Os macrófagos são células fagocíticas derivadas dos monócitos sanguíneos produzidos pela medula óssea e estão diretamente envolvidos em um conjunto de processos biológicos vitais. Durante o repasto sanguíneo, fêmeas do mosquito Aedes aegypti inoculam saliva na pele de seu hospedeiro vertebrado e, devido sua localização estratégica nos tecidos, os macrófagos estão dentre as primeiras células residentes a ser exposta a saliva. Apesar dessa evidência fisiológica, pouco se sabe sobre os efeitos imunomoduladores da saliva desse mosquito sobre os macrófagos. Assim, o objetivo deste projeto foi avaliar o papel dos componentes salivares de A. aegypti em macrófagos murinos ativados por LPS+IFN-γ e o potencial efeito de uma proteína salivar no desenvolvimento da encefalomielite autoimune experimental (EAE), um modelo experimental para estudo da esclerose múltipla. Em conclusão, o EGS de A. aegypti apresenta efeito imunomodulatório sobre macrófagos peritoneais ativados com LPS e IFN-γ. Além disso, nossos resultados sugerem que a proteína identificada com possível inibidor da IL-6 produzida por macrófagos ativados pode ser capaz de diminuir a polarização de respostas Th1 e Th17, afetando assim o desenvolvimento da EAE. / Macrophages are phagocytic cells derived from blood monocytes produced by the bone marrow and are directly engaged in a set of vital biological processes. During blood feeding, Aedes aegypti female mosquitoes inoculate saliva into the skin of their vertebrate hosts and, due to its strategic location in the tissues, macrophages are possibly among the first resident cells to be exposed to saliva. Despite this physiological evidence, little is known about the immunomodulatory effects of this mosquitos saliva on macrophages. Thus, the aim of this study was to evaluate the role of A. aegypti salivary components in LPS/IFN-γ-activated murine macrophages and the potential effect of a salivary protein on the development of experimental autoimmune encephalomyelitis (EAE), an experimental model for multiple sclerosis studies. In conclusion, A. aegypti SGE presents immunomodulatory effect on peritoneal macrophages activated by LPS/IFN-γ. Furthermore, our results suggest that the protein identified as a putative inhibitor of IL-6 produced by activated macrophages may be able to down modulate the polarization of Th1 and Th17 responses, thus affecting the development of EAE.

A esclerose múltipla (EM) é doença desmielinizante do sistema nervoso central com vários sinais e sintomas, dentre eles a paralisia muscular. Essa paralisia foi estudada neste trabalho utilizando um modelo animal (camundongo) de EM, a Encefalomielite Autoimune Eperimental (EAE). Comparando a controles, os animais EAE, além da paralisia muscular, apresentaram diminuição da massa corporal e do músculo extensor longo dos dedos (ELD). Isolado com ou sem o nervo isquiático, o ELD mostrou decréscimo das contrações indiretas e diretas, tanto isoladas como tetânicas, e maior resistência à fadiga muscular. No ELD, o bloqueador neuromuscular pancurônio mostrou potência semelhante sobre contrações indiretas isoladas, em animais EAE e controles, enquanto as contrações indiretas tetânicas foram mais resistentes ao pancurônio, em animais EAE. A área de secção transversa das fibras musculares foi menor e houve troca (shift) de tipos de fibras de IIB para IIA, em animais EAE. Concluiu-se que as alterações nos animais EAE são tanto da transmissão neuromuscular como do músculo. / Multiple sclerosis (MS) is a demielinating disease of the Central Nervous System with a number of signs and symptoms, among them muscle paralysis. In this work this paralysis was studied using an animal (mouse) model of MS: the experimental autoimmune encephalomyelitis (EAE). Compared to controls, the EAE animals, besides muscle paralysis, had a lower body and extensor digitorum longus (EDL) muscle mass. Isolated with or without the sciatic nerve, the indirect and the direct isolated contractions of the EDL were smaller and the muscle fatigue was lower, in EAE animals. The neuromuscular blocker pancuronium was equally potent on indirect isolated contractions, in control and EAE animals, while the tetanic contractions were more resistant to pancuronium, in EAE animals. Compared to controls, the area of the transverse section of the muscle fibers was smaller and there was a shift from the IIB to the IIA type of fiber in EAE animals. It is concluded that the alterations in EAE animals result from changes in the process of neuromuscular transmission and in the muscle.

