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Die Rheumatoide Arthritis ist die häufigste inflammatorische Arthritis mit einer Prävalenz von 0.5-1%. Pathophysiologisch spielen intrinsische Dysregulationen der Zytokinexpression insbesondere von TNF von Monozyten eine bedeutende Rolle. Die Regulation der TNF Expression ist komplex und manifestiert sich in erster Linie posttranslational. Hier steht das proteolytische Shedding durch die Metalloproteinase TACE, sowie deren Inhibierung durch TIMP-3 im Vordergrund. Ziel der Arbeit war die Aufdeckung potentieller Fehlsteuerungen der monozytären TNF Expression und der betreffenden regulatorischen Proteine, sowohl auf Ebene der mRNA Expression als auch posttranslational. Es konnte gezeigt werden, das Monozyten von RA Patienten vermehrt intrazelluläres TNF exprimieren. Der Anteil TIMP-3 positiver Monozyten scheint bei RA Patienten tendenziell vermindert zu sein.:1. Einleitung 1 1.1. Die Rheumatoide Arthritis 1 1.1.1. Epidemiologie und Klinik 1 1.1.2. Ätiologie und Pathogenese 1 1.2 Der Tumornekrosefaktor 3 1.2.1 Struktur und Signaltransduktion von TNF 4 1.2.2 Regulationsmechanismen der TNF Expression in Monozyten 5 1.3 Fragestellung und Ziele 9 2. Material und Methoden 11 2.1 Rekrutierung von Patienten und gesunden Probanden 11 2.2 Materialien 12 2.3 Methoden 15 2.3.1 Separation von PBMCs mittels Dichtegradientenzentrifugation 15 2.3.2 Separation von Monozyten mit negativer Magnetseparation 15 2.3.3 Bestimmung der monozytären Expression von TACE mittels Durchflusszytometrie 16 2.3.4 Bestimmung der intrazellulären Expression von TNF, TIMP-3 und PR-3 in Monozyten 17 2.3.5 Messung der TNF und TNF Rezeptor 2 Sekretion von Monozyten mit Hilfe eines ELISA 17 2.3.6 Bestimmung der RNA Expression von TNF, TIMP-3,TACE und PR-3 in Monozyten mittels Real Time PCR 19 2.4 Statistische Auswertung 20 3. Ergebnisse 21 3.1 Deskriptive Statistik der Kohorten 21 3.2 Expression der mRNA von TNF, TACE, TIMP-3 und PR-3 in Monozyten 22 3.3 Expression von TACE auf Monozyten 23 3.4 Expression von intrazellulärem TNF, TIMP-3 und PR-3 in Monozyten 24 3.5 Sekretion von TNF und TNFR2 von Monozyten 28 4. Diskussion 32 4.1 Expression von TNF sowie regulatorischer Moleküle auf mRNA Ebene 32 4.2 Expression von tmTNF und TACE auf der Oberfläche von Monozyten 35 4.3 Intrazelluläres Vorkommen von TNF sowie regulatorischer Moleküle in Monozyten 36 4.4 Sekretion von TNF und TNFR2 durch Monozyten 39 5. Zusammenfassung 42 6. Literaturverzeichnis 47 7. Abbildungsverzeichnis 61 8. Eigenständigkeitserklärung 63 9. Lebenslauf 63 10. Danksagung 65

Tumor necrosis factor-alpha (TNF-α) is a cytokine produced primarily by macrophages during acute inflammation. In this study we examined the differential effect of retinoic acid (RA) and phorbol 12-myristate 13-acetate (PMA) on the induction of TNF-α secretion from U937 monocytic cell populations by using the reverse hemolytic plaque assay (RHPA). The RHPA will allow us to investigate both changes in TNF-α secreting populations as well as monitor the relative amount of TNF-α released from individual cells. Our results indicate that treatment of U937 cells with RA (10-6M) moderately increases the secreting cell populations, and dramatically enhances the amount of TNF-α secreted from cells already committed to secretion. In contrast, treatment with PMA (250ng/ml) drastically increased the secreting population, but only slightly increasing the amount of TNF-α released. These results suggest that induction of TNF-α secretion from U937 cells occurs by different pathways.

