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Background: Inferring regulatory interactions between genes from transcriptomics time-resolved data, yielding reverse engineered gene regulatory networks, is of paramount importance to systems biology and bioinformatics studies. Accurate methods to address this problem can ultimately provide a deeper insight into the complexity, behavior, and functions of the underlying biological systems. However, the large number of interacting genes coupled with short and often noisy time-resolved read-outs of the system renders the reverse engineering a challenging task. Therefore, the development and assessment of methods which are computationally efficient, robust against noise, applicable to short time series data, and preferably capable of reconstructing the directionality of the regulatory interactions remains a pressing research problem with valuable applications.
Results: Here we perform the largest systematic analysis of a set of similarity measures and scoring schemes within the scope of the relevance network approach which are commonly used for gene regulatory network reconstruction from time series data. In addition, we define and analyze several novel measures and schemes which are particularly suitable for short transcriptomics time series. We also compare the considered 21 measures and 6 scoring schemes according to their ability to correctly reconstruct such networks from short time series data by calculating summary statistics based on the corresponding specificity and sensitivity. Our results demonstrate that rank and symbol based measures have the highest performance in inferring regulatory interactions. In addition, the proposed scoring scheme by asymmetric weighting has shown to be valuable in reducing the number of false positive interactions. On the other hand, Granger causality as well as information-theoretic measures, frequently used in inference of regulatory networks, show low performance on the short time series analyzed in this study.
Conclusions: Our study is intended to serve as a guide for choosing a particular combination of similarity measures and scoring schemes suitable for reconstruction of gene regulatory networks from short time series data. We show that further improvement of algorithms for reverse engineering can be obtained if one considers measures that are rooted in the study of symbolic dynamics or ranks, in contrast to the application of common similarity measures which do not consider the temporal character of the employed data. Moreover, we establish that the asymmetric weighting scoring scheme together with symbol based measures (for low noise level) and rank based measures (for high noise level) are the most suitable choices.
The femtosecond excited-state dynamics following resonant photoexcitation enable the selective deformation of N-H and N-C chemical bonds in 2-thiopyridone in aqueous solution with optical or X-ray pulses. In combination with multiconfigurational quantum-chemical calculations, the orbital-specific electronic structure and its ultrafast dynamics accessed with resonant inelastic X-ray scattering at the N 1s level using synchrotron radiation and the soft X-ray free-electron laser LCLS provide direct evidence for this controlled photoinduced molecular deformation and its ultrashort time-scale.
Many studies demonstrated interactions between number processing and either spatial codes (effects of spatial-numerical associations) or visual size-related codes (size-congruity effect). However, the interrelatedness of these two number couplings is still unclear. The present study examines the simultaneous occurrence of space- and size-numerical congruency effects and their interactions both within and across trials, in a magnitude judgment task physically small or large digits were presented left or right from screen center. The reaction times analysis revealed that space- and size-congruency effects coexisted in parallel and combined additively. Moreover, a selective sequential modulation of the two congruency effects was found. The size-congruency effect was reduced after size incongruent trials. The space-congruency effect, however, was only affected by the previous space congruency. The observed independence of spatial-numerical and within magnitude associations is interpreted as evidence that the two couplings reflect Different attributes of numerical meaning possibly related to orginality and cardinality.
