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  • Priyadarshini, Madhusmita (Helsingin yliopisto, 2013)
    Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease (AD). The quest for better therapies to modify the progression of PD is still ongoing. During the last two decades, the concept of the etiological basis of PD has changed, which has been driven by genetics, the recognition of familial forms, knowledge of the effects of the environment and toxins, and genome-wide association studies. Although most cases are sporadic, approximately 5-10% of PD cases are due to genetic mutations that give rise to the familial forms. Studies using neurotoxins and also genetic mutations that underlie familial PD have implicated mitochondrial dysfunction in the pathogenesis of PD. Among the different genes associated with familial PD, PTEN-induced putative kinase1 (Pink1), responsible for the autosomal recessive type, is strongly linked to the mitochondria. To investigate in depth the underlying mechanisms of Pink1, we inhibited the function of pink1 in zebrafish using morpholino oligonucleotides (MOs). The MO was first thoroughly characterized with all necessary control experiments to avoid unspecific effects. Since the dopaminergic system is affected in PD, a marker for dopamine, tyrosine hydroxylase (TH), was used to assess damage to the system. Due to a genome duplication event that occurred early in the evolution of teleosts after the divergence from the mammals, two TH non-allelic isoforms were identified in zebrafish: th1 and th2. In the pink1 morphants, both the TH gene isoforms were altered. With in situ hybridization, the loss of th1 was found in the ventral diencephalon (dopaminergic cell groups 5, 6, 11) and th2 was reduced in the caudal hypothalamus (cell group 10b). Similar results were obtained with the cell counting method for TH1 immunoreactive cells. TH-ir indicated the loss of cells in the pretectum (group 7) and the ventral diencephalic cluster represented by cell groups 5,6,11. These pink1 morphants were exposed to subeffective doses of the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). This amalgamation of the toxin and genetic manipulation caused a locomotor deficit and also facilitated the loss of TH-ir in the same cell populations in the larval brains as was instigated by pink1 knockdown alone. To investigate the involvement of pink1 in cell damage, we used a two-color gene expression-based microarray and identified a number of genes that were potentially involved in the pathogenic mechanism of the disease. After successful data analysis, the changes in critical genes were successfully validated by quantitative real-time PCR. The gene expression changes in the morphants, identified by the microarray, were rescued by pink1 mRNA injections, suggesting the specific involvement of pink1 in the differentially expressed gene regulation. One of the significant findings was HIF signaling, an important pathway affected by pink1 knockdown. Individual factors and genes in the same pathway were validated by independent methods in the pink1 morphants to reveal whether pink1 affected hif1α or the cascade of events in the signaling pathway. Changes in the VEGF transcripts, erythropoiesis, and reactive oxygen species were observed, as were other antioxidant system genes, including cat and sod2. These pathways may provide new targets for drug development in PD. To study the mechanisms underlying the involvement of pink1 in oxidative stress-mediated PD pathology using zebrafish as a tool, we generated a transgenic line, Tg(pink1:EGFP). The Tol2 transgenic approach was used to generate Tg(pink1:EGFP) by using the zebrafish pink1 promoter. Expression of the pink1 transgene was detected in the telencephalon, midbrain, and rhombencephalon in the CNS, and in the muscle, heart, and liver among the peripheral organs. The transgenic fish line was used to study the effect of oxidative stress. When subjected to a low concentration of hydrogen peroxide (H2O2), which had no effect on the mortality or phenotype of the fish, the transgenic fish showed an increase in pink1 transgene activity in the brain of the larval zebrafish. Oxidative stress-mediated changes in TH expression are valuable for PD study. H2O2 administration did not affect the th1 transcript levels, but it significantly increased pink1 expression and reduced the th2 transcript levels. This transgenic model will be highly useful for drug development and the screening of new potential therapeutic approaches as an in vivo model.
