Poly(lactide): from hyperbranched copolyesters to new block copolymers with functional methacrylates

The prologue of this thesis (Chapter 1.0) gives a general overview on lactone based poly(ester) chemistry with a focus on advanced synthetic strategies for ring-opening polymerization, including the emerging field of organo catalysis. This section is followed by a presentation of the state-of the art regarding the two central fields of the thesis: (i) polyfunctional and branched poly(ester)s in Chapter 1.1 as well as (ii) the development of new poly(ester) based block copolymers with functional methacrylates (Chapter 1.2). Chapter 2 deals with the synthesis of new, non-linear poly(ester) structures. In Chapter 2.1, the synthesis of poly(lactide)-based multiarm stars, prepared via a grafting-from method, is described. The hyperbranched poly(ether)-poly(ol) poly(glycerol) is employed as a hydrophilic core molecule. The resulting star block copolymers exhibit potential as phase transfer agents and can stabilize hydrophilic dyes in a hydrophobic environment. In Chapter 2.2, this approach is expanded to poly(glycolide) multiarm star polymers. The problem of the poor solubility of linear poly(glycolide)s in common organic solvents combined with an improvement of the thermal properties has been approached by the reduction of the total chain length. In Chapter 2.3, the first successful synthesis of hyperbranched poly(lactide)s is presented. The ring-opening, multibranching copolymerization of lactide with the “inimer” 5HDON (a hydroxyl-functional lactone monomer) was carefully examined. Besides a precise molecular characterization involving the determination of the degree of branching, we were able to put forward a reaction model for the formation of branching during polymerization. Several innovative approaches to amphiphilic poly(ester)/poly(methacrylate)-based block copolymers are presented in the third part of the thesis (Chapter 3). Block copolymer build-up especially relies on the combination of ring-opening and living radical polymerization. Atom transfer radical polymerization has been successfully combined with lactide ring-opening, using a “double headed” initiator. This strategy allowed for the realization of poly(lactide)-block-poly(2-hydroxyethyl methacrylate) copolymers, which represent promising materials for tissue engineering scaffolds with anti-fouling properties (Chapter 3.1). The two-step/one-pot approach forgoes the use of protecting groups for HEMA by a careful selection of the reaction conditions. A series of potentially biocompatible and partially biodegradable homo- and block copolymers is described in Chapter 3.2. In order to create a block copolymer with a comparably strong hydrophilic character, a new acetal-protected glycerol monomethacrylate monomer (cis-1,3- benzylidene glycerol methacrylate/BGMA) was designed. The hydrophobic poly(BGMA) could be readily transformed into the hydrophilic and water-soluble poly(iso-glycerol methacrylate) (PIGMA) by mild acidic hydrolysis. Block copolymers of PIGMA and poly(lactide) exhibited interesting spherical aggregates in aqueous environment which could be significantly influenced by variation of the poly(lactide)s stereo-structure. In Chapter 3.3, pH-sensitive poly(ethylene glycol)-b-PBGMA copolymers are described. At slightly acidic pH values (pH 4/37°C), they decompose due to a polarity change of the BGMA block caused by progressing acetal cleavage. This stimuli-responsive behavior renders the system highly attractive for the targeted delivery of anti-cancer drugs. In Chapter 3.4, which was realized in cooperation, the concept of biocompatible, amphiphilic poly(lactide) based polymer drug conjugates, was pursued. This was accomplished in the form of fluorescently labeled poly(HPMA)-b-poly(lactide) copolymers. Fluorescence correlation spectroscopy (FCS) of partially biodegradable block copolymer aggregates exhibited fast cellular uptake by human cervix adenocarcinoma cells without showing toxic effects in the examined concentration range (Chapter 4.1). The current state of further projects which will be pursued in future studies is addressed in Chapter 4. This covers the synthesis of biocompatible star block copolymers (Chapter 4.2) and the development of new methacrylate monomers for biomedical applications (Chapters 4.3 and 4.4). Finally, the further investigation of hydroxyl-functional lactones and carbonates which are promising candidates for the synthesis of new hydrophilic linear or hyperbranched biopolymers, is addressed in Chapter 4.5.

