Picard, M; Weller, M (2010). Phase I/IIa study of cilengitide and temozolomide with concomitant radiotherapy followed by cilengitide and temozolomide maintenance therapy in patients with newly diagnosed glioblastoma. Patients and MethodsPatients (≥18 to ≤70 years) were treated with cilengitide (500 mg) administered twice weekly i.v. in addition to standard radiotherapy with comcomitant and adjuvant temozolomide. Treatment was continued until disease progression or for a maximum of 35 weeks. The primary endpoint was progression-free survival (PFS) at 6 months. ResultsFifty-two patients (median age 57 years; 62% male) were included. Six-and 12-month PFS rates were 69% (95% confidence interval [CI], 54-80%) and 33% (95% CI, 21-46%). Median PFS was 8 months (95% CI, 6.0-10.7). Twelve-and 24-month overall survival (OS) rates were 68% (95% CI, 53-79%) and 35% (95% CI, 22-48%). Median ConclusionCompared with historical controls, the addition of concomitant and adjuvant cilengitide to standard chemoradiation demonstrated promising activity in patients with glioblastoma with MGMT promoter methylation.5

Whether contact of an axon with a dendrite is a necessary inductive signal for the assembly of functional presynaptic machinery is controversial. Combining FM1-43 imaging with retrospective immunocytochemistry, we observe many functional synaptic vesicle (SV) release sites lacking postsynaptic specializations in cultured hippocampal neurons. These "orphan" release sites share the same exocytic machinery and mechanisms of endocytic recycling as mature synaptic sites. Moreover, quantitative analysis of FM1-43 destaining at these orphan release sites reveals similar kinetics with slightly lower release probabilities. Time-lapse imaging of FM1-43 reveals that orphans are generated by complete or partial mobilization of synaptic release sites that retain their functionality in transit. Orphan clusters fuse with existing synaptic release sites or form novel release sites onto dendrites. Mobilization and stabilization of orphan boutons to new sites of dendritic contact may represent a necessary presynaptic counterpart to postsynaptic changes observed during development and plasticity in the CNS.

Neuroserpin is a serine protease inhibitor of the serpin family that has been identified as an axonally secreted glycoprotein in neuronal cultures of chicken dorsal root ganglia. To obtain an indication for possible functions of neuroserpin, we analyzed its expression in the developing and the adult CNS of the mouse. In the adult CNS, neuroserpin was most strongly expressed in the neocortex, the hippocampal formation, the olfactory bulb, and the amygdala. In contrast, most thalamic nuclei, the caudate putamen, and the cerebellar granule cells were devoid of neuroserpin mRNA. During embryonic development, neuroserpin mRNA was not detectable in neuroepithelia, but it was expressed in the differentiating fields of most CNS regions concurrent with their appearance. In the cerebellum, the granule cells and a subgroup of Purkinje cells were neuroserpin-positive during postnatal development. As a further step toward the elucidation of neuroserpin function, we performed a study to identify potential target proteases. In vitro, neuroserpin formed SDS-stable complexes and inhibited the amidolytic activity of tissue plasminogen activator, urokinase, and plasmin. In contrast, no complex formation with or inhibition of thrombin was found. Expression pattern and inhibitory specificity implicate neuroserpin as a candidate regulator of plasminogen activators, which have been suggested to participate in the modulation or reorganization of synaptic connections in the adult. During development, neuroserpin may attenuate extracellular proteolysis related to processes such as neuronal migration, axogenesis, or the formation of mature synaptic connections.

Ceftaroline fosamil achieved high clinical cure and microbiological response rates in patients hospitalized with CAP of PORT risk class III or IV. Ceftaroline fosamil was well tolerated, with a safety profile that is similar to that of ceftriaxone and other cephalosporins. Ceftaroline fosamil is a promising agent for the treatment of CAP.

The acid-sensitive ion channel ASIC1 is a proton-gated ion channel from the mammalian nervous system. Its expression in sensory neurons and activation by low extracellular pH suggest that ASIC is involved in transmitting nociceptive impulses produced by the acidification caused by injury or inflammation. However, ASIC1 expression is not restricted to sensory neurons. To understand the functional role of ASIC1 in the CNS we investigated its expression and subcellular distribution therein. In particular, we examined the presence of ASIC1 in domains where the local pH may drop sufficiently to activate ASIC1 under physiological conditions. Immunostaining with specific antibodies revealed broad expression of ASIC1 in many areas of the adult rat brain including the cerebral cortex, hippocampus and cerebellum. Within cells, ASIC1 was found predominantly throughout the soma and along the branches of axons and dendrites. ASIC1 was not enriched in the microdomains where pH may reach low values, such as in synaptic vesicles or synaptic membranes. Pre-or postsynaptic ASIC1 was not gated by synaptic activity in cultured hippocampal neurons. Blockage or desensitization of ASIC1 with amiloride or pH 6.7, respectively, did not modify postsynaptic currents. Finally, the ontogeny of ASIC1 in mouse brain revealed constant levels of expression of ASIC1 protein from embryonic day 12 to the postnatal period, indicating an early and almost constant level of expression of ASIC1 during brain development.