In the context of back pain, great emphasis has been placed on the importance of trunk stability, especially in situations requiring compensation of repetitive, intense loading induced during high-performance activities, e.g., jumping or landing. This study aims to evaluate trunk muscle activity during drop jump in adolescent athletes with back pain (BP) compared to athletes without back pain (NBP). Eleven adolescent athletes suffering back pain (BP: m/f: n = 4/7; 15.9 ± 1.3 y; 176 ± 11 cm; 68 ± 11 kg; 12.4 ± 10.5 h/we training) and 11 matched athletes without back pain (NBP: m/f: n = 4/7; 15.5 ± 1.3 y; 174 ± 7 cm; 67 ± 8 kg; 14.9 ± 9.5 h/we training) were evaluated. Subjects conducted 3 drop jumps onto a force plate (ground reaction force). Bilateral 12-lead SEMG (surface Electromyography) was applied to assess trunk muscle activity. Ground contact time [ms], maximum vertical jump force [N], jump time [ms] and the jump performance index [m/s] were calculated for drop jumps. SEMG amplitudes (RMS: root mean square [%]) for all 12 single muscles were normalized to MIVC (maximum isometric voluntary contraction) and analyzed in 4 time windows (100 ms pre- and 200 ms post-initial ground contact, 100 ms pre- and 200 ms post-landing) as outcome variables. In addition, muscles were grouped and analyzed in ventral and dorsal muscles, as well as straight and transverse trunk muscles. Drop jump ground reaction force variables did not differ between NBP and BP (p > 0.05). Mm obliquus externus and internus abdominis presented higher SEMG amplitudes (1.3–1.9-fold) for BP (p < 0.05). Mm rectus abdominis, erector spinae thoracic/lumbar and latissimus dorsi did not differ (p > 0.05). The muscle group analysis over the whole jumping cycle showed statistically significantly higher SEMG amplitudes for BP in the ventral (p = 0.031) and transverse muscles (p = 0.020) compared to NBP. Higher activity of transverse, but not straight, trunk muscles might indicate a specific compensation strategy to support trunk stability in athletes with back pain during drop jumps. Therefore, exercises favoring the transverse trunk muscles could be recommended for back pain treatment.
Trunk loading and back pain
(2017)
An essential function of the trunk is the compensation of external forces and loads in order to guarantee stability. Stabilising the trunk during sudden, repetitive loading in everyday tasks, as well as during performance is important in order to protect against injury. Hence, reduced trunk stability is accepted as a risk factor for the development of back pain (BP). An altered activity pattern including extended response and activation times as well as increased co-contraction of the trunk muscles as well as a reduced range of motion and increased movement variability of the trunk are evident in back pain patients (BPP). These differences to healthy controls (H) have been evaluated primarily in quasi-static test situations involving isolated loading directly to the trunk. Nevertheless, transferability to everyday, dynamic situations is under debate. Therefore, the aim of this project is to analyse 3-dimensional motion and neuromuscular reflex activity of the trunk as response to dynamic trunk loading in healthy (H) and back pain patients (BPP).
A measurement tool was developed to assess trunk stability, consisting of dynamic test situations. During these tests, loading of the trunk is generated by the upper and lower limbs with and without additional perturbation. Therefore, lifting of objects and stumbling while walking are adequate represents. With the help of a 12-lead EMG, neuromuscular activity of the muscles encompassing the trunk was assessed. In addition, three-dimensional trunk motion was analysed using a newly developed multi-segmental trunk model. The set-up was checked for reproducibility as well as validity. Afterwards, the defined measurement set-up was applied to assess trunk stability in comparisons of healthy and back pain patients.
Clinically acceptable to excellent reliability could be shown for the methods (EMG/kinematics) used in the test situations. No changes in trunk motion pattern could be observed in healthy adults during continuous loading (lifting of objects) of different weights. In contrast, sudden loading of the trunk through perturbations to the lower limbs during walking led to an increased neuromuscular activity and ROM of the trunk. Moreover, BPP showed a delayed muscle response time and extended duration until maximum neuromuscular activity in response to sudden walking perturbations compared to healthy controls. In addition, a reduced lateral flexion of the trunk during perturbation could be shown in BPP.
It is concluded that perturbed gait seems suitable to provoke higher demands on trunk stability in adults. The altered neuromuscular and kinematic compensation pattern in back pain patients (BPP) can be interpreted as increased spine loading and reduced trunk stability in patients. Therefore, this novel assessment of trunk stability is suitable to identify deficits in BPP. Assignment of affected BPP to therapy interventions with focus on stabilisation of the trunk aiming to improve neuromuscular control in dynamic situations is implied. Hence, sensorimotor training (SMT) to enhance trunk stability and compensation of unexpected sudden loading should be preferred.
Trends in precipitation over Germany and the Rhine basin related to changes in weather patterns
(2017)
Precipitation as the central meteorological feature for agriculture, water security, and human well-being amongst others, has gained special attention ever since. Lack of precipitation may have devastating effects such as crop failure and water scarcity. Abundance of precipitation, on the other hand, may as well result in hazardous events such as flooding and again crop failure. Thus, great effort has been spent on tracking changes in precipitation and relating them to underlying processes. Particularly in the face of global warming and given the link between temperature and atmospheric water holding capacity, research is needed to understand the effect of climate change on precipitation.
