Untersuchungen zur autoimmunen Genese der thrombotisch thrombozytopenischen Purpura

Untersuchungen zur autoimmunen Genese der thrombotisch thrombozytopenischen Purpura. rnEinführung: Die idiopathische thrombotisch thrombozytopenische Purpura (TTP) ist eine lebensbedrohliche Mikroangiopathie und wird durch ein Autoantikörper-induziertes Defizit der ADAMTS13-Protease ausgelöst. Eine Assoziation zwischen Krankheitsprädisposition und Vorliegen bestimmter humaner Leukozytenantigene (HLA) wird vermutet. Untersuchungen zu diesem Zusammenhang stellen einen Teil dieser Arbeit dar. rnAutoimmunkrankheiten tendieren zum gemeinsamen Auftreten innerhalb eines Individuums. Im zweiten Teil dieser Arbeit wird untersucht, ob eine solche Kookkurrenz verschiedener Autoimmunkrankheiten auch bei Patienten mit idiopathischer TTP beobachtet werden kann.rnMethodik: Zur Untersuchung der ersten Fragestellung werden die HLA-Klasse I und II-Merkmale von 54 deutschen TTP-Patienten bestimmt. Alle Patienten weisen Autoantikörper gegen ADAMTS13 und eine Protease-Aktivität <5% vor. Die Blutproben werden mittels Sequence Specific Primer-Polymerase Chain Reaction (PCR) und Sequence Specific Oligonucleotid-PCR auf HLA-DRB1, -DRB3-5 und –DQB1 untersucht. Als Referenz dienen die Werte deutscher Knochenmark- und Blutspender, erhalten über www.allelefrequencies.net. Die statistische Auswertung erfolgt mittels zweiseitigem Binomialtest und die resultierenden p-Werte werden nach Benjamini-Hochberg korrigiert.rnZur Beantwortung der zweiten Fragestellung werden 76 deutsche TTP-Patienten anhand eines standardisierten Fragebogens nach Begleiterkrankungen befragt. Als Vergleichswerte dient die Prävalenz der jeweiligen Erkrankung in der Allgemeinbevölkerung. Die statistische Auswertung erfolgt mittels zweiseitigem Binomialtest. Da die p-Werte nicht korrigiert werden, sind die Ergebnisse nur deskriptiv zu verstehen.rnErgebnis: Der Vergleich der HLA-Frequenzen ergibt ein signifikant gehäuftes Vorkommen von HLA-DQB1*02:02 (p<0,001) und -DRB1*11 (p=0,003) innerhalb des Patientenkollektivs. 20% (DQB1*02:02) bzw. 48,1% (DRB1*11) der TTP-Patienten sind im Gegensatz zu nur 1,2% (DQB1*02:02) bzw. 23,5% (DRB1*11) innerhalb der Vergleichsgruppe für das jeweilige HLA-Merkmal positiv.rnDie Befragung der TTP-Patienten bezüglich weiterer Erkrankungen ergab im Vergleich mit der Allgemeinbevölkerung fünf auffällig häufig im Patientenkollektiv vorkommende Autoimmunkrankheiten: Hashimoto Thyreoiditis (23,5% in der Patientengruppe zu 0,7% in der Allgemeinbevölkerung; p<0,001), systemischer Lupus erythematodes (6,5% der Patienten im Gegensatz zu 0,025% in der Allgemeinbevölkerung, p<0,001), Immunthrombozytopenie (6,3% der Patienten zu 0,02% in der Allgemeinbevölkerung; p<0,001), Psoriasis (9,4% der Patienten zu 2,5% in der Allgemeinbevölkerung; p=0,005) und glutensensitive Enteropathie (3,1% der Patienten zu 0,2% in der Allgemeinbevölkerung; p=0,007). rnSchlussfolgerung: Das vermehrte Vorkommen bestimmter HLA-Merkmale im Patientenkollektiv spricht für eine prädisponierende Wirkung dieser Antigene im Krankheitsgeschehen. Eine mögliche HLA-vermittelte Assoziation zwischen TTP und den genannten Autoimmunkrankheiten wird vermutet, kann jedoch nicht in allen Fällen die beobachtete Kookkurrenz ausreichend erklären. Insgesamt bestätigt die vorliegende Arbeit die Assoziation verschiedener Autoimmunkrankheiten untereinander und spricht für eine genetische Prädisposition zur Ausbildung autoimmuner Störungen. rn

Hydrodynamics and solid dosage form disintegration/dissolution : immediate release tablets and novel in situ polyelectrolyte gastroretentive drug delivery systems

