Skip to main content
Erschienen in: Clinical and Experimental Medicine 3/2019

03.05.2019 | Review Article

Adeno-associated virus as a gene therapy vector: strategies to neutralize the neutralizing antibodies

verfasst von: Majid Lotfinia, Meghdad Abdollahpour-Alitappeh, Behzad Hatami, Mohammad Reza Zali, Morteza Karimipoor

Erschienen in: Clinical and Experimental Medicine | Ausgabe 3/2019

Einloggen, um Zugang zu erhalten

Abstract

Adeno-associated virus (AAV)-derived vectors are currently the most common type of viral vectors used in gene therapy clinical trials. The presence of neutralizing antibodies (NAbs) against wild-type AAVs in the host body is one of the limitations for the successful use of AAV vectors. AAV capsid manipulation, by which recombinant vectors lose their ability to interact with NAbs, can help overcome this obstacle. Various methods can be used for this purpose, including directed evolution as well as conjugation of certain chemical groups to AAV epitopes. The present review concisely explains the use of AAV vectors in the clinic for gene therapy of some diseases, their limitations, and solutions to these limitations.
Literatur
1.
2.
Zurück zum Zitat Dunbar CE, High KA, Joung JK, Kohn DB, Ozawa K, Sadelain M. Gene therapy comes of age. Science (80-) [Internet]. 2018;359. Dunbar CE, High KA, Joung JK, Kohn DB, Ozawa K, Sadelain M. Gene therapy comes of age. Science (80-) [Internet]. 2018;359.
3.
Zurück zum Zitat Atchison RW, Casto BC, Hammon WM. Adenovirus-associated defective virus particles. Science. United States. 1965;149:754–6. Atchison RW, Casto BC, Hammon WM. Adenovirus-associated defective virus particles. Science. United States. 1965;149:754–6.
4.
Zurück zum Zitat Mori S, Wang L, Takeuchi T, Kanda T. Two novel adeno-associated viruses from cynomolgus monkey: pseudotyping characterization of capsid protein. Virology. United States. 2004;330:375–83.CrossRef Mori S, Wang L, Takeuchi T, Kanda T. Two novel adeno-associated viruses from cynomolgus monkey: pseudotyping characterization of capsid protein. Virology. United States. 2004;330:375–83.CrossRef
5.
Zurück zum Zitat Srivastava A, Lusby EW, Berns KI. Nucleotide sequence and organization of the adeno-associated virus 2 genome. J Virol. United States. 1983;45:555–64. Srivastava A, Lusby EW, Berns KI. Nucleotide sequence and organization of the adeno-associated virus 2 genome. J Virol. United States. 1983;45:555–64.
6.
Zurück zum Zitat Becerra SP, Koczot F, Fabisch P, Rose JA. Synthesis of adeno-associated virus structural proteins requires both alternative mRNA splicing and alternative initiations from a single transcript. J Virol. United States. 1988;62:2745–54. Becerra SP, Koczot F, Fabisch P, Rose JA. Synthesis of adeno-associated virus structural proteins requires both alternative mRNA splicing and alternative initiations from a single transcript. J Virol. United States. 1988;62:2745–54.
7.
Zurück zum Zitat Bartlett JS, Wilcher R, Samulski RJ. Infectious entry pathway of adeno-associated virus and adeno-associated virus vectors. J Virol. United States. 2000;74:2777–85. Bartlett JS, Wilcher R, Samulski RJ. Infectious entry pathway of adeno-associated virus and adeno-associated virus vectors. J Virol. United States. 2000;74:2777–85.
8.
Zurück zum Zitat Daya S, Berns KI. Gene therapy using adeno-associated virus vectors. Clin Microbiol Rev. United States. 2008;21:583–93.CrossRef Daya S, Berns KI. Gene therapy using adeno-associated virus vectors. Clin Microbiol Rev. United States. 2008;21:583–93.CrossRef
9.