The present work aims at understanding past changes in precipitation and other meteorological variables. Trends were detected for various time periods and related to associated changes in large-scale atmospheric circulation. The results derived in this thesis may be used as the foundation for attributing changes in floods to climate change. Assumptions needed for the downscaling of large-scale circulation model output to local climate stations are tested and verified here.
In a first step, changes in precipitation over Germany were detected, focussing not only on precipitation totals, but also on properties of the statistical distribution, transition probabilities as a measure for wet/dry spells, and extreme precipitation events.
Shifting the spatial focus to the Rhine catchment as one of the major water lifelines of Europe and the largest river basin in Germany, detected trends in precipitation and other meteorological variables were analysed in relation to states of an ``optimal'' weather pattern classification. The weather pattern classification was developed seeking the best skill in explaining the variance of local climate variables.
The last question addressed whether observed changes in local climate variables are attributable to changes in the frequency of weather patterns or rather to changes within the patterns itself. A common assumption for a downscaling approach using weather patterns and a stochastic weather generator is that climate change is expressed only as a changed occurrence of patterns with the pattern properties remaining constant. This assumption was validated and the ability of the latest generation of general circulation models to reproduce the weather patterns was evaluated.
% Paper 1
Precipitation changes in Germany in the period 1951-2006 can be summarised briefly as negative in summer and positive in all other seasons. Different precipitation characteristics confirm the trends in total precipitation: while winter mean and extreme precipitation have increased, wet spells tend to be longer as well (expressed as increased probability for a wet day followed by another wet day). For summer the opposite was observed: reduced total precipitation, supported by decreasing mean and extreme precipitation and reflected in an increasing length of dry spells.
Apart from this general summary for the whole of Germany, the spatial distribution within the country is much more differentiated. Increases in winter precipitation are most pronounced in the north-west and south-east of Germany, while precipitation increases are highest in the west for spring and in the south for autumn. Decreasing summer precipitation was observed in most regions of Germany, with particular focus on the south and west.
The seasonal picture, however, was again differently represented in the contributing months, e.g.\ increasing autumn precipitation in the south of Germany is formed by strong trends in the south-west in October and in the south-east in November. These results emphasise the high spatial and temporal organisation of precipitation changes.
% Paper 2
The next step towards attributing precipitation trends to changes in large-scale atmospheric patterns was the derivation of a weather pattern classification that sufficiently stratifies the local climate variables under investigation. Focussing on temperature, radiation, and humidity in addition to precipitation, a classification based on mean sea level pressure, near-surface temperature, and specific humidity was found to have the best skill in explaining the variance of the local variables. A rather high number of 40 patterns was selected, allowing typical pressure patterns being assigned to specific seasons by the associated temperature patterns. While the skill in explaining precipitation variance is rather low, better skill was achieved for radiation and, of course, temperature.
Most of the recent GCMs from the CMIP5 ensemble were found to reproduce these weather patterns sufficiently well in terms of frequency, seasonality, and persistence.
% Paper 3
Finally, the weather patterns were analysed for trends in pattern frequency, seasonality, persistence, and trends in pattern-specific precipitation and temperature. To overcome uncertainties in trend detection resulting from the selected time period, all possible periods in 1901-2010 with a minimum length of 31 years were considered. Thus, the assumption of a constant link between patterns and local weather was tested rigorously. This assumption was found to hold true only partly. While changes in temperature are mainly attributable to changes in pattern frequency, for precipitation a substantial amount of change was detected within individual patterns.
Magnitude and even sign of trends depend highly on the selected time period. The frequency of certain patterns is related to the long-term variability of large-scale circulation modes.
Changes in precipitation were found to be heterogeneous not only in space, but also in time - statements on trends are only valid for the specific time period under investigation. While some part of the trends can be attributed to changes in the large-scale circulation, distinct changes were found within single weather patterns as well.
The results emphasise the need to analyse multiple periods for thorough trend detection wherever possible and add some note of caution to the application of downscaling approaches based on weather patterns, as they might misinterpret the effect of climate change due to neglecting within-type trends.
