Mitochondrial Malfunction in Tumor Formation and Neuromuscular Diseases : Consequences of defects in fumarate hydratase and in the respiratory chain

The mitochondrion is an organelle of outmost importance, and the mitochondrial network performs an array of functions that go well beyond ATP synthesis. Defects in mitochondrial performance lead to diseases, often affecting nervous system and muscle. Although many of these mitochondrial diseases have been linked to defects in specific genes, the molecular mechanisms underlying the pathologies remain unclear. The work in this thesis aims to determine how defects in mitochondria are communicated within - and interpreted by - the cells, and how this contributes to disease phenotypes. Fumarate hydratase (FH) is an enzyme of the citrate cycle. Recessive defects in FH lead to infantile mitochondrial encephalopathies, while dominant mutations predispose to tumor formation. Defects in succinate dehydrogenase (SDH), the enzyme that precedes FH in the citrate cycle, have also been described. Mutations in SDH subunits SDHB, SDHC and SDHD are associated with tumