<p>IC2, a well known monoclonal autoantibody, derived from newly diabetic BB rat and seems to be an important biomarker for non-invasive functional imaging of beta cells in vivo. It specially and uniquely binds with pancreatic beta cells as confirmed in some previous studies. RIN-5AH is a pancreatic beta cell, which reacts with IC2 is used here to identify and characterize the molecular nature of the IC2 auto antigen by using TLC and HPTLC following by immuno-staining. An unpublished work already had done by Spitalnik et al, 1991 with another rat pancreatic beta cell (RINm5F) extracted glycolipids. In this study, the same work was done, not only with glycolipids from various cell lines but also lipids extracted from purified plasma membrane is made to confirm or refuge that IC2 was found to bind with only the glycolipids containing galactose-3-sulfate. This highly unique observation can however hardly explain the unique beta cell surface specificity without involvement of other more beta cell specific antigenic structures. We are therefore also searching the protein part involved in the auto antigenic determinant. Analyzing the molecular nature of IC2 binding auto-antigen, will help to understand both the role it might plays in the pathogenesis of insulin dependant diabetes. It could also help to elucidate the etiology of diabetes and finally to be a new serum autoantibody biomarker.</p>

Inflammatory bowel disease (IBD) comprises diseases that are characterized by chronic or relapsing inflammation of the gastrointestinal tract. Primary sclerosing cholangitis (PSC) is an extraintestinal manifestation in IBD. Immunoreactivity against an autoantigen that is expressed both in the gastrointestinal tract and the biliary tract could be the link between these diseases. A possible source of such an antigen is goblet cells. Immunostainings of normal human tissues using IBD patient sera showed goblet cell immunoreactivity against goblet cells in all parts of the gastrointestinal tract. The most frequent immunostaining was found against goblet cells in the appendix against which 84% (42/50) of IBD patients compared to 8% (4/50) of healthy blood donors showed immunoreactivity. To identify the corresponding antigen we used three different approaches, investigation of immunoreactivity to different candidate proteins compared to IBD sera, immunoscreening of an appendiceal cDNA library, and immunoprecipitation of protein lysates from mucin producing cells followed by SDS-PAGE and 2D gel electrophoresis. These approaches led to the identification of several candidate autoantigens of which complement C3 is the most promising. A novel staining pattern with strong immunoreactivity to granules and the apical membrane of biliary epithelial cells was identified with 35% (12/34) of PSC sera compared to none of healthy controls (n=28). Screening of a cDNA library from normal human choledochus identified PDZ domain containing 1 (Pdzk1) and Glutathion S transferase theta 1 (GSTT1) as potential candidates. Pdzk1 is an interesting candidate which is expressed in the intestinal tract and bile ducts. GSTT1 antibodies were not specific for PSC and are thought to develop as an alloimmune response in patients with the GSTT1-null genotype. In conclusion, we have identified specific immunoreactivity to goblet cells and biliary epithelial cells using sera from patients with IBD and PSC respectively. We have also identified several potential autoantigens.

IC2, a well known monoclonal autoantibody, derived from newly diabetic BB rat and seems to be an important biomarker for non-invasive functional imaging of beta cells in vivo. It specially and uniquely binds with pancreatic beta cells as confirmed in some previous studies. RIN-5AH is a pancreatic beta cell, which reacts with IC2 is used here to identify and characterize the molecular nature of the IC2 auto antigen by using TLC and HPTLC following by immuno-staining. An unpublished work already had done by Spitalnik et al, 1991 with another rat pancreatic beta cell (RINm5F) extracted glycolipids. In this study, the same work was done, not only with glycolipids from various cell lines but also lipids extracted from purified plasma membrane is made to confirm or refuge that IC2 was found to bind with only the glycolipids containing galactose-3-sulfate. This highly unique observation can however hardly explain the unique beta cell surface specificity without involvement of other more beta cell specific antigenic structures. We are therefore also searching the protein part involved in the auto antigenic determinant. Analyzing the molecular nature of IC2 binding auto-antigen, will help to understand both the role it might plays in the pathogenesis of insulin dependant diabetes. It could also help to elucidate the etiology of diabetes and finally to be a new serum autoantibody biomarker.