Translating innovation
(2017)
This doctoral thesis studies the process of innovation adoption in public administrations, addressing the research question of how an innovation is translated to a local context. The study empirically explores Design Thinking as a new problem-solving approach introduced by a federal government organisation in Singapore. With a focus on user-centeredness, collaboration and iteration Design Thinking seems to offer a new way to engage recipients and other stakeholders of public services as well as to re-think the policy design process from a user’s point of view. Pioneered in the private sector, early adopters of the methodology include civil services in Australia, Denmark, the United Kingdom, the United States as well as Singapore. Hitherto, there is not much evidence on how and for which purposes Design Thinking is used in the public sector.
For the purpose of this study, innovation adoption is framed in an institutionalist perspective addressing how concepts are translated to local contexts. The study rejects simplistic views of the innovation adoption process, in which an idea diffuses to another setting without adaptation. The translation perspective is fruitful because it captures the multidimensionality and ‘messiness’ of innovation adoption. More specifically, the overall research question addressed in this study is: How has Design Thinking been translated to the local context of the public sector organisation under investigation? And from a theoretical point of view: What can we learn from translation theory about innovation adoption processes?
Moreover, there are only few empirical studies of organisations adopting Design Thinking and most of them focus on private organisations. We know very little about how Design Thinking is embedded in public sector organisations. This study therefore provides further empirical evidence of how Design Thinking is used in a public sector organisation, especially with regards to its application to policy work which has so far been under-researched.
An exploratory single case study approach was chosen to provide an in-depth analysis of the innovation adoption process. Based on a purposive, theory-driven sampling approach, a Singaporean Ministry was selected because it represented an organisational setting in which Design Thinking had been embedded for several years, making it a relevant case with regard to the research question. Following a qualitative research design, 28 semi-structured interviews (45-100 minutes) with employees and managers were conducted. The interview data was triangulated with observations and documents, collected during a field research research stay in Singapore.
The empirical study of innovation adoption in a single organisation focused on the intra-organisational perspective, with the aim to capture the variations of translation that occur during the adoption process. In so doing, this study opened the black box often assumed in implementation studies. Second, this research advances translation studies not only by showing variance, but also by deriving explanatory factors. The main differences in the translation of Design Thinking occurred between service delivery and policy divisions, as well as between the first adopter and the rest of the organisation. For the intra-organisational translation of Design Thinking in the Singaporean Ministry the following five factors played a role: task type, mode of adoption, type of expertise, sequence of adoption, and the adoption of similar practices.
Working memory (WM) performance declines with age. However, several studies have shown that WM training may lead to performance increases not only in the trained task, but also in untrained cognitive transfer tasks. It has been suggested that transfer effects occur if training task and transfer task share specific processing components that are supposedly processed in the same brain areas. In the current study, we investigated whether single-task WM training and training-related alterations in neural activity might support performance in a dual-task setting, thus assessing transfer effects to higher-order control processes in the context of dual-task coordination. A sample of older adults (age 60–72) was assigned to either a training or control group. The training group participated in 12 sessions of an adaptive n-back training. At pre and post-measurement, a multimodal dual-task was performed in all participants to assess transfer effects. This task consisted of two simultaneous delayed match to sample WM tasks using two different stimulus modalities (visual and auditory) that were performed either in isolation (single-task) or in conjunction (dual-task). A subgroup also participated in functional magnetic resonance imaging (fMRI) during the performance of the n-back task before and after training. While no transfer to single-task performance was found, dual-task costs in both the visual modality (p < 0.05) and the auditory modality (p < 0.05) decreased at post-measurement in the training but not in the control group. In the fMRI subgroup of the training participants, neural activity changes in left dorsolateral prefrontal cortex (DLPFC) during one-back predicted post-training auditory dual-task costs, while neural activity changes in right DLPFC during three-back predicted visual dual-task costs. Results might indicate an improvement in central executive processing that could facilitate both WM and dual-task coordination.
