Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 5 uppsatser.

Le Syndrome de Détresse Respiratoire Aiguë (SDRA) est la forme la plus sévère d’agression alvéolaire aiguë. Il estcaractérisé par un dommage alvéolaire diffus, suivi d’une phase de réparation nécessaire à la guérison. Bien queles monocytes/macrophages soient des acteurs incontournables de la pathogénie et de la résolution du SDRA, leurpolarisation et leur rôle dans la réparation alvéolaire restent mal connus chez l’Homme. L’hypothèse défendue parcette thèse est que l’environnement alvéolaire module la différenciation et la polarisation desmonocytes/macrophages au cours du SDRA, et que les macrophages alvéolaires ainsi polarisés participentactivement à la réparation et à sa régulation. Les principaux résultats de nos travaux ont permis d’établir que : 1)l’environnement alvéolaire de SDRA inhibe la différenciation des monocytes en fibrocytes (précurseursmésenchymateux associés à la fibroprolifération et à pronostic péjoratif). L’inhibition est majoritairement due à laSerum Amyloid protein P (SAP), provenant en partie du relargage de ses stocks matriciels pulmonaires à la faveurde la lésion alvéolaire ; 2) l’environnement alvéolaire de SDRA induit une polarisation anti-inflammatoire desmacrophages se rapprochant de la polarisation induite in vitro par l’IL-10 ; 3) les macrophages anti-inflammatoirespolarisés par le lavage broncho-alvéolaire (LBA) de patients SDRA favorisent la réparation alvéolaire épithéliale viala production polarisation-dépendante d’Hepatocyte Growth Factor (HGF). Cette production macrophagique d’HGFest amplifiée via une boucle autocrine PTGS2/PGE2 chez l’Homme ; 4) ces résultats semblent étayés par lesdonnées obtenues sur une cohorte clinique qui montrent que les concentrations de sCD163 (marqueur depolarisation anti-inflammatoire) et d’HGF rapportées au nombre de macrophages alvéolaires sont plus élevéeschez les patients survivants que chez les patients décédés de SDRA. L’ensemble de nos travaux démontrent pour lapremière fois chez l’Homme le rôle bénéfique de l’environnement alvéolaire sur les monocytes/macrophages,d’une part en inhibant leur différenciation en fibrocytes contribuant ainsi à limiter la fibroprolifération pulmonaire,et d’autre part en induisant un phénotype macrophagique anti-inflammatoire, contribuant à limiter l’inflammationengendrée par la lésion alvéolaire initiale et favorisant la réparation épithéliale via la production d’HGF. Lesdonnées physiopathologiques obtenues pourraient permettre d’envisager la reprogrammation anti-inflammatoiredes macrophages comme une cible thérapeutique du SDRA en cas d’excès d’inflammation ou de fibro-proliférationavec réparation aberrante. / Acute Respiratory Distress Syndrome (ARDS) is the most severe form of acute lung injury. ARDS is characterized bydiffuse alveolar damage followed by a phase of alveolar repair necessary to recovery. Althoughmonocytes/macrophages are key actors of pathogenicity and resolution of ARDS, little is known about theirpolarization and role on alveolar repair during human ARDS. The hypothesis of our studies was that ARDS alveolarenvironment modulates differentiation and polarization of monocytes and macrophages, and that polarizedmacrophages are involved in alveolar repair and its regulation. The main results of our work have shown that: 1)ARDS alveolar environment inhibited monocytes differentiation into fibrocytes (mesenchymal progenitorsassociated with fibroprolifération and a poor prognosis), mainly through its Serum Amyloid P (SAP) content,originating, at least in part, from the release of SAP associated with lung connective tissue during ARDS; 2) ARDSalveolar environment drove an anti-inflammatory macrophage polarization, close to that induced by IL-10 in vitro;3) anti-inflammatory macrophages polarized by broncho-alveolar lavage (BAL) from ARDS patients favored alveolarepithelial repair through a polarization-dependent production of Hepatocyte Growth Factor (HGF). This HGFproduction is amplified by an autocrine PTGS2/PGE2 dependent loop in human macrophages; 4) these results mayhave clinical relevance, since sCD163 (a marker of anti-inflammatory polarization) and HGF concentrations,expressed relatively to BAL macrophage count, were higher in ARDS survivors than non-survivors. Taken together,our works demonstrate for the first time the beneficial role of the ARDS alveolar environment onmonocytes/macrophages, inhibiting their differentiation into fibrocytes, thus limiting excessive lungfibroproliferation, and inducing an anti-inflammatory macrophage polarization, thus limiting the inflammationgenerated by the initial alveolar damage and favoring epithelial repair through HGF production. The datapresented in this thesis may allow considering anti-inflammatory macrophage repolarization as a potential newtherapeutic target of ARDS with excessive inflammation or fibro-proliferation with aberrant repair.

