Background. Rheumatoid Arthritis (RA) is an autoimmune inflammatory disease that, without powerful treatment, may lead to irreversible joint damage. During the past decade, anti-cytokine therapy has become available, e.g., infliximab, a chimeric antibody targeting the pro-inflammatory cytokine TNF that has a central role in the inflammatory process in RA patients. Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease that may affect all organs and is characterized by a massive antibody production. Chemokines, chemokine receptors and lipoprotein receptor-related protein 1(CD91) are regulators of inflammation in autoimmune diseases and T-cell migration. Objectives. The aim of this study was to get a deeper understanding how TNF blocking treatment influences inflammatory mechanisms and autoantibody formation in RA with special reference to similarities and differences with SLE. Methods. In patients with RA treated with anti-TNF, and in SLE patients (ACR criteria) clinical evaluation was performed and blood samples analyzed. Autoantibodies were analyzed using indirect immunofluorescence, ELISA and multiplex flow cytometry in samples from anti-TNF treated RA patients (n=59) followed longitudinally for 54 weeks, in pre-diseased samples from SLE patients (n=38) and matched population-based controls (n=152). T-cell expression of chemokine receptors and CD91 was analyzed by flow cytometry, whilst serum levels of chemokines were determined using ELISA in anti-TNF treated RA-patients (n=24) followed longitudinally (30 weeks), and cross-sectionally in SLE-patients (n=23). Expression of mRNA for chemokines was analyzed in T-cells from SLE-patients (n=10) using PCR. Results. After treatment with infliximab, RA patients produced ANA, anti-dsDNA and anti-nucleosome antibodies, but not anti-ENA antibodies. Although these antibodies are considered typical for SLE only one patient developed a transient lupus-syndrome. Antibodies against cell nuclear antigens, including ENA, were detected several years before the first clinical symptom of SLE; anti-SSA was the earliest detectable antibody. In RA-patients before infliximab treatment, the T-cell expression of several chemokine receptors was elevated compared with healthy controls. In contrast, only one soluble chemokine, IP-10 was elevated. After treatment the levels of soluble MIP-1β, MCP-1 and IP-10, and the T-cell expression of CCR2 were decreased. In SLE-patients MIP-1β, MCP-1, SDF-1, IP-10 and RANTES in blood were elevated, whilst expression of CXCR5 and CCR6 on T-cells was lower than in healthy controls. T-cell expression of CXCR2 and CCR1 was elevated in active disease (measured as SLEDAI index), whereas the CXCR5 and CCR2 expression was lower in inactive SLE. In SLE patients with nephritis IP-10 was lower and T-cell expression of CXCR3 and CCR3 elevated compared with patients without nephritis. The expression of CD91 was higher on T-cells from patients not responsive to infliximab treatment compared with responders. Conclusion. These findings indicate that anti-TNF (infliximab) treatment in RA-patients has a major impact on the production of autoantibodies and chemokines. The autoantibody profile in infliximab-treated patients was similar to that predating disease onset in SLE patients with the exception of anti-ENA being detectable in SLE, but the development of lupus-syndromes was rare. The expression of CD91 on T-cells may predict responsiveness to infliximab. The expression of chemokine receptors in SLE- patients seemed to be related to disease activity. Anti-nuclear antibodies were detectable years before clinical disease onset in patients who developed SLE suggesting a gradual pathogenic process.

Tuberculosis, caused by Mycobacterium tuberculosis infection, results in the development of granulomas in affected tissues. These structures are formed by a myeloid cell core including multinucleated giant cells and surrounded by T lymphocytes. We studied mechanisms of survival, formation and functions of giant cells in Mycobacterium granulomas. Previously, our group showed that the cytokine IL-17A induces the fusion of dendritic cells (DC). Here, we identified molecules induced by the IL-17A genetic program in myeloid cells: BFL1 regulated DC survival, while the chemokines CCL2 and CCL20 directed clustering required for DC fusion. In situ, in human TB granulomas, we found that IL-17A was expressed by T lymphocytes while BFL1, CCL2 and CCL20 were expressed by the mono- and multi-nucleated myeloid cells. Then we characterized phenotype, immune functions and microbicidal activity of IL-17A-treated DC and their derived giant cells. They expressed a mixed DC-macrophage phenotype, retained classical DC functions, synthesized several destructive enzymes and had increased and differential microbicidal activities against Mycobacterium species. We named GMIC (giant myeloid inflammatory cells) these IL-17A-dependent giant cells, and propose that they constitute a new inflammatory myeloid effector with potent microbicidal activities. Altogether, our results show that IL-17A may participate in the maintenance of the myeloid core of human tuberculosis granuloma by promoting the formation of GMIC with potent destructive and microbicidal functions. The molecular mechanisms we have documented should help the development of new tuberculosis therapeutic and vaccination strategies.