The likelihood with which an action potential elicits neurotransmitter release, the release probability (p r ), is an important component of synaptic strength. Regulatory mechanisms controlling several steps of synaptic vesicle (SV) exocytosis may affect p r , yet their relative importance in determining p r and eliciting temporal changes in neurotransmitter release at individual synapses is largely unknown. We have investigated whether the size of the active zone cytomatrix is a major determinant of p r and whether changes in its size lead to corresponding alterations in neurotransmitter release. We have used a fluorescent sensor of SV exocytosis, synaptophysin-pHluorin, to measure p r at individual synapses with high accuracy and employed a fluorescently labeled cytomatrix protein, Bassoon, to quantify the amount of active zone cytomatrix present at these synapses. We find that, for synapses made by a visually identified presynaptic neuron, p r is indeed strongly correlated with the amount of active zone cytomatrix present at the presynaptic specialization. Intriguingly, active zone cytomatrices are frequently subject to synapse-specific changes in size on a time scale of minutes. These spontaneous alterations in active zone size are associated with corresponding changes in neurotransmitter release. Our results suggest that the size of the active zone cytomatrix has a large influence on the reliability of synaptic transmission. Furthermore, they implicate mechanisms leading to rapid structural alterations at active zones in synapse-specific forms of plasticity. release probability | synaptic vesicle docking | active zone cytomatrix | plasticity | pHluorin S ynaptic transmission between most neurons is unreliable as a presynaptic action potential elicits neurotransmitter (NT) release at any individual synapse with a release probability (p r ) of less than one. This probability can vary considerably among synapses of the same axon, often in a target-specific manner (1-3). Similarly, synapses onto a single neuron often display widely varying release probabilities (4-7). Moreover, p r can undergo sustained activity-dependent changes over time (8)(9)(10)(11). These observations suggest that p r is an important determinant of synaptic strength that is tightly controlled by the presynaptic neuron and/or, indirectly, by its postsynaptic target.Although numerous studies have highlighted specific regulatory mechanisms affecting p r of synapses at rest, a concise picture of how p r at individual synapses is determined is only beginning to emerge. Synaptic vesicle (SV) exocytosis is a multistep process during which SVs have to dock at the active zone cytomatrix and undergo a priming step before they are "readily releasable," i.e., immediately available for fusion with the plasma membrane in response to calcium influx through voltage-gated calcium channels (12). Evidence that the size of a synapse's readily releasable pool (RRP) of SVs is closely correlated with its p r (7, 13) suggests that p r is mainly determined by pro...

Background Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. Results The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the fixed cut-offs to only one for mild to moderate and one for severe disease (0.25 μg/L and 0.5 μg/L, respectively). Further, guidance on interpretation of PCT results to initiate, withhold or discontinue ABx treatment was included. Conclusions A combination of clinical patient assessment with PCT levels in well-defined ABS algorithms, in context with continuous education and regular feedback to all ABS stakeholders, has the potential to improve the diagnostic and therapeutic management of patients suspected of bacterial infection, thereby improving ABS effectiveness.

Neuroserpin is an axonally secreted serine proteinase inhibitor that is expressed in neurons during embryogenesis and in the adult nervous system. To identify target proteinases, we used a eucaryotic expression system based on the mouse myeloma cell line J558L and vectors including a promoter from an Ig--variable region, an Ig-enhancer, and the exon encoding the Igconstant region (C) and produced recombinant neuroserpin as a wild-type protein or as a fusion protein with C. We investigated the capability of recombinant neuroserpin to form SDS-stable complexes with, and to reduce the amidolytic activity of, a variety of serine proteinases in vitro. Consistent with its primary structure at the reactive site, neuroserpin exhibited inhibitory activity against trypsin-like proteinases. Although neuroserpin bound and inactivated plasminogen activators and plasmin, no interaction was observed with thrombin. A reactive site mutant of neuroserpin neither formed complexes with nor inhibited the amidolytic activity of any of the tested proteinases. Kinetic analysis of the inhibitory activity revealed neuroserpin to be a slow binding inhibitor of plasminogen activators and plasmin. Thus, we postulate that neuroserpin could represent a regulatory element of extracellular proteolytic events in the nervous system mediated by plasminogen activators or plasmin.Extracellular proteolysis exerted by serine proteinases has been implicated in a variety of processes in the nervous system during development and in adulthood. Among the serine proteinases recently reported to play a role in neural development and function, there are several well known proteins that had previously been found and characterized in nonneuronal functions, in particular blood coagulation and fibrinolysis. For example, tissue-type plasminogen activator (tPA) 1 and urokinase plasminogen activator (uPA) were found to be expressed in the nervous system (1, 2), and they have been demonstrated to be engaged in developmental processes such as cerebellar granule cell migration (3, 4), Schwann cell migration, and wrapping of axons (5), or neuromuscular synapse elimination (6). In the period of neurite outgrowth, plasminogen activators (PAs) have been found to be secreted at the growth cones of cultured neurons or neuronal cell lines (7,8), and they were demonstrated to modify the molecular composition of the neurites' substrata in vitro (9). In the adult nervous system, tPA is induced in the hippocampus after seizure, kindling, and long term potentiation (LTP) (10) and in the cerebellum after motor learning tasks (11), and mice lacking the gene for tPA (12) show a different form of hippocampal LTP (13,14). Furthermore, tPA has been demonstrated to be involved in excitotoxin-induced neuronal cell death in the murine hippocampus by converting locally secreted plasminogen to active plasmin (15, 16). Thrombin, which has been extensively characterized due to its important function in the blood clotting system, has been reported to be expressed in the nervous system (17). I...