Zurück zum Zitat Mingozzi F, High KA. Therapeutic in vivo gene transfer for genetic disease using AAV: progress and challenges. Nat Rev Genet. England. 2011;12:341–55.CrossRef Mingozzi F, High KA. Therapeutic in vivo gene transfer for genetic disease using AAV: progress and challenges. Nat Rev Genet. England. 2011;12:341–55.CrossRef
10.
Zurück zum Zitat Samulski RJ, Muzyczka N. AAV-Mediated Gene Therapy for Research and Therapeutic Purposes. Annu Rev Virol. United States. 2014;1:427–51.CrossRef Samulski RJ, Muzyczka N. AAV-Mediated Gene Therapy for Research and Therapeutic Purposes. Annu Rev Virol. United States. 2014;1:427–51.CrossRef
11.
Zurück zum Zitat Nathwani AC, Tuddenham EGD, Rangarajan S, et al. Adenovirus-associated virus vector-mediated gene transfer in hemophilia B. N Engl J Med. United States. 2011;365:2357–65.CrossRef Nathwani AC, Tuddenham EGD, Rangarajan S, et al. Adenovirus-associated virus vector-mediated gene transfer in hemophilia B. N Engl J Med. United States. 2011;365:2357–65.CrossRef
12.
Zurück zum Zitat Nathwani AC, Reiss UM, Tuddenham EGD, et al. Long-term safety and efficacy of factor IX gene therapy in hemophilia B. N Engl J Med. United States. 2014;371:1994–2004.CrossRef Nathwani AC, Reiss UM, Tuddenham EGD, et al. Long-term safety and efficacy of factor IX gene therapy in hemophilia B. N Engl J Med. United States. 2014;371:1994–2004.CrossRef
13.
Zurück zum Zitat Sarkar R, Tetreault R, Gao G, et al. Total correction of hemophilia A mice with canine FVIII using an AAV 8 serotype. Blood [Internet]. 2004;103:1253–60.CrossRefPubMed Sarkar R, Tetreault R, Gao G, et al. Total correction of hemophilia A mice with canine FVIII using an AAV 8 serotype. Blood [Internet]. 2004;103:1253–60.CrossRefPubMed
14.
Zurück zum Zitat Thomas CE, Storm TA, Huang Z, Kay MA. Rapid uncoating of vector genomes is the key to efficient liver transduction with pseudotyped adeno-associated virus vectors. J Virol. United States. 2004;78:3110–22. Thomas CE, Storm TA, Huang Z, Kay MA. Rapid uncoating of vector genomes is the key to efficient liver transduction with pseudotyped adeno-associated virus vectors. J Virol. United States. 2004;78:3110–22.
15.
Zurück zum Zitat Wang L, Bell P, Lin J, Calcedo R, Tarantal AF, Wilson JM. AAV8-mediated hepatic gene transfer in infant rhesus monkeys (Macaca mulatta). Mol Ther. United States. 2011;19:2012–20.CrossRef Wang L, Bell P, Lin J, Calcedo R, Tarantal AF, Wilson JM. AAV8-mediated hepatic gene transfer in infant rhesus monkeys (Macaca mulatta). Mol Ther. United States. 2011;19:2012–20.CrossRef
16.
Zurück zum Zitat Bell P, Gao G, Haskins ME, et al. Evaluation of adeno-associated viral vectors for liver-directed gene transfer in dogs. Hum Gene Ther. United States. 2011;22:985–97.CrossRef Bell P, Gao G, Haskins ME, et al. Evaluation of adeno-associated viral vectors for liver-directed gene transfer in dogs. Hum Gene Ther. United States. 2011;22:985–97.CrossRef
17.
Zurück zum Zitat Margaritis P, Roy E, Aljamali MN, et al. Successful treatment of canine hemophilia by continuous expression of canine FVIIa. Blood. United States. 2009;113:3682–9. Margaritis P, Roy E, Aljamali MN, et al. Successful treatment of canine hemophilia by continuous expression of canine FVIIa. Blood. United States. 2009;113:3682–9.
18.
Zurück zum Zitat Calcedo R, Morizono H, Wang L, et al. Adeno-associated virus antibody profiles in newborns, children, and adolescents. Clin Vaccine Immunol. United States. 2011;18:1586–8.CrossRef Calcedo R, Morizono H, Wang L, et al. Adeno-associated virus antibody profiles in newborns, children, and adolescents. Clin Vaccine Immunol. United States. 2011;18:1586–8.CrossRef
19.
