticographic (ECoG) data sets obtained over the left hemisphere in ten patients during presentation of either a rock song or a read-out narrative. First, the time courses of five acoustic features (intensity, presence/absence of vocals with lyrics, spectral centroid, harmonic change, and pulse clarity) were extracted from the audio tracks and found to be correlated with each other to varying degrees. In a second step, we uncovered the specific impact of each musical feature on ECoG high-gamma power (70-170 Hz) by calculating partial correlations to remove the influence of the other four features. In the music condition, the onset and offset of vocal lyrics in ongoing instrumental music was consistently identified within the group as the dominant driver for ECoG high-gamma power changes over temporal auditory areas, while concurrently subject-individual activation spots were identified for sound intensity, timbral, and harmonic features. The distinct cortical activations to vocal speech-related content embedded in instrumental music directly demonstrate that song integrated in instrumental music represents a distinct dimension in complex music. In contrast, in the speech condition, the full sound envelope was reflected in the high gamma response rather than the onset or offset of the vocal lyrics. This demonstrates how the contributions of stimulus features that modulate the brain response differ across the two examples of a full-length natural stimulus, which suggests a context-dependent feature selection in the processing of complex auditory stimuli. © 2014 Sturm, Blankertz, Potes, Schalk and Curio.


Heinz A.,ChariteUniversity Medicine Berlin | Muller D.J.,University of Toronto | Krach S.,University of Marburg | Cabanis M.,Center for Mental Health | Kluge U.P.,ChariteUniversity Medicine Berlin
Frontiers in Human Neuroscience | Year: 2014

The aim of this Hypothesis and Theory is to question the recently increasing use of the “race” concept in contemporary genetic, psychiatric, neuroscience as well as social studies. We discuss “race” and related terms used to assign individuals to distinct groups and caution that also concepts such as “ethnicity” or “culture” unduly neglect diversity. We suggest that one factor contributing to the dangerous nature of the “race” concept is that it is based on a mixture of traditional stereotypes about “physiognomy”, which are deeply imbued by colonial traditions. Furthermore, the social impact of “race classifications” will be critically reflected. We then examine current ways to apply the term “culture” and caution that while originally derived from a fundamentally different background, “culture” is all too often used as a proxy for “race”, particularly when referring to the population of a certain national state or wider region. When used in such contexts, suggesting that all inhabitants of a geographical or political unit belong to a certain “culture” tends to ignore diversity and to suggest a homogeneity, which consciously or unconsciously appears to extend into the realm of biological similarities and differences. Finally, we discuss alternative approaches and their respective relevance to biological and cultural studies. © 2014 Heinz, Müller, Krach, Cabanis and Kluge.


Dorner T.,ChariteUniversity Medicine Berlin | Lipsky P.E.,RILITE Foundation
Nature Reviews Rheumatology | Year: 2016

New insights into the mechanisms of autoimmune diseases have been obtained not only from preclinical studies, but also from clinical trials of pan-B-cell-directed therapy. Overall, the results of these clinical trials suggest that more-specific approaches focusing on pathogenic B-cell functions, and perhaps sparing or even enhancing regulatory B-cell activity, might be attractive alternatives. Importantly, pathogenic B-cell subpopulations function within a network of cellular interactions, many of which might require additional interventions to restore immunologic balance and suppress autoimmune disease. Thus, approaches that simultaneously target innate immune cells as well as multiple nodes of T-cell and B-cell interactions might hold the promise of improved therapeutic efficacy. Interfering with B-cell intracellular signalling pathways, altering their intracellular metabolic pathways and perturbing transcription factors are additional options. This Review critically analyses these approaches, examines the role of cytokines and other functions of B-lineage cells separate from antibody secretion, and provides insights into the potential next generation of therapies targeting B-lineage cells. © 2016 Macmillan Publishers Limited, part of Springer Nature.


Funke-Kaiser H.,ChariteUniversity Medicine Berlin | Zollmann F.S.,ChariteUniversity Medicine Berlin | Schefe J.H.,ChariteUniversity Medicine Berlin | Unger T.,ChariteUniversity Medicine Berlin
Hypertension Research | Year: 2010

The (pro)renin receptor ((P)RR) not only represents a novel component of the renin-angiotensin system but is also a promising novel drug target because of its crucial involvement in the pathogenesis of renal and cardiac end-organ damage. This review discusses the signal transduction of the (P)RR with its adapter protein promyelocytic zinc-finger protein, the impact of this receptor, especially on cardiovascular disease, and its putative interaction with renin inhibitors such as aliskiren. Furthermore, the increasing complexity regarding the cellular function of the (P)RR is addressed, which arises by the intimate link with proton pumps and the phosphatase PRL-1, as well as by the presence of different subcellular localizations and of a soluble isoform of the (P)RR. Finally, the rationale and strategy for the development of small-molecule antagonists of the (P)RR, called renin/prorenin receptor blockers, are presented. © 2010 The Japanese Society of Hypertension All rights reserved.