  • Pischik, Elena (Helsingin yliopisto, 2006)
    Acute intermittent porphyria (AIP, MIM #176000) is an inherited metabolic disease due to a partial deficiency of the third enzyme, hydroxymethylbilane synthase (HMBS, EC:, in the haem biosynthesis. Neurological symptoms during an acute attack, which is the major manifestation of AIP, are variable and relatively rare, but may endanger a patient's life. In the present study, 12 Russian and two Finnish AIP patients with severe neurological manifestations during an acute attack were studied prospectively from 1995 to 2006. Autonomic neuropathy manifested as abdominal pain (88%), tachycardia (94%), hypertension (75%) and constipation (88%). The most common neurological sign was acute motor peripheral neuropathy (PNP, 81%) often associated with neuropathic sensory loss (54%) and CNS involvement (85%). Despite heterogeneity of the neurological manifestations in our patients with acute porphyria, the major pattern of PNP associated with abdominal pain, dysautonomia, CNS involvement and mild hepatopathy could be demonstrated. If more strict inclusion criteria for biochemical abnormalities (>10-fold increase in excretion of urinary PBG) are applied, neurological manifestations in an acute attack are probably more homogeneous than described previously, which suggests that some of the neurological patients described previously may not have acute porphyria but rather secondary porphyrinuria. Screening for acute porphyria using urinary PBG is useful in a selected group of neurological patients with acute PNP or encephalopathy and seizures associated with pain and dysautonomia. Clinical manifestations and the outcome of acute attacks were used as a basis for developing a 30-score scale of the severity of an acute attack. This scale can easily be used in clinical practice and to standardise the outcome of an attack. Degree of muscle weakness scored by MRC, prolonged mechanical ventilation, bulbar paralysis, impairment of consciousness and hyponatraemia were important signs of a poor prognosis. Arrhythmia was less important and autonomic dysfunction, severity of pain and mental symptoms did not affect the outcome. The delay in the diagnosis and repeated administrations of precipitating factors were the main cause of proceeding of an acute attack into pareses and severe CNS involvement and a fatal outcome in two patients. Nerve conduction studies and needle EMG were performed in eleven AIP patients during an acute attack and/or in remission. Nine patients had severe PNP and two patients had an acute encephalopathy but no clinically evident PNP. In addition to axonopathy, features suggestive of demyelination could be demonstrated in patients with severe PNP during an acute attack. PNP with a moderate muscle weakness was mainly pure axonal. Sensory involvement was common in acute PNP and could be subclinical. Decreased conduction velocities with normal amplitudes of evoked potentials during acute attacks with no clinically evident PNP indicated subclinical polyneuropathy. Reversible symmetrical lesions comparable with posterior reversible encephalopathy syndrome (PRES) were revealed in two patients' brain CT or MRI during an acute attack. In other five patients brain MRI during or soon after the symptoms was normal. The frequency of reversible brain oedema in AIP is probably under-estimated since it may be short-lasting and often indistinguishable on CT or MRI. In the present study, nine different mutations were identified in the HMBS gene in 11 unrelated Russian AIP patients from North Western Russia and their 32 relatives. AIP was diagnosed in nine symptom-free relatives. The majority of the mutations were family-specific and confirmed allelic heterogeneity also among Russian AIP patients. Three mutations, c.825+5G>C, c.825+3_825+6del and c.770T>C, were novel. Six mutations, c.77G>A (p.R26H), c.517C>T (p.R173W), c.583C>T (p.R195C), c.673C>T (p.R225X), c.739T>C (p.C247R) and c.748G>C (p.E250A), have previously been identified in AIP patients from Western and other Eastern European populations. The effects of novel mutations were studied by amplification and sequencing of the reverse-transcribed total RNA obtained from the patients' lymphoblastoid or fibroblast cell lines. The mutations c.825+5G>C and c.770T>C resulted in varyable amounts of abnormal transcripts, r.822_825del (p.C275fsX2) and [r.770u>c, r.652_771del, r.613_771del (p.L257P, p.G218_L257del, p.I205_L257del)]. All mutations demonstrated low residual activities (0.1-1.3 %) when expressed in COS-1 cells confirming the causality of the mutations and the enzymatic defect of the disease. The clinical outcome, prognosis and correlation between the HMBS genotype and phenotype were studied in 143 Finnish and Russian AIP patients with ten mutations (c.33G>T, c.97delA, InsAlu333, p.R149X, p.R167W, p.R173W, p.R173Q, p.R225G, p.R225X, c.1073delA) and more than six patients in each group. The patients were selected from the pool of 287 Finnish AIP patients presented in a Finnish Porphyria Register (1966-2003) and 23 Russian AIP patients (diagnosed 1995-2003). Patients with the p.R167W and p.R225G mutations showed lower penetrance (19% and 11%) and the recurrence rate (33% and 0%) in comparison to the patients with other mutations (range 36 to 67% and 0 to 66%, respectively), as well as milder biochemical abnormalities [urinary porphobilinogen 47±10 vs. 163±21 mol/L, p<0.001; uroporphyrin 130±40 vs. 942±183 nmol/L, p<0.001] suggesting a milder form of AIP in these patients. Erythrocyte HMBS activity did not correlate with the porphobilinogen excretion in remission or the clinical of the disease. In all AIP severity patients, normal PBG excretion predicted freedom from acute attacks. Urinary PBG excretion together with gender, age at the time of diagnosis and mutation type could predict the likelihood of acute attacks in AIP patients.
  • Nevalainen, Päivi (Helsingin yliopisto, 2010)
    Until recently, objective investigation of the functional development of the human brain in vivo was challenged by the lack of noninvasive research methods. Consequently, fairly little is known about cortical processing of sensory information even in healthy infants and children. Furthermore, mechanisms by which early brain insults affect brain development and function are poorly understood. In this thesis, we used magnetoencephalography (MEG) to investigate development of cortical somatosensory functions in healthy infants, very premature infants at risk for neurological disorders, and adolescents with hemiplegic cerebral palsy (CP). In newborns, stimulation of the hand activated both the contralateral primary (SIc) and secondary somatosensory cortices (SIIc). The activation patterns differed from those of adults, however. Some of the earliest SIc responses, constantly present in adults, were completely lacking in newborns and the effect of sleep stage on SIIc responses differed. These discrepancies between newborns and adults reflect the still developmental stage of the newborns’ somatosensory system. Its further maturation was demonstrated by a systematic transformation of the SIc response pattern with age. The main early adult­like components were present by age two. In very preterm infants, at term age, the SIc and SIIc were activated at similar latencies as in healthy fullterm newborns, but the SIc activity was weaker in the preterm group. The SIIc response was absent in four out of the six infants with brain lesions of the underlying hemisphere. Determining the prognostic value of this finding remains a subject for future studies, however. In the CP adolescents with pure subcortical lesions, contrasting their unilateral symptoms, the SIc responses of both hemispheres differed from those of controls: For example the distance between SIc representation areas for digits II and V was shorter bilaterally. In four of the five CP patients with cortico­subcortical brain lesions, no normal early SIc responses were evoked by stimulation of the palsied hand. The varying differences in neuronal functions, underlying the common clinical symptoms, call for investigation of more precisely designed rehabilitation strategies resting on knowledge about individual functional alterations in the sensorimotor networks.