Uveal Melanoma is the most common primary intraocular tumor in adults. Despite the advances in numerous ophthalmic techniques leading to the increased accuracy of diagnosing this malignancy, the ten-year mortality rate for patients has remained unchanged at approximately fifty percent. Knowing this, further understanding of the specific steps that occur within the metastatic cascade of uveal melanoma is required. / Our laboratory utilizes five human uveal melanoma cell lines (92.1, SP6.5, MKT-BR, OCM-1, UW-1) of known proliferative, invasive, and metastatic potential. We used four methods to characterize the presence and roles of the chemotactic factors CXCL12, CXCL8, CXCL1 and HGF in these five cell lines. We also used a novel peptide inhibitor (TN14003) to block the biological action of CXCL12 on its receptor CXCR4. / With the results obtained from this thesis, we were able to establish the novel presence and importance of the four chosen factors for this malignancy. We were also able to display the positive effects TN14003 had on inhibiting uveal melanoma cell migration in vitro. This may lead to a future therapeutic target, which ultimately may delay or inhibit the metastatic process in uveal melanoma patients, improving the present unaffected ten-year mortality rate.

Monocyte recruitment promotes the accumulation of myeloid foam cells in early atherosclerotic plaques. However, initial foam cells form prior to increased monocyte recruitment in hypercholesterolemic Ldlr-/- mice. These initial foam cells are derived from myeloid cells residing in the normal intima, and express integrin alphaX (CD11c). The goal of this thesis was to assess the role of initial foam cells in atherogenesis. The approach was to delete these cells by diphtheria toxin-induced apoptosis in Ldlr-/- bone marrow chimeras. Depletion of CD11c+ leukocytes resulted in significant reductions of intimal lipid accumulation, monocyte recruitment, intimal chemokine expression, but not endothelial cell adhesion molecule expression, at 10 and 21 days of hypercholesterolemia. These data suggest that lipid uptake by resident intimal CD11c-expressing myeloid cells during the earliest stages of atherosclerosis promotes chemokine production that is required for increased monocyte recruitment.

Monocyte recruitment promotes the accumulation of myeloid foam cells in early atherosclerotic plaques. However, initial foam cells form prior to increased monocyte recruitment in hypercholesterolemic Ldlr-/- mice. These initial foam cells are derived from myeloid cells residing in the normal intima, and express integrin alphaX (CD11c). The goal of this thesis was to assess the role of initial foam cells in atherogenesis. The approach was to delete these cells by diphtheria toxin-induced apoptosis in Ldlr-/- bone marrow chimeras. Depletion of CD11c+ leukocytes resulted in significant reductions of intimal lipid accumulation, monocyte recruitment, intimal chemokine expression, but not endothelial cell adhesion molecule expression, at 10 and 21 days of hypercholesterolemia. These data suggest that lipid uptake by resident intimal CD11c-expressing myeloid cells during the earliest stages of atherosclerosis promotes chemokine production that is required for increased monocyte recruitment.

