Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease that cause various inflammatory conditions in the body. The pathogenesis of this disease is yet unknown, and the diversity within the patients bring on major obstacle to clinical research for specific diagnostic markers. As a biomarker of SLE, both Interferon Regulatory Factor-5 (IRF5) and Microparticles (MP) have been suggested. Recently a study demonstrated higher concentration of IRF5+ MP in a small number of SLE patients compared to controls.  Aim: The purpose of this study was to validate and analyze IRF5+ MPs in a larger number of SLE patients and compare the results to known SLE subgroup based on IRF5 concentration.  Materials and methods: Totally 50 plasma samples from a larger cohort of SLE-patients (n=35) was analyzed together with population-based controls(n=15). Three different antibodies (in-house and commercial) were used for detection of IRF5+ MP with flow cytometry. Students t-test was used to investigate significant differences between SLE subgroup, controls and compared to the previous values. Results and Conclusion: The concentration of IRF5+ MP in SLE subgroup was significantly higher compared to controls (p<0,05). However, there were no correlations between our results and the values from the previous study, suggesting that both methods measure various forms of IRF5. These results imply that IRF5+ MP could be a possible biomarker for pathogenesis in SLE, but further studies are needed for a better understanding of IRF5, as well as of MP.

The human gamma-delta (gd) TCR+ T-cell subset may undergo specific antigen-driven activation and clonal expansion, in the context of systemic sclerosis (SSc) pathogenesis. The purpose of this study was; 1) To determine whether gd TCR+ T-cells are clonally expanded in skin biopsies and peripheral blood from patients with SSc; and 2) To develop approaches for identification of the antigens recognized by these clonally-expanded gd TCR+ T-cells. Total RNA was isolated from the skin biopsies and peripheral blood of patients with SSc (n=8). After cDNA synthesis, the g- and d-chain TCR transcripts were amplified by PCR, cloned and sequenced for analysis. Full length copies of the TCR transcripts were constructed, expressed in a TCR-negative Jurkat T-cell line using retroviral gene transduction, and verified by RT-PCR and flow cytometry for gd TCR expression. Putative antigen recognition, by the transduced gd TCR+ Jurkat T-cell lines, was assessed via; 1) Measuring intracellular calcium flux in the transduced cells after stimulation with putative SSc antigens, including DNA topoisomerase I, centromere proteins A and B, hsp 27, hsp 90 and the viral lysate of human cytomegalovirus; and 2) Cytotoxicity against human endothelial cell lines (HUVEC and HLMVEC) via measurement of lactate dehydrogenase release from the targets. We report the presence of substantial, statistically-significant, proportions of identical g- and d-chain transcripts in skin biopsies and PBMC of patients with SSc, demonstrating the presence of antigen-driven clonal expansions. Jurkat T-cells, transduced with the clonally-expanded gd TCR transcripts from a patient, showed no evidence of cytotoxicity against the human endothelial cell lines, or calcium flux in response to stimulation with the putative SSc antigens assessed. In conclusion, extensive clonal expansions of g- and d-chain TCR transcripts were identified in skin biopsies and peripheral blood of patients with SSc, demonstrating the presence of oligoclonal populations of gd TCR+ T-cells in these patients. These gd TCR+ T-cells have undergone proliferation and clonal expansion in vivo in response to as yet unidentified antigens. Furthermore, an approach has been developed for the identification of the antigens recognized by the clonally-expanded gd TCR transcripts, which can be expanded to additional patients with SSc. / Microbiology and Immunology

Doctor of Philosophy / In healthy individuals, the autoimmune system is the body's natural defense against foreign materials and organisms. The main tools utilized for this defense mechanism are immune cells. However, in patients suffering from autoimmune diseases, the autoimmune system is overactive resulting in its attack on healthy cells, which leads to reduced or eliminated function of the targeted organs. To suppress these overreactive immune responses, pharmaceutical intervention is needed. An integral part of autoimmune response is the lipid sphingosine-1-phosphate (S1P). Interactions of S1P with its response-inducing receptors prompts the release of immune cells, lymphocytes in particular, from lymph tissue to migrate and participate in the invoked immune response. The pharmaceutical industry has produced five FDA approved drugs that disrupt this S1P-receptor interaction by blocking the receptor to reduce the autoimmune response in patients suffering from autoimmune diseases such as multiple sclerosis and ulcerative colitis. However, these treatments had adverse side effects on the cardiovascular system due to the presence of S1P receptors in the heart. Due to this, there is attraction to target a different node of the S1P signaling pathway to avoid these side effects while still suppressing the immune response. A node that is a viable target for therapeutic target that has recently become the focus of medicinal chemistry campaigns is the transporter protein spinster homolog 2 (Spns2). This protein is responsible for the transport of S1P from intracellular space to extracellular space to interact with its receptors and induce the immune response. Recently, our group has developed several effective inhibitors of Spns2. In this dissertation, several improvements of previously reported inhibitors are revealed. The pinnacle of this work is the development of 4.22v that is optimized to have drug-like properties for testing in mice. Administration of 4.22v to mice resulted in reduced circulating lymphocytes and without showing signs of toxicity following chronic dosing for 14 days. These results suggest that 4.22v is a potential drug candidate and is currently undergoing further biological evaluation.

