Molekulargenetische Untersuchungen zur Reblausresistenz bei der Unterlagsrebe Börner

Dass Pflanzen gegen phytopathogene Infektionen resistent sind, ist das Ergebnis von multip-len Abwehrreaktionen. Eine solche ist auch die Hypersensitivitätsreaktion (HR). Sie ist die Folge eines Befalls von Börner mit Rebläusen und zeigt sich an Blättern und Wurzeln der resistenten Unterlagsrebe in Form von lokalen Nekrosen. Die Erzeugung von neuen, trans-genen reblausresistenten Unterlagsreben verlangt präzise Kenntnisse über die Mechanismen der Reblausresistenz. Um Resistenzgene zu identifizieren, wurden im Rahmen dieser Arbeit differenzielle Genexpressionsanalysen eingesetzt. Diese waren die Microarray Analyse mit der Geniom one Technik und die real time (RT) -PCR. Sie erlaubten eine Gegenüberstellung der Genexpression in behandeltem Wurzelgewebe mit der Expression im Normalgewebe der Unterlagsrebe Börner. Als experimenteller Induktor der HR in Börner diente die Indol-3-Essigsäure (IES), ein Bestandteil des Reblausspeichels. Frühere Untersuchungen zur Reb-lausresistenz zeigten, dass bei einer Behandlung mit IAA an Wurzeln von Börner Nekrosen entstehen, nicht jedoch an Wurzeln von der reblaustoleranten Unterlagssorte SO4 oder dem reblausanfälligem Edelreis. Das war der Grund, SO4 und Riesling als Vergleichsobjekte zu Börner für diese Studie auszuwählen. So sollte die Bedeutung der Rolle von IES als Auslö-ser der Resistenzmechanismen in Börner erklärt werden. Insgesamt konnten deutliche Unter-schiede in den Reaktionen der drei Rebsorten auf die IES Behandlung aufgedeckt werden. Während in Börner eine hohe Anzahl an Genen und diese intensiv auf den IES Reiz reagiert, fallen die Gene bei SO4 und Riesling zahlenmäßig kaum ins Gewicht und die Reaktionen der beiden Sorten auf IES zudem eher schwach aus. In der Summe waren es 27 Gene, die für die Reblausresistenz in Börner verantwortlich sein könnten. So konnte eine IES bedingte Aktivierung von Genen beobachtet werden, die bei der Produktion von Phytoalexinen be-deutsam sind, wie z.B. die phenylalanine ammonia-lyase, die lipoxygenase und die stilbene synthase. Weiter ließ sich eine Regulation von allgemein Stress assoziierten Genen und von Zellwandproteinen und eine Induktion von Signalkomponenten, etwa des Transkriptionsfak-tors ethylene response factor, nachweisen. Eine deutliche Hochregulation von Au-xintransportern in den IES behandelten Börnerwurzeln gab zudem Anhaltspunkte auf sorten-spezifische Unterschiede in der zellulären Aufnahme und Abgabe der IES. Durch die Ausar-beitung des Zusammenspiels der durch IES regulierten Gene konnten in dieser Arbeit wert-volle Hinweise auf die Mechanismen der Reblausresistenz in Börner gewonnen werden.

Adipose-derived stem cells and tissue revascularization: enhancing islet survival and performance for diabetes care.

Pancreatic islet transplantation represents a fascinating procedure that, at the moment, can be considered as alternative to standard insulin treatment or pancreas transplantation only for selected categories of patients with type 1 diabetes mellitus. Among the factors responsible for leading to poor islet engraftment, hypoxia plays an important role. Mesenchymal stem cells (MSCs) were recently used in animal models of islet transplantation not only to reduce allograft rejection, but also to promote revascularization. Currently adipose tissue represents a novel and good source of MSCs. Moreover, the capability of adipose-derived stem cells (ASCs) to improve islet graft revascularization was recently reported after hybrid transplantation in mice. Within this context, we have previously shown that hyaluronan esters of butyric and retinoic acids can significantly enhance the rescuing potential of human MSCs. Here we evaluated whether ex vivo preconditioning of human ASCs (hASCs) with a mixture of hyaluronic (HA), butyric (BU), and retinoic (RA) acids may result in optimization of graft revascularization after islet/stem cell intrahepatic cotransplantation in syngeneic diabetic rats. We demonstrated that hASCs exposed to the mixture of molecules are able to increase the secretion of vascular endothelial growth factor (VEGF), as well as the transcription of angiogenic genes, including VEGF, KDR (kinase insert domain receptor), and hepatocyte growth factor (HGF). Rats transplanted with islets cocultured with preconditioned hASCs exhibited a better glycemic control than rats transplanted with an equal volume of islets and control hASCs. Cotransplantation with preconditioned hASCs was also associated with enhanced islet revascularization in vivo, as highlighted by graft morphological analysis. The observed increase in islet graft revascularization and function suggests that our method of stem cell preconditioning may represent a novel strategy to remarkably improve the efficacy of islets-hMSCs cotransplantation.