Molekulare und supramolekulare Eigenschaften von neuen Donor-Akzeptor-Polymeren

Die organische Halbleitertechnologie befindet sich seit Jahrzehnten im Focus des Interesses, da sie eine kostengünstige und umweltverträgliche Alternative zu anorganischen Silizium-basierten Halbleitern darstellt. Die Möglichkeit der gezielten Funktionalisierung von definierten Strukturen durch synthetische Methoden, welche eine große Vielfalt an Materialien ermöglicht, steht dabei besonders im Vordergrund. Die Modifikation von physikalischen Eigenschaften ermöglicht dabei eine stark erleichterte Anpassung für den geplanten Anwendungsbereich. Im Rahmen der vorliegenden Dissertation wurden organische Halbleitermaterialien basierend auf Cyclopenta[2,1-b:3,4-b']dithiophen (CDT) dargestellt und hinsichtlich ihrer strukturellen und elektronischen Eigenschaften untersucht. In Kombination mit Benzo[c][1,2,5]thiadiazol (BTZ) und weiteren Akzeptoren wurden zunächst Donor(D)-Akzeptor(A)-Polymere synthetisiert und Struktur-Eigenschaft-Beziehungen aufgestellt. So konnte ein sehr hochmolekulares Polymer CDT-BTZ-Polymer (Mn = 36 kg mol-1, PDI = 2.6) erhalten werden, welches sich durch eine hohe lamellare Ordnung und eine gemessene Ladungsträgermobilität in FETs von über 5.0 cm2V-1s-1 bei Raumtemperatur auszeichnete; bei niedrigen Temperaturen (240 K) war letztgenannte 6.5 cm2V-1s-1. Aufgrund dieses hohen Ladungstransports und der Abwesenheit niedermolekularer Polymerketten innerhalb des Polymers konnte erstmals eine Messung eines HALL-Effektes bewerkstelligt werden. Dies war der erste Beweis eines Band-artigen Ladungstransportes an einem Polymerhalbleiter. Des Weiteren wurde durch synthetische Veränderung der Grundstruktur des Polymers zu längeren Alkylketten eine anisotrope Anordnung der Polymerketten erreicht und die Ladungsträgermobilität (6.5 cm2V-1s-1 bei Raumtemperatur) weiter gesteigert. Darauf aufbauend wurde der Einfluss von stereoisomeren Seitenketten an CDT-BTZ-Polymeren auf Packungsverhalten, Parametern (Sperrstrom, Einschaltstrom) in FETs und Löslichkeit in organischen Lösungsmitteln untersucht. Durch cis-trans-Isomerisierung der Seitenketten wurde hier eine neue Methode zur Optimierung des Packungsverhaltens von Polymeren in dünnen Filmen und Lösung gefunden. Zuletzt wurden D-π-A-Farbstoffen, welche CDT als Verbrückungseinheit (π) beinhalten, dargestellt. Durch Variation von D und A konnten Struktur-Eigenschaft-Beziehungen in der Anwendung in Solarzellen (Feststoffsolarzellen, Flüssigsolarzellen) gefunden werden. Die Untersuchungen der photoinduzierten Absorption und der Photolumisenzenzquantenausbeute lieferten dabei Erklärungen für physikalische Prozesse wie Ladungsinjektion- und rekombination.

Evolutionäre Veränderungen in der Nutzung redox-aktiver Aminosäuren und ihre Ursachen