Yes / The development of androgenetic alopecia is associated with a risk of developing cardiovascular diseases, but the association of alopecia areata with cardiovascular diseases in humans is largely unexplored. We measured the plasma level of two common cardiovascular disease markers, cardiac troponin I and Creactive protein, in alopecia areata and androgenetic alopecia-affected subjects. Also, we investigated the possible presence of pro-apoptotic factors in the plasma of hair loss subjects. The mean plasma cardiac troponin I level was highest in alopecia areata subjects, moderately higher in androgenetic alopecia subjects, and lowest in subjects without hair loss (p < 0.05). Alopecia areata subjects not receiving treatments had highest levels of cardiac troponin I (p < 0.05). Alopecia areata plasma samples with high cardiac troponin I levels also induced significantly higher rates of cardiomyocyte apoptosis in cell culture assays. The results suggest the potential for increased heart remodelling. Close monitoring of cardiovascular health in alopecia areata subjects, as well as subsets of androgenetic alopecia patients, may be appropriate. / Canadian Institutes of Health Research (CIHR; MOP-82927). EW is the recipient of a Banting Postdoctoral Fellowship (SAC-92845).

Die vorliegende Arbeit befaßt sich mit T-Helferzellen und ihren Interaktionen mit Gewebszellen, wie sie im gesunden Organismus und in Autoimmunerkrankungen auftreten. Es werden Fragen der Toleranzinduktion durch orale Gabe von Antigenen, speziell der oralen Verabreichung von Collagen II bei Patienten mit rheumatoider Arthritis diskutiert. Eine Immundeviation als Mittel, inflammatorische Th1-Zellantworten in anti-inflammatorische Th2-Zellantworten zu verwandeln, kann durch Eingriffe in die T-Zell-Signaltransduktion erreicht werden. Es werden neue Ansätze zu Mechanismen diskutiert, die das Immunprivileg des Zentralnervensystems gewährleisten. Die hirnresidenten Immunzellen, zu denen Mikrogliazellen und Astrozyten zählen, besitzen Eigenschaften, die eine Entzündung unwahrscheinlich machen. Sie müssen aktiviert werden, um Antigene präsentieren zu können. In organtypischen entorhinal-hippocampalen Schnittkulturen konnte gezeigt werden, dass Mikrogliazellen durch Th1-Zellen aktiviert, von Th2-Zellen hingegen deaktiviert werden. Die Möglichkeit, dass die Costimulation über CD80 oder CD86 differentielle Effekte auf den Charakter der Immunantwort hat, wird diskutiert. Der Einfluß von pro-inflammatorischen Zytokinen auf Mikrogliaaktivierung und den Erhalt von Nervenfasern wurde ebenfalls in Hirnschnittkulturen untersucht. Astrozyten sind wesentlicher Bestandteil der Blut-Hirn-Schranke. Diese kann jedoch von aktivierten T-Zellen überwunden werden. In dieser Arbeit wird gezeigt, dass Astrozyten über eine Expression von CD95L in aktivierten T-Zellen Apoptose induzieren können. Davon sind jedoch nicht alle T-Zellen betroffen. Andererseits wird eine T-Zellproliferation unterdrückt, indem T-Zellen unter Astrozyteneinfluß verstärkt CTLA-4 exprimieren, was einen Zellzyklusarrest zur Folge hat. Darüber hinaus ist eine verstärkte Produktion von Nervenwachstumfaktor (NGF; nerve growth factor) nach antigenspezifischer Interaktion von Astrozyten mit Th1- und Th2-Zellen als zusätzliches Mittel, eine Neuroinflammation einzudämmen, anzusehen. Die Arbeit stellt diese Ergebnisse in fünf Kapiteln dar, welche gleichzeitig eine Einführung in die als Anlagen enthaltenen zehn Publikationen geben. / This thesis deals with T helper cells and their interactions with tissue cells as they occur in the healthy organism and in autoimmune diseases. Questions of