Biologiska läkemedel är stora molekyler som har renats eller producerats från ett biologiskt ursprung. De används idag i stor utsträckning runt om i världen på grund av deras effektivitet att minska symtomen som kan uppstå vid olika mycket svåra sjukdomar. Detta arbete fokuserar på biologiska läkemedel som hämmar cytokinet tumörnekrotisk faktor (TNF). Läkemedlen används bland annat vid svåra autoimmuna sjukdomar. Vid autoimmuna sjukdomar aktiveras cellerna i immunsystemet vilket leder till utsöndring av olika cytokiner till exempel interleukin 1 och TNF. Dessa cytokiner påverkar kroppen på olika sätt genom att aktivera eller inhibera vissa produktionsprocesser i kroppen. Syftet med projektet var att verifiera en cellbaserad metod som används för koncentrationsmätning av det biologiska läkemedlet Infliximab (en TNF antagonist) i patientserum. Metoden som används i detta projekt kallas för reporter gene assay och den baseras på användning av en iLite cellinje. iLite är humana erytroleukemiceller K562 som är transfekterade med nukleär faktor kappa-B. Denna faktor aktiveras när TNF binder sig till TNF receptorer på cellytan. Aktiveringen av denna faktor leder till produktion av enzymet Eldflugeluciferas. Produktionen av enzymet är indirekt proportionell mot koncentrationen av TNF antagonist i serum. Dessutom innehåller cellerna en reporter gen för Renilla luciferas som uttrycks konstant. Renilla luciferas används som en internkontroll för att normalisera variationer som kan orsakas av provhantering samt transfektionseffektivitet. Luminescensen som utvecklas på grund av inverkan av Eldflugeluciferas på luciferas substrat samt inverkan av Renilla luciferas på stopp substrat mäts med hjälp av en luminometer. Dag-till-dag variationen för fem analyserade prov som analyserades vid fyra olika tillfällen var mellan 5 - 28 %, lot-till-lot variationen för fyra prov som analyserades fyra gånger vid fyra olika tillfällen var mellan 14 - 21 %. Alla normala serumprover från friska frivilliga blodgivare var negativa med en koncentration av Infliximab mindre än 0,65 µg/ ml. Resultaten visar att metoden är stabil och känslig jämfört med Biomonitors resultat. Dessutom visar resultaten att medelvärden av de olika körningarna från Euro Diagnostica (ett laboratorium som tillverkar immunologiska kit, Malmö) korrelerar väl med resultaten från Biomonitors laboratorium i Köpenhamn. Korrelationen för 19 analyserade prov var 0,99. / Biological drugs are large molecules that have been purified from or produced from a biological origin. They are used in great extent around the whole world because of their efficiency in reducing the symptoms of very severe diseases. The present work focus on biological drugs that inhibit tumor necrosis factor (TNF). Biological drugs are used for treatment of different autoimmune diseases. In autoimmune diseases activated cells of the immune system leads to secretion of various cytokines such as interleukin 1 and TNF. These cytokines affect the body in different ways by activating or inhibiting certain processes in the body. The purpose of this project was to verify a cell-based method which used for concentration measurement of the biological drug Infliximab (a TNF antagonist) in patient serum. The method which used in this project is called the reporter gene assay, and it is based on the use of an iLite cell line. iLite are human erythroleukemia K562 cells which are transfected with the nuclear factor kappa-B. This factor is activated when the tumor necrosis factor binds to its receptors on the cell surface. The activation of this factor leads to the production of the enzyme Firefly luciferase. Production of the enzyme is indirectly proportional to the concentration of TNF antagonist in the serum. Moreover, the cells contain a reporter gene for Renilla luciferase which is under constant expression. Renilla luciferase is used as an internal control to normalize the variations that may be caused by sample handling and transfection efficiency. The luminescence developed due to the influence of Firefly luciferase on luciferase substrate and Renilla luciferase on stop substrate is measured by using a luminometer. Day-to-day variations for five samples were analyzed at four different times were between 5 - 28 % while variations of lot-to-lot of 4 samples were analyzed at four different times were 14 - 21 %. The concentration of Infliximab in all the serum samples from healthy volunteer blood donors were less than 0.65 µg / ml. The results show that the method is robust and sensitive as compared to Biomonitors results. Furthermore, the results show that the mean value of the different runs from Euro Diagnostica (a laboratory that produces immunological kits, Malmö) for day-to-day and lot-to-lot variation agrees quite well with those from Biomonitors laboratory in Copenhagen. The correlation for the nineteen analyzed samples was 0.99.