Zurück zum Zitat Murphy SL, Li H, Mingozzi F, et al. Diverse IgG subclass responses to adeno-associated virus infection and vector administration. J Med Virol. United States. 2009;81:65–74.CrossRef Murphy SL, Li H, Mingozzi F, et al. Diverse IgG subclass responses to adeno-associated virus infection and vector administration. J Med Virol. United States. 2009;81:65–74.CrossRef
20.
Zurück zum Zitat High KA, Aubourg P. rAAV human trial experience. Methods Mol Biol. United States. 2011;807:429–57.CrossRef High KA, Aubourg P. rAAV human trial experience. Methods Mol Biol. United States. 2011;807:429–57.CrossRef
21.
Zurück zum Zitat Zinn E, Pacouret S, Khaychuk V, et al. In Silico Reconstruction of the Viral Evolutionary Lineage Yields a Potent Gene Therapy Vector. Cell Rep [Internet]. 2015;12:1056–68.CrossRefPubMedPubMedCentral Zinn E, Pacouret S, Khaychuk V, et al. In Silico Reconstruction of the Viral Evolutionary Lineage Yields a Potent Gene Therapy Vector. Cell Rep [Internet]. 2015;12:1056–68.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Grieger JC, Samulski RJ. Packaging capacity of adeno-associated virus serotypes: impact of larger genomes on infectivity and postentry steps. J Virol. United States. 2005;79:9933–44. Grieger JC, Samulski RJ. Packaging capacity of adeno-associated virus serotypes: impact of larger genomes on infectivity and postentry steps. J Virol. United States. 2005;79:9933–44.
23.
Zurück zum Zitat Ghosh A, Duan D. Expanding adeno-associated viral vector capacity: a tale of two vectors. Biotechnol Genet Eng Rev. England. 2007;24:165–77.CrossRef Ghosh A, Duan D. Expanding adeno-associated viral vector capacity: a tale of two vectors. Biotechnol Genet Eng Rev. England. 2007;24:165–77.CrossRef
24.
Zurück zum Zitat Samulski RJ, Berns KI, Tan M, Muzyczka N. Cloning of adeno-associated virus into pBR322: rescue of intact virus from the recombinant plasmid in human cells. Proc Natl Acad Sci U S A. 1982;79:2077–81.CrossRefPubMedPubMedCentral Samulski RJ, Berns KI, Tan M, Muzyczka N. Cloning of adeno-associated virus into pBR322: rescue of intact virus from the recombinant plasmid in human cells. Proc Natl Acad Sci U S A. 1982;79:2077–81.CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Tratschin JD, Miller IL, Carter BJ. Genetic analysis of adeno-associated virus: properties of deletion mutants constructed in vitro and evidence for an adeno-associated virus replication function. J Virol. United States. 1984;51:611–9. Tratschin JD, Miller IL, Carter BJ. Genetic analysis of adeno-associated virus: properties of deletion mutants constructed in vitro and evidence for an adeno-associated virus replication function. J Virol. United States. 1984;51:611–9.
26.
Zurück zum Zitat Raper SE, Chirmule N, Lee FS, et al. Fatal systemic inflammatory response syndrome in a ornithine transcarbamylase deficient patient following adenoviral gene transfer. Mol Genet Metab [Internet]. 2003;80:148–58.CrossRefPubMed Raper SE, Chirmule N, Lee FS, et al. Fatal systemic inflammatory response syndrome in a ornithine transcarbamylase deficient patient following adenoviral gene transfer. Mol Genet Metab [Internet]. 2003;80:148–58.CrossRefPubMed
27.
Zurück zum Zitat Zhu J, Huang X, Yang Y. The TLR9-MyD88 pathway is critical for adaptive immune responses to adeno-associated virus gene therapy vectors in mice. J Clin Invest [Internet]. 2009;119:2388–98.CrossRefPubMedPubMedCentral Zhu J, Huang X, Yang Y. The TLR9-MyD88 pathway is critical for adaptive immune responses to adeno-associated virus gene therapy vectors in mice. J Clin Invest [Internet]. 2009;119:2388–98.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Suzuki M, Bertin TK, Rogers GL, et al. Differential type I interferon-dependent transgene silencing of helper-dependent adenoviral vs. adeno-associated viral vectors in vivo. Mol Ther [Internet]. 2013;21:796–805. Suzuki M, Bertin TK, Rogers GL, et al. Differential type I interferon-dependent transgene silencing of helper-dependent adenoviral vs. adeno-associated viral vectors in vivo. Mol Ther [Internet]. 2013;21:796–805.