With its transparent orthography, Standard Indonesian is spoken by over 160 million inhabitants and is the primary language of instruction in education and the government in Indonesia. An assessment battery of reading and reading-related skills was developed as a starting point for the diagnosis of dyslexia in beginner learners. Founded on the International Dyslexia Association’s definition of dyslexia, the test battery comprises nine empirically motivated reading and reading-related tasks assessing word reading, pseudoword reading, arithmetic, rapid automatized naming, phoneme deletion, forward and backward digit span, verbal fluency, orthographic choice (spelling), and writing. The test was validated by computing the relationships between the outcomes on the reading-skills and reading-related measures by means of correlation and factor analyses. External variables, i.e., school grades and teacher ratings of the reading and learning abilities of individual students, were also utilized to provide evidence of its construct validity. Four variables were found to be significantly related with reading-skill measures: phonological awareness, rapid naming, spelling, and digit span. The current study on reading development in Standard Indonesian confirms findings from other languages with transparent orthographies and suggests a test battery including preliminary norm scores for screening and assessment of elementary school children learning to read Standard Indonesian.
As an emerging sub-field of music information retrieval (MIR), music imagery information retrieval (MIIR) aims to retrieve information from brain activity recorded during music cognition–such as listening to or imagining music pieces. This is a highly inter-disciplinary endeavor that requires expertise in MIR as well as cognitive neuroscience and psychology. The OpenMIIR initiative strives to foster collaborations between these fields to advance the state of the art in MIIR. As a first step, electroencephalography (EEG) recordings of music perception and imagination have been made publicly available, enabling MIR researchers to easily test and adapt their existing approaches for music analysis like fingerprinting, beat tracking or tempo estimation on this new kind of data. This paper reports on first results of MIIR experiments using these OpenMIIR datasets and points out how these findings could drive new research in cognitive neuroscience.
We present a setup combining a liquid flatjet sample delivery and a MHz laser system for time-resolved soft X-ray absorption measurements of liquid samples at the high brilliance undulator beamline UE52-SGM at Bessy II yielding unprecedented statistics in this spectral range. We demonstrate that the efficient detection of transient absorption changes in transmission mode enables the identification of photoexcited species in dilute samples. With iron(II)-trisbipyridine in aqueous solution as a benchmark system, we present absorption measurements at various edges in the soft X-ray regime. In combination with the wavelength tunability of the laser system, the set-up opens up opportunities to study the photochemistry of many systems at low concentrations, relevant to materials sciences, chemistry, and biology.
We introduce three strategies for the analysis of financial time series based on time averaged observables. These comprise the time averaged mean squared displacement (MSD) as well as the ageing and delay time methods for varying fractions of the financial time series. We explore these concepts via statistical analysis of historic time series for several Dow Jones Industrial indices for the period from the 1960s to 2015. Remarkably, we discover a simple universal law for the delay time averaged MSD. The observed features of the financial time series dynamics agree well with our analytical results for the time averaged measurables for geometric Brownian motion, underlying the famed Black–Scholes–Merton model. The concepts we promote here are shown to be useful for financial data analysis and enable one to unveil new universal features of stock market dynamics.
In October 2016, following a campaign led by Labour Peer Lord
Alfred Dubs, the first child asylum-seekers allowed entry to the UK
under new legislation (the ‘Dubs amendment’) arrived in England.
Their arrival was captured by a heavy media presence, and very
quickly doubts were raised by right-wing tabloids and politicians
about their age. In this article, I explore the arguments
underpinning the Dubs campaign and the media coverage of
the children’s arrival as a starting point for interrogating
representational practices around children who seek asylum. I
illustrate how the campaign was premised on a universal politics
of childhood that inadvertently laid down the terms on which
these children would be given protection, namely their innocence.
The universality of childhood fuels public sympathy for child
asylum-seekers, underlies the ‘child first, migrant second’
approach advocated by humanitarian organisations, and it was a
key argument in the ‘Dubs amendment’. Yet the campaign
highlights how representations of child asylum-seekers rely on
codes that operate to identify ‘unchildlike’ children. As I show, in
the context of the criminalisation of undocumented migrants‘,
childhood is no longer a stable category which guarantees
protection, but is subject to scrutiny and suspicion and can,
ultimately, be disproved.