It is a striking observation that tissue of patients invaded by the deep mycoses often lacks evidence of an inflammatory response. This lack of host response is often attributed to neutropenia secondary to chemotherapy. However, systematic studies do not support this simplistic explanation. However, invasive fungal lesions are characterized by abundant fungal functional amyloid, which in turn is bound by serum amyloid P component (SAP). We postulate that SAP is important in the local immune response in invasive fungal infections. The interaction between fungal functional amyloid, SAP, and the immune response in deep mycoses is discussed.

Compositions are vectors of nonnegative numbers that sum to a constant, usually one or 100%. They arise in a wide array of fields: geological sampling, budgets,fat/protein/carbohydrate in foods, percentage of the vote acquired by each political party, and more. The usual candidate distributions for modeling compositions -- the Dirichlet and the logistic normal distribution -- have density zero if any component is zero. While statistical methods have been developed for "rounded" zeros, zeros stemming from values below a detection level, and zeros arising from count data, there remain problems with essential zeros, i.e. cases in continuous compositions where a component is truly absent. We develop a model for compositions with essential zeros based on an approach by Aitchison and Kay (2003). It uses a mixture of additive logistic normal distributions of different dimension, related by common parameters. With the requirement of an additional constraint, we develop a likelihood and methods estimating parameters for location and dispersion. We also develop a permutation test for a two-group comparison, and demonstrate the model and test using data from a diabetes study. These results provide the first use of the additive logistic normal distribution formodeling and testing compositional data in the presence of essential zeros.

A common theme in amyloid disorders is the deposition of disease-specific protein aggregates in tissues. Amyloid proteins bind to heparan sulfate (HS), a sulfated glycosaminoglycan, and HS has been found to promote the aggregation process. The present work relates to HS mediated mechanisms of amyloidosis, particularly transthyretin (TTR) amyloidosis, AA-amyloidosis and Alzheimer’s disease (AD). TTR is a transport protein present in the blood and cerebrospinal fluid, which under unclear circumstances can deposit as amyloid in the myocardium of elderly individuals. Examination of cardiac tissue from a 70 year old patient with reported cardiomyopathy reveald co-deposition of TTR amyloid and HS. Studies revealed that HS promotes TTR fibrillization through interaction with a basic motif in the protein. Empolyment of a cell model demonstrated that cell surface HS mediates internalization of TTR, an effect likely facilitated by HS-binding to the basic motif on TTR. Collectively, HS-TTR interactions at the cell surface may have dual outcomes, resulting in either fibrillization or internalization, respectively. During inflammatory conditions, serum amyloid A (SAA), an acute-phase protein associated with the high-density lipoprotein (HDL), can assemble into insoluble amyloid fibrils, causing AA-amyloidosis. We found that HS structures exceeding 12-14 sugar units in length separates SAA from HDL and induces subsequent aggregation of the polypeptide. Our result proposes a novel role for HS in AA-amyloidosis in which a critical length of HS is required for separation of SAA from HDL. Late-onset AD patients show reduced ability to clear cerebral amyloid-β (Aβ) aggregates, a pathological hallmark of the disease. Althought the pathway of Aβ clearance is still unclear, several cell-surface receptors are implicated in Aβ internalization. We found that ApoE facilitated Aβ uptake through interactions with HS-proteoglycans and low-density lipoprotein receptor-related protein 1. The ApoE interaction with Aβ likely promotes Aβ clearance in the brain, but, if unbalanced, may contribute to the pathology of AD.     These findings are in accord with the concept of HS as a promoter of amyloid protein aggregation, but also point to more complex relationship.

Cardiovascular disease is now the leading cause of death worldwide. Serum amyloid A (SAA), a positive acute phase reactant, along with C-reactive protein is used clinically as a marker of cardiovascular disease risk. However, recent data has shed light on a possible causal role of SAA in the development of atherosclerosis, the most pervasive form of cardiovascular disease. Several inflammatory diseases such as diabetes and obesity are known to confer increased risk of developing cardiovascular disease. Individuals with these diseases all have modest but persistent elevation of SAA. To determine if SAA caused the development of atherosclerosis, apoe-/-chow fed mice were injected with either an adenoviral vector expressing human SAA1 (ad-hSAA1), a null adenoviral vector (ad-Null) or saline. Human SAA levels rapidly increased, albeit briefly then returned to baseline within 14 days in mice that received ad-hSAA1. After 16 weeks, mice that received ad-hSAA1 had significantly increased atherosclerosis compared to controls on the aortic intimal surface (p<0.0001), aortic sinus (p<0.05) and the brachiocephalic artery (p<0.05). According to the “response to retention” hypothesis; lipoprotein retention by vascular wall proteoglycans is a key initiating event in the development of atherosclerosis. We previously reported that SAA-stimulated vascular smooth muscle cells expressed biglycan with increased glycosaminoglycan chain length and increased binding affinity for low density lipoprotein. To further test the role of biglycan on the development of atherosclerosis we generated biglycan transgenic mice. These mice were crossed to the ldlr-/- mouse on a C57BL/6 background and fed a pro-atherogenic western diet for 12 weeks. There was a significant increase in atherosclerotic lesion area on the aortic intimal surface (p<0.05) and the aortic sinus (p<0.006), as well as a significant correlation between vascular biglycan content and aortic sinus atherosclerotic lesion area (p<0.0001). These data demonstrate that transiently increased SAA resulted in increased atherosclerosis compared to control mice, possibly via increased vascular biglycan content. In support of this we found that biglycan transgenic mice had significantly increased atherosclerosis compared to wildtype controls, likely through increased lipid retention in the vascular wall.

Diss. (sammanfattning) Umeå : Umeå universitet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2010. / Härtill 4 uppsatser.

Bacterial infection within a joint, septic arthritis, is a serious condition in horses that can lead to long-term joint disease if the infection is not resolved quickly. Equine septic arthritis is diagnosed primarily based on clinical signs and synovial fluid cytology. Septic synovial fluid is characterized by significant elevations in total protein (TP) and total nucleated cell count (TNCC). However, in some cases it can be difficult to distinguish between septic arthritis and non-septic joint inflammation (synovitis) based on clinical signs and synovial fluid cytology alone. A rapid assay to help confirm septic arthritis would be advantageous. A new assay to quantify the major equine acute phase protein, serum amyloid A (SAA) may fulfill this need. Serum amyloid A increases in the body in response to injury, infection, and inflammation and shows promise as a useful tool in confirming a diagnosis of sepsis, as inflammation causes mild increases in SAA and infection causes marked elevations. In our study, serial serum and synovial fluid samples were collected from horses with experimental models of synovitis and septic arthritis, synovial fluid cytology was performed, and serum and synovial fluid SAA were quantified. Synovial fluid TNCC and TP concentrations increased significantly following induction of both models. Serum and synovial fluid SAA concentrations remained normal in synovitis horses and increased significantly in septic arthritis horses. Any elevation in serum or synovial fluid SAA above normal values may be supportive of synovial sepsis since synovial inflammation alone did not result in SAA elevations in our model. / Master of Science

Einleitung: Bei Fohlen ist bisher wenig bekannt über die Eisenparameter im Blut. Das Spurenelement Eisen ist für Säugetiere essenziell, seine Hauptaufgabe ist der Sauerstofftransport. Adulte Pferde nehmen das benötigte Eisen mit dem Raufutter auf, welches in der Regel ausreichend hohe Eisengehalte aufweist. Das Hauptmolekül zur Eisenspeicherung ist Gewebe-Ferritin. Das im Serum vorkommende Serum-Ferritin spiegelt die Gesamteisenmenge des Körpers wider. Im Rahmen einer systemischen Entzündung sinkt der Serum-Eisenspiegel, da Eisen ins Gewebe umverteilt wird und in das Gebiet der Entzündung abwandert. Für die Parameter des Eisenstoffwechsels gibt es keine Referenzwerte für Fohlen, für adulte Pferde gibt es lediglich einen Referenzbereich für Serum-Eisen von 1,00-3,61 mg/l. Es gibt keine Studien, bei denen die Eisenparameter von Fohlen im Alter von ein bis sechs Monaten bestimmt wurden. Ziel der Studie: Ziel der vorliegenden Arbeit war es, die Parameter des Eisenstoffwechsels im Serum bei akuter systemischer Entzündung bei ein bis sechs Monate alten Fohlen zu untersuchen. Außerdem sollte überprüft werden, inwiefern diese Veränderung des Eisenstoffwechsels zu einem Abfall der Serum-Eisenwerte führt. Tiere, Material und Methoden: In dieser prospektiven Studie wurden EDTA-Vollblut- und Serumproben von 66 gesunden Fohlen und 84 Fohlen mit einer akuten systemischen Entzündung in Form einer abszedierenden Bronchopneumonie genommen. Die Fohlen waren im Median 109 Tage alt. Die Diagnose 'Bronchopneumonie' wurde mittels Ultraschalldiagnostik gestellt, die Fohlen hatten am Tag der Probennahme einen sonografisch ermittelten Abszesscore von über 15 cm sowie eine rektal gemessene Körperinnentemperatur über 39,0 °C. Die gesunden Fohlen wiesen eine unauffällige klinische Allgemeinuntersuchung sowie Lungenultraschalluntersuchung am Tag der Probennahme sowie in der vorherigen und darauffolgenden Woche auf. Im Labor wurde der Serum-Amyloid-A-Gehalt bestimmt. Die gesunden Pferde wiesen SAA-Werte innerhalb des Referenzbereiches auf, bei den kranken Pferden bestätigte ein Wert > 7µg/ml die Diagnose einer akuten systemischen Entzündung. Aus der EDTA-Vollblutprobe wurde innerhalb von einer Stunde mittels Durchflusszytometrie die Blutleukozytenzahl bestimmt. Die Analyse der Serumproben erfolgte im Labor LABOKLIN mit dem Analysesystem Cobas 8000 von Roche. Die statistische Auswertung der Daten erfolgte mit dem Statistikprogramm SPSS (IBM Statistics 27). Die Daten der Gesamtpopulation (n = 150) waren nicht normalverteilt. Es wurde ein Mann-Whitney-U-Test als nicht parametrischer Test für zwei unabhängige Stichproben durchgeführt, um signifikante Unterschiede zwischen den Gruppen zu ermitteln. Das Signifikanzniveau wurde auf p < 0,05 festgelegt. Ergebnisse: Bei der Auswertung der Probanden ergab sich für die gesunden Fohlen ein medianer SAA-Wert von 3,50 µg/ml, der der kranken Fohlen liegt mit 541 µg/ml hochsignifikant darüber. Die Bestimmung des Serum-Ferritin-Wertes ergab für die Gruppe der gesunden Fohlen einen Median von 3,80 µg/l (IQR 2,00-4,40 