Gewebe, Zellen und speziell Zellkompartimente unterscheiden sich in ihrer Sauerstoffkonzentration, Stoffwechselrate und in der Konzentration an gebildeten reaktiven Sauerstoffspezies. Um eine mögliche Änderung in der Aminosäurennutzung durch den Einfluss von Sauerstoff und seinen reaktiven Spezies untersuchen zu können wurden, Bereiche bzw. Kompartimente der menschlichen Zelle definiert, die einen Referenzrahmen bildeten und bekannt dafür sind, einen relativ hohen Grad an reaktiven Sauerstoffspezies aufzuweisen. Aus dem Vergleich wurde deutlich, dass vor allem die beiden redox-aktiven und schwefeltragenden Aminosäuren Cystein und Methionin durch eine besondere Verteilung und Nutzung charakterisiert sind. Cystein ist hierbei diejenige Aminosäure mit den deutlichsten Änderungen in den fünf untersuchten Modellen der oxidativen Belastung. In all diesen Modellen war die Nutzung von Cystein deutlich reduziert, wohingegen Methionin in Proteinen des Mitochondriums und der Elektronentransportkette angereichert war. Dieser auf den ersten Blick paradoxe Unterschied zwischen Cystein und Methionin wurde näher untersucht, indem die differenzierte Methioninnutzung in verschiedenen Zellkompartimenten von Homo sapiens charakterisiert wurde.rnDie sehr leicht zu oxidierende Aminosäure Methionin zeigt ein ungewöhnliches Verteilungsmuster in ihrer Nutzungshäufigkeit. Entgegen mancher Erwartung wird Methionin in zellulären Bereichen hoher oxidativer Belastung und starker Radikalproduktion intensiv verwendet. Dieses Verteilungsmuster findet man sowohl im intrazellulären Vergleich, als auch im Vergleich verschiedener Spezies untereinander, was daraufhin deutet, dass es einen lokalen Bedarf an redox-aktiven Aminosäuren gibt, der einen sehr starken Effekt auf die Nutzungshäufigkeit von Methionin ausübt. Eine hohe Stoffwechselrate, die im Allgemeinen mit einer erhöhten Produktion von Oxidantien assoziiert wird, scheint ein maßgeblicher Faktor der Akkumulation von Methionin in Proteinen der Atmungskette zu sein. Die Notwendigkeit, oxidiertes Antioxidans wieder zu reduzieren, findet auch bei Methionin Anwendung, denn zu Methioninsulfoxid oxidiertes Methionin wird durch die Methioninsulfoxidreduktase wieder zu Methionin reduziert. Daher kann die spezifische Akkumulation von Methionin in Proteinen, die verstärkt reaktiven Sauerstoffspezies ausgesetzt sind, als eine systematische Strategie angesehen werden, um andere labile Strukturen vor ungewollter Oxidation zu schützen. rnDa Cystein in allen untersuchten Modellen der oxidativen Belastung und im Besonderen in Membranproteinen der inneren Mitochondrienmembran lebensspannenabhängig depletiert war, wurde dieses Merkmal näher untersucht. Deshalb wurde die Hypothese getestet, ob ein besonderer Redox-Mechanismus der Thiolfunktion für diese selektive Depletion einer im Allgemeinen als harmlos oder antioxidativ geltenden Aminosäure verantwortlich ist. Um den Effekt von Cysteinresten in Membranen nachzustellen, wurden primäre humane Lungenfibroblasten (IMR90) mit diversen Modellsubstanzen behandelt. Geringe Konzentrationen der lipophilen Substanz Dodecanthiol verursachten eine signifikante Toxizität in IMR90-Zellen, die von einer schnellen Zunahme an polyubiquitinierten Proteinen und anderen Indikatoren des proteotoxischen Stresses, wie Sequestosom 1 (P62), HSP70 und HSP90 begleitet wurde. Dieser Effekt konnte spezifisch der Chemie der Thiolfunktion in Membranen zugeordnet werden, da Dodecanol (DOH), Dodecylmethylsulfid (DMS), Butanthiol oder wasserlösliche Thiole weder eine cytotoxische Wirkung noch eine Polyubiquitinierung von Proteinen verursachten. Die Ergebnisse stimmen mit der Hypothese überein, dass Thiole innerhalb von biologischen Membranen als radikalische Kettentransferagentien wirken. Diese Eigenschaft wird in der Polymerchemie durch Nutzung von lipophilen Thiolen in hydrophoben Milieus technisch für die Produktion von Polymeren benutzt. Da die Thiylradikal-spezifische Reaktion von cis-Fettsäuren zu trans-Fettsäuren in 12SH behandelten Zellen verstärkt ablief, kann gefolgert werden, dass 12SH zellulär radikalisiert wurde. In lebenden Organismen kann demnach die Oxidation von Cystein die Schädigung von Membranen beschleunigen und damit Einfallstore für die laterale Radikalisierung von integralen Membranproteinen schaffen, welche möglicherweise der Langlebigkeit abträglich ist, zumindest, wenn sie in der inneren Mitochondrienmembran auftritt.

Epigallocatechin-3-gallate induces cell death in acute myeloid leukaemia cells and supports all-trans retinoic acid-induced neutrophil differentiation via death-associated protein kinase 2