Studio di fase I sulla reinfusione intraepatica di cellule staminali CD 133+ altamente purificate nei pazienti con malattia epatica terminale

Numerose evidenze sperimentali hanno dimostrato il contributo delle cellule staminali di derivazione midollare nei processi di rigenerazione epatica dopo danno tissutale. E’ cresciuto pertanto l’interesse sul loro potenziale impiego in pazienti con cirrosi. Questo studio si propone di valutare la fattibilità e la sicurezza della reinfusione intraepatica di cellule staminali midollari autologhe CD133+ in 12 pazienti con insufficienza epatica terminale definita da un punteggio di Model for End Stage of Liver Disease (MELD) compreso tra 17 e 25. L’efficacia in termini di funzionalità epatica rappresenta un obiettivo secondario. Previa mobilizzazione nel sangue periferico mediante somministrazione di granulocyte-colony stimulating factor (G-CSF) alla dose di 7,5 mcg/Kg/b.i.d. e raccolta per leucoaferesi, le cellule CD133+ altamente purificate vengono reinfuse in arteria epatica a partire da 5x104/Kg fino a 1x106/kg. Nei tre giorni successivi si somministra G-CSF per favorire l’espansione e l’attecchimento delle cellule. Durante la mobilizzazione, la reinfusione e nei 12 mesi successivi i pazienti sono sottoposti a periodici controlli clinici, laboratoristici e strumentali e ad attenta valutazione di effetti collaterali. Lo studio è tuttora in corso e ad oggi, 11 pazienti sono stati sottoposti a reinfusione e 4 hanno completato i 12 mesi di follow-up. Il G-CSF è stato ben tollerato e ha consentito di ottenere una buona espansione cellulare. Dopo la reinfusione sono stati documentati un ematoma inguinale e due episodi transitori di encefalopatia portosistemica. Durante il follow-up 4 pazienti sono stati trapiantati e 2 sono morti. Non è stata osservata alcuna modificazione significativa degli indici di funzione epatica. Questi risultati preliminari confermano la possibilità di mobilizzare e reinfondere un numero adeguato di cellule staminali di derivazione midollare in pazienti con malattia epatica in stadio terminale.

Valutazione dell'efficacia dell'infusione intraepatica di cellule staminali (SC) autologhe CD133+ in pazienti affetti da cirrosi ed insufficienza epatica di grado avanzato

Numerose evidenze sperimentali hanno dimostrato il contributo delle cellule staminali (SC) di derivazione midollare nei processi di rigenerazione epatica dopo danno tissutale. E’ cresciuto pertanto l’interesse sul loro potenziale impiego in pazienti con cirrosi. Questo studio si proponeva di valutare la fattibilità e la sicurezza della reinfusione intraepatica di cellule staminali midollari autologhe CD133+ in 12 pazienti con insufficienza epatica terminale. Previa mobilizzazione nel sangue periferico mediante somministrazione di granulocyte-colony stimulating factor (G-CSF) alla dose di 7,5 mcg/Kg/b.i.d. e raccolta per leucoaferesi (solo se la concentrazione di CD133 + SC era > 8/μL), le cellule CD133+ altamente purificate sono state reinfuse in arteria epatica a partire da 5x104/Kg fino a 1x106/kg. Nei tre giorni successivi è stato somministrato G-CSF per favorire l’espansione e l’attecchimento delle cellule. Durante la fase della mobilizzazione e quella della reinfusione sono stati eseguiti saggi biologici quali: caratterizzazione fenotipica delle SC circolanti, saggi clonogenici, valutazione della concentrazione sierica del Hepatocyte Growth Factor (HGF), Stromal-Derived Factor-1 (SDF-1) ed il Vascular-Endotelial Growth Factor (VEGF) e caratterizzazione fenotipica delle CD133+SC purificate. Fino ad oggi sono stati reinfusi 12 pazienti. Questi dati preliminari suggeriscono che è possibile mobilizzare e reinfondere un numero considerevole di SC autologhe CD133+ altamente purificate in pazienti con ESLD . Gli studi biologici mostrano che: il numero di progenitori ematopoietici ed endoteliali circolanti è aumentato dopo il trattamento con G–CSF; le SCs CD133+ altamente purificato esprimono marcatori emopoietici ed endoteliali; la concentrazione sierica di HGF, SDF-1, VEGF e la capacità clonogenica di progenitori emopoietici sono aumentati durante la mobilitazione e nelle fasi di reinfusione; il potenziale clonogenico dei progenitori endoteliali mostra espressione variabile.