Thermal cis-trans isomerization of azobenzene studied by path sampling and QM/MM stochastic dynamics
(2017)
Azobenzene-based molecular photoswitches have extensively been applied to biological systems, involving photo-control of peptides, lipids and nucleic acids. The isomerization between the stable trans and the metastable cis state of the azo moieties leads to pronounced changes in shape and other physico-chemical properties of the molecules into which they are incorporated. Fast switching can be induced via transitions to excited electronic states and fine-tuned by a large number of different substituents at the phenyl rings. But a rational design of tailor-made azo groups also requires control of their stability in the dark, the half-lifetime of the cis isomer. In computational chemistry, thermally activated barrier crossing on the ground state Born-Oppenheimer surface can efficiently be estimated with Eyring’s transition state theory (TST) approach; the growing complexity of the azo moiety and a rather heterogeneous environment, however, may render some of the underlying simplifying assumptions problematic.
In this dissertation, a computational approach is established to remove two restrictions at once: the environment is modeled explicitly by employing a quantum mechanical/molecular mechanics (QM/MM) description; and the isomerization process is tracked by analyzing complete dynamical pathways between stable states. The suitability of this description is validated by using two test systems, pure azo benzene and a derivative with electron donating and electron withdrawing substituents (“push-pull” azobenzene). Each system is studied in the gas phase, in toluene and in polar DMSO solvent. The azo molecules are treated at the QM level using a very recent, semi-empirical approximation to density functional theory (density functional tight binding approximation). Reactive pathways are sampled by implementing a version of the so-called transition path sampling method (TPS), without introducing any bias into the system dynamics. By analyzing ensembles of reactive trajectories, the change in isomerization pathway from linear inversion to rotation in going from apolar to polar solvent, predicted by the TST approach, could be verified for the push-pull derivative. At the same time, the mere presence of explicit solvation is seen to broaden the distribution of isomerization pathways, an effect TST cannot account for.
Using likelihood maximization based on the TPS shooting history, an improved reaction coordinate was identified as a sine-cosine combination of the central bend angles and the rotation dihedral, r (ω,α,α′). The computational van’t Hoff analysis for the activation entropies was performed to gain further insight into the differential role of solvent for the case of the unsubstituted and the push-pull azobenzene. In agreement with the experiment, it yielded positive activation entropies for azobenzene in the DMSO solvent while negative for the push-pull derivative, reflecting the induced ordering of solvent around the more dipolar transition state associated to the latter compound. Also, the dynamically corrected rate constants were evaluated using the reactive flux approach where an increase comparable to the experimental one was observed for a high polarity medium for both azobenzene derivatives.
Rezensiertes Werk
Theresa Biberauer u. George Walkden (Hgg.): Syntax over Time: Lexical, Morphological, and Information – Structural Interactions - Oxford, Oxford University Press, 2015, 418 S.
Einleitung: Die Erdnussallergie zählt zu den häufigsten Nahrungsmittelallergien im Kindesalter. Bereits kleine Mengen Erdnuss (EN) können zu schweren allergischen Reaktionen führen. EN ist der häufigste Auslöser einer lebensbedrohlichen Anaphylaxie bei Kindern und Jugendlichen. Im Gegensatz zu anderen frühkindlichen Nahrungsmittelallergien entwickeln Patienten mit einer EN-Allergie nur selten eine natürliche Toleranz. Seit mehreren Jahren wird daher an kausalen Therapiemöglichkeiten für EN-Allergiker, insbesondere an der oralen Immuntherapie (OIT), geforscht. Erste kleinere Studien zur OIT bei EN-Allergie zeigten erfolgsversprechende Ergebnisse. Im Rahmen einer randomisierten, doppelblind, Placebo-kontrollierten Studie mit größerer Fallzahl werden in der vorliegenden Arbeit die klinische Wirksamkeit und Sicherheit dieser Therapieoption bei Kindern mit EN-Allergie genauer evaluiert. Des Weiteren werden immunologische Veränderungen sowie die Lebensqualität und Therapiebelastung unter OIT untersucht.