  • Lonka, Liina (Helsingin yliopisto, 2004)
  • Vanhanen, Jenni (Helsingin yliopisto, 2015)
    Neuronal histamine and its H3 receptor (H3R) regulate several physiological functions and are involved in the pathophysiology of various central nervous system disorders such as Parkinson s disease, Alzheimer s disease, Tourette syndrome and narcolepsy. Studies conducted in experimental animals have also suggested a role for histamine and especially H3R in the effects of drugs of abuse. In this thesis, the main aim was to study how histamine and H3R regulate alcohol-related behaviors. Furthermore, our goal was to investigate the underlying mechanisms in the observed behaviors. By using both wild type mice in different background strains and genetically modified mice, we studied whether histamine and H3R regulate the behavioral responses to alcohol. Three different H3R antagonists (ciproxifan, JNJ-10181457 and JNJ-39220675) were used and it was found that both pharmacological antagonism and genetic knockout of H3R (H3R KO) lead to diminished alcohol consumption and reward. By using histamine deficient histidine decarboxylase knockout (HDC KO) mice, we found that the lack of histamine does not alter alcohol consumption or reward but histamine is indeed required for the H3R-mediated alcohol reward inhibition. We also found that JNJ-39220675 inhibited the acute stimulation of amphetamine, but failed to inhibit the rewarding properties of amphetamine. This indicates that although H3R antagonists inhibit alcohol reward, they may not possess the same ability on psychostimulants, such as amphetamine. The findings obtained from the behavioral experiments led us to hypothesize that H3R interacts with the dopaminergic system. This was further studied on a molecular level using both radioactive in situ hybridization and semi-quantitative Western blotting. We found that compared with control mice, H3R KO mice displayed lower levels of dopamine D1 receptor messenger RNA in the striatum, which is an area important in the regulation of e.g. reward. In addition, we found that activation of dopamine D1 and D2 receptors resulted in abnormal striatal cell signaling in the absence of H3Rs. Taken together, these findings demonstrate that H3R is an important regulator of alcohol-related behaviors. The mechanism by which H3R regulates these phenomena might involve the interaction between the striatal H3R and dopamine receptors. In addition, these results provide preclinical evidence that H3R antagonists may serve as a novel approach to treat alcohol dependence.
  • Carlsson, Emilia (Helsingin yliopisto, 2012)
    This thesis is based on the original observation of an allelic deletion of the recently described Neuron navigator 3 (NAV3) gene in patients with primary cutaneous T-cell lymphoma (CTCL) and CTCL-associated lung cancer. Thereafter mutations or copy number changes of NAV3 have been reported in melanoma, glioblastoma (GBM) and adrenal carcinoma. The aim of this study has been to shed light on the function and interactions of the NAV3 protein, as well as characterizing NAV3 copy number changes and their effect on patient survival in several forms of cancer. NAV3 is a novel cancer-associated gene at 12q21. The specific function of NAV3 is not known except that it carries actin-binding domains with ATPase activity, and is therefore likely to have an action on microtubules and cytoskeleton reorganization. The three Navigator genes, NAV1, NAV2 and NAV3 share homology among themselves and among different species. This suggests a central role for the encoded proteins in cell biology. In this study, NAV3 copy number changes have been studied by fluorescence in situ hybridisation (FISH) and array comparative genomic hybridisation (aCGH) in non-melanoma skin cancers, colorectal cancer and neural system tumours, and the relevant NAV3-regulated target genes have been identified. Furthermore, the expression levels of NAV3 and NAV3-regulated signalling molecules have been correlated to disease progression and patient outcome. In Basal cell carcinomas (BCC) and Squamous cell carcinomas (SCC) we found NAV3 copy number loss and corresponding absence of protein in 21% of the BCC and in 25% of the SCC tumours. In the nodular/superficial BCC subgroup, also low-level NAV3 amplification was found. NAV3 aberrations were independent of the known chromosome 6 amplification in BCC. Chromosome 12 polysomy, also independent of chromosome 6 polysomy, was found in 33% and 25% of the invasive type of BCC and in SCC, respectively. In colorectal carcinomas NAV3 deletion and chromosome 12 polysomy were detected in 30% and 70% of MSS carcinomas, and in 12.5% and 50% of MSI carcinomas, but also in 23% and 30% of adenomas, respectively. Low copy number amplification of NAV3 was found in 25% of MSS samples. 119 patient samples representing different central and peripheral nervous system tumours were studied for NAV3 copy number changes. Neuronally differentiated tumours (neuroblastomas and medulloblastomas) entailed more NAV3 aberrations than the glial tumours. In glial tumours, those with grade IV (gliobalstoma (GBM)) had significantly more NAV3 deletions than tumours with grades I, II or III. Log rank analysis also linked NAV3 deletion to a poor prognosis in gliomas. In contrast, glioma patients with NAV3 amplification showed better prognosis than those with normal NAV3 copy numbers. The FISH result was also supported by aCGH analysis, which showed results matching the FISH analysis for tumour samples with NAV3 amplification and deletion. To understand the in vivo functional consequences of NAV3 copy number changes, especially of NAV3 deletion, we silenced NAV3 in normal colon, GBM and primary keratinocyte cells, using a commercially available small inhibitory ribonucleic acid (siRNA) construct. Post transfection RNA samples from several time points were analyzed with Agilent 44K microarray. In GBM and colorectal cell lines we identified, among others, GnRHR and IL-23R as upregulated by NAV3 gene silencing. The upregulation of the selected genes were confirmed by quantitative PCR. In primary keratinocytes, NAV3 silencing led to consistent upregulation of 22 annotated genes, and several Wnt/HH pathway genes were slightly overexpressed too. Taken together the results of this thesis support the previously suggested role of NAV3 as a novel cancer associated gene, and we suggest that NAV3 affects the malignant potential of a given tumour through multiple pathways. This assumption is based on the fact that gene expression analysis of NAV3 silenced cells indicates that NAV3 affects genes with involvement in both inflammation and carcinogenesis.
