The emergence of pesticide-resistant mosquitoes and drug-resistant parasites in the last twenty years has made control of malaria more difficult. One novel strategy to better control malaria is the development and release of transgenic mosquitoes whose enhanced immunity prevents transmission of the parasite to the mammalian host. One candidate effector gene is Anopheles stephensi nitric oxide synthase (AsNOS), whose inducible expression and subsequent synthesis of nitric oxide (NO) limits Plasmodium development in A. stephensi. In mammals, one of the most potent physiological regulators of NOS gene expression and catalytic activity is transforming growth factor-β (TGF-β). Moreover, human TGF-β can activate Drosophila melanogaster Smads, the proteins responsible for TGF-β signal transduction. We have determined that following a bloodmeal, active human TGF-β1 (hTGF-β1) persists in the midgut of A. stephensi for up to 48 hours. My data demonstrate that the midgut epithelium recognizes hTGF-β1 as an immunomodulatory cytokine. Specifically, induction of AsNOS by hTGF-β1 occurs in the midgut within minutes of bloodfeeding. Moreover, hTGF-β1 limits development of the human malaria parasite Plasmodium falciparum in the midgut. In other experiments, provision of the AsNOS catalytic inhibitor L-NAME partially reverses the effect of hTGF-β1 on Plasmodium development. These results suggest that AsNOS is a target of hTGF-β1 signaling and additional effectors that impact parasite development may be regulated by hTGF-β1 as well. The fact that hTGF-β1 signals mosquito cells to limit malaria parasite development suggests that there is an endogenous TGF-β signaling network in place. An analysis of the A. gambiae genome database revealed the presence of six TGF-β ligands, including gene duplication in the 60A gene, the first evidence of ligand gene duplication outside of chordates. In addition to five receptors, three Smads were identified in the A. gambiae genome predicted to support TGF-β/Activin- and BMP-like signaling. Midgut epithelial cells and an immunocompetent A. stephensi cell line express all three Smads, confirming that a signaling pathway is in place to support signaling by divergent exogenous and endogenous TGF-β superfamily proteins. The results presented here provide the first evidence of immunological crosstalk between divergent free living hosts of a single parasite. Further, these results imply that the interface between mammals and the mosquitoes that feed on them provide a unique opportunity for circulating molecules in the blood, including TGF-β and other cytokines, to alter the mosquito immune response. / Master of Science

Histiocytic sarcoma (HS) is an exceptionally rare malignant neoplasm derived from dendritic cells and histiocytes, with no available effective treatment options. Akt signaling and proteasome dysfunction have been implicated in the pathogenesis of the disease, both in humans and dogs. Our work aims to investigate the importance of the Akt signaling pathway and evaluate the potential of Akt-targeted therapy in a canine model of histiocytic sarcoma. We demonstrated Akt signaling to be active in 9 out of 10 canine HS tumor samples, regardless the presence of PTEN. Moreover, the Akt signaling pathway appears to be constitutively active in DH82 cells — a cell line model of canine HS, when compared to control canine dendritic cells. Pharmacologic Akt inhibition resulted in significant decrease in Akt S473 phosphorylation, GSK-3β S9 phosphorylation, Akt activity, cell viability, increased apoptosis, and resulted in sensitization to proteasome inhibition-depended cell death in a synergistic manner. Proteasome inhibition using carfilzomib, an irreversible proteasome inhibitor, induced dose-depended/caspase-3 independent cell death, at clinically relevant drug concentrations. The therapeutic effect of Akt inhibition was validated in vivo using a DH82 xenograft murine model. Akt inhibition lead to reduced tumor growth, prolonged overall survival, and ameliorated splenomegaly, but not affected the lung metastasis. Moreover, the therapeutic effect of Akt inhibition was potentiated in combination with carfilzomib. In conclusion, targeting Akt signaling may represent an attractive potential therapeutic target for the HS. Future studies are required to examine the clinical efficacy of Akt-targeted therapy in dogs with HS using novel selective Akt inhibitors. / Ph. D. / Histiocytic sarcoma (HS) is an exceptionally rare cancer of the immune system, with no effective treatment options available. Canine histiocytic sarcoma (cHS) is an aggressive tumor of the same cellular lineage, identified at increased relative frequency in specific dog breeds, with significant translational value. Akt signaling and proteasome dysfunction have been implicated in the pathogenesis of the disease, both in humans and dogs. Our study aims to investigate the importance of the Akt signaling pathway in the dog model of the disease and evaluate the potential of Akt-targeted therapy in a translational of histiocytic sarcoma. The work presented here demonstrates that Akt signaling appears aberrantly and constitutively activated in the canine model of HS. Importantly, Akt inhibition significantly reduced the tumor growth and prolonged the overall survival of the experimental animals. Moreover, Akt inhibition potentiated the anti-cancer activities of other anticancer drugs. Collectively, these findings provide an attractive therapeutic approach for the treatment of HS.