29.
Zurück zum Zitat Hosel M, Broxtermann M, Janicki H, et al. Toll-like receptor 2-mediated innate immune response in human nonparenchymal liver cells toward adeno-associated viral vectors. Hepatology [Internet]. 2012;55:287–97.CrossRefPubMed Hosel M, Broxtermann M, Janicki H, et al. Toll-like receptor 2-mediated innate immune response in human nonparenchymal liver cells toward adeno-associated viral vectors. Hepatology [Internet]. 2012;55:287–97.CrossRefPubMed
30.
Zurück zum Zitat Manno CS, Pierce GF, Arruda VR, et al. Successful transduction of liver in hemophilia by AAV-Factor IX and limitations imposed by the host immune response. Nat Med [Internet]. 2006;12:342–7.CrossRefPubMed Manno CS, Pierce GF, Arruda VR, et al. Successful transduction of liver in hemophilia by AAV-Factor IX and limitations imposed by the host immune response. Nat Med [Internet]. 2006;12:342–7.CrossRefPubMed
31.
Zurück zum Zitat Kotterman MA, Chalberg TW, Schaffer DV. Viral Vectors for Gene Therapy: Translational and Clinical Outlook. Annu Rev Biomed Eng. United States. 2015;17:63–89.CrossRef Kotterman MA, Chalberg TW, Schaffer DV. Viral Vectors for Gene Therapy: Translational and Clinical Outlook. Annu Rev Biomed Eng. United States. 2015;17:63–89.CrossRef
32.
Zurück zum Zitat Tseng YS, Agbandje-McKenna M. Mapping the AAV Capsid Host Antibody Response toward the Development of Second Generation Gene Delivery Vectors. Front Immunol [Internet]. 2014;5:9.PubMedPubMedCentral Tseng YS, Agbandje-McKenna M. Mapping the AAV Capsid Host Antibody Response toward the Development of Second Generation Gene Delivery Vectors. Front Immunol [Internet]. 2014;5:9.PubMedPubMedCentral
33.
Zurück zum Zitat Maheshri N, Koerber JT, Kaspar BK, Schaffer DV. Directed evolution of adeno-associated virus yields enhanced gene delivery vectors. Nat Biotechnol [Internet]. 2006;24:198–204.CrossRefPubMed Maheshri N, Koerber JT, Kaspar BK, Schaffer DV. Directed evolution of adeno-associated virus yields enhanced gene delivery vectors. Nat Biotechnol [Internet]. 2006;24:198–204.CrossRefPubMed
34.
Zurück zum Zitat Le HT, Yu QC, Wilson JM, Croyle MA. Utility of PEGylated recombinant adeno-associated viruses for gene transfer. J Control Release [Internet]. 2005;108:161–77.CrossRefPubMed Le HT, Yu QC, Wilson JM, Croyle MA. Utility of PEGylated recombinant adeno-associated viruses for gene transfer. J Control Release [Internet]. 2005;108:161–77.CrossRefPubMed
35.
Zurück zum Zitat Carlisle RC, Benjamin R, Briggs SS, et al. Coating of adeno-associated virus with reactive polymers can ablate virus tropism, enable retargeting and provide resistance to neutralising antisera. J Gene Med [Internet]. 2008;10:400–11.CrossRefPubMed Carlisle RC, Benjamin R, Briggs SS, et al. Coating of adeno-associated virus with reactive polymers can ablate virus tropism, enable retargeting and provide resistance to neutralising antisera. J Gene Med [Internet]. 2008;10:400–11.CrossRefPubMed
36.
37.
Zurück zum Zitat Kreppel F, Gackowski J, Schmidt E, Kochanek S. Combined genetic and chemical capsid modifications enable flexible and efficient de- and retargeting of adenovirus vectors. Mol Ther [Internet]. 2005;12:107–17.CrossRefPubMed Kreppel F, Gackowski J, Schmidt E, Kochanek S. Combined genetic and chemical capsid modifications enable flexible and efficient de- and retargeting of adenovirus vectors. Mol Ther [Internet]. 2005;12:107–17.CrossRefPubMed