µg/l), der Median für die Gruppe der kranken Fohlen ist mit 4,60 µg/l (IQR 2,48-6,40 µg/l) signifikant (p = 0,003) höher. Die Serum-Eisenwerte der gesunden Fohlen lagen innerhalb des laborinternen Referenzbereichs für adulte Pferde (Median 1,57 mg/l; IQR 1,21-1,79 mg/l), auch die weiteren Bluteisenwerte entsprachen denen adulter Pferde. Die kranken Fohlen zeigten signifikant niedrigere Serum-Eisenwerte (Median 0,550 mg/l; IQR 0,368-0,778 mg/l), signifikant höhere Ferritin- und UIBC-Werte sowie eine signifikant geringere Eisensättigung. Die Auswertung der Leberenzymaktivitäten aus dem Serum ergab für die kranken Fohlen bei allen gemessenen Parametern im Durchschnitt niedrigere Werte als für die gesunden Fohlen. Bei dem Spurenelement Kupfer liegt der Median der gesunden Fohlen mit 18,8 µmol/l (IQR 16,4-20,1 µmol/l) im oberen Bereich der Referenzwerte von 7,9-21 µmol/l, der Median der kranken Fohlen liegt mit 25,7 µmol/l (IQR 23,1-29,0 µmol/l) signifikant über den Werten der gesunden Fohlen (p < 0,001). Schlussfolgerung: Durch eine akute systemische Entzündung kommt es zu einem Abfall des Serum-Eisens durch Umverteilung ins Gewebe und Abwanderung ins Entzündungsgebiet. Da es jedoch sowohl in der Literatur als auch in den Ergebnissen dieser Studie keine Hinweise auf einen absoluten Eisenmangel beim Fohlen gibt, sollte von einer Eisensupplementation in jedem Fall abgesehen werden.:1 Einleitung 1 2 Literaturübersicht 2 2.1 Vorkommen und chemische Eigenschaften von Eisen 2 2.2 Eisenmetabolismus 2 2.2.1 Absorption 2 2.2.2 Transport 3 2.2.3 Speicherung, Mobilisierung 4 2.2.4 Exkretion, Verlust 5 2.3 Physiologische Funktionen 6 2.4 Feststellung des Eisenstatus 7 2.5 Eisenbedarf des Pferdes 9 2.6 Eisengehalt von Futtermitteln 10 2.7 Eisenmangel 11 2.8 Supplementation von Eisen 12 2.9 Eisenüberschuss, Toxizität 12 2.10 Bakterieller Eisenstoffwechsel 13 2.11 Entzündung 14 2.11.1 Abszedierende Bronchopneumonie 15 2.12 Eisenstoffwechsel bei systemischer Entzündung 16 2.12.1 Ferritin als Akute-Phase-Protein 17 2.12.2 Serum-Eisen als Entzündungsmarker 17 3 Publikation 19 3.1 Vergleich des Eisenstatus im Serum von gesunden Fohlen und Fohlen mit Bronchopneumonie 19 4 Diskussion 30 5 Zusammenfassung 34 6 Summary 36 7 Literaturverzeichnis 38 Danksagung 47 / Introduction: Little is known about iron parameters in the blood of foals. The trace element iron is essential for mammals, its main task is the transport of oxygen. Horses take up the required iron with roughage, which has sufficiently high iron contents. The main molecule for iron storage is tissue ferritin. The serum ferritin found in the serum reflects the total amount of iron in the body. In the context of systemic inflammation, serum iron levels decrease as iron is redistributed to the tissues and migrates to the area of inflammation. There are no reference values for the parameters of iron metabolism for foals, for adult horses there is only a reference range for serum iron from 1.00-3.61 mg/L. There are no studies in which the iron parameters of foals were determined at the age of one to six months. Aim of the study: The aim of the present work was to investigate the parameters of serum iron metabolism in acute systemic inflammation in one- to six-month-old foals. In addition, it was to be determined to what extent this change in iron metabolism leads to a drop in serum iron levels. Animals, material, and methods: In this prospective study, EDTA whole blood and serum samples were collected from 66 healthy foals and 84 foals with acute systemic inflammation in the form of abscessed bronchopneumonia. The median age