In areas where malaria is endemic, pregnant women and children bear the main burden of severe and life-threatening malarial disease. The aim of this work was to study the impact of Plasmodium falciparum infection on inflammatory responses in pregnant women and children residing in African countries. In paper I we investigated peripheral blood samples from pregnant women, living in Tanzania, for potential biomarkers of P. falciparum infection during pregnancy. We found that IL-10 and IP-10 were potential candidates, which increased upon infection, irrespective of gestational age. In addition, increased IL-10 and IP-10 and decreased RANTES levels were predictive of an infection. In paper II we investigated frequencies of peripheral blood-cell types and biomarkers upon infection, in pregnant women living in Benin, and assessed the predictive values of variables measured at inclusion for pregnancy outcomes at delivery. Higher IL-10 levels distinguished quantitative PCR-detectable, sub-microscopic infections, at inclusion, but not at delivery. Maternal anaemia at delivery was associated with increased numbers of circulating monocytes, Treg cells and IL-10 levels measured at inclusion. In paper III we investigated neutrophil functions in the context of pregnancy malaria in vivo and in vitro. Numbers of circulating neutrophils and IL-8 levels were reduced in the infected women, whilst increased levels of IL-8 were found in placental blood of those infected. In vitro assays suggested migration of neutrophils to infected placentas, which also was supported by histological examinations showing the presence of neutrophils containing hemozoin (Hz), in the infected placenta. Stimulation of neutrophils with various Hz preparations revealed distinct patterns of neutrophil activation. In paper IV we investigated cytokines and malaria-specific antibody titres in children belonging to two African ethnic groups, living in Mali, with known different susceptibility to malaria. The Fulani showed increased cytokines (IL-6, IL-8, IL-12, IFN-α, IFN-γ) and higher titres of malaria-specific antibody subclasses (IgG, IgM and IgG1-IgG3), compared to the Dogon. Taken together, this thesis shows that host biomarkers in peripheral blood may represent useful diagnostic markers for malaria during pregnancy. The neutrophil population was shown to be highly affected by the presence of P. falciparum parasites, suggesting a role for neutrophils during malaria infections. The Fulani, showed increased pro-inflammatory and antibody responses against P. falciparum parasites, as compared to Dogon, and these differences are established already at an early age. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Manuscript. Paper 3: Manuscript.</p>

Bis heute sind über 50 Chemokine und fast 20 Chemokinrezeptoren identifiziert. Dennoch gibt es Chemokine und Chemokinrezeptoren, deren zugehörige Rezeptoren bzw. Liganden noch nicht bekannt sind. PARC (=CCL18) ist ein ausschließlich in Primaten nachgewiesenes, bisher nur wenig charakterisiertes, im Organismus jedoch weit verbreitetes Chemokin, für das bisher noch kein Rezeptor beschrieben wurde. Die Wirkung dieses Chemokins wurde bisher vor allem an T Lymphozyten nachgewiesen. Die vorliegende Arbeit untersucht die Wirkung von PARC auf B-Lymphozyten und das Vorkommen des putativen PARC-Rezeptors DRY12. Dabei wurden B-Zellen von CLL Patienten sowie mehrere standardisierte B-Zelllinien als Untersuchungsgut verwendet. In funktionellen Assays (Kalziummobilisation, Aktinpolymerisation und Chemotaxis) wurde die Wirkung von PARC auf diese Zellen charakterisiert. Untersuchungen zu beteiligten Signalkaskaden wurden durch Einsatz von spezifischen Inhibitoren (Pertussis-Toxin) und mittels Western Blot durchgeführt. Weiterhin wurde das Vorkommen des putativen PARC-Rezeptors DRY12 bei den verschiedenen B Lymphozyten mittels Antikörperfärbung und RT-PCR sowohl auf Protein- als auch auf mRNA-Ebene nachgewiesen. Der Nachweis der genauen Lokalisation des Rezeptors in der Zelle erfolgte mittels Immunfluoreszenzcytologie. Abschließend wurde vergleichend das Vorkommen des DRY12 im Lymphknoten von CLL-Patienten und gesunden Spendern untersucht. PARC löst bei den B-Zellen der CLL-Patienten die Polymerisation von Aktin aus. Es induziert jedoch keine gerichtete Migration der Zellen. PARC wirkt auf die in dieser Arbeit untersuchten B-Zellen also nicht als Chemokin im klassischen Sinne. Seine Wirkung besteht möglicherweise in einem synergistischen Effekt, indem es im Zusammenspiel mit anderen Faktoren die Migration der Zellen beeinflusst. Weiterhin wäre denkbar, dass PARC das Verhalten von hämatopoetischen Stamm- und Vorläuferzellen beeinflusst. Die beteiligte Signalkaskade beinhaltet ein Pertussis-Toxin-sensitives Gi-Protein und die Aktivierung der p42/44-MAP Kinase. Ein intrazellulärer Einstrom von Ca2+ spielt