Fabrication, Electrical Characterization and Simulation of Thin Film Solar Cells: CdTe and CIGS Materials

CdTe and Cu(In,Ga)Se2 (CIGS) thin film solar cells are fabricated, electrically characterized and modelled in this thesis. We start from the fabrication of CdTe thin film devices where the R.F. magnetron sputtering system is used to deposit the CdS/CdTe based solar cells. The chlorine post-growth treatment is modified in order to uniformly cover the cell surface and reduce the probability of pinholes and shunting pathways creation which, in turn, reduces the series resistance. The deionized water etching is proposed, for the first time, as the simplest solution to optimize the effect of shunt resistance, stability and metal-semiconductor inter-diffusion at the back contact. In continue, oxygen incorporation is proposed while CdTe layer deposition. This technique has been rarely examined through R.F sputtering deposition of such devices. The above experiments are characterized electrically and optically by current-voltage characterization, scanning electron microscopy, x-ray diffraction and optical spectroscopy. Furthermore, for the first time, the degradation rate of CdTe devices over time is numerically simulated through AMPS and SCAPS simulators. It is proposed that the instability of electrical parameters is coupled with the material properties and external stresses (bias, temperature and illumination). Then, CIGS materials are simulated and characterized by several techniques such as surface photovoltage spectroscopy is used (as a novel idea) to extract the band gap of graded band gap CIGS layers, surface or bulk defect states. The surface roughness is scanned by atomic force microscopy on nanometre scale to obtain the surface topography of the film. The modified equivalent circuits are proposed and the band gap graded profiles are simulated by AMPS simulator and several graded profiles are examined in order to optimize their thickness, grading strength and electrical parameters. Furthermore, the transport mechanisms and Auger generation phenomenon are modelled in CIGS devices.

Transport Properties and Novel Sensing Applications of Organic Semiconducting Crystals

The present thesis is focused on the study of Organic Semiconducting Single Crystals (OSSCs) and crystalline thin films. In particular solution-grown OSSC, e.g. 4-hdroxycyanobenzene (4HCB) have been characterized in view of their applications as novel sensors of X-rays, gamma-rays, alpha particles radiations and chemical sensors. In the field of ionizing radiation detection, organic semiconductors have been proposed so far mainly as indirect detectors, i.e. as scintillators or as photodiodes. I first study the performance of 4HCB single crystals as direct X-ray detector i.e. the direct photon conversion into an electrical signal, assessing that they can operate at room temperature and in atmosphere, showing a stable and linear response with increasing dose rate. A dedicated study of the collecting electrodes geometry, crystal thickness and interaction volume allowed us to maximize the charge collection efficiency and sensitivity, thus assessing how OSSCs perform at low operating voltages and offer a great potential in the development of novel ionizing radiation sensors. To better understand the processes generating the observed X-ray signal, a comparative study is presented on OSSCs based on several small-molecules: 1,5-dinitronaphthalene (DNN), 1,8-naphthaleneimide (NTI), Rubrene and TIPS-pentacene. In addition, the proof of principle of gamma-rays and alpha particles has been assessed for 4HCB single crystals. I have also carried out an investigation of the electrical response of OSSCs exposed to vapour of volatile molecules, polar and non-polar. The last chapter deals with rubrene, the highest performing molecular crystals for electronic applications. We present an investigation on high quality, millimeter-sized, crystalline thin films (10 – 100 nm thick) realized by exploiting organic molecular beam epitaxy on water-soluble substrates. Space-Charge-Limited Current (SCLC) and photocurrent spectroscopy measurements have been carried out. A thin film transistor was fabricated onto a Cytop® dielectric layer. The FET mobility exceeding 2 cm2/Vs, definitely assess the quality of RUB films.