Acute promyelocytic leukaemia (APL) patients are successfully treated with all-trans retinoic acid (ATRA). However, concurrent chemotherapy is still necessary and less toxic therapeutic approaches are needed. Earlier studies suggested that in haematopoietic neoplasms, the green tea polyphenol epigallocatechin-3-gallate (EGCG) induces cell death without adversely affecting healthy cells. We aimed at deciphering the molecular mechanism of EGCG-induced cell death in acute myeloid leukaemia (AML). A significant increase of death-associated protein kinase 2 (DAPK2) levels was found in AML cells upon EGCG treatment paralleled by increased cell death that was significantly reduced upon silencing of DAPK2. Moreover, combined ATRA and EGCG treatment resulted in cooperative DAPK2 induction and potentiated differentiation. EGCG toxicity of primary AML blasts correlated with 67 kDa laminin receptor (67LR) expression. Pretreatment of AML cells with ATRA, causing downregulation of 67LR, rendered these cells resistant to EGCG-mediated cell death. In summary, it was found that (i) DAPK2 is essential for EGCG-induced cell death in AML cells, (ii) ATRA and EGCG cotreatment significantly boosted neutrophil differentiation, and 67LR expression correlates with susceptibility of AML cells to EGCG. We thus suggest that EGCG, by selectively targeting leukaemic cells, may improve differentiation therapies for APL and chemotherapy for other AML subtypes.

Natural products as leads for anticancer drug discovery: discovery of new chemotypes of microtubule stabilizers through reengineering of the epothilone scaffold

Epothilones are bacterial macrolides with potent microtubule-stabilizing and antiproliferative activity, which have served as successful lead structures for the discovery of several clinical candidates for cancer treatment. Overall, seven epothilone-type agents have been advanced to clinical evaluation in humans so far and one of these has been approved by the FDA in 2007 for clinical use in breast cancer patients. Notwithstanding these impressive numbers, however, the structural diversity represented by the collection of epothilone analogs that have been (or still are) investigated clinically is rather limited and their individual structures show little divergence from the original natural product leads. In contrast, we have elaborated a series of epothilone-derived macro-lactones, whose overall structural features significantly deviate from those of the natural epothilone scaffold and thus define new structural families of microtubule-stabilizing agents. Key elements of our hypermodification strategy are the change of the natural epoxide geometry from cis to trans, the incorporation of conformationally constrained side chains, the removal of the C(3)-hydroxyl group, and the replacement of C(12) with nitrogen. The latter modification leads to aza-macrolides that may be described as 'non-natural natural products'.

Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association

This study aims to analyse the collective experience of participating European Congenital Heart Surgeons Association centres in the surgical management of complications resulting from trans-catheter closure of atrial septal defects (ASDs).

Thermodynamics of the Hydroxyl Radical Addition to Isoprene

Oxidation of isoprene by the hydroxyl radical leads to tropospheric ozone formation. Consequently, a more complete understanding of this reaction could lead to better models of regional air quality, a better understanding of aerosol formation, and a better understanding of reaction kinetics and dynamics. The most common first step in the oxidation of isoprene is the formation of an adduct, with the hydroxyl radical adding to one of four unsaturated carbon atoms in isoprene. In this paper, we discuss how the initial conformations of isoprene, s-trans and s-gauche, influences the pathways to adduct formation. We explore the formation of pre-reactive complexes at low and high temperatures, which are often invoked to explain the negative temperature dependence of this reaction’s kinetics. We show that at higher temperatures the free energy surface indicates that a pre-reactive complex is unlikely, while at low temperatures the complex exists on two reaction pathways. The theoretical results show that at low temperatures all eight pathways possess negative reaction barriers, and reaction energies that range from −36.7 to −23.0 kcal·mol−1. At temperatures in the lower atmosphere, all eight pathways possess positive reaction barriers that range from 3.8 to 6.0 kcal·mol−1 and reaction energies that range from −28.8 to −14.4 kcal·mol−1.

Correcting mortality for loss to follow-up: a nomogram applied to antiretroviral treatment programmes in sub-Saharan Africa

Background The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART. Methods and Findings We developed a nomogram to correct mortality estimates for loss to follow-up, based on the fact that mortality of all patients starting ART in a treatment programme is a weighted average of mortality among patients lost to follow-up and patients remaining in care. The nomogram gives a correction factor based on the percentage of patients lost to follow-up at a given point in time, and the estimated ratio of mortality between patients lost and not lost to follow-up. The mortality observed among patients retained in care is then multiplied by the correction factor to obtain an estimate of programme-level mortality that takes all deaths into account. A web calculator directly calculates the corrected, programme-level mortality with 95% confidence intervals (CIs). We applied the method to 11 ART programmes in sub-Saharan Africa. Patients retained in care had a mortality at 1 year of 1.4% to 12.0%; loss to follow-up ranged from 2.8% to 28.7%; and the correction factor from 1.2 to 8.0. The absolute difference between uncorrected and corrected mortality at 1 year ranged from 1.6% to 9.8%, and was above 5% in four programmes. The largest difference in mortality was in a programme with 28.7% of patients lost to follow-up at 1 year. Conclusions The amount of bias in mortality estimates can be large in ART programmes with substantial loss to follow-up. Programmes should routinely report mortality among patients retained in care and the proportion of patients lost. A simple nomogram can then be used to estimate mortality among all patients who started ART, for a range of plausible mortality rates among patients lost to follow-up.