京都大学 / 新制・論文博士 / 博士(農学) / 乙第13497号 / 論農博第2901号 / 新制||農||1093(附属図書館) / 学位論文||R4||N5403(農学部図書室) / (主査)教授 谷 史人, 教授 佐々木 努, 教授 保川 清 / 学位規則第4条第2項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

Juvenil idiopatisk artrit (JIA) är en autoimmun reumatisk sjukdom som drabbar barn före 16 års ålder. Den vanligaste varianten är oligoartikulär JIA, vilket innebär att den påverkar två till fyra leder med symptom så som svullnad, ömhet, stelhet, rodnad eller nedsatt motorik. Oligoartikulär JIA är även associerad med uveit, vilket är en autoimmun ögonsjukdom som förstör synen. Sjukdomen är i nuläget dåligt förstådd och forskning behövs för att kunna identifiera markörer som kan användas för diagnostik. Enzymkopplad immunadsorberande analys (ELISA) är inom vårdens laborativa arbete en mycket vanlig metod för att undersöka patienters serum och identifiera specifika markörer som tyder på sjukdom. En ELISA kan utföras på olika sätt beroende på om den letar efter antigen eller antikroppar. Syftet med denna studie var att optimera en indirekt ELISA för detektion av autoantikroppar och genomföra en metodjämförelse med en redan väl undersökt kulbaserad autoantikroppsmetod. Studien omfattar 14 serumprov från olika patienter och använder sig av rekombinant framställda protein epitope signature tag (PrEST)-antigener för att identifiera autoantikroppar. PrEST-antigener består av ett humant variabelt proteinsegment och en protein-tag som består av ett albuminbindande protein (ABP) med en N-terminal HIS-tag (His6ABP). För att förhindra ospecifik inbindning till His6ABP-delen av PrEST-antigenerna så framställdes His6ABP, med vilket serum inkuberades innan de undersöktes med ELISA. Då resultatet tolkades binärt kunde stor likhet ses mellan de två olika metoderna för samtliga PrEST-antigener som undersöktes, vilket innebär att metoden kan fortsätta utforskas. Resultatet visade också att His6ABP-delen skulle kunna orsaka korsreaktivitet, vilket dock inte är något negativt för metodens validitet. / Juvenile idiopathic arthritis (JIA) is an autoimmune rheumatic disease that affects children before the age of 16. The most common variant is oligoarticular JIA, which means it affects two to four joints with symptoms such as swelling, tenderness, stiffness, redness, or reduced mobility. Oligoarticular JIA is also associated with uveitis, an autoimmune eye disease which damage eyesight. The disease is currently poorly understood, and research is needed to identify markers that can be used for diagnostics. Enzyme-linked immunosorbent assay (ELISA) is a very common method in healthcare laboratory work to examine patients' serum and identify specific markers that indicate disease. An ELISA method can be performed in different ways depending on whether it is looking for antigen or antibodies. The aim of this study was to optimize an indirect ELISA for detection of autoantibodies and conduct a method comparison with an already well established bead-based autoantibody array method. The study included 14 sera samples from different patients and used recombinantly produced protein epitope signature tag (PrEST) antigens to identify autoantibodies. PrEST antigens consist of a human variable protein segment and a protein tag consisting of albumin binding protein (ABP) with an N-terminal HIS-tag (His6ABP). To prevent non-specific binding to the His6ABP portion of the PrEST antigens, His6ABP were recombinantly produced and used for pre-absorption of serum before being examined by ELISA. When the result was interpreted binary, great similarity could be seen between the two different methods for all PrEST antigens examined, which calls for further exploring of the method. The result also showed that the His6ABP part could possibly cause cross-reactivity, which is interesting but doesn’t affect the validity of the method.