Caratterizzazione microscopica di un transistor organico a effetto di campo

Negli ultimi anni uno dei settori di ricerca più interessanti in ambito tecnologico è sicuramente quello dell'elettronica organica. Lo sviluppo è spinto dai vantaggi che portano i dispositivi basati su materiali organici: bassi costi di produzione, facilità di fabbricazione su grandi aree e flessibilità. In questa tesi andiamo ad esaminare un transistor organico a effetto di campo (OFET) dal punto di vista macroscopico e microscopico, cercando di mettere in relazione le sue caratteristiche morfologiche ed elettriche. Il dispositivo sottoposto ai test è un OFET realizzato con TIPS-pentacene come semiconduttore. Dai risultati ottenuti si evince che le prestazioni elettriche del transistor sono fortemente legate alla microstruttura assunta dal materiale organico durante la deposizione. I primi due capitoli illustrano i principi di funzionamento degli OFET e la tecnica SPM (scanning probe microscopy) utilizzata per l'indagine microscopica. Il terzo e quarto capitolo descrivono rispettivamente gli apparati sperimentali e i risultati ottenuti dall'indagine su due aree diverse del dispositivo.

Wet bioadhesion in tree frogs

Viele Tiere wie etwa Geckos oder Laubfrösche können mittels ihrer Haftscheiben an Oberflächen kleben. Diese Haftscheiben ermöglichen es den Tieren, sich während ihrerrnFortbewegung an Oberflächen anzuheften und wieder zu lösen unabhängig von denrnvorherrschenden Umweltbedingungen. Frösche besitzen mikro- und nanostrukturierternsowie charakteristisch geformte Haftscheiben an Finger- und Zehenenden. Ihre besonderernevolutionäre Errungenschaft, sich stark und zugleich reversibel in sowohl trockenen alsrnauch feuchten Umgebungen anzuhaften, hat die Wissenschaft zur Nachahmung und Untersuchungrndieser Strukturen inspiriert. Zum besseren Verständnis der Mechanismen vonrnAnhaftung und Loslösung bei Laubfröschen wurden weiche, elastische und mikrostrukturierternOberflächen hergestellt, indem PDMS (Polydimethylsiloxan) auf einer Siliziummaskernmit Hexagonstruktur aufgetragen und vernetzt wurde. Dadurch wurden Anordnungenrnvon hexagonalen Mikrosäulen mit spezifischen geometrischen Eigenschaften undrnunterschiedlichen Kontaktgeometrien (normale, flache Form, T-Form und konkave Formrnder Säulenenden) erhalten. Um den Einfluss der van-der-Waals, hydrodynamischen,rnKapillar-und Adhäsionskräfte zu verstehen, wurden verschiedene experimentelle Ansätzernverfolgt: Die auf eine einzelne Säule wirkenden Adhäsionskräfte wurden mittelsrnRasterkraftmikroskopie gemessen. Dazu wurden speziell hergestellte kolloidale Sensorenrnverwendet. Diese Experimente wurden sowohl mit als auch ohne Flüssigkeitsfilm auf derrnSäule durchgeführt. Die Ergebnisse zeigten den Beitrag von Kapillarkraft und direktenrnKontaktkräften zur Adhäsionskraft bei Vorliegen eines Flüssigkeitsfilms. Die Adhäsionrnfiel umso größer aus, je weniger Flüssigkeit zwischen Sensor und Säule vorhanden war.rnIm Falle einer trockenen Adhäsion zeigte die Säule mit T-Form die höchste Adhäsion. Darndie Haftscheiben der Laubfrösche weich sind, können sie dynamisch ihre Form ändern,rnwas zu einer Änderung der hydrodynamischen Kraft zwischen Scheibe und Oberflächernführt. Der Einfluss der Oberflächenverformbarkeit auf die hydrodynamische Kraft wurderndaher am Modellsystem einer Kugel untersucht, welche sich einer weichen und ebenenrnOberfläche annähert. Dieses System wurde sowohl theoretisch über die Simulation finiterrnElemente als auch experimentell über die Messung mit kolloidalen Sonden untersucht.rnSowohl experimentelle Ergebnisse als auch die Simulationen ergaben eine Abnahme derrnhydrodynamischen Kraft bei Annäherung des kolloidalen Sensors an eine weiche undrnelastische Oberfläche. Beim Entfernen der Sensors von der Oberfläche verstärkte sichrndie hydrodynamische Anziehungskraft. Die Kraft, die zur Trennung eines Partikels von einer Oberfläche in Flüssigkeit notwendig ist, ist für weiche und elastischen Oberflächenrngrößer als für harte Oberflächen. In Bezug zur Bioadhäsion bei Laubfröschen konnternfestgestellt somit festgestellt werden, dass sich der hydrodynamische Anteil zur feuchtenrnBioadhäsion aufgrund der weichen Oberfläche erhöht. Weiterhin wurde der Einflussrndes Aspektverhältnisses der Säulen auf die Reibungskraft mittels eines kolloidalen Sensorsrnuntersucht. Gestreckte Säulen zeigten dabei eine höhere Reibung im Vergleich zu.rnSäulen mit einem gestreckten Hexagon als Querschnitt.