  • den Hollander, Bjørnar (Helsingin yliopisto, 2015)
    In recent years there has been a large increase in the use of a new kind of amphetamine- type stimulants known as substituted cathinones. These compounds have a short history of human use, and little is known about their potential neurotoxicity. Two of the most popular substituted cathinones, 4-methylmethcathinone (4-MMC, mephedrone) and 3,4- methylenedioxymethcathinone (MDMC, methylone} are, aside from their β-ketone group, close structural analogues of potentially neurotoxic amphetamines such as methamphetamine (METH) and 3,4-methylenedioxymethamphetamine (MDMA, ecstasy). This has led to concern about the potential neurotoxicity of these novel compounds, and warrants a closer investigation into their possible long-term neurotoxic effects. METHODS The long-term effects of METH and MDMA as well as 4-MMC and MDMC were assessed using a range of biochemical assays, including assessment of monoamine levels and their transporters. The effects on brain activity were investigated using manganese-enhanced magnetic resonance imaging. Furthermore, behavioral experiments assessing cognition and neuropsychiatric function were performed. Finally, in vitro experiments in a neuroblastoma cell line were performed to identify mechanisms responsible for the observed differences in toxicity between the amphetamines and cathinones. RESULTS Unlike METH and MDMA, which produced strong reductions in dopamine and serotonin levels or brain activation, 4-MMC produced few notable effects on monoamine levels and had only minor effects on brain activation, although MDMC produced a reduction in 5-HT levels similar to MDMA. No clear effects on behavioral tests of memory function were observed as both increases and decreases in test performance were seen following 4- MMC and MDMC. In vitro experiments revealed that cathinones differ from amphetamines in their redox properties, and 4-MMC produced different effects than METH on the mitochondrial electron transport chain. CONCLUSIONS The substituted cathinones 4-MMC and MDMC do not appear to be more neurotoxic than METH and MDMA. If anything, they show a more favorable safety profile. Therefore, these substances do not appear to present an imminent and severe threat to public health. From a harm reduction perspective, these compounds may be good alternatives toMETH and MDMA. However, future work is needed to assess with certainty the long- term effects of amphetamine-type stimulants in humans.
  • Heikkilä, Tero (Helsingin yliopisto, 2003)
  • Juutistenaho, Sari (Helsingin yliopisto, 2010)
    Cord blood is a well-established alternative to bone marrow and peripheral blood stem cell transplantation. To this day, over 400 000 unrelated donor cord blood units have been stored in cord blood banks worldwide. To enable successful cord blood transplantation, recent efforts have been focused on finding ways to increase the hematopoietic progenitor cell content of cord blood units. In this study, factors that may improve the selection and quality of cord blood collections for banking were identified. In 167 consecutive cord blood units collected from healthy full-term neonates and processed at a national cord blood bank, mean platelet volume (MPV) correlated with the numbers of cord blood unit hematopoietic progenitors (CD34+ cells and colony-forming units); this is a novel finding. Mean platelet volume can be thought to represent general hematopoietic activity, as newly formed platelets have been reported to be large. Stress during delivery is hypothesized to lead to the mobilization of hematopoietic progenitor cells through cytokine stimulation. Accordingly, low-normal umbilical arterial pH, thought to be associated with perinatal stress, correlated with high cord blood unit CD34+ cell and colony-forming unit numbers. The associations were closer in vaginal deliveries than in Cesarean sections. Vaginal delivery entails specific physiological changes, which may also affect the hematopoietic system. Thus, different factors may predict cord blood hematopoietic progenitor cell numbers in the two modes of delivery. Theoretical models were created to enable the use of platelet characteristics (mean platelet volume) and perinatal factors (umbilical arterial pH and placental weight) in the selection of cord blood collections with high hematopoietic progenitor cell counts. These observations could thus be implemented as a part of the evaluation of cord blood collections for banking. The quality of cord blood units has been the focus of several recent studies. However, hemostasis activation during cord blood collection is scarcely evaluated in cord blood banks. In this study, hemostasis activation was assessed with prothrombin activation fragment 1+2 (F1+2), a direct indicator of thrombin generation, and platelet factor 4 (PF4), indicating platelet activation. Altogether three sample series were collected during the set-up of the cord blood bank as well as after changes in personnel and collection equipment. The activation decreased from the first to the subsequent series, which were collected with the bank fully in operation and following international standards, and was at a level similar to that previously reported for healthy neonates. As hemostasis activation may have unwanted effects on cord blood cell contents, it should be minimized. The assessment of hemostasis activation could be implemented as a part of process control in cord blood banks. Culture assays provide information about the hematopoietic potential of the cord blood unit. In processed cord blood units prior to freezing, megakaryocytic colony growth was evaluated in semisolid cultures with a novel scoring system. Three investigators analyzed the colony assays, and the scores were highly concordant. With such scoring systems, the growth potential of various cord blood cell lineages can be assessed. In addition, erythroid cells were observed in liquid cultures of cryostored and thawed, unseparated cord blood units without exogenous erythropoietin. This was hypothesized to be due to the erythropoietic effect of thrombopoietin, endogenous erythropoietin production, and diverse cell-cell interactions in the culture. This observation underscores the complex interactions of cytokines and supporting cells in the heterogeneous cell population of the thawed cord blood unit.