<p>Autoimmune polyendocrine syndrome type I (APS) is a monogenous, recessively inherited disease characterised by endocrine and non-endocrine autoimmune manifestations. One fifth of APS I patients suffer from periodic intestinal dysfunction with varying degrees of malabsorbtion, steatorrhea and constipation. Alopecia areata is found in one third of APS I patients. By immunoscreening human cDNA libraries derived from normal human duodenum and scalp with APS I sera, we identified tryptophan hydroxylase (TPH) as an intestinal autoantigen and tyrosine hydroxylase (TH) as a dermal autoantigen. Forty-eight percent (38/80) of the APS I patients had TPH antibodies (Ab) and 44% (41/94) showed TH immunoreactivity. No reactivity against TPH or TH was seen in healthy controls. TPH-Abs showed a statistically significant correlation with gastrointestinal dysfunction (p<0.0001) and TH-Abs were significantly correlated to alopecia (p=0.02). TPH-Ab positive APS I sera specifically immunostained TPH containing enterochromaffin cells in normal duodenal mucosa. In affected mucosa a depletion of the TPH containing EC cells was seen. In enzyme inhibition experiments TPH and TH activity <i>in vitro</i> was reduced by adding APS I sera. TPH and TH together with phenylalanine hydroxylase (PAH) constitute the group of pteridine dependent hydroxylases. These are highly homologous enzymes involved in the biosynthesis of neurotransmitters. Immunoprecipitation of PAH expressed <i>in vitro</i> showed that 27% (25/94) of APS I patients had antibodies reacting with PAH, but no associations with clinical manifestations was observed. An immunocompetition assay showed that the PAH reactivity reflects a cross-reactivity with TPH.</p><p>In conclusion, we have identified TPH and TH as intestinal and dermal autoantigens in APS I, coupled to gastrointestinal dysfunction and alopecia. We have also demonstrated immunoreactivity against PAH in APS I patient sera reflecting a cross-reactivity with TPH.</p>

Autoimmune polyendocrine syndrome type I (APS) is a monogenous, recessively inherited disease characterised by endocrine and non-endocrine autoimmune manifestations. One fifth of APS I patients suffer from periodic intestinal dysfunction with varying degrees of malabsorbtion, steatorrhea and constipation. Alopecia areata is found in one third of APS I patients. By immunoscreening human cDNA libraries derived from normal human duodenum and scalp with APS I sera, we identified tryptophan hydroxylase (TPH) as an intestinal autoantigen and tyrosine hydroxylase (TH) as a dermal autoantigen. Forty-eight percent (38/80) of the APS I patients had TPH antibodies (Ab) and 44% (41/94) showed TH immunoreactivity. No reactivity against TPH or TH was seen in healthy controls. TPH-Abs showed a statistically significant correlation with gastrointestinal dysfunction (p&lt;0.0001) and TH-Abs were significantly correlated to alopecia (p=0.02). TPH-Ab positive APS I sera specifically immunostained TPH containing enterochromaffin cells in normal duodenal mucosa. In affected mucosa a depletion of the TPH containing EC cells was seen. In enzyme inhibition experiments TPH and TH activity in vitro was reduced by adding APS I sera. TPH and TH together with phenylalanine hydroxylase (PAH) constitute the group of pteridine dependent hydroxylases. These are highly homologous enzymes involved in the biosynthesis of neurotransmitters. Immunoprecipitation of PAH expressed in vitro showed that 27% (25/94) of APS I patients had antibodies reacting with PAH, but no associations with clinical manifestations was observed. An immunocompetition assay showed that the PAH reactivity reflects a cross-reactivity with TPH. In conclusion, we have identified TPH and TH as intestinal and dermal autoantigens in APS I, coupled to gastrointestinal dysfunction and alopecia. We have also demonstrated immunoreactivity against PAH in APS I patient sera reflecting a cross-reactivity with TPH.

<p>Organ-specific autoimmunity constitutes a large health problem, where both the clinical management and our understanding of the pathogenetic mechanisms need to improve. Women with Addison's disease have abnormally low levels of dehydroepiandrosterone (DHEA), its sulphate ester (DHEA-S) and androgens relative to age, and many patients complain of physical and mental fatigue and low stress tolerance. To define a suitable dose, the effect of oral DHEA replacement was evaluated in women with Addison's disease. </p><p> DHEA was administered for three months to nine women with Addison's disease in either of two doses, 50 mg (n=5) or 200 mg (n=4). A dose of 50 mg restored the DHEA(S) and androgen levels to normal without altering the insulin sensitivity, body composition or serum lipid profile.</p><p> Autoimmune polyendocrine syndrome type I (APS I) is a rare but useful model disorder of autoimmunity, characterised by multiple organ-specific autoimmune manifestations and high-titre autoantibodies and with adrenocortical insufficiency, Addison's disease, as one of its cardinal manifestations. Approximately 10-20% of APS I patients suffer from autoimmune hepatitis, which carries a high mortality, if untreated. The presence of putative antigenic targets in the liver was investigated.</p><p> Cytochrome P4501A2 (CYP1A2) and aromatic L-amino acid decarboxylase (AADC) were identified as hepatic autoantigens with the use of APS I sera for immunofluorescent staining of normal human liver, Western blot of microsomal and cytosol fractions of human liver homogenate, and immunoprecipitation of <i>in vitro</i> transcribed and translated radioactively labelled proteins. The presence of CYP1A2- and AADC-antibodies was significantly correlated to AIH, and CYP1A2 antibodies inhibited enzyme activity <i>in vitro</i>.</p><p><i> In conclusion</i>, a daily replacement dose of 50 mg of DHEA sufficiently restores levels of DHEA, DHEA(S) and androgens in women with Addison's disease, without severe side-effects. We have further identified CYP1A2 and AADC as hepatic autoantigens associated with autoimmune hepatitis in APS I.</p>