Synthesis, base pairing properties and trans-lesion synthesis by reverse transcriptases of oligoribonucleotides containing the oxidatively damaged base 5-hydroxycytidine

The synthesis of a caged RNA phosphoramidite building block containing the oxidatively damaged base 5-hydroxycytidine (5-HOrC) has been accomplished. To determine the effect of this highly mutagenic lesion on complementary base recognition and coding properties, this building block was incorporated into a 12-mer oligoribonucleotide for Tm and CD measurements and a 31-mer template strand for primer extension experiments with HIV-, AMV- and MMLV-reverse transcriptase (RT). In UV-melting experiments, we find an unusual biphasic transition with two distinct Tm's when 5-HOrC is paired against a DNA or RNA complement with the base guanine in opposing position. The higher Tm closely matches that of a C-G base pair while the lower is close to that of a C-A mismatch. In single nucleotide extension reactions, we find substantial misincorporation of dAMP and to a lesser extent dTMP, with dAMP almost equaling that of the parent dGMP in the case of HIV-RT. A working hypothesis for the biphasic melting transition does not invoke tautomeric variability of 5-HOrC but rather local structural perturbations of the base pair at low temperature induced by interactions of the 5-HO group with the phosphate backbone. The properties of this RNA damage is discussed in the context of its putative biological function.

Structure-Function Relations in the PI-PLC/GDPD Enzyme Superfamily

Phosphatidylinositol-specific phospholipases C (PI-PLC) are known to participate in many eukaryotic signal transduction pathways and act as virulence factors in lower organisms. Glycerophosphoryl diester phosphodiesterase (GDPD) enzymes are involved in phosphate homeostasis and phospholipid catabolism for energy production. Streptomyces antibioticus phosphatidylinositol-specific phospholipase C (SaPLC1) is a 38 kDa enzyme that displays characteristics of both enzyme superfamilies, representing an evolutionary link between these divergent enzyme classes. SaPLC1 also boasts a unique catalytic mechanism that involves a trans 1,6-cyclic inositol phosphate intermediate instead of the typical cis 1,2-cyclic inositol phosphate. The mechanism by which this occurs is still unclear. To attack this problem, we established a wide mutagenesis scan of the active site and measured activities of alanine mutants. A chemical rescue assay was developed to verify that the activity loss was due to the removal of the functional role of the mutated residue. 31P-NMR was employed in characterizing and quantifying intermediates in mutants that slowed the reaction sufficiently. We found that the H37A and H76A mutations support the hypothesis that these structurally conserved residues are also conserved in terms of their catalytic roles. H37 was found to be the general base (GB), while H76 plays the role of general acid (GA). K131 was identified as a semi-conserved key positive charge donor found at the entrance of the active site. By elucidating the SaPLC1 mechanism in relation to its active site architecture, we have increased our understanding of the structure-function relations that support catalysis in the PI-PLC/GDPD superfamily. These findings provide groundwork for in vivo studies of SaPLC1 function and its possible role in novel signaling or metabolism in Streptomyces.

Extramedullary relapse in acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy

We analyzed the incidence, presenting features, risk factors of extramedullary (EM) relapse occurring in acute promyelocytic leukemia (APL) treated with all-trans retinoic acid (ATRA) and chemotherapy by using a competing-risk method. In total, 740/ 806 (92%) patients included in three multicenter trials (APL91, APL93 trials and PETHEMA 96) achieved CR, of whom 169 (23%) relapsed, including 10 EM relapses. Nine relapses involved the central nervous system (CNS) and one the skin, of which two were isolated EM relapse. In patients with EM disease, median WBC count was 26950/mm3 (7700-162000). The 3-year cumulative incidence of EM disease at first relapse was 5.0%. Univariate analysis identified age <45 years (P=0.05), bcr3 PML-RARalpha isoform (P= 0.0003) and high WBC counts (> or = 10,000/ mm3) (P<0.0001) as risk factors for EM relapse. In multivariate analysis, only high WBC count remained significant (P= 0.001). Patients with EM relapse had a poorer outcome since median survival from EM relapse was 6.7 months as compared to 26.3 months for isolated BM relapse (P=0.04). In conclusion, EM relapse in APL occurs more frequently in patients with increased WBC counts (> or = 10,000/mm3) and carries a poor prognosis. Whether CNS prophylaxis should be systematically performed in patients with WBC > or = 10,000/mm3 at diagnosis remains to be established.