Methoden: Kinder zwischen 3-18 Jahren mit einer IgE-vermittelten EN-Allergie wurden in die Studie eingeschlossen. Vor Beginn der OIT wurde eine orale Provokation mit EN durchgeführt. Die Patienten wurden 1:1 randomisiert und entsprechend der Verum- oder Placebogruppe zugeordnet. Begonnen wurde mit 2-120 mg EN bzw. Placebo pro Tag, abhängig von der Reaktionsdosis bei der oralen Provokation. Zunächst wurde die tägliche OIT-Dosis alle zwei Wochen über etwa 14 Monate langsam bis zu einer Erhaltungsdosis von mindestens 500 mg EN (= 125 mg EN-Protein, ~ 1 kleine EN) bzw. Placebo gesteigert. Die maximal erreichte Dosis wurde dann über zwei Monate täglich zu Hause verabreicht. Im Anschluss erfolgte erneut eine orale Provokation mit EN. Der primäre Endpunkt der Studie war die Anzahl an Patienten der Verum- und Placebogruppe, die unter oraler Provokation nach OIT ≥1200 mg EN vertrugen (=„partielle Desensibilisierung“). Sowohl vor als auch nach OIT wurde ein Hautpricktest mit EN durchgeführt und EN-spezifisches IgE und IgG4 im Serum bestimmt. Außerdem wurden die Basophilenaktivierung sowie die Ausschüttung von T-Zell-spezifischen Zytokinen nach Stimulation mit EN in vitro gemessen. Anhand von Fragebögen wurde die Lebensqualität vor und nach OIT sowie die Therapiebelastung während OIT erfasst.
Ergebnisse: 62 Patienten wurden in die Studie eingeschlossen und randomisiert. Nach etwa 16 Monaten unter OIT zeigten 74,2% (23/31) der Patienten der Verumgruppe und nur 16,1% (5/31) der Placebogruppe eine „partielle Desensibilisierung“ gegenüber EN (p<0,001). Im Median vertrugen Patienten der Verumgruppe 4000 mg EN (~8 kleine EN) unter der Provokation nach OIT wohingegen Patienten der Placebogruppe nur 80 mg EN (~1/6 kleine EN) vertrugen (p<0,001). Fast die Hälfte der Patienten der Verumgruppe (41,9%) tolerierten die Höchstdosis von 18 g EN unter Provokation („komplette Desensibilisierung“). Es zeigte sich ein vergleichbares Sicherheitsprofil unter Verum- und Placebo-OIT in Bezug auf objektive Nebenwirkungen. Unter Verum-OIT kam es jedoch signifikant häufiger zu subjektiven Nebenwirkungen wie oralem Juckreiz oder Bauchschmerzen im Vergleich zu Placebo (3,7% der Verum-OIT-Gaben vs. 0,5% der Placebo-OIT-Gaben, p<0,001). Drei Kinder der Verumgruppe (9,7%) und sieben Kinder der Placebogruppe (22,6%) beendeten die Studie vorzeitig, je zwei Patienten beider Gruppen aufgrund von Nebenwirkungen. Im Gegensatz zu Placebo, zeigten sich unter Verum-OIT signifikante immunologische Veränderungen. So kam es zu einer Abnahme des EN-spezifischen Quaddeldurchmessers im Hautpricktest, einem Anstieg der EN-spezifischen IgG4-Werte im Serum sowie zu einer verminderten EN-spezifischen Zytokinsekretion, insbesondere der Th2-spezifischen Zytokine IL-4 und IL-5. Hinsichtlich der EN-spezifischen IgE-Werte sowie der EN-spezifischen Basophilenaktivierung zeigten sich hingegen keine Veränderungen unter OIT. Die Lebensqualität von Kindern der Verumgruppe war nach OIT signifikant verbessert, jedoch nicht bei Kindern der Placebogruppe. Während der OIT wurde die Therapie von fast allen Kindern (82%) und Müttern (82%) als positiv bewertet (= niedrige Therapiebelastung).
Diskussion: Die EN-OIT führte bei einem Großteil der EN-allergischen Kinder zu einer Desensibilisierung und einer deutlich erhöhten Reaktionsschwelle auf EN. Somit sind die Kinder im Alltag vor akzidentellen Reaktionen auf EN geschützt, was die Lebensqualität der Kinder deutlich verbessert. Unter den kontrollierten Studienbedingungen zeigte sich ein akzeptables Sicherheitsprofil, mit vorrangig milder Symptomatik. Die klinische Desensibilisierung ging mit Veränderungen auf immunologischer Ebene einher. Langzeitstudien zur EN-OIT müssen jedoch abgewartet werden, um die klinische und immunologische Wirksamkeit hinsichtlich einer möglichen langfristigen oralen Toleranzinduktion sowie die Sicherheit unter langfristiger OIT zu untersuchen, bevor das Therapiekonzept in die Praxis übertragen werden kann.