Solid oral dosage form disintegration in the human stomach is a highly complex process dependent on physicochemical properties of the stomach contents as well as on physical variables such as hydrodynamics and mechanical stress. Understanding the role of hydrodynamics and forces in disintegration of oral solid dosage forms can help to improve in vitro disintegration testing and the predictive power of the in vitro test. The aim of this work was to obtain a deep understanding of the influence of changing hydrodynamic conditions on solid oral dosage form performance. Therefore, the hydrodynamic conditions and forces present in the compendial PhEur/USP disintegration test device were characterized using a computational fluid dynamics (CFD) approach. Furthermore, a modified device was developed and the hydrodynamic conditions present were simulated using CFD. This modified device was applied in two case studies comprising immediate release (IR) tablets and gastroretentive drug delivery systems (GRDDS). Due to the description of movement provided in the PhEur, the movement velocity of the basket-rack assembly follows a sinusoidal profile. Therefore, hydrodynamic conditions are changing continually throughout the movement cycle. CFD simulations revealed that the dosage form is exposed to a wide range of fluid velocities and shear forces during the test. The hydrodynamic conditions in the compendial device are highly variable and cannot be controlled. A new, modified disintegration test device based on computerized numerical control (CNC) technique was developed. The modified device can be moved in all three dimensions and radial movement is also possible. Simple and complex moving profiles can be developed and the influence of the hydrodynamic conditions on oral solid dosage form performance can be evaluated. Furthermore, a modified basket was designed that allows two-sided fluid flow. CFD simulations of the hydrodynamics and forces in the modified device revealed significant differences in the fluid flow field and forces when compared to the compendial device. Due to the CNC technique moving velocity and direction are arbitrary and hydrodynamics become controllable. The modified disintegration test device was utilized to examine the influence of moving velocity on disintegration times of IR tablets. Insights into the influence of moving speed, medium viscosity and basket design on disintegration times were obtained. An exponential relationship between moving velocity of the modified basket and disintegration times was established in simulated gastric fluid. The same relationship was found between the disintegration times and the CFD predicted average shear stress on the tablet surface. Furthermore, a GRDDS was developed based on the approach of an in situ polyelectrolyte complex (PEC). Different complexes composed of different grades of chitosan and carrageenan and different ratios of those were investigated for their swelling behavior, mechanical stability, and in vitro drug release. With an optimized formulation the influence of changing hydrodynamic conditions on the swelling behavior and the drug release profile was demonstrated using the modified disintegration test device. Both, swelling behavior and drug release, were largely dependent on the hydrodynamic conditions. Concluding, it has been shown within this thesis that the application of the modified disintegration test device allows for detailed insights into the influence of hydrodynamic conditions on solid oral dosage form disintegration and dissolution. By the application of appropriate test conditions, the predictive power of in vitro disintegration testing can be improved using the modified disintegration test device. Furthermore, CFD has proven a powerful tool to examine the hydrodynamics and forces in the compendial as well as in the modified disintegration test device. rn

High precision swept volume approximation with conservative error bounds

In technical design processes in the automotive industry, digital prototypes rapidly gain importance, because they allow for a detection of design errors in early development stages. The technical design process includes the computation of swept volumes for maintainability analysis and clearance checks. The swept volume is very useful, for example, to identify problem areas where a safety distance might not be kept. With the explicit construction of the swept volume an engineer gets evidence on how the shape of components that come too close have to be modified.rnIn this thesis a concept for the approximation of the outer boundary of a swept volume is developed. For safety reasons, it is essential that the approximation is conservative, i.e., that the swept volume is completely enclosed by the approximation. On the other hand, one wishes to approximate the swept volume as precisely as possible. In this work, we will show, that the one-sided Hausdorff distance is the adequate measure for the error of the approximation, when the intended usage is clearance checks, continuous collision detection and maintainability analysis in CAD. We present two implementations that apply the concept and generate a manifold triangle mesh that approximates the outer boundary of a swept volume. Both algorithms are two-phased: a sweeping phase which generates a conservative voxelization of the swept volume, and the actual mesh generation which is based on restricted Delaunay refinement. This approach ensures a high precision of the approximation while respecting conservativeness.rnThe benchmarks for our test are amongst others real world scenarios that come from the automotive industry.rnFurther, we introduce a method to relate parts of an already computed swept volume boundary to those triangles of the generator, that come closest during the sweep. We use this to verify as well as to colorize meshes resulting from our implementations.