Most existing transceivers are Fourier-centric where complex sinusoids play a central role in the internals of the core building blocks. From the channel perspective, complex sinusoids constitute the fundamental effects in the wireless baseband equivalent channel model; exemplified by the time-invariant and time-varying transfer functions in static and time-varying channel conditions respectively. In addition, complex sinusoids are used as signaling waveforms for data transmission through the channel. The dominant mode of transmission in modern communications is in the form of finite time duration blocks having approximately finite bandwidth. As a result, the time-frequency space becomes projected to a time-frequency subspace having essentially limited support where complex sinusoids suffer from leakage effects due to the finite time extent of a block. In addition, Kronecker delta signals (duals of complex sinusoids) suffer from the same vulnerability due to the finite extent bandwidth. Gabor signaling bases using non-rectangular pulse shapes can attain good confinement in the time-frequency space, however, at the expense of completeness which reduces the utilization efficiency of the time-frequency signaling resources. Over a signaling block period, a doubly dispersive (DD) channel is projected onto an essentially limited time-frequency subspace. In this subspace, the Discrete Prolate Spheroidal (DPS) basis matched to the channel parameters is known to be optimally compact in representing the channel using a basis expansion decomposition. Unlike the Discrete Fourier Transform (DFT) basis which lacks compactness due to the leakage effect. Leakage in the expansion coefficients of a particular channel using the DFT basis has a direct correspondence with the Inter-Symbol Interference (ISI) between the DFT signaling components when transmitted through the same channel. For the DPS basis, however, the correspondence is not as obvious. Nevertheless, DPS when used for signaling results in ISI compactness in the form of an exponential decay of distant ISI components. The efficacy of DPS signaling in DD channels in addition to its efficiency in modeling DD channels motivates the investigation of a new transceiver baseband architecture where DFT is supplanted by DPS. / Ph. D. / Radio communication technology is undeniably a vital organ in modern societies, witnessed by its compelling socio-economic impact. Social media terms such as Facebook and Twitter, etc., have spurred a trans-geographical neologism in the vernacular of nations across the globe. This is all thanks to the seamless ubiquity afforded by untethered wireless communication technology. High data rate wireless communication for nomadic modes of operation, movement across locations with intermittent dwelling, has been an uncontested success. However, the quality of communications while on the move at ambitiously high speeds, up to 500Km/h, is a completely different state of affairs. Orthogonal Frequency Division Multiplexing (OFDM) is the working horse technology driving all modern communication systems including Bluetooth, WiFi, 4G Long Term Evolution (LTE), High Definition TV broadcast (HDTV) and more. As the adage goes “no one size fits all”, OFDM so far has been the size that fits nomadic and relatively slow mobility modes of operation which correspond to the majority of behavior patterns of communicating entities. However, scenarios that rely on high mobility modes are gradually moving out of the fringes and into the center scene, examples being Wide-band Vehicle-to-Vehicle (V2V) and Vehicle-to-Anything (V2X) communication. Because of OFDM’s inadequacy in such high mobility conditions, both academic and industrial bodies have embarked on their research efforts to investigate signaling schemes resilient to hostile channel effects that arise in high mobility conditions. The thesis of this work is that Discrete Prolate Spheroidal (DPS) Sequences is the most suitable candidate from the list of competitors, DPS being our discovery, that has been presented by the v research community so far. We provide both theoretical arguments to demonstrate the essential merits of DPS as well as case-specific simulations to demonstrate its efficacy.