bei der Wirkungsvermittlung von PARC keine Rolle. Der putative PARC-Rezeptor DRY12 konnte bei verschiedenen B-Zellen in unterschiedlicher Intensität nachgewiesen werden. Die Expression des DRY12 scheint sowohl auf Ebene der mRNA als auch auf Proteinebene durch multiple Faktoren reguliert zu sein. Dazu gehören z.B. der Reifungs- und Aktivierungszustand der Zellen oder die Kultivierungsdauer nach dem Auftauen der Zellen bis zur Durchführung des Versuchs. Bisher konnten jedoch keine entsprechenden Zusammenhänge nachgewiesen werden. Der DRY12 ist demnach kein konstitutiv exprimierter Rezeptor. Durch Immunfluoreszenzcytologie konnte die Lokalisation des Rezeptormoleküls auf der Zelloberfläche gezeigt werden. Im Lymphknoten wird DRY12 v.a. von Lymphozyten exprimiert. Bei Makrophagen konnte das Rezeptorprotein nicht nachgewiesen werden. In den Lymphknoten von CLL-Patienten exprimieren die Lymphozyten deutlich mehr DRY12 als Lymphozyten im Gewebe gesunder Individuen. Ein direkter Zusammenhang zwischen Rezeptorexpression und Reaktion auf PARC konnte nicht sicher aufgezeigt werden. Die Ergebnisse dieser Arbeit schließen aber auch nicht aus, dass PARC ein möglicher Bindungspartner von DRY12 ist. Bei der Wirkungsvermittlung spielen vermutlich auch andere Botenstoffe und weitere Faktoren eine Rolle, indem sie die Reaktionsfähigkeit der Zellen gegenüber PARC bzw. die Rezeptorexpression des DRY12 beeinflussen. Hinsichtlich der Frage, ob es sich bei DRY12 um einen Rezeptor für PARC handelt, kann diese Untersuchung zu keinem abschließenden Ergebnis gelangen, so dass dieser Aspekt in weiterführenden Analysen eingehender betrachtet werden sollte. / Today there are more than 50 chemokines and almost 20 chemokine receptors described. Despite growing knowledge, the ligands for some orphan chemokine receptors have not been identified and for several chemokines the receptor has not been discovered. PARC (=CCL18) is one of these chemokines for which the receptor has not been recognized. It has been detected in primates only and, despite being widely spread in the organism, it is still poorly characterized. Up to now, the effects of PARC were mainly shown on T-lymphocytes. Therefore, the objective of this study was to investigate the function of PARC and the expression of the putative PARC-receptor DRY12 in B-lymphocytes. For the purpose of the present study, B-CLL-cells and several lymphocytic B-cell-lines served as models to cover different stages of B-cell maturation. In order to characterize the effect of PARC, several functional assays (calciummobilisation, actinpolymerisation and chemotaxis), specific inhibitors (pertussis toxin) and Western Blotting were used. Expression analyses of the DRY12-receptor were performed by FACS-analysis, RT-PCR and immunofluorescence cytochemistry. In addition, lymph nodes from patients with CLL and healthy donors were stained immunohistochemically. In B-CLL-cells, PARC stimulation leads to phosphorylation of p42/44-MAP-Kinase and polymerization of actin, which can be inhibited by pertussis toxin, but does not induce calcium signaling or chemotactic migration. In this case, PARC is no classical chemokine but may act as synergist to potentiate the effect of other chemokines or may influence the behavior of hematopoetic stemm-cells. The results of the study show expression of the putative PARC-receptor DRY12 present on several subsets of B lymphocytes. As they showed different intensity of expression, DRY12 may be regulated by different factors in translation as well as transduction. Among these factors might be their current state of maturation and activation and the time period from revitalization to the start of the experiments. The reasons for these differences are still unknown. According to these findings, the receptor is not constitutively expressed, but may be itself regulated by several chemokines and other factors. DRY12 is located at the surface of the cell, as shown by immunocytochemistry. In lymph nodes, particularly lymphocytes but not macrophages express DRY12. In lymph nodes of CLL-patients lymphocytes express much more DRY12 than in healthy samples. However, it could not be proved that DRY12 is the agonistic receptor for PARC, as the expression of DRY12 did not completely correlate with the effects on PARC stimulation. But results of this study do not exclude this possibility either, as different factors are considered to influence the effect of PARC and the expression of DRY12 in B-cells. Although there are hints to it, from this study we can not conclude that DRY12 is the agonistic receptor for PARC. Therefore, further investigation is necessary to find the answer to this question.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Dissertation (M.D.)--University of South Florida, 2006. / Includes vita. Includes bibliographical references (leaves 71-84).