  • Veijola, Lea (Helsingin yliopisto, 2007)
    Aims: Helicobacter pylori infection, although the prevalence is declining in Western world, is still responsible for several clinically important diseases. None of the diagnostic tests is perfect and in this study, the performance of three stool antigen tests was assessed. In areas of high H. pylori prevalence, the definition of patients with the greatest benefit from eradication therapy may be a problem; the role of duodenal gastric metaplasia in categorizing patients at risk for duodenal ulcer was evaluated in this respect. Whether persistent chronic inflammation and elevated H. pylori antibodies after successful eradication are associated with each other or with atrophic gastritis, a long term sequelae of H. pylori infection, were also studied. Patients and methods: The three stool antigen tests were assessed in pre- and post-eradication settings among 364 subjects in two studies as compared to the rapid urease test (RUT), histology, culture, the 13C-urea breath test (UBT) and enzyme immunoassay (EIA) based H. pylori serology. The association between duodenal gastric metaplasia with duodenal ulcer was evaluated in a retrospective study including 1054 patients gastroscopied due to clinical indications and 154 patients previously operated for duodenal ulcer. The extent of duodenal gastric metaplasia was assessed from histological specimens in different patient groups formed on the basis of gastroscopy findings and H. pylori infection. Chronic gastric inflammation (108 patients) and H. pylori antibodies and serum markers for atrophy (77 patients) were assessed in patients earlier treated for H. pylori. Results: Of the stool antigen tests studied, the monoclonal antibody-based EIA-test showed the highest sensitivity and specificity both in the pre-treatment setting (96.9% and 95.9%) and after therapy (96.9% and 97.8%). The polyclonal stool antigen test and the in-office test had at baseline a sensitivity of 91% and 94%, and a specificity of 96% and 89%, respectively and in a post-treatment setting, a sensitivity of 78% and 91%, and a specificity of 97%, respectively. Duodenal gastric metaplasia was strongly associated with H. pylori positive duodenal ulcer (odds ratio 42). Although common still five years after eradication, persistent chronic gastric inflammation (21%) and elevated H. pylori antibodies (33%) were neither associated with each other nor with atrophic gastritis. Conclusions: Current H. pylori infection can feasibly be diagnosed by a monoclonal antibody-based EIA test with the accuracy comparable to that of reference methods. The performance of the polyclonal test as compared to the monoclonal test was inferior especially in the post-treatment setting. The in-office test had a low specificity for primary diagnosis and hence positive test results should probably be confirmed with another test before eradication therapy is prescribed. The presence of widespread duodenal gastric metaplasia showed promising results in detecting patients who should be treated for H. pylori due to an increased risk of duodenal ulcer. If serology is used later on in patients with earlier successfully treated for H. pylori, it should be taken into account that H. pylori antibodies may persist elevated for years for unknown reason. However, this phenomenon was not found to be associated with persistent chronic inflammation or atrophic changes.