Eckstein J.,ChariteUniversity Medicine Berlin | Berndt N.,ChariteUniversity Medicine Berlin | Holzhutter H.-G.,ChariteUniversity Medicine Berlin
PLoS Computational Biology | Year: 2015

The bile fluid contains various lipids that are secreted at the canalicular membrane of hepatocytes. As the secretion mechanism is still a matter of debate and a direct experimental observation of the secretion process is not possible so far, we used a mathematical model to simulate the extraction of the major bile lipids cholesterol, phosphatidylcholine and sphingomyelin from the outer leaflet of the canalicular membrane. Lipid diffusion was modeled as random movement on a triangular lattice governed by next-neighbor interaction energies. Phase separation in liquid-ordered and liquid-disordered domains was modeled by assigning two alternative ordering states to each lipid species and minimization of next-neighbor ordering energies. Parameterization of the model was performed such that experimentally determined diffusion rates and phases in ternary lipid mixtures of model membranes were correctly recapitulated. The model describes the spontaneous formation of nanodomains in the external leaflet of the canalicular membrane in a time window between 0.1 ms to 10 ms at varying lipid proportions. The extraction of lipid patches from the bile salt soluble nanodomain into the bile reproduced observed biliary phospholipid compositions for a physiologi-cal membrane composition. Comparing the outcome of model simulations with available experi-mental observations clearly favors the extraction of tiny membrane patches composed of about 100–400 lipids as the likely mechanism of biliary lipid secretion. © 2015 Eckstein et al.


Schwabe P.,ChariteUniversity Medicine Berlin | Altintas B.,ChariteUniversity Medicine Berlin | Schaser K.-D.,ChariteUniversity Medicine Berlin | Druschel C.,ChariteUniversity Medicine Berlin | And 3 more authors.
Journal of Orthopaedic Trauma | Year: 2014

Objective: Anatomic reduction and articular restoration after acetabular fractures occur (Ac-Fxs) are accepted predictors for good function and slow progression of posttraumatic osteoarthritis of the hip. The aim of this study was to retrospectively analyze Ac-Fxs, which were treated with closed reduction and percutaneous (threedimensional) fluoroscopy-based navigated screw fixation.Design: Level 4, retrospective clinical and radiographic assessment.\r\nSetting: Level 1 trauma center.\r\nPatients: Twelve patients (male/female: 9/3; mean age: 60 years; range: 16-80 years) with moderately displaced Ac-Fxs were included. Intervention: In enrolled patients, the treatment involved percutaneous three-dimensional fluoroscopy-based navigated lag screw positioning. Closed reduction was achieved by lag screws, or reduction was aided by the insertion of percutaneous Schanz pins. Main Outcome Measurements: The quality of the reduction and screw positions were assessed using intraoperative and postoperative computed tomography scans. Functional outcome was assessed using the Harris hip score, the visual analog scale for pain, and the Tegener activity scale.\r\nResults: A total of 22 periacetabular screws were placed (mean: 1.8 ± 1.1 screws/patient, range: 1-5). The mean follow-up was done for 30 (16-72) months. The postoperative reduction was anatomical in all patients, and the mean fracture displacement was significantly reduced (gap: 4.1 ± 1.8 mm to 0.4 ± 0.7 mm/step: 1.4 ± 0.6 mm to 0.2 ± 0.4 mm). No secondary dislocations or malunions/nonunions were found. All screws correctly addressed the fracture morphology and corresponded to preoperative planning. The Harris hip score, the visual analog scale (motion), and Tegener activity scale showed excellent to very good results (92.4 ± 6.8, 1.9 ± 1.3, and 3.8 ± 1.6, respectively).\r\nConclusions: The navigated, percutaneous screw fixation of selected Ac-Fxs is a promising method that allows for closed reduction and fixation while obtaining a very good radiographic and functional outcome. © 2014 Lippincott Williams & Wilkins.

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