Inflammation has been found to play a role in the development of many different tumors. However, a tumor's ability to evade immune cell recognition can be integral to its progression as well. The following works explore this complicated role with a focus on histiocytic sarcoma (HS) and breast cancer. Chapter 1 opens with a broad overview of inflammation in tumorigenesis while Chapter 2 focuses on a review and discussion of current HS literature. Our investigations into the role of inflammation specifically in HS are initiated in Chapter 3 where we explore the role of the regulatory NLR, NLRX1, in the development of HS in mice. NLRX1 is an intracellular patter recognition receptor that functions to regulate pro-inflammatory cell pathways. Our studies reveal that in carcinogen-induced HS in mice, NLRX1 acts as a tumor suppressor. Moreover, when NLRX1 is lost, tumors that develop are associated with increases in expression of genes in NF-κB and AKT pathways. Though uncommon, HS is a clinically relevant tumor in dogs. In Chapter 4, we further investigate the role of the pathways identified in Chapter 3 in canine patients. Not only were these pathways increased, but our results also revealed previously unreported differences in tumors diagnosed as HS versus those diagnosed as hemophagocytic HS. To improve the use of canine HS both as an experimental and translational model, we sought to create a murine xenograft model. In Chapter 5, we discuss the development of our model and the results of pilot studies using targeted drug therapy. The focus of Chapters 3-5 is to further explore the role of inflammation in the development of HS. However, as aforementioned, the role of inflammation in tumorigenesis is quite complicated. In Chapter 6, we aim to address the concept that the lack of inflammation through immune evasion, can also be important in tumors. Breast cancer in humans is traditionally recognized as being highly immunosuppressive. In this final chapter, we investigate the use of an attenuated strain of bacteria to treat these tumors by way of shifting the immunosuppressive tumor microenvironment to a more pro-inflammatory state. / Ph. D. / The role of inflammation in the development and progression of cancer has been studied for many years. It is well-accepted that chronic inflammation can lead to an environment that is favorable for tumor development. However, more recently it has been shown that being able to escape the immune system and avoid inflammation can also be important in tumor development. The aim of this work was to further investigate these dichotomous roles. In Chapters 1-5 we review and further explore the role of inflammation in a poorly studied tumor called histiocytic sarcoma (HS). Through our studies we have found that a receptor protein present in many cells, NLRX1, is important in the development of chemically-induced HS in mice. Moreover, the development of these tumors is associated with increases in pro-inflammatory and cell growth pathways. Further studies reveal that these pathways are also important to the development of the tumor in dogs. Because HS is rare and poorly studied in humans, we describe the development of an additional mouse model to study HS. This model will help reveal important information about the disease in dogs that can help us study it in humans. Finally, in Chapter 6, we sought to investigate the other potential role of inflammation in decreasing tumorigenesis. In these studies, we used a mouse model of breast cancer to investigate whether or not we could decrease tumorigenesis by increasing the immune system’s ability to recognize the tumor.

No / Wnt signaling normally functions in cell determination and proliferation and is essential for embryonic development. It does this by regulating target genes through a tightly regulated but complex signaling cascade. Overexpression of these genes due to aberrant Wnt activity can lead to uncontrolled cell growth and survival, and ultimately oncogenesis. Wnt signaling is also involved in epithelial–mesenchymal transition that contributes to tumor progression and metastasis evidence that tumor growth can be suppressed irrespective of other neoplastic promoters when the Wnt pathway is blocked and this has led to interest in its use as a therapeutic target. Recent developments in our understanding of the Wnt signaling cascade have led to research into drugs that specifically target different levels in this pathway, and the identification of β-catenin as the primary cause of dysregulated Wnt signaling has led to a number of protein knockdown strategies. Moreover, increased knowledge of the 300–400 Wnt inducible genes has provided a large untapped source of new potential therapeutic targets. Existing drugs such as nonsteroidal anti-inflammatory drugs and vitamin A and D derivatives have also shown efficacy in disrupting the Wnt signaling pathway and, together with a new generation of derivatives, they may soon be in clinical trials. This chapter details the Wnt signaling pathway, its role in different cancers, and some potential therapeutic targets that may show promise as effective cancer treatments.