  • Kluger, Nicolas (Helsingin yliopisto, 2015)
    Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED, OMIM 240300) is a rare autosomal recessive disorder caused by mutations in the autoimmune regulator (AIRE) gene located on chromosome 21 (21q22.3). AIRE deficiency causes a loss in central immune tolerance, leading to the failure to eliminate autoreactive T cells in the thymus and allowing their escape to the periphery. Because of a founder effect, APECED is particularly prevalent in Finland (1/25,000) but is observed worldwide with variable prevalence. APECED patients are susceptible to mucocutaneous candidiasis and multiple endocrine autoimmune diseases such as primary hypoparathyroidism, adrenal insufficiency, primary hypogonadism, type 1 diabetes, hypothyroidism, and hypophysitis. They may also develop additional nonendocrine autoimmune diseases, such as alopecia areata/totalis, vitiligo, gastro-intestinal (GI) diseases, keratitis or tubulointerstitial nephritis (TIN). In addition, the patients typically develop a variety of serum tissue-specific autoantibodies, which are predictive of the development of autoimmune disease and anticytokine antibodies such as those against type I interferons and Th17-related interleukin IL-17 and IL-22. The aim of this thesis was to study such manifestations of APECED that have not been well characterized before and also, to study health-related quality of life among Finnish APECED and Addison s disease/APS2 patients. We evaluated the clinical GI features and searched for novel markers of GI dysfunction in a Finnish cohort of 31 APECED patients. The main upper GI symptoms were dysphagia and retrosternal pain (45%) and the lower GI symptoms were constipation (48%), diarrhoea (45%) and malabsorption (16%). Previously, L-amino-acid decarboxylase (AADC) and tryptophan hydroxylase type 1 (TPH-1) antibodies have been demonstrated in APECED. AADC antibodies were found in 51% and TPH-1 antibodies in 39% of all patients. Also, a T cell response to AADC was detected in 43%. One third of the patients had autoimmune enteropathy (AIE)-related 75 kDa antigen (AIE-75, 33%) and villin (29%) autoantibodies, and antibodies against brush borders and Paneth cells (PCs) were detected in 29% and 20%, respectively. Mucosal intestinal IL-17 expression was decreased or negative in 77% of the intestinal samples. Duodenal chromogranin A and serotonin expression was absent or decreased in 50% and 66% of the patients, respectively. Of the clinical symptoms, constipation correlated with negative serotonin staining (p less than 0.05) and with AADC antibodies (p = 0.019). Importantly, we found a correlation between autoantibodies against AADC, which are critical for serotonin and DOPA synthesis, and constipation. Constipation was also associated with a lack of serotonin expression in the enteroendocrine cells (EECs). Paneth cells (PCs) were lacking in the duodenum in 20% of our intestinal samples, even though this was not associated with GI symptoms. In this Finnish APECED patient cohort, 17% (5/30) had moderate-to-severe renal failure, including 10% (3/30) with TIN requiring transplantation, haemodialysis or immunosuppressive treatment. However, the latter did not seem to be efficient in controlling disease progression. All 3 patients with TIN had circulating antibodies against the distal part of the nephron, as did 30% of all cohort cases. The pathogenic relevance of such circulating antibodies is still unclear. The immunological basis of hypoparathyroidism in APECED was explored by studying circulating calcium-sensing receptor (CaSR) and NALP5 antibodies. Although they were detected in 16 of 44 (36%) and 13 of 44 (30%) patients, respectively, we failed to find any clinically relevant statistical association. These APECED patients did not present circulating antibodies for other autoimmune diseases such as rheumatoid arthritis, celiac disease, bullous pemphigoid or pemphigus vulgaris. Some patients had antinuclear antibodies at a low-titre without clinical significance. Secondly, we evaluated the health-related quality of life among Finnish APECED and Addison s disease/APS2 patients and sought to determine which factors may predict a possible impairment. Using health-related quality of life (HRQoL) questionnaires for APECED (SF-36) and Addison s disease/APS2 patients (SF-36, 15D), we indeed observed impaired HRQoL. For the APECED patients, general health, emotional well-being and energy/vitality were the most diminished aspects of HRQoL. Among the patients with Addison s disease/APS2, compared to a large control population, physical or emotional role functioning, energy/vitality and general health were most affected. Discomfort and symptoms, vitality, and sexual activity were the most affected dimensions of the 15D scores. Affiliation with a patients association, female gender, the presence of non-APS2 inflammatory comorbidities, lower educational level and a longer disease duration were independent predictors of impaired HRQoL in these patients. Taken together, the results of this thesis show that APECED patients are genetically prone to develop autoantibodies to a multitude of tissue antigens but are still tolerant to some common autoantigens. The true clinical and biological relevance of these circulating autoantibodies has not yet been elucidated, and it is possible that they are only a reflection of T cell-mediated immunity. They may, however, have a cumulative effect and clinical disease may arise only in patients with a combination of circulating antibodies, as seen in diabetes type 1. This may explain why we failed to find any association between any single type of antibody and a given symptom. For the lower GI track manifestations, we hypothesise a cumulative effect of the autoimmunity directed against both the enteroendocrine cells and the Paneth cells, leading to a dysfunction in both the secretion of serotonin in the gut and the secretion of antimicrobiobial defensins. Such a disturbance would have an effect on the gut microbiota. The question of whether the neutralising antibodies against cytokines may have a paradoxical protective effect is open to debate. Lastly, despite having a high number of manifestations, patients with APECED seem to cope with their disease. Patients with Addison s disease have significantly impaired HRQoL compared to the general population.