Lysosomal storage disorders are a group of rare neurodegenerative diseases that are collectively common, sharing many aspects with other neurodegenerative disorders, including substrate build-up and neuroinflammation. The GM2 Gangliosidoses, Tay-Sachs disease and Sandhoff disease, are pathologically overlapping lysosomal storage disorders, with high prevalence within specific ethnicities. Their effects are neurologically devastating and often fatal at young ages. Current treatments only slow or stall an inevitable decline in health. Novel treatment targets are needed for these disorders, and others with similar pathologies. In these works we demonstrate the negative effect the inflammatory cytokine tumour necrosis factor-alpha has on survival of a model of Sandhoff disease. We demonstrate its role in the upregulation of astrogliosis, and apoptosis, and we present evidence that this effect on astrogliosis occurs through an upregulation of the JAK-2/STAT3 pathway. Though fruitful, a singular focus on inflammation/gliosis in these diseases has left a vacuum in the research into neuron specific molecular processes. We observe the development of inflammation, astrogliosis and neuronal processes in our model, and demonstrate a bi-phasic disease progression, in which early onset microgliosis precedes terminal astrogliosis, apoptosis, and a decline in excitatory glutamate receptors, suggesting neuron-specific malfunction. Furthermore, we show that knockout of the synaptic protein neuronal pentraxin 1 retards neurodegeneration and extends the lifespan of Sandhoff disease mice, independent of inflammation or astrogliosis. Through electrophysiology, we provide evidence of dysregulation of glutamate receptors in Sandhoff disease, and show that knockout of neuronal pentraxin 1 provides rescue from this dysregulation. This work expands on research into gliosis in GM2 gangliosidoses, presents the finding of a novel protein isoform, and presents a new focus on non-glial disease mechanisms and treatments for these and other neurodegenerative disorders. / Thesis / Doctor of Philosophy (PhD) / Lysosomal storage disorders are a group of neurological diseases that are debilitating, and often fatal at a young age. Two diseases of this group- Tay-Sachs disease and Sandhoff disease – are similar in their causes and symptoms. Current treatments for these diseases only slow or stall an inevitable decline in health. New targets for treatment are required, and we provide data suggesting several proteins that may fit this criterion. We also provide evidence of the discovery of a new form of one of these proteins, which is found in high levels in the disease, indicating it may be important in these and other neurodegenerative diseases. Finally, we provide findings indicating that a certain cell type, which is largely ignored in current research for these diseases, may be important in the disease progress. These findings increase our knowledge of Tay-Sachs disease and Sandhoff disease, and open new avenues for medicinal intervention.

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Traumatic brain injury (TBI) is a leading cause of morbidity and mortality around the world. It has multiple causative factors including sports injuries, vehicular accidents, war, and other forms of trauma. Though patients can recover, it has the potential to cause mild to severe persistent cognitive deficits. Medical treatment involves treating individual problems as they arise; this treatment is based upon clinical signs. Developing a standard of care for TBI is complex due to the difficulty in finding common cell and molecular changes in TBI variants that can be prevented or ameliorated. Tumor necrosis factor (TNF) is a prominent inflammatory cytokine present in all forms of traumatic brain injury. It is the target of multiple therapies in other disease processes. As TNF inhibitors lead to billions of dollars in worldwide sales, their use in neuropathologies is an active research area. XPro1595, a preclinical drug developed by Xencor, uniquely inhibits more than 99% of soluble TNF. However, there is only one published study to date on the effects of XPro1595 in any model of traumatic brain injury. The purpose of this study was to characterize the presence of TNF and the proinflammatory TNFR1 pathway in a controlled cortical impact (CCI) mouse model of TBI and to determine if XPro1595 could improve behavioral and neuropathological outcomes. TNF and the TNFR1 pathway have shown to be chronically present in a CCI mouse model for at least two weeks. Injured animals treated with one course of the drug did not show any improvements in spatial learning or memory. However, decreased activity in the TNFR1 pathway and changes in glial markers indicated that XPro1595 lessened neuroinflammation via this mechanism. This study suggests potential benefits of XPro1595 in TBI that could lead to a common standard of care.

Macrophages (MF) are known to exhibit distinct responses to viral and bacterial infection, but how they react when exposed to the pathogens in succession is less well understood. Accordingly, we determined the effect of a rubella virus (RV)-induced infection followed by an LPS-induced challenge on cytokine production, signal transduction and metabolic pathways in human GM (M1-like)- and M (M2-like)-MF. We found that infection of both subsets with RV resulted in a low TNF-a and a high interferon (IFN, type I and type III) release whereby M-MF produced far more IFNs than GM-MF. Thus, TNF-a production in contrast to IFN production is not a dominant feature of RV infection in these cells. Upon addition of LPS to RV-infected MF compared to the addition of LPS to the uninfected cells the TNF-a response only slightly increased, whereas the IFN-response of both subtypes was greatly enhanced. The subset specific cytokine expression pattern remained unchanged under these assay conditions. The priming effect of RV was also observed when replacing RV by IFN-b one putative priming stimulus induced by RV. Small amounts of IFN-b were sufficient for phosphorylation of Stat1 and to induce IFN-production in response to LPS. Analysis of signal transduction pathways activated by successive exposure of MF to RV and LPS revealed an increased phosphorylation of NFkB (MMF), but different to uninfected MF a reduced phosphorylation of ERK1/2 (both subtypes). Furthermore, metabolic pathways were affected; the LPS-induced increase in glycolysis was dampened in both subtypes after RV infection. In conclusion, we show that RV infection and exogenously added IFN-b can prime MF to produce high amounts of IFNs in response to LPS and that changes in glycolysis and signal transduction are associated with the priming effect. These findings will help to understand to what extent MF defense to viral infection is modulated by a following exposure to a bacterial infection.

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