京都大学 / 新制・課程博士 / 博士(生命科学) / 甲第25513号 / 生博第529号 / 新制||生||70(附属図書館) / 京都大学大学院生命科学研究科統合生命科学専攻 / (主査)教授 中野 雄司, 教授 河内 孝之, 教授 荒木 崇 / 学位規則第4条第1項該当 / Doctor of Philosophy in Life Sciences / Kyoto University / DFAM

Thesis advisor: Charles S. Hoffman / Glucose detection in yeast occurs via a cAMP signaling pathway that is similar to that of other signaling pathways in humans. The presence of glucose in the environment ultimately represses, as a result of cAMP signaling, the transcription of the gene fbp1. Adenylate cyclase is known to convert ATP to cAMP, and is thus a central protein in the propagation of the signal. Mutant forms of the adenylate cyclase gene (git2) have been found by the inability for the organism to repress fbp1 transcription in the presence of glucose. In this study, two questions were under investigation. The first was focused on the ability of the mutations to affect the dimerization of the catalytic domain. The second investigated multiple protein-protein interactions in the leucine rich-repeat (LRR) domain of adenylate cyclase. Both domains contain mutations that confer an activation defect, and they are thus are thought to have a relationship. / Thesis (BS) — Boston College, 2005. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Biology. / Discipline: College Honors Program.

Le traitement de l’obésité est devenu un problème majeur de santé publique aussi bien dans les pays industrialisés que dans les pays en voie de développement. La leptine est une hormone clé dans le contrôle de l’homéostasie énergétique et glucidique en agissant au niveau du noyau arqué de l’hypothalamus (ARC). La résistance à la leptine au niveau de ce noyau hypothalamique contribue au développement de l’obésité. Par conséquent, prévenir son installation et lever cette résistance constitue un enjeu thérapeutique majeur. Notre laboratoire à récemment mis en évidence que la protéine Endospanine 1 est un régulateur négatif des fonctions du récepteur de la leptine (OB-R). En effet, cette protéine, exprimée à partir du même gène qu’OB-R, est capable d’interagir avec ce récepteur et de le retenir dans le compartiment intracellulaire. L’extinction d’Endospanine 1 spécifiquement au niveau de l’ARC prévient l’installation d’une obésité induite par un régime gras. Ces données démontrent donc, in vivo, l’importance de cette protéine dans la régulation des fonctions d’OB-R. Suite a ces résultats prometteurs, l’objectif premier de ma thèse a été d’approfondir nos connaissances sur le rôle joué, in vitro et in vivo, par Endospanine 1, ainsi que par son homologue Endospanine 2, dans la régulation des fonctions d’OB-R. Le second objectif de ce travail de thèse a été d’identifier de nouveaux composés capables de sensibiliser la réponse à la leptine chez les individus obèses. Ce travail a permis de montré que des souris rendues obèses par un régime gras présentaient une surexpression d’Endospanine 1 dans l’ARC suggérant ainsi une potentielle implication de cette protéine dans le développement de la résistance à la leptine. D’autre part, nous avons démontré que l’extinction d’Endospanine 1, dans l’ARC, permet de prévenir l’installation d’une obésité et de la corriger chez des souris obèses et conduit à une altération de la sécrétion d’insuline par le pancréas. Cet effet double sur le poids corporel et sur la glycémie pourrait être expliqué par l’effet différentiel de l’extinction d’Endospanine 1 sur l’activation des voies STAT3 et PI3K/AKT. En effet, en absence d’Endospanine 1 la voie STAT3 est suractivée tandis que la voie PI3K est inhibée. De façon surprenante, l’extinction d’Endospanine 2, second membre de la famille des Endospanines, inhibe de façon drastique l’activation de la voie STAT3 suggérant que ces protéines pourraient jouer des rôles différents dans la régulation des fonctions d’OB-R. Ce travail a également permis de décrire, pour la première fois, les conséquences d’une déficience en Endospanine 1 chez l’Homme. Nos données suggèrent qu’Endospanine 1 ne régule pas les fonctions d’autres protéines, définissant ainsi Endospanine 1 comme une cible thérapeutique hautement spécifique dans la correction de la signalisation leptine.La dernière partie de cette étude a consisté en l’identification de nouveaux composés capables d’activer OB-R ou d’augmenter son expression de surface. Deux tests de criblages ont permis d’identifier de telles molécules. Après validation et caractérisation, de tels composés pourraient être utilisés comme outils thérapeutique afin de restaurer la sensibilité à la leptine perdue chez les individus obèses. / Obesity is