Conformational analysis of a potent SSTR3-selective somatostatin analogue by NMR in water solution

The three-dimensional structure of a potent SSTR3-selective analogue of somatostatin, cyclo(3-14)H-Cys(3)-Phe(6)-Tyr(7)-D-Agl(8)(N(beta) Me, 2-naphthoyl)-Lys(9)-Thr(10)-Phe(11)-Cys(14)-OH (des-AA(1, 2, 4, 5, 12, 13)[Tyr(7), D-Agl(8)(N(beta) Me, 2-naphthoyl)]-SRIF) (peptide 1) has been determined by (1)H NMR in water and molecular dynamics (MD) simulations. The peptide exists in two conformational isomers differing mainly by the cis/trans isomerization of the side chain in residue 8. The structure of 1 is compared with the consensus structural motifs of other somatostatin analogues that bind predominantly to SSTR1, SSTR2/SSTR5 and SSTR4 receptors, and to the 3D structure of a non-selective SRIF analogue, cyclo(3-14)H-Cys(3)-Phe(6)-Tyr(7)-D-2Nal(8)-Lys(9)-Thr(10)-Phe(11)-Cys(14)-OH (des-AA(1, 2, 4, 5, 12, 13)[Tyr(7), D-2Nal(8)]-SRIF) (peptide 2). The structural determinant factors that could explain selectivity of peptide 1 for SSTR3 receptors are discussed.

Biological safety concepts of genetically modified live bacterial vaccines

Live vaccines possess the advantage of having access to induce cell-mediated and antibody-mediated immunity; thus in certain cases they are able to prevent infection, and not only disease. Furthermore, live vaccines, particularly bacterial live vaccines, are relatively cheap to produce and easy to apply. Hence they are suitable to immunize large communities or herds. The induction of both cell-mediated immunity as well as antibody-mediated immunity, which is particularly beneficial in inducing mucosal immune responses, is obtained by the vaccine-strain's ability to colonize and multiply in the host without causing disease. For this reason, live vaccines require attenuation of virulence of the bacterium to which immunity must be induced. Traditionally attenuation was achieved simply by multiple passages of the microorganism on growth medium, in animals, eggs or cell cultures or by chemical or physical mutagenesis, which resulted in random mutations that lead to attenuation. In contrast, novel molecular methods enable the development of genetically modified organisms (GMOs) targeted to specific genes that are particularly suited to induce attenuation or to reduce undesirable effects in the tissue in which the vaccine strains can multiply and survive. Since live vaccine strains (attenuated by natural selection or genetic engineering) are potentially released into the environment by the vaccinees, safety issues concerning the medical as well as environmental aspects must be considered. These involve (i) changes in cell, tissue and host tropism, (ii) virulence of the carrier through the incorporation of foreign genes, (iii) reversion to virulence by acquisition of complementation genes, (iv) exchange of genetic information with other vaccine or wild-type strains of the carrier organism and (v) spread of undesired genes such as antibiotic resistance genes. Before live vaccines are applied, the safety issues must be thoroughly evaluated case-by-case. Safety assessment includes knowledge of the precise function and genetic location of the genes to be mutated, their genetic stability, potential reversion mechanisms, possible recombination events with dormant genes, gene transfer to other organisms as well as gene acquisition from other organisms by phage transduction, transposition or plasmid transfer and cis- or trans-complementation. For this, GMOs that are constructed with modern techniques of genetic engineering display a significant advantage over random mutagenesis derived live organisms. The selection of suitable GMO candidate strains can be made under in vitro conditions using basic knowledge on molecular mechanisms of pathogenicity of the corresponding bacterial species rather than by in vivo testing of large numbers of random mutants. This leads to a more targeted safety testing on volunteers and to a reduction in the use of animal experimentation.

Long-term outcome of trans-scleral diode laser cyclophotocoagulation in refractory glaucoma

BACKGROUND: Long-term outcome and complications of diode laser cyclophotocoagulation (DCPC) may be important, since eyes, once treated with DCPC, are less likely to be subjected to other types of interventions in the further follow-up. METHODS: Retrospective review of 131 eyes of 127 patients treated from 2000 through 2004. Success was defined as intraocular pressure (IOP) at last visit 6-21 mm Hg; hypotony: IOP