38.
Zurück zum Zitat Gurda BL, Raupp C, Popa-Wagner R, et al. Mapping a neutralizing epitope onto the capsid of adeno-associated virus serotype 8. J Virol [Internet]. 2012;86:7739–51.CrossRefPubMedPubMedCentral Gurda BL, Raupp C, Popa-Wagner R, et al. Mapping a neutralizing epitope onto the capsid of adeno-associated virus serotype 8. J Virol [Internet]. 2012;86:7739–51.CrossRefPubMedPubMedCentral
39.
Zurück zum Zitat Wilson DS, Keefe AD. Random mutagenesis by PCR. Curr Protoc Mol Biol [Internet]. 2001;Chapter 8:Unit8 3. Wilson DS, Keefe AD. Random mutagenesis by PCR. Curr Protoc Mol Biol [Internet]. 2001;Chapter 8:Unit8 3.
40.
Zurück zum Zitat Coco WM, Levinson WE, Crist MJ, et al. DNA shuffling method for generating highly recombined genes and evolved enzymes. Nat Biotechnol [Internet]. 2001;19:354–9.CrossRefPubMed Coco WM, Levinson WE, Crist MJ, et al. DNA shuffling method for generating highly recombined genes and evolved enzymes. Nat Biotechnol [Internet]. 2001;19:354–9.CrossRefPubMed
41.
Zurück zum Zitat Lee GK, Maheshri N, Kaspar B, Schaffer DV. PEG conjugation moderately protects adeno-associated viral vectors against antibody neutralization. Biotechnol Bioeng [Internet]. 2005;92:24–34.CrossRefPubMed Lee GK, Maheshri N, Kaspar B, Schaffer DV. PEG conjugation moderately protects adeno-associated viral vectors against antibody neutralization. Biotechnol Bioeng [Internet]. 2005;92:24–34.CrossRefPubMed
42.
Zurück zum Zitat Jang J-H, Schaffer DV, Shea LD. Engineering biomaterial systems to enhance viral vector gene delivery. Mol Ther. United States. 2011;19:1407–15.CrossRef Jang J-H, Schaffer DV, Shea LD. Engineering biomaterial systems to enhance viral vector gene delivery. Mol Ther. United States. 2011;19:1407–15.CrossRef
43.
Zurück zum Zitat Bartel M, Schaffer D, Buning H. Enhancing the Clinical Potential of AAV Vectors by Capsid Engineering to Evade Pre-Existing Immunity. Front Microbiol. Switzerland; 2011;2:204. Bartel M, Schaffer D, Buning H. Enhancing the Clinical Potential of AAV Vectors by Capsid Engineering to Evade Pre-Existing Immunity. Front Microbiol. Switzerland; 2011;2:204.
44.
Zurück zum Zitat Mok H, Palmer DJ, Ng P, Barry MA. Evaluation of polyethylene glycol modification of first-generation and helper-dependent adenoviral vectors to reduce innate immune responses. Mol Ther [Internet]. 2005;11:66–79.CrossRefPubMed Mok H, Palmer DJ, Ng P, Barry MA. Evaluation of polyethylene glycol modification of first-generation and helper-dependent adenoviral vectors to reduce innate immune responses. Mol Ther [Internet]. 2005;11:66–79.CrossRefPubMed
45.
Zurück zum Zitat Hauck B, Xu RR, Xie J, et al. Efficient AAV1-AAV2 hybrid vector for gene therapy of hemophilia. Hum Gene Ther. United States. 2006;17:46–54.CrossRef Hauck B, Xu RR, Xie J, et al. Efficient AAV1-AAV2 hybrid vector for gene therapy of hemophilia. Hum Gene Ther. United States. 2006;17:46–54.CrossRef
46.
Zurück zum Zitat Moskalenko M, Chen L, van Roey M, et al. Epitope mapping of human anti-adeno-associated virus type 2 neutralizing antibodies: implications for gene therapy and virus structure. J Virol [Internet]. 2000;74:1761–6.CrossRefPubMedPubMedCentral Moskalenko M, Chen L, van Roey M, et al. Epitope mapping of human anti-adeno-associated virus type 2 neutralizing antibodies: implications for gene therapy and virus structure. J Virol [Internet]. 2000;74:1761–6.CrossRefPubMedPubMedCentral