one of the greatest current public health challenges, not only in industrialized countries but also in developing countries. The hypothalamic arcuate nucleus (ARC) is a major integration centre for energy and glucose homeostasis that responds to peripheral hormones such as leptin. Resistance to leptin in the ARC is an important component of obesity development and its prevention or reversal represents a major therapeutic goal. Our laboratory recently described endospanin 1 as a negative regulator of the leptin receptor (OB-R) that by interacting with OB-R retains the receptor inside the cell. Interestingly, both proteins are expressed from the same promoter. Silencing of endospanin 1 in the ARC prevented the development of diet-induced obesity demonstrating the importance of this protein on OB-R in vivo function.Based on these encouraging findings the first aim of this thesis was to extend our understanding of the in vitro and in vivo role of endospanin 1 and its homologue, endospanin 2, on OB-R function. The second aim consisted in the identification of chemical compounds able to sensitize the leptin response in obese patients. We show here that endospanin 1 is up-regulated in the ARC of obese mice suggesting a potential contribution of this protein to the development of leptin resistance. Its silencing in the ARC of naïve and obese mice reverses obesity development and impairs pancreatic insulin secretion. This dual effect correlates with the differential effect of endospanin 1 on OB-R signaling, inhibition of the STAT3 pathway and activation of the AKT pathway. Intriguingly, endospanin 2, the second member of the endospanin family, promotes efficient STAT3 activation suggesting differential roles of both endospanins on OB-R function.We characterized an obese patient carrying a homozygous deletion in the chromosomal 1p31.3 region coding for endospanin 1. This is the first report defining the consequences of endospanin 1-deficiency in humans. Our data suggest that endospanin 1 has no major OB-R-independent functions thus defining endospanin 1 as an attractive and highly specific therapeutic target for the improvement of impaired leptin signaling.In the last part of the thesis two screening assays were developed to identify compounds that either activate OB-R or promote its cell surface expression. Primary screens were successfully performed for both assays and positive hits identified. Validated hits might be useful to resensitize the impaired leptin response in obese patients.

Lors du développement de l'asymétrie gauche droite dans le cerveau du poisson zèbre, un petit groupe de cellules, le parapinéale, migre collectivement depuis la ligne médiane vers la partie gauche de l'épithalamus. Cette migration est défectueuse dans des mutants pour le gène fgf8, indiquant que le facteur Fgf8 (Fibroblast Growth Factor 8), sécrété de part et d'autre de la ligne médiane, est requis pour la migration. Cependant, l'orientation gauche de la migration dépend de l'activation, plus précocement dans l'épithalamus gauche, de la voie de signalisation Nodal/TGFb (Transforming Growth Factor). Par conséquent, la parapinéale est un modèle de choix pour comprendre comment les cellules migrent collectivement en réponse aux Fgf et pour étudier comment d'autres voies de signalisation modulent ce processus. L'imagerie en temps réel d'un transgène rapporteur de la signalisation FGF a révélé que la voie FGF est activée préférentiellement dans quelques cellules de tête, c'est à dire localisées au front de migration. L'expression globale d'un récepteur aux Fgf activé de façon constitutive (CA-FgfR1) interfère avec la migration de la parapinéale en contexte sauvage mais est capable de restaurer à la fois la migration de la parapinéale et l'activation focale de la voie FGF au front de migration dans les mutants fgf8-/-. De plus, l'activation focale de la voie FGF dans seulement quelques cellules de parapinéale est suffisante pour restaurer la migration de tout le collectif dans les mutants fgf8-/-. Finalement, nos données montrent que la signalisation Nodal contribue à restreindre et à biaiser l'activation de la voie FGF afin d'orienter la migration de la parapinéale vers le côté gauche (Manuscript n°1). Par la suite, mes travaux de thèse ont visé à comprendre comment l'activation de la voie FGF est restreinte à quelques cellules, bien que toutes les cellules de parapinéale semblent compétentes pour activer la voie. Nos résultats montrent que la signalisation Notch est capable de restreindre l'activation de la voie FGF. La perte ou le gain de fonction de