tolerance induction by oral application of antigens are discussed especially oral treatment with type II collagen in patients with rheumatoid arthritis. In order to transform inflammatory Th1 responses into anti-inflammatory Th2 responses, immune deviation can be reached by interference with T-cell signal transduction. New approaches towards the different ways that the immune privilege of the central nervous system is maintained are discussed. The resident immune cells, i.e. microglia and astrocytes possess properties that make inflammation unlikely. They have to be activated in order to present antigens. It has been shown in organotypic entorhinal-hippocampal slice cultures that Th1 cells activate whereas Th2 cells deactivate microglial cells. The possibility is discussed as to whether costimulation via CD80 or CD86 differentially influences the character of the immune response. The influence of pro-inflammatory cytokines on microglial activation and preservation of nerve fibers has also been studied in brain slice cultures. Astrocytes are an essential part of the blood-brain barrier, which can be crossed by activated T cells. The thesis shows that astrocytes can induce apoptosis in activated T cells via expression of CD95L. However, not all T cells are affected. T cell proliferation is suppressed by increased CTLA-4 expression in T cells under the influence of astrocytes, resulting in a cell cycle arrest. An additional mechanism of confining neuroinflammation is increased production of the nerve growth factor (NGF) following antigen-specific interaction of astrocytes and Th1 and Th2 cells, respectively. These results are presented in five chapters that also introduce the ten attached publications.

Die Myasthenia Gravis (MG) ist ein Prototyp einer Antikörper-vermittelte Autoimmunerkrankung. Die Autoantikörper richten sich hauptsächlich gegen den Acetylcholinrezeptor (AChR). Welche Bedeutung TH17-Zellen für die Pathogenese der MG haben, konnte bisher noch nie direkt gezeigt werden. Mithilfe des Tiermodells Experimentelle Autoimmune Myasthenia Gravis (EAMG) sollte die Rolle der TH17-Zellen im Rahmen dieser Arbeit analysiert werden. Eine signifikante Anzahl tAChR-spezifischer CD4+ T-Zellen, die IL17 exprimieren, konnte nach der Immunisierung mit torpedo AChR in CFA in Wildtyp-Mäusen (WT) beobachtet werden. Die IL17ko Mäuse entwickelten weniger oder keine EAMG Symptome, obwohl weder die Frequenz tAChR-spezifischer CD4+ T-Zellen, die IL2, IFNgamma oder IL21 sezernierten noch der prozentuale Anteil der FoxP3+ Treg-Zellen einen Unterschied aufwiesen. Im Gegensatz dazu waren die Level pathogener anti-muriner AChR Antikörper statistisch geringer in IL17ko Mäusen, während bei anti-tAChR Antikörpertitern kein Unterschied festzustellen war. Ähnliche Resultate erbrachten TCRbeta/delta ko Mäuse rekonstituiert mit entweder WT oder IL17ko CD4+ T-Zellen. Die Depletion von Treg-Zellen mithilfe von DEREG Mäusen in der frühen Erkrankungsphase zeigte keine signifikanten Unterschiede bezüglich der analysierten Parameter. Zusammenfassend lässt sich hier festhalten, dass die Frequenz und Differenzierung Antigen-spezifischer CD4+ T-Zellen sowie der Antikörpertiter gegen den tAChR nicht durch die IL17-Defizienz im EAMG Modell beeinflusst wird. Auch hat eine frühe Treg-Zell-Depletion keinen Einfluß auf die Erkrankungsstärke. Allerdings scheint das Durchbrechen der B-Zell Toleranz, das zur Produktion von pathogenen Anti-mAChR-spezifischen Antikörpern und somit zu einer Induktion der Erkrankung führt, abhängig von IL17-produzierenden CD4+ T-Zellen zu sein. Der Einsatz von Anti-IL17-Antikörpern könnte insofern auch für die MG eine Therapieoption darstellen. / Myasthenia gravis (MG) is an antibody-mediated autoimmune disease. The autoantibodies are directed against the acetylcholine receptor (AChR). The importance TH17 cells have for MG pathogenesis has never been directly demonstrated. Therefore, the analysis of TH17 cells in the Experimental Autoimmune Myasthenia Gravis (EAMG) animal model was the aim of this work. Here, it is shown that in wildtype mice (WT) significant numbers of IL17-producing tAChR-specific CD4+ T cells could be observed after immunization with torpedo AChR in CFA. IL17ko mice developed less or no EAMG symptoms, although frequencies of tAChR-specific CD4+T cells secreting IL2, IFNgamma or IL21 as well as percentage of FoxP3+ Treg cells were similar. In contrast, pathogenic anti-murine AChR antibody levels were significantly lower in IL17ko mice, while anti-tAChR antibody levels were equal. Similar results were obtained by the reconstitution of TCR beta/delta ko mice with CD4+ T cells of either WT or IL17ko origin. For the depletion of Treg cells using DEREG mice in the initial phase of the disease no significant differences could be detected in terms of the analyzed parameters. In summary, this thesis demonstrates, that frequencies and differentiation of antigen specific CD4+ T cells as well as the level of anti-tAChR specific antibody titers are not affected by IL17-deficiency in the EAMG model. Likewise, an early Treg cell depletion seems to have no impact on disease severity. However, breaking of B cell tolerance resulting in pathogenic anti-murine AChR specific antibodies and subsequent disease induction, seems to be dependent on IL17 producing CD4+ T cells. In this respect, the application of anti-IL17 antibodies could also become a MG therapy option.

Made available in DSpace on 2016-01-26T12:51:54Z (GMT). No. of bitstreams: 1 marioabbudfilho_tese.pdf: 593929 bytes, checksum: 5a51471e6a2867571b8d0d10243eafa1 (MD5) Previous issue date: 2006-12-01 / Systemic lupus erythematosus (LES) is a serious systemic autoimmune disease of which the pathogenesis remains elusive. Bi-directional cell traffic during pregnancy gives rise to fetal microchimerism (FMC). There is accumulating evidence suggesting that FMC can cause or exacerbate autoimmunity. Objetive. To determine the incidence of FMC in LES patients (pts) and to assess the effect of pregnancy and some epidemiological characteristics of LES on the FMC. Patientes and Methods. Real time polymerase chain reaction for specific Y chromosome sequences was used to detect fetal male cells (IPF) in the peripheral blood of 46 women selected according to this criteria: 1- pregnancy of at least one male offspring; 2- absence of history of previous transfusions, miscarriages or transplants. Information was obtained on the age of the mother at first male birth, number of male offspring, time since birth of the first son (time of microchimerism), time since disease diagnosis and renal involvement of LES.Results.Twenty eight pts and 18 healthy women were included in the study. The number of fmc/ml of maternal blood was higher among LES pts than in control group (252 ± 654 vs 2,13 ± 3,7 fmc/ml; p= 0,029). Multiple linear regression did show a strong positive correlation between the number of fmc/ml and the length of the disease (p= 0,027). The number of male cells also increase with duration of microchimerism in LES pts ( 15y = 140 ± 382; >15y = 395 ± 860 fmc/ml; p= 0,003) while slightly decreasing among healthy women during the same time periods (2,55 ± 4,34; 2,66 ± 3,79; 1,64 ± 3,81fmc/ml; p= NS). FMC was not associated with this number of male births