of the foals was 109 days. The diagnosis 'bronchopneumonia' was made by ultrasound diagnosis, the foals had a sonographically determined abscess score of more than 15cm as well as a rectally measured internal body temperature of more than 39.0 °C on the day of sampling. The healthy foals had an unremarkable clinical general examination and lung ultrasound on the day of sampling and in the previous and following week. In the laboratory, the serum amyloid A content was determined, a value > 7µg/mL confirmed the diagnosis of acute systemic inflammation. From the EDTA whole blood sample, the blood leucocyte count was determined within one hour by flow cytometry. The serum samples were analyzed in the LABOKLIN laboratory using the analyzer Cobas 8000 from Roche. Statistical analysis of the data was performed with SPSS (IBM Statistics 27). The data of the total population (n = 150) were not normally distributed. A Mann-Whitney U test was performed as a non-parametric test for two independent samples to determine significant differences between the groups. The significance level was set at p < 0.05. Results: The evaluation of the blood samples showed a median SAA level of 3.50 µg/mL for the healthy foals, the median of 541 µg/mL for the sick foals was significantly higher than in healthy foals. The determination of serum ferritin showed a median of 3.80 µg/l (IQR 2.00-4.40 µg/l) for the group of healthy foals, the median for the group of sick foals was significantly (p = 0.003) higher at 4.60 µg/l (IQR 2.48-6.40 µg/l). The serum iron values of the healthy foals were within the laboratory reference range for adult horses (median 1.57 mg/l; IQR 1.21-1.79 mg/l). The other blood iron values also corresponded to those of adult horses. The sick foals showed significantly lower serum iron levels (median 0.550 mg/l; IQR 0.368-0.778 mg/l), significantly higher ferritin and UIBC levels and significantly lower iron saturation. The evaluation of liver enzyme activities from the serum showed lower values on average for the sick foals than for the healthy foals for all measured parameters. For the trace element copper, the median of the healthy foals with 18.8 µmol/l (IQR 16.4-20.1µmol/l) is in the upper range of the reference values of 7.9-21µmol/l, the median of the sick foals with 25.7 µmol/l (IQR 23.1-29.0 µmol/l) is significantly higher than the values of the healthy foals (p < 0.001). Conclusion Acute systemic inflammation causes a drop in serum iron due to redistribution into the tissues and migration into the area of inflammation. However, since there is no evidence of an absolute iron deficiency in foals, either in the literature or in the results of this study, iron supplementation should be avoided in any case.:1 Einleitung 1 2 Literaturübersicht 2 2.1 Vorkommen und chemische Eigenschaften von Eisen 2 2.2 Eisenmetabolismus 2 2.2.1 Absorption 2 2.2.2 Transport 3 2.2.3 Speicherung, Mobilisierung 4 2.2.4 Exkretion, Verlust 5 2.3 Physiologische Funktionen 6 2.4 Feststellung des Eisenstatus 7 2.5 Eisenbedarf des Pferdes 9 2.6 Eisengehalt von Futtermitteln 10 2.7 Eisenmangel 11 2.8 Supplementation von Eisen 12 2.9 Eisenüberschuss, Toxizität 12 2.10 Bakterieller Eisenstoffwechsel 13 2.11 Entzündung 14 2.11.1 Abszedierende Bronchopneumonie 15 2.12 Eisenstoffwechsel bei systemischer Entzündung 16 2.12.1 Ferritin als Akute-Phase-Protein 17 2.12.2 Serum-Eisen als Entzündungsmarker 17 3 Publikation 19 3.1 Vergleich des Eisenstatus im Serum von gesunden Fohlen und Fohlen mit Bronchopneumonie 19 4 Diskussion 30 5 Zusammenfassung 34 6 Summary 36 7 Literaturverzeichnis 38 Danksagung 47