la voie Notch entrainent respectivement une augmentation ou une diminution de l'activité FGF, associés à des défauts de migration de la parapinéale dans les deux contextes. De plus, la diminution ou l'augmentation artificielle du niveau d'activation de la voie FGF peut respectivement restaurer la migration de la parapinéale ou aggraver les défauts de migration en absence d'activité Notch. Nos données indiquent que la signalisation Notch restreint l'activation de la voie FGF au sein des cellules de parapinéale pour permettre la migration du collectif (Manuscript n°2). La voie Notch est également requise pour la spécification d'un nombre correct de cellules de parapinéale, indépendamment de la voie FGF. En parallèle, nous avons analysé la fonction de MMP2 (Matrix Metalloprotease 2), une protéine exprimée mosaïquement dans la parapinéale et candidate pour moduler la signalisation FGF. Cependant, nous n'avons observé aucun défaut de spécification ou de migration de la parapinéale dans les embryons mutants pour le gène mmp2 -/- (Manuscript n°3). Mon travail de thèse révèle un rôle de la voie Notch pour restreindre l'activation de la signalisation FGF dans quelques cellules de parapinéale, un processus qui est biaisé par la voie Nodal afin d'orienter la migration du collectif vers la gauche. Ces données pourraient permettre de mieux comprendre les interactions entre les voies de signalisation FGF, Notch et Nodal dans d'autres modèles de migration cellulaire collective comme, par exemple, la migration des cellules cancéreuses. / During the establishment of left-right asymmetry in the zebrafish brain, a small group of cells, the parapineal, collectively migrates from the dorsal midline of the epithalamus to the left in most wild-type embryos. Parapineal migration requires Fibroblastic Growth Factor 8 (Fgf8), a secreted signal expressed bilaterally in epithalamic tissues surrounding the parapineal. The left bias in the orientation of parapineal migration depends on the activity of Cyclops, a secreted factor of the Nodal/TGFß family that is transiently expressed in the left epithalamus prior to parapineal migration. Therefore, the parapineal provides a powerful new model to understand FGF dependent collective cell migration and to study how other signaling pathways modulate this process. Live imaging of an FGF reporter transgene revealed that the FGF pathway is activated in only few parapineal cells that are usually located at the leading edge of migration. Global expression of a constitutively activated Fgf receptor (CA-FGFR) delays migration in wild-type, while it partially restores both parapineal migration and focal activation of the FGF reporter transgene in fgf8-/- mutant embryos. Importantly, focal activation of FGF signaling in few parapineal cells is sufficient to restore collective migration in fgf8-/- mutants. Finally, Nodal asymmetry contributes to restrict and left-bias the activation of the FGF pathway (Manuscript n°1). Following this work, my thesis project aimed at understanding how the activation of the FGF pathway is restricted to few cells, despite all parapineal cells apparently being competent to activate the pathway. We showed that Notch signaling is able to restrict FGF activity. Loss or gain of function of the Notch pathway respectively triggers an increase or decrease in FGF activity, which correlate with PP migration defects. Moreover, decreasing or increasing FGF activity levels respectively rescues or aggravates parapineal migration defects in Notch loss-of-function context. Our data indicate that Notch signaling restricts the activation of the FGF pathway within parapineal cells to promote their collective migration (Manuscript n°2). We also found that Notch pathway is required for the specification of a correct number of parapineal cells, independently of FGF pathway. In parallel, we analysed the function of MMP2 (Matrix Metalloprotease 2), a protein mosaïcally expressed in the parapineal and a candidate to modulate FGF signaling. However, we found no significant defects in the specification or migration of parapineal cells in mmp2-/- mutant embryos (Manuscript n°3). My PhD work reveals a role for Notch signaling in restricting the activation of FGF signaling within few parapineal cells, a process that is biased by Nodal pathway to the left and required for the migration of the entire parapineal. These data provide insights into the interaction of FGF, Notch and Nodal/TGFb signaling pathways that may be applicable to other models of collective cell migration, such as cancer cells migration for instance.