and was also not associated with the mother s age at the birth of the first son. Higher numbers of fmc/ml were detected among pts without nephropathy when compared to those of pts with lupus nephritis (388 ± 827 YV 95,5 ± 338 fmc/ml; xiii p=0,019). This same observation was made in pts 18 years old at first male birth 9=(355 ± 623 YV 0,23 ± 0,22 fmc/ml respectively; p= 0,028). Conclusions. Our data demonstrates that the number of fmc/ml is higher in LES pts than in healthy women and it does increase with length of disease and duration of microchimerism. These results strongly suggest that in LES pts fetal microchimeric cells do proliferate with time but decrease or tend to disappear in healthy women. It is possible that FMC may not be totally detrimental to the host because it may provide some benefits in lupus nephritis cases. / Lupus eritematoso sistêmico (LES) é uma doença auto-imune grave com fisiopatologia ainda desconhecida. Na gestação o trânsito bidirecional que ocorre entre as células da mãe e feto causa o aparecimento do microquimerismo fetal (MCF). Existem evidências que a persistência do MCF poderia causar ou exacerbar doença auto-imune. Objetivo: Determinar a freqüência de ocorrência de MCF em pacientes (pts) acometidas pelo LES e avaliar o efeito da gestação e de características epidemiológicas do LES sobre o MCF. Pacientes e Métodos. Reação em cadeia da polimerase em tempo real para seqüências de DNA específicas do cromossomo Y foi a técnica usada para detectar células fetais masculinas (IPF) no sangue de 46 mulheres selecionadas conforme os critérios: 1- história com presença de pelo menos uma gravidez do sexo masculino; 2- ausência de abortos, transfusão sanguínea ou transplantes prévios. Foram ainda obtidas informações sobre tempo decorrido desde o nascimento do primeiro filho (tempo de microquimerismo), número de gestações do sexo masculino, idade ao nascimento do primeiro filho, tempo de diagnóstico de LES e evidências de nefrite lúpica. Resultados. Vinte oito pts e 18 mulheres saudáveis foram incluídas no estudo. O número de fmc/ml de sangue materno foi maior nas pts com LES do que no grupo controle (252 654) YV (2,13 3,7) fmc/ml; (p=0,029). Regressão linear múltipla mostrou significante correlação positiva entre o número de fmc/ml e o tempo de doença lúpica (p=0,027). Enquanto nas pts com LES a quantidade de fmc/ml aumentou progressivamente com o tempo de microquimerismo (. DQRV . fmc/ml; 11 - 15a = 140 382; >15a = 395 860 mfc/ml; p=0,003) nas mulheres saudáveis ocorreu uma leve redução nos mesmos intervalos de tempo (respectivamente 2,55 4,34; 2,66 3,79; 1,64 3,81 fmc/ml; p= NS). MCF não foi associado com o número de gestações do sexo masculino nem com a idade ao nascimento do primeiro filho. Nota de Resumo número de gestações do sexo masculino nem com a idade ao nascimento do primeiro filho. Maior número de fmc/ml foi detectado nas pacientes sem nefrite lúpica quando comparado com as pts com doença renal (388 827 YV 95,5 338 fmc/ml; p=0,019). Essa observação também foi notada entre pts sem nefrite que pariram o primeiro filho até 18 anos de idade (355 623 YV 0,23 0,22 fmc/ml respectivamente; p=0,028). Conclusões.A quantidade de células fetais microquiméricas é maior entre as pts com LES e o número dessas células aumenta com decorrer do tempo de doença e do tempo de microquimerismo. Essas observações sugerem que as células fetais masculinas podem proliferar, aumentando nas pts com LES e diminuindo ou mesmo desaparecendo nas mulheres saudáveis. Ainda é possível que o FMC não tenha apenas um papel deletério no LES podendo produzir benefícios nos casos de nefrite lúpica.