  • Lilius, Tuomas (Helsingin yliopisto, 2014)
    Opioid analgesics are effective in relieving acute and chronic pain. However, adverse effects and the development of opioid dependence and tolerance may restrict the use of opioids and result in inadequate pain relief. The effects of four structurally and functionally different drugs already on the market, ibudilast, atipamezole, spironolactone, and ketamine, were studied in coadministration with morphine, the prototypical mu-opioid receptor agonist. Experiments were conducted using thermal and mechanical tests of nociception in male Sprague-Dawley rats. Morphine tolerance was produced during four days by subcutaneous or intrathecal delivery of morphine. Drug and metabolite concentrations were measured using high-pressure liquid chromatography-tandem mass spectrometry. The objective of the thesis study was to search for potential drugs to augment morphine antinociception and prevent opioid tolerance. Ibudilast, a phosphodiesterase and macrophage inhibitory factor inhibitor, had transient sedative effects, but it restored the antinociceptive effect of morphine in morphine-tolerant rats after single and repeated administration. It did not prevent the development of opioid tolerance. Atipamezole, an alpha-2-adrenoceptor antagonist used for the reversal of sedation in animals during anesthesia, was effective in augmenting intrathecal morphine antinociception in both opioid-naïve and opioid-tolerant animals. These effects were observed at doses lower than those required for the antagonism of alpha-2-adrenoceptors. In subcutaneous administration, low doses of atipamezole did not influence morphine antinociception. The mineralocorticoid receptor antagonist spironolactone dose-dependently enhanced morphine antinociception. This effect was mediated via the increased access of morphine to the central nervous system by the inhibition of the efflux protein P-glycoprotein. Spironolactone did not inhibit the metabolism of morphine to the pronociceptive metabolite morphine-3-glucuronide, and it did not prevent the development of opioid tolerance. The effects of ketamine in augmenting opioid analgesia in tolerance are thought to result from a beneficial pharmacodynamic interaction. When acute ketamine was administered to rats under chronic morphine treatment, the brain concentrations of morphine, ketamine and norketamine were increased compared with the situation where either morphine treatment or acute ketamine were administered alone. The results indicate a potentially beneficial pharmacokinetic interaction between the two drugs. The results of the thesis study demonstrate that ibudilast and atipamezole modulate nociception at systemic and spinal levels in preclinical models of pain, and they may prove advantageous as an adjuvant to opioid therapy. Spironolactone had a pharmacokinetic interaction with morphine, leading to increased morphine concentrations in the central nervous system. Ketamine, a drug used for the treatment of opioid tolerance in cancer patients, may undergo previously unrecognized beneficial pharmacokinetic interactions with morphine.
  • Gylfe, Alexandra (Helsingin yliopisto, 2014)
    Colorectal cancer (CRC) is the third most common cancer, and the second most common cause of cancer mortality. The aim of this thesis work was to gain novel insight into the molecular mechanisms behind CRC predisposition, as well as tumor progression and development. Microsatellite instability (MSI) arises due to a defective mismatch repair system and is characteristic for a subset of all CRCs. Here, we aimed to identify novel MSI target genes with potential oncogenic effects. We characterized all genes overexpressed in MSI CRCs and predicted to escape nonsense-mediated decay when mutated. The mitotic checkpoint kinase TTK was identified with protein-elongating mutations in 59% of MSI CRCs. TTK has an essential role in spindle assembly checkpoint (SAC) signaling, however, the mutated protein did not show SAC weakening. While no evidence of oncogenic mechanisms was observed, the high mutation frequency of TTK argues for biological significance. In another screening effort on MSI CRCs, we sought to identify novel oncogenes with activating hotspot mutations. The exomes of 25 tumor and respective healthy colon tissues were sequenced. A total of 15 candidate oncogenes with hotspot mutations were identified. Three genes, ZBTB2, PSRC1 and RANBP2, displayed hotspot mutations also in the validation set of 86 MSI CRCs. Interestingly, the CRC-associated mutant form of ZBTB2 increased cell proliferation. Additional work is needed to further clarify the role of the identified somatic mutations in CRC tumorigenesis. The candidate oncogenes identified in this thesis work might be used to develop personalized tumor profiling and therapy. Inherited susceptibility is estimated to be involved in approximately one-third of all CRCs. However, the great majority of inherited CRC susceptibility remains still molecularly unexplained. A recent systematic sequencing study on CRC reported a set of somatically mutated genes, termed candidate cancer (CAN) genes. We examined the mutational profiles of 15 top-ranked CAN genes for somatic mutations as well as for germline variants in 45 familial CRC cases. In our tumor set, six of the CAN genes were somatically mutated. In germline, three private missense variants were identified in CSMD3, EPHB6 and c10orf137. In another effort, we exome sequenced 96 independent cases with familial CRC. We identified 11 novel candidate CRC susceptibility genes with rare putative LoF variants. Seven loss-of-heterozygosity events, involving four genes, were observed in the data. In each occasion, the losses targeted the wild-type allele (P=0.0078), providing further support that true culprits are among the eleven genes. This study provides an interesting set of candidate predisposing genes, which might explain a subset of common familial CRC. The identified germline variants need to be validated in larger sample sets to provide firm evidence for disease predisposition. Additional work is also needed to characterize the detailed functional and clinical relevance of the identified candidate CRC predisposing genes. This information, then, can ultimately be translated into tools for cancer prevention and early diagnosis in individuals carrying true predisposition alleles.