Die Rheumatoide Arthritis (RA) ist eine der häufigsten Autoimmunerkrankungen des Menschen. Sie ist durch einen chronischen Verlauf mit Allgemeinsymptomen und erosiven Gelenkentzündungen gekennzeichnet. Die klinischen Beschwerden reichen von Morgensteifigkeit der Gelenke bis zu deren Funktionsverlust mit Deformationen. Extraartikuläre Manifestationen, vor allem das kardiovaskuläre System betreffend, erschweren den Krankheitsverlauf und verkürzen die Lebenserwartung. In der Pathogenese der RA steht die Synovitis, die Entzündung der Gelenkinnenhaut, im Mittelpunkt. Die Ansammlung von Lymphozyten und Monozyten in der Synovialmembran und sezernierte proinflammatorische Zytokine bewirken eine Aufrechterhaltung des Entzündungsgeschehens. Das hauptsächlich von Monozyten produzierte Zytokin Tumornekrosefaktor (TNF) spielt eine entscheidende Rolle in diesem Immunprozess. TNF stimuliert Fibroblasten zur Sezernierung destruktiver Enzyme und regt zur Produktion weiterer, proinflammatorischer Botenstoffe an. Klassischerweise wirkt TNF in seiner löslichen Form und bindet an TNF-Rezeptoren auf nahezu allen Körperzellen. Ein weiterer Wirkmechanismus ist die retrograde Signaltransduktion über membranständiges TNF (tmTNF). Die Funktion von tmTNF, als Rezeptor Signale in die tmTNF-tragende Zelle zu vermitteln, wird als Reverse Signaling bezeichnet. Es ist bekannt, dass Reverse Signaling via tmTNF in Monozyten von RA-Patienten Apoptose auslöst und in weiteren komplexen Immunprozessen involviert ist. Die Bedeutung von TNF für die Rheumatoide Arthritis wird nicht zuletzt dadurch unterstrichen, dass die anti-TNF-Therapie einen sehr wirksamen Therapieansatz darstellt. Die Behandlung führt bei ca. zwei Drittel der Patienten zu einer Reduktion der entzündlichen und schmerzhaften Gelenkschwellung und zu einem Sistieren der Gelenkdestruktion. Es ist jedoch bekannt, dass ein Teil der Patienten schlecht auf die Therapie anspricht. Das dadurch verzögerte Erreichen eines guten Therapieerfolgs führt zu einer Verlängerung des Leidens und zu unnötigen, zum Teil schwerwiegenden Nebenwirkungen. Gesundheitsökonomisch ist dies ebenfalls kritisch zu sehen, da mit hohen Behandlungskosten zu rechnen ist. Eine Vorhersage des Therapieansprechens ist jedoch aktuell nicht möglich. Ziel dieser Studie war es, einen prädiktiven Marker für das anti-TNF-Therapieansprechen bei Patienten mit RA zu finden. Dabei galt der Bedeutung des Reverse Signaling via tmTNF großes Interesse. In der Studie wurden 20 Patienten mit Rheumatoider Arthritis vor und während einer Therapie mit dem TNF-Antagonist Etanercept insgesamt 24 Wochen betreut. Die Erhebung klinischer Daten, wie die Anzahl der druckschmerzhaften und geschwollenen Gelenke, die Einschätzung der Krankheitsaktivität durch den Patienten auf einer visuellen Analogskala (VAS) und die Untersuchung der Entzündungsaktivität mit CRP und BSG, erfolgte einmalig vor und alle vier Wochen unter Therapie. Zur Einschätzung der Krankheitsaktivität wurde der Disease Activity Score (DAS) genutzt. Das Therapieansprechen wurde entsprechend einer Klassifikation und der Veränderung der einzelnen klinischen Parameter im Therapieverlauf gewertet. Auf der Suche