Palmoplantar pustulosis (PPP) is a chronic disease of unknown pathogenesis. Most of the patients were smokers. High prevalence of a number of autoimmune diseases was observed among the patients (thyroid disease 14%, gluten intolerance 8%, diabetes type 1 3%). Eosinophils and neutrophils were found in large numbers in the pustules. Massive infiltrates of lymphocytes and mast cells in the dermis below the pustule and an abnormal acrosyringial pattern indicate that the acrosyringium is the target for the inflammation. Immunofluorescence (IF) revealed decreased innervation of the sweat gland, outward migration of substance P-positive granulocytes in the acrosyringium and an increased number of contacts between mast cells and nerve fibres in the dermis. Distributions of choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) were studied, since they regulate the level of acetylcholine, the main inducer of sweating. The most intense AChE-like immunoreactivity (LI) was observed in the acrosyringium in the lowest part of the stratum corneum, corresponding to the site of the pustule in PPP. ChAT-LI in granulocytes and AChE-LI in mast cells were demonstrated, which may have implications for inflammatory processes in general. Nicotinic acetylcholine receptors (nAChR) are activated by acetylcholine but also by nicotine. Immunohistochemstry of α-3 and α-7 subtypes of the nAChRs showed that the nAChR expression in healthy skin was influenced by smoking. A highly abnormal α-7 nAChR distribution in PPP skin was observed. The levels of nAChR antibodies were elevated in 42% of the PPP sera, and 68% of these sera gave specific endothelial IF in the papillary dermis in skin from non-smokers. Positive IF in the acrosyringium was also noted in skin from smokers. Conclusions: Smoking seems to induce up-regulation of an antigen in palmar skin. The results indicate that PPP is an autoimmune disease and that nicotine might have a role in the onset of the inflammation.

Alzheimer’s Disease (AD) is a chronic progressive neurological condition, clinically characterized by memory deficits, cognitive and physical impairment, and personality changes. Traditionally, AD was considered a type of protein folding disorder. Here, the concept of AD as an autoimmune disease of the innate immune system was developed. After exploring evolutionary connections between the AD peptide β-amyloid (Aβ) and known antimicrobial peptides (AMPs), and elucidating the structural similarities between Aβ and AMPs, a mechanism of action for Aβ’s antimicrobial activity is proposed that is based on the compromise of bacterial membranes. Following these theoretical considerations, experimental evidence is presented for the production of Aβ by cells in response to infection, and for Aβ’s antibacterial and antiviral activity. Rooted in similarities of the cell membranes of neuronal and bacterial cells in terms of lipid composition and transmembrane potential, it is hypothesised that Aβ’s neurotoxicity is caused by its misguided attack on neurons as an AMP. In reversing the concept of Aβ as an AMP, the similarity of AMPs to Aβ is demonstrated in experiments revealing the neurotoxicity of two AMPs, LL 37, and cecropin A. To determine a mechanism for the progressive nature of AD, it was shown that, although apoptosis may be involved in AD, it is actually necrosis that is responsible for the propagation of neuronal cell death so characteristic of AD. With the Vicious Cycle of AD, a scheme was devised, integrating the results obtained here with data and research from other groups, which explains the chronic and progressive nature of AD as a result of Aβ’s physiological role as an AMP and innate immune system effector. Borne from Aβ’s activity as an AMP and its central role in the Vicious Cycle of AD, a question was investigated: do antibiotics, such as penicillin, that cause release of bacterial endotoxins due to their mechanism of action, trigger the Vicious Cycle of AD and thus lead to the development of AD? Preliminary evidence supporting this notion was presented.

Despite the central role of IFNγ in vitiligo pathogenesis, systemic IFNγ neutralization is an impractical treatment option due to strong immunosuppression. However, most vitiligo patients present with less than 20% affected body surface area, which provides an opportunity for localized treatments that avoid systemic side effects. After identifying keratinocytes as key cells that amplify IFNγ signaling during vitiligo, I hypothesized that tethering an IFNγ neutralizing antibody to keratinocytes would limit anti-IFNγ effects to the treated skin for the localized treatment. To that end, I developed a bispecific antibody (BsAb) capable of blocking IFNγ signaling while binding to desmoglein expressed by keratinocytes. I characterized the effect of the BsAb in vitro, ex vivo, and in a mouse model of vitiligo. SPECT/CT biodistribution and serum assays after local footpad injection revealed that the BsAb had improved skin retention, faster elimination from the blood, and less systemic IFNγ inhibition than the non-tethered version. Furthermore, the BsAb conferred localized protection almost exclusively to the treated footpad during vitiligo that was not possible by local injection of the non-tethered anti-IFNγ antibody. Thus, keratinocyte-tethering proved effective while significantly diminishing off-tissue effects of IFNγ blockade, offering a new treatment strategy for localized skin diseases, including vitiligo.