47.
Zurück zum Zitat Harbison CE, Weichert WS, Gurda BL, Chiorini JA, Agbandje-McKenna M, Parrish CR. Examining the cross-reactivity and neutralization mechanisms of a panel of mAbs against adeno-associated virus serotypes 1 and 5. J Gen Virol [Internet]. 2012;93:347–55.CrossRefPubMedPubMedCentral Harbison CE, Weichert WS, Gurda BL, Chiorini JA, Agbandje-McKenna M, Parrish CR. Examining the cross-reactivity and neutralization mechanisms of a panel of mAbs against adeno-associated virus serotypes 1 and 5. J Gen Virol [Internet]. 2012;93:347–55.CrossRefPubMedPubMedCentral
48.
Zurück zum Zitat Gurda BL, DiMattia MA, Miller EB, et al. Capsid antibodies to different adeno-associated virus serotypes bind common regions. J Virol [Internet]. 2013;87:9111–24.CrossRefPubMedPubMedCentral Gurda BL, DiMattia MA, Miller EB, et al. Capsid antibodies to different adeno-associated virus serotypes bind common regions. J Virol [Internet]. 2013;87:9111–24.CrossRefPubMedPubMedCentral
49.
Zurück zum Zitat Lochrie MA, Tatsuno GP, Christie B, et al. Mutations on the external surfaces of adeno-associated virus type 2 capsids that affect transduction and neutralization. J Virol [Internet]. 2006;80:821–34.CrossRefPubMedPubMedCentral Lochrie MA, Tatsuno GP, Christie B, et al. Mutations on the external surfaces of adeno-associated virus type 2 capsids that affect transduction and neutralization. J Virol [Internet]. 2006;80:821–34.CrossRefPubMedPubMedCentral
50.
Zurück zum Zitat Mingozzi F, Chen Y, Murphy SL, et al. Pharmacological modulation of humoral immunity in a nonhuman primate model of AAV gene transfer for hemophilia B. Mol Ther [Internet]. 2012;20:1410–6.CrossRefPubMedPubMedCentral Mingozzi F, Chen Y, Murphy SL, et al. Pharmacological modulation of humoral immunity in a nonhuman primate model of AAV gene transfer for hemophilia B. Mol Ther [Internet]. 2012;20:1410–6.CrossRefPubMedPubMedCentral
51.
Zurück zum Zitat Tabebordbar M, Zhu K, Cheng JKW, et al. In vivo gene editing in dystrophic mouse muscle and muscle stem cells. Science. United States. 2016;351:407–11. Tabebordbar M, Zhu K, Cheng JKW, et al. In vivo gene editing in dystrophic mouse muscle and muscle stem cells. Science. United States. 2016;351:407–11.
52.
Zurück zum Zitat Yang Y, Wang L, Bell P, et al. A dual AAV system enables the Cas9-mediated correction of a metabolic liver disease in newborn mice. Nat Biotechnol. United States. 2016;34:334–8.CrossRef Yang Y, Wang L, Bell P, et al. A dual AAV system enables the Cas9-mediated correction of a metabolic liver disease in newborn mice. Nat Biotechnol. United States. 2016;34:334–8.CrossRef
Metadaten
Titel
Adeno-associated virus as a gene therapy vector: strategies to neutralize the neutralizing antibodies
verfasst von
Majid Lotfinia
Meghdad Abdollahpour-Alitappeh
Behzad Hatami
Mohammad Reza Zali
Morteza Karimipoor
Publikationsdatum
03.05.2019
Verlag
Springer International Publishing
Erschienen in
Clinical and Experimental Medicine / Ausgabe 3/2019
Print ISSN: 1591-8890
Elektronische ISSN: 1591-9528
DOI
https://doi.org/10.1007/s10238-019-00557-8

Weitere Artikel der Ausgabe 3/2019

Clinical and Experimental Medicine 3/2019 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Reizdarmsyndrom: Diäten wirksamer als Medikamente

29.04.2024 Reizdarmsyndrom Nachrichten

Bei Reizdarmsyndrom scheinen Diäten, wie etwa die FODMAP-arme oder die kohlenhydratreduzierte Ernährung, effektiver als eine medikamentöse Therapie zu sein. Das hat eine Studie aus Schweden ergeben, die die drei Therapieoptionen im direkten Vergleich analysierte.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.