nach einem prädiktiven Faktor wurden ebenfalls einmalig vor und alle vier Wochen während der Therapie mit Etanercept laborchemische Experimente durchgeführt. Dazu wurden aus dem Blut der RA-Patienten die Monozyten mit Hilfe einer Dichtegradientenzentrifugation und einer Magnetseparation isoliert. Diese wurden hinsichtlich ihrer Expression von tmTNF sowie TNFR1 und TNFR2 nach Inkubation mit entsprechenden Antikörpern durchflusszytometrisch untersucht. Weiterhin wurden die RA-Monozyten mit Etanercept bzw. einer Negativkontrolle inkubiert. Im Anschluss wurde die Apoptose der Monozyten mittels Durchflusszytometrie und Färbung mit Propidiumiodid bzw. Annexin V quantifiziert. Entsprechend den EULAR-Kriterien kam es bei 10 Patienten (53%) zu einem guten, bei 7 Patienten (37%) zu einem mittleren und bei 2 Patienten (10%) zu einem schlechten Ansprechen. Aufgrund der klinischer Beurteilung erfolgte eine Einteilung in zwei Gruppen, sodass unter den Patienten 10 Responder (53%) und 9 (47%) Non-Responder waren. Die Monozyten der RA-Patienten exprimierten tmTNF mit einer mittleren Fluoreszenzintensität (MFI) von 14,23 ± 3,04. Es wurde eine MFI für TNFR1 mit 31,84 ± 12,99 und für TNFR2 mit 30,02 ± 8,9 gemessen. Die Inkubation der RA-Monozyten mit Etanercept bzw. mit der Negativkontrolle ergab unterschiedliche Resultate innerhalb der Patientengruppe. Dabei wurde die Apoptose der Monozyten in Spontanapoptose (Negativkontrolle) und in Reverse Signaling induzierte Apoptose eingeteilt. Vor Beginn der anti-TNF-Therapie zeigte ein Teil der Patienten eine niedrige Spontanapoptose und eine erhöhte Reverse Signaling induzierte Apoptose. Die Monozyten der anderen RA-Patienten zeigten umgekehrt eine hohe Spontanapoptose und eine niedrige Reverse Signaling induzierte Apoptose. Im Folgenden wurde der Einfluss der Etanercept-Therapie auf die Apoptose der Monozyten untersucht. Es wurde ein Anstieg der niedrigen Spontanapoptose bzw. Reverse Signaling induzierte Apoptose und ein Abfall der hohen Spontanapoptose bzw. Reverse Signaling induzierte Apoptose gesehen. Bezieht man in die Analyse das Therapieansprechen mit ein, so ergibt sich für Responder eine initial hohe Spontanapoptose, die unter Therapie signifikant sinkt. Non-Responder hingegen haben vor Therapie eine niedrige Spontanapoptose, die unter einer Therapie mit Etanercept ansteigt. Für den Verlauf der Reverse Signaling induzierte Apoptose unter der anti-TNF-Therapie gab es keine signifikanten Unterschiede hinsichtlich des Therapieansprechens. Im Fisher-Exact-Test zeigte sich eine deutliche Tendenz (p=0,07), dass Patienten mit niedriger Spontanapoptose bzw. hoher Reverse Signaling induzierter Apoptose zu Studienbeginn schlecht auf die Therapie ansprechen. Dieses Ergebnis konnte mit Einzelparametern verifiziert werden. Die Studie kam zu dem Schluss, dass RA-Patienten, deren Monozyten eine niedrige Reverse Signaling induzierte Apoptose bzw. eine hohe Spontanapoptose aufwiesen, besser auf eine anti-TNF-Therapie mit Etanercept ansprachen. Dieses Ergebnis kann hilfreich für die Entwicklung einer entscheidenden Diagnostik vor Therapieeinstellung sein und leistet einen Beitrag für die Vorhersage des Therapieansprechens.