<p>In this study, metastasizing serotonin-producing ileocaecal carcinoid tumours (MSPCs) were examined for biological characteristics that could be used to define clinically relevant subgroups within this patient population. Possible targets for new treatment options were also explored.</p><p>It was found that MSPCs share several biological characteristics such as expression of serotonin, tachykinins (TKs), chromogranin A, islet autoantigen-2 and connective tissue growth factor (CTGF). TKs and serotonin were demonstrated in the same endocrine tumours in the gut and lung. IA-2 expression was shown to be up-regulated in MSPCs, possibly in connection with active hormone secretion. CTGF expression was high in tumour areas adjacent to extensive stroma expressing alpha-smooth muscle actin. This indicated myofibroblast differentiation, which may be associated with fibrosis-related complications prevalent in patients with MSPCs. When compared with other endocrine tumours, MSPCs behaved as a relatively homogeneous group, though within the MSPC population several subgroups could be defined. Patients with tumours displaying either a solid growth pattern and/or a Ki67 index ≥1% had a less favourable prognosis than those who did not. Another group of patients, who had increased plasma TK concentrations, were more likely to suffer from severe diarrhea. This information should be considered when discussing clinical treatment and when undertaking tumour biological studies. New treatment possibilities, such as drugs that specifically target TK receptors and antibodies to CTGF, are also discussed.</p><p>In conclusion, MSPCs comprise a clinically relevant tumour group with similar biological features that are distinct from other endocrine tumours. Subgroups of patients within this patient category can be defined which may be relevant when establishing prognosis and when selecting future treatment modalities.</p>

Organ-specific autoimmunity constitutes a large health problem, where both the clinical management and our understanding of the pathogenetic mechanisms need to improve. Women with Addison's disease have abnormally low levels of dehydroepiandrosterone (DHEA), its sulphate ester (DHEA-S) and androgens relative to age, and many patients complain of physical and mental fatigue and low stress tolerance. To define a suitable dose, the effect of oral DHEA replacement was evaluated in women with Addison's disease. DHEA was administered for three months to nine women with Addison's disease in either of two doses, 50 mg (n=5) or 200 mg (n=4). A dose of 50 mg restored the DHEA(S) and androgen levels to normal without altering the insulin sensitivity, body composition or serum lipid profile. Autoimmune polyendocrine syndrome type I (APS I) is a rare but useful model disorder of autoimmunity, characterised by multiple organ-specific autoimmune manifestations and high-titre autoantibodies and with adrenocortical insufficiency, Addison's disease, as one of its cardinal manifestations. Approximately 10-20% of APS I patients suffer from autoimmune hepatitis, which carries a high mortality, if untreated. The presence of putative antigenic targets in the liver was investigated. Cytochrome P4501A2 (CYP1A2) and aromatic L-amino acid decarboxylase (AADC) were identified as hepatic autoantigens with the use of APS I sera for immunofluorescent staining of normal human liver, Western blot of microsomal and cytosol fractions of human liver homogenate, and immunoprecipitation of in vitro transcribed and translated radioactively labelled proteins. The presence of CYP1A2- and AADC-antibodies was significantly correlated to AIH, and CYP1A2 antibodies inhibited enzyme activity in vitro. In conclusion, a daily replacement dose of 50 mg of DHEA sufficiently restores levels of DHEA, DHEA(S) and androgens in women with Addison's disease, without severe side-effects. We have further identified CYP1A2 and AADC as hepatic autoantigens associated with autoimmune hepatitis in APS I.