As células T exercem papel crucial nas respostas imunes adaptativas e em doenças autoimunes, como a esclerose múltipla. O glutamato, neurotransmissor mais abundante no SNC, age por meio de duas famílias de receptores: metabotrópico e ionotrópico. As células T são alvo do glutamato durante a ativação e apresentação de antígenos, pois está presente nas sinapses imunológicas, porém, pouco se sabe a respeito de seu papel na função das células T. Nós estudamos o papel do NMDAR nas respostas mediadas por células T. In vitro, o uso do antagonista MK801 reduziu a linfoproliferação e a síntese de IFN-γ e IL-17A, bem com o NMDA reduziu a proliferação e produção de IFN-γ e IL-17A. In vivo, o MK801 reduziu a gravidade da EAE, resultado da menor infiltração de linfócitos Th1 e Th17 no SNC. Além disso, o MK801 reduziu a expressão de Rorc, Il17a, Stat4, Ccr4, Ccr6 e Ifna2 no SNC. Em suma, esses dados confirmam que o NMDAR exerce papel nas funções mediadas por células T, indicando que as células T são alvos do excesso do glutamato via NMDAR em doenças neuroinflamatórias. / T cells play a crucial role in adaptive immune responses and autoimmune diseases, such as multiple sclerosis. Glutamate is the most abundant neurotransmitter in the CNS, and it acts through two receptor families: metabotropic and ionotropic. T cells are target of glutamate during activation and antigen presentation, because glutamate is also present in the immunological synapses, however, little is known about its role on T cell functions. We investigated the role of NMDAR in immune-mediated T cell responses. In vitro, the use of the antagonist MK801 reduced T cell proliferation and cytokine production (IFN-γ e IL-17A), as well as NMDA reduced lymphocyte proliferation and IFN-γ e IL-17A production, in a dose dependent manner. In vivo, MK801 diminished severity of EAE, result of the minor Th1 and Th17 infiltration in the CNS. In addition, MK801 reduced Rorc, Il17a, Stat4, Ccr4, Ccr6 and Ifna2 expression in the CNS. In short, our data confirm that the NMDAR play a role in T cell-mediated functions, indicating that T cells are target of glutamate excess via NMDAR in neuroinflammatory diseases.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) är en komplex sjukdom av okänd etologi. ME/CFS syns inte på utsidan men leder till funktionsnedsättning i varierande grad. Okunskapen om sjukdomen är stor vilket leder till att många får diagnos i ett sent skede eller en felaktig diagnos. ME/CFS innebär en etisk utmaning för forskningen, samhället och inte minst för sjukvården, då evidens för både omvårdnad och behandling fortfarande saknas. Syftet var att undersöka personers erfarenheter av att leva med ME/CFS. I databearbetningen framkom tre kategorier: möte med vården, påverkan på vardagen samt anpassning till livssituationen. I resultatet påvisas erfarenheter från personer med ME/CFS och hur de upplever bemötandet med vården och den okunskap som råder. Det framkommer att sjukdomen påverkar identitet, relationer och aktivitetsförmåga. Resultatet visar även hur livet förändras samt vilka strategier som krävs för att hantera vardagen när förutsättningarna i livet förändras. För att möta omvårdnadsbehovet hos personer med ME/CFS krävs mer forskning och utbildning för vårdpersonal. / Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex disease of unknown etiology. Although ME/CFS is not visible on the outside, it leads to disability in varying degrees. There is a lack of knowledge regarding the disease, which often leads to a delayed or incorrect diagnosis. ME/CFS represents an ethical challenge for research, society and especially for healthcare professionals since no evidence-based nursing or treatment are available. The aim was to investigate people’s experiences with ME/CFS. Three categories emerged in the data analysis: meeting with the health care, impact on daily life and adaption to the new life situation. The result shows experiences of people with ME/CFS and how they feel they are treated by the healthcare system and the lack of knowledge that exists. It appears that the disease affects identity, relationships and abilities in physical activity. The result also shows how life changes and what strategies are required to manage everyday life when the conditions in life change. To meet the nursing needs of people with ME/CFS, more research on the subject, as well as education for healthcare professionals, are necessary.