  • Tigerstedt, Nina-Maria (Helsingin yliopisto, 2009)
    Vascular intimal hyperplasia is a major complication following angioplasty. The hallmark feature of this disorder is accumulation of dedifferentiated smooth muscle cells (SMCs) to the luminal side of the injured artery, cellular proliferation, migration, and synthesis of extracellular matrix. This finally results in intimal hyperplasia, which is currently considered an untreatable condition. According to current knowledge, a major part of neointimal cells derive from circulating precursor cells. This has outdated the traditional in vitro cell culture methods of studying neointimal cell migration and proliferation using cultured medial SMCs. Somatostatin and some of its analogs with different selectivity for the five somatostatin receptors (sst1 through sst5) have been shown to have vasculoprotective properties in animal studies. However, clinical trials using analogs selective for sst2/sst3/sst5 to prevent restenosis after percutaneous transluminal coronary angioplasty (PTCA) have failed to show any major benefits. Sirolimus is a cell cycle inhibitor that has been suggested to act synergistically with the protein-tyrosine kinase inhibitor imatinib to inhibit intimal hyperplasia in rat already at well-tolerated submaximal oral doses. The mechanisms behind this synergy and its long-term efficacy are not known. The aim of this study was to set up an ex vivo vascular explant culture model to measure neointimal cell activity without excluding the participation of circulating progenitor cells. Furthermore, two novel potential vasculoprotective treatment strategies were evaluated in detail in rat models of intimal hyperplasia and in the ex vivo explant model: sst1/sst4-selective somatostatin receptor analogs and combination treatment with sirolimus and imatinib. This study shows how whole vessel explants can be used to study the kinetics of neointimal cells and their progenitors, and to evaluate the anti-migratory and anti-proliferative properties of potential vasculoprotective compounds. It also shows how the influx of neointimal progenitor cells occurs already during the first days after vascular injury, how the contribution of cell migration is more important in the injury response than cell proliferation, and how the adventitia actively contribute in vascular repair. The vasculoprotective effect of somatostatin is mediated preferentially through sst4, and through inhibition of cell migration rather than of proliferation, which may explain why sst2/sst3/sst5-selective analogs have failed in clinical trials. Furthermore, a brief early oral treatment with the combination of sirolimus and imatinib at submaximal doses results in long-term synergistic suppression of intimal hyperplasia. The synergy is a result of inhibition of post-operative thrombocytosis and leukocytosis, inhibition of neointimal cell migration to the injury-site, and maintenance of cell integrity by inhibition of apoptosis and SMC dedifferentiation. In conclusion, the influx of progenitor cells already during the first days after injury and the high neointimal cell migratory activity underlines the importance of early therapeutic intervention with anti-migratory compounds to prevent neointimal hyperplasia. Sst4-selective analogs and the combination therapy with sirolimus and imatinib represent potential targets for the development of such vasculoprotective therapies.
  • Broms, Ulla (Helsingin yliopisto, 2008)
    The worldwide health burden caused by the tobacco epidemic highlights the importance of study-ing determinants of smoking behaviour and key factors sustaining nicotine dependence. Despite vast-ranging preventive efforts, smoking remains one of the most deleterious health behaviours, and its genetic and environmental factors warrant continuous investigation. The heritability of smoking behaviour and nicotine dependence has been suggested to be relatively high. Earlier smoking behaviour, nicotine dependence, socio-economic position and demographic factors have all been shown to be associated with smoking cessation. This thesis aimed to examine various aspects of smoking behaviour and nicotine dependence from an epidemiological and genetic per-spective. Data for Studies I and IV were obtained from the Older Finnish Twin Cohort, a postal health sur-vey conducted in 1975, 1981 and 1990 on same-sexed pairs and in 1996-1997 on male-female adult pairs. The number of ever-smoking participants was 8941 in Study I and 3069 in Study IV. Data for Studies II and III came from the Family Study of Cigarette Smoking - Vulnerability to Nicotine Addiction. This study is linked to the Older Finnish Twin Cohort with new data collec-tion during 2001-2006 that focused on smoking twin pairs and their family members. The meas-ures included intensive telephone interviews, blood samples and additional postal questionnaires. The numbers of ever-smoking participants was 1370 in Study II and 529 in Study III. Study I examined whether a genetic component underlies smoking behaviour among Finnish adults. Genetic factors were important in the amount smoked and smoking cessation, with about half of the phenotypic differences explained by genetic variance. A novel finding was that genetic influences on amount smoked and smoking cessation were largely independent of genetic influ-ences on age at initiation. This result has implications for defining phenotypes in the search for genes underlying smoking behaviour. Furthermore, even if smoking initiation is postponed to a later age, potential vulnerability to subsequent nicotine dependence cannot be completely inhib-ited. Study II investigated the effect of genetic and environmental factors on nicotine dependence, as measured by the novel multidimensional Nicotine Dependence Syndrome Scale (NDSS). This scale was validated in the Finnish data. The NDSS correlated highly with other established nico-tine dependence scales (FTND and DSM-IV), suggesting that this new scale would be a feasible and valid measure for identifying nicotine-dependent smokers among the ever-smoking popula-tion. About one-third of the phenotypic variation in nicotine dependence in this sample was ex-plained by genetic influences. Study III aimed at identifying chromosomal regions harbouring genes that influence smoking be-haviour and nicotine dependence. Linkage analysis of family data revealed that for smoker and nicotine dependence phenotypes as well as for co-morbidity between nicotine dependence and alcohol use signals on specific chromosome regions (chromosomes 2q33, 5q12, 5q34 7q21, 7q31, 10q25, 11p15, 20p13) exist. Results further support the hypothesis that smoking behaviour phe-notypes have a genetic background. Study IV examined associations of smoking behaviour, socio-economic position and transition of marital status with smoking cessation. Indicators of socio-economic position were important pre-dictors of smoking cessation even when adjusted for previous smoking behaviour. Getting married was associated with an increased probability of cessation in men, a finding confirmed among dis-cordant twin pairs. Thus, having a partner appears to have a positive impact on smoking cessation. In conclusion, nicotine dependence and smoking behaviour demonstrate significant genetic liabil-ity, but also substantial environmental influences among Finnish adults. Smoking initiation should be prevented or at least postponed to a later age. Although genetic factors are important in nicotine dependence and smoking behaviour, societal actions still have a primary role in tobacco control and smoking prevalence. Future studies should examine the complex interactions between genetic and environmental factors in nicotine dependence.