Rivelatori a stato solido per raggi X a base di pentacene

I rivelatori a stato solido per raggi X hanno applicazioni in diversi ambiti, in particolare sono ampiamente utilizzati in ambito medico, in ambito industriale e come dispositivi per la sicurezza. Essendo molto diffusi nella nostra quotidianità si è sempre alla ricerca di nuovi materiali e di nuove tecniche di fabbricazione in grado di ridurne i costi di produzione. Le ricerche attuali sono incentrate sullo studio di nuovi materiali sensibili ai raggi X, l'attenzione è particolarmente diretta ai semiconduttori organici. Questi materiali risultano molto interessanti in quanto sono solubili in molti solventi, tale caratteristica permette lo sviluppo di nuove tecniche di fabbricazione a basso costo per rivelatori di grandi aree. Una delle tecniche di maggiore interesse è la stampa a inchiostro su substrati flessibili e trasparenti. In questa tesi si analizzeranno le proprietà elettriche, in particolare la variazione del segnale di corrente in seguito all'irraggiamento da raggi X, di alcuni campioni costituiti da TIPS-pentacene. Ci si soffermerà in particolare sui metodi con cui tali cristalli sono stati deposti quali inkjet e drop-cast.

Characterization of X-ray detectors based on organic semiconducting single crystals

Negli anni recenti, lo sviluppo dell’elettronica organica ha condotto all’impiego di materiali organici alla base di numerosi dispositivi elettronici, quali i diodi ad emissione di luce, i transistor ad effetto di campo, le celle solari e i rivelatori di radiazione. Riguardo quest’ultimi, gli studi riportati in letteratura si riferiscono per la maggiore a dispositivi basati su materiali organici a film sottile, che tuttavia presentano problemi relativi ad instabilità e degradazione. Come verrà illustrato, l’impiego di singoli cristalli organici come materiali alla base di questi dispositivi permette il superamento delle principali limitazioni che caratterizzano i rivelatori basati su film sottili. In questa attività sperimentale, dispositivi basati su cristalli organici semiconduttori verranno caratterizzati in base alle principali figure di merito dei rivelatori. Tra i campioni testati, alcuni dispositivi basati su singoli cristalli di 6,13-bis (triisopropylsilylethynyl)-pentacene (TIPS-Pentacene) e 5,6,11,12-tetraphenyltetracene (Rubrene) hanno mostrato interessanti proprietà e sono stati quindi maggiormente studiati.

Fotoconduttori organici come rivelatori di raggi X

Rispetto alle loro controparti inorganiche, i semiconduttori organici presentano proprietà che consentono di usarli in modi fino a qualche anno fa impensabili: sono facili ed economici da depositare, flessibili, leggeri e robusti. Queste caratteristiche li rendono tra le altre cose ottimi candidati come rilevatori a stato solido di raggi X che possono persino essere comodamente indossati o utilizzati in situazioni e luoghi prima inaccessibili a quelli inorganici. I semiconduttori organici sono tuttavia fondamentalmente diversi da quelli inorganici e i fenomeni che regolano il trasporto e la generazione di cariche sono più complessi e non ancora compiutamente compresi. Allo scopo di migliorare la loro comprensione, questa tesi mette a confronto alcuni modelli teorici di generazione e ricombinazione di eccitoni, così da individuare quello più rispondente alle misure sperimentali effettuate relativamente alla risposta fotoconduttiva di cristalli singoli di TIPS-pentacene irradiati con raggi X.

In-situ detection of defect formation in organic flexible electronics by Kelvin Probe Force Microscopy

Organic semiconductor technology has attracted considerable research interest in view of its great promise for large area, lightweight, and flexible electronics applications. Owing to their advantages in processing and unique physical properties, organic semiconductors can bring exciting new opportunities for broad-impact applications requiring large area coverage, mechanical flexibility, low-temperature processing, and low cost. In order to achieve highly flexible device architecture it is crucial to understand on a microscopic scale how mechanical deformation affects the electrical performance of organic thin film devices. Towards this aim, I established in this thesis the experimental technique of Kelvin Probe Force Microscopy (KPFM) as a tool to investigate the morphology and the surface potential of organic semiconducting thin films under mechanical strain. KPFM has been employed to investigate the strain response of two different Organic Thin Film Transistor with active layer made by 6,13-bis(triisopropylsilylethynyl)-pentacene (TIPS-Pentacene), and Poly(3-hexylthiophene-2,5-diyl) (P3HT). The results show that this technique allows to investigate on a microscopic scale failure of flexible TFT with this kind of materials during bending. I find that the abrupt reduction of TIPS-pentacene device performance at critical bending radii is related to the formation of nano-cracks in the microcrystal morphology, easily identified due to the abrupt variation in surface potential caused by local increase in resistance. Numerical simulation of the bending mechanics of the transistor structure further identifies the mechanical strain exerted on the TIPS-pentacene micro-crystals as the fundamental origin of fracture. Instead for P3HT based transistors no significant reduction in electrical performance is observed during bending. This finding is attributed to the amorphous nature of the polymer giving rise to an elastic response without the occurrence of crack formation.

NCX-1000, a nitric oxide-releasing derivative of UDCA, does not decrease portal pressure in patients with cirrhosis: results of a randomized, double-blind, dose-escalating study

NCX-1000 (2(acetyloxy) benzoic acid-3(nitrooxymethyl)phenyl ester) is an nitric oxide (NO)-releasing derivative of ursodeoxycholic acid (UDCA), which showed selective vasodilatory effect on intrahepatic circulation in animal models of cirrhosis. This study was aimed at testing the efficacy and tolerability of this compound in patients with cirrhosis and portal hypertension.

Mechanical insertion properties of calcium-phosphate implant coatings

Abstract Objectives: To investigate the influence of protein incorporation on the resistance of biomimetic calcium-phosphate coatings to the shear forces that are generated during implant insertion. Materials and Methods: Thirty-eight standard (5 x 13 mm) Osseotite((R)) implants were coated biomimetically with a layer of calcium phosphate, which either lacked or bore a co-precipitated (incorporated) depot of the model protein bovine serum albumin (BSA). The coated implants were inserted into either artificial bone (n=18) or the explanted mandibles of adult pigs (n=12). The former set-up was established for the measurement of torque and of coating losses during the insertion process. The latter set-up was established for the histological and histomorphometric analysis of the fate of the coatings after implantation. Results: BSA-bearing coatings had higher mean torque values than did those that bore no protein depot. During the insertion process, less material was lost from the former than from the latter type of coating. The histological and histomorphometric analysis revealed fragments of material to be sheared off from both types of coating at vulnerable points, namely, at the tips of the threads. The sheared-off fragments were retained within the peri-implant space. Conclusion: The incorporation of a protein into a biomimetically prepared calcium-phosphate coating increases its resistance to the shear forces that are generated during implant insertion. In a clinical setting, the incorporated protein would be an osteogenic agent, whose osteoinductive potential would not be compromised by the shearing off of coating material, and the osteoconductivity of an exposed implant surface would not be less than that of a coated one. To cite this article: Hägi TT, Enggist L, Michel D, Ferguson SJ, Liu Y, Hunziker EB. Mechanical insertion properties of calcium-phosphate implant coatings. Clin. Oral Impl. Res. xx, 2010; 000-000. doi: 10.1111/j.1600-0501.2010.01916.x.

Prevention of stroke in patients with patent foramen ovale

Patent foramen ovale is found in 24% of healthy adults and 38% of patients with cryptogenic stroke. This ratio and case reports indicate that patent foramen ovale and stroke are associated, probably because of paradoxical embolism. In healthy people with patent foramen ovale, embolic events are not more frequent than in controls, and therefore no primary prevention is needed. However, once ischaemic events occur, the risk of recurrence is substantial and prevention becomes an issue. Acetylsalicylic acid and warfarin reduce this risk to the same level as in patients without patent foramen ovale. Patent foramen ovale with a coinciding atrial septal aneurysm, spontaneous or large right-to-left shunt, or multiple ischaemic events potentiates the risk of recurrence. Transcatheter device closure has therefore become an intriguing addition to medical treatment, but its therapeutic value still needs to be confirmed by randomised-controlled trials.