abstract: Medical policies, practices, and definitions do not exist solely in the clinical realm; they show up in the lived experiences of patients. This research examines how people with the chronic illness called myalgic encephalomyelitis (ME) define their own illness experiences. They have situated knowledge about their illness onset, search for care, and clinical encounters. Their knowledge complicates and challenges the existing norms in clinical practice and medical discourse, as the experience of searching for care with ME reveals weaknesses in a system that is focused on acute care. Patient narratives reveal institutional patterns that obstruct access to medical care, such as disbelief from clinicians and lack of training in chronic illness protocols. They also reveal patterns in physician behavior that indicate the likelihood of receiving effective care. These patient narratives serve as a basis for continued examination of ME as well as further reconstruction of medical practice and procedure. / Dissertation/Thesis / Masters Thesis Social Justice and Human Rights 2019

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that causes motor, visual, and sensory symptoms. Patients also experience constipation, which is not yet understood, but could involve dysfunction of the enteric nervous system (ENS). Autoimmune targeting of the ENS occurs in other autoimmune diseases that exhibit gastrointestinal (GI) symptoms, and similar mechanisms could lead to GI dysfunction in MS. Here, we characterize GI dysmotility in the experimental autoimmune encephalomyelitis (EAE) model of MS and test whether autoantibodies targeting the ENS are present in the serum of MS patients. Male SJL or B6 mice were induced with EAE by immunization against PLP139-151, MOG35-55, or mouse spinal cord homogenate, and monitored daily for somatic motor symptoms. EAE mice developed GI symptoms consistent with those observed in MS. In vivo motility analysis demonstrated slower whole GI transit, and decreased colonic propulsive motility. EAE mice had faster rates of gastric emptying, with no changes in small intestinal motility. Consistent with these results, ex vivo evaluation of isolated colons demonstrated that EAE mice have slower colonic migrating myoelectric complexes and slow wave contractions. Immunohistochemistry of EAE colons exhibited a significant reduction in GFAP area of ENS ganglia, with no changes in HuD, S100, or neuron numbers. To test whether antibodies in MS bind to ENS structures, we collected serum samples from MS patients with constipation and without constipation, and healthy control patients without constipation. Immunoreactivity was tested using indirect immunofluorescence by applying serum samples to guinea pig ENS tissue. MS serum exhibited significantly higher immunoreactivity against guinea pig ENS than control patients, which was particularly evident in MS patients who did not experience constipation. There was no significant difference in immunoreactivity between MS patients with and without constipation. Targets of human MS and mouse EAE serum include enteric glia and neurons. Taken together, these data validate EAE as a model for constipation in MS, and support the concept that this symptom involves changes within the neuromuscular system of the colon. EAE mice develop symptoms consistent with constipation that affects functional ENS networks and may result in structural or phenotypic changes at the cellular level. Serum immunoreactivity suggests that autoantibodies could play a role in the development of constipation in MS by targeting the ENS itself.

Multiple sclerosis (MS) is an autoimmune demyelinating disorder of the central nervous system (CNS) with characteristic multifocal lesions or ‘ plaques’ of demyelination mainly in the white matter of the brain ( involving cerebral cortex, cerebellar, brain stem and spinal cord). These MS plaques vary in size and shape, and are composed of infiltrates of lymphocytes and macrophages - which contain myelin debris. CD8 T cells are more prevalent in CNS lesions and display oligoclonal expansion. However, their role in disease remains unclear with studies showing both protective and pathogenic roles for myelin-specific CD8 T cells in the experimental autoimmune encephalomyelitis (EAE) model. Our studies have demonstrated a disease-suppressive function for CNS-specific CD8 T cells in a model where the antigen is exogenously administered in vivo and used for in vitro CD8 activation. My studies focus on probing the nature of the CD8 response elicited by endogenously presented myelin antigens in vivo utilizing a novel approach, infection with Listeria monocytogenes (LM) encoding for myelin proteolipid protein peptide PLP178-191 (LM-PLP). I show that LM-PLP infection preferentially induces PLP-specific CD8, but not CD4, T cell responses. Despite this, infection does not result in autoimmunity. In fact, routinely induced EAE is significantly ameliorated in LM-PLP-infected mice, compared to controls. Disease suppression is dependent on the presence of CD8 T cells, and the effector molecules IFN-g and perforin. CNS T cell infiltration and inflammatory responses are reduced in LM-PLP-protected mice, and CD4 T cells from LM-PLP-protected mice are less inflammatory than those from controls. Importantly, infection with LM-PLP ameliorates already established disease. My studies indicate that myelin-specific CD8 T cells induced by endogenous presentation of antigen attenuate CNS autoimmunity in multiple mouse models of EAE, implicating the potential of this approach as a novel immunotherapeutic strategy.

This research is the exploration of the lived experience of tertiary students in Australia with the medical condition usually known as ME/CFS (Myalgic Encephalomyelitis /Chronic Fatigue Syndrome) seeking to explore issues of equity and human rights from the perspective of the Disability Discrimination Act 1992. Students feel that their difficulties are not caused just by the illness itself but by the failure of the tertiary institutions to understand the effects of this illness on them, the student, especially within the areas of accommodations and assessments. Their lived experiences are studied to ascertain if their experiences differ from those of other tertiary students. Forty participants came from every state and territory of Australia and twenty -four of Australia's universities as well as eight Technical and Further Education/Open Training Education Network (TAFE/OTEN) colleges are represented. The selection of the chosen methodology, Critical Ethnography from a Habermasian perspective, has been circumscribed by the medical condition which placed limitations on methodology and also data gathering methods. Non-structured stories, in which the participants wrote of their lived experience as students, were considered the most appropriate source of data. These were transmitted by electronic mail (with some by postal mail) to the researcher. A short questionnaire provided a participant background to the stories and was also collated for a composite overview of the participants. The stories are analysed in a number of ways: six selected stories are retold and the issues arising from these stories have been weighed against the remainder of the stories. Four intertwined themes were constructed from the issues raised in each story. Apparent infringements of the Disability Discrimination Act (1992) which impact on quality of life, human rights and equity are found. No accommodations are being made by the academic institutions for the cognitive dysfunctions and learning difficulties. Students are stigmatised and lack credibility to negotiate appropriate academic accommodations. A possible means of improving the ability of students to negotiate appropriate accommodations is explored. Finally the researcher reflects on her own involvement in the research as an 'insider' researcher.

<p>The purpose with this work is to describe the language that is built around the chronic fatigue syndrome (CFS) in Sweden. Our questions are: What does the professional field look like; who writes, about what and for which kind of readers? How do they describe the expressions and the upcoming of CFS? For which reasons can CFS be considered as a medical diagnosis/illness? How can CFS be understood from a social perspective? Our theoretical starting point is a social constructive theory and also Karin Johannisson's theory about medicalization and Foucault’s theory about power. We have from a literature-exposition of Swedish articles from 1989 to 2006, done a social constructive discourse analysis with help from Laclau & Mouffe's discourse theory, and Fairclough's model of social practices. In our textual analysis we found three dominating discourses: A medical discourse, a social/cultural discourse and a general/popular discourse. Our results showed that the dominating professional category is doctors and those who have medical direction within their work. In most cases they wrote articles that searched for medical explanations of CFS and their common factor was that they looked at CFS as an illness. The articles that had a social constructive, anthropological, idea historical or religious perspective to CFS was in a minority and they often defined the phenomenon as an expression of different kind of public elements and were often critical to medicalization.</p>

The purpose with this work is to describe the language that is built around the chronic fatigue syndrome (CFS) in Sweden. Our questions are: What does the professional field look like; who writes, about what and for which kind of readers? How do they describe the expressions and the upcoming of CFS? For which reasons can CFS be considered as a medical diagnosis/illness? How can CFS be understood from a social perspective? Our theoretical starting point is a social constructive theory and also Karin Johannisson's theory about medicalization and Foucault’s theory about power. We have from a literature-exposition of Swedish articles from 1989 to 2006, done a social constructive discourse analysis with help from Laclau &amp; Mouffe's discourse theory, and Fairclough's model of social practices. In our textual analysis we found three dominating discourses: A medical discourse, a social/cultural discourse and a general/popular discourse. Our results showed that the dominating professional category is doctors and those who have medical direction within their work. In most cases they wrote articles that searched for medical explanations of CFS and their common factor was that they looked at CFS as an illness. The articles that had a social constructive, anthropological, idea historical or religious perspective to CFS was in a minority and they often defined the phenomenon as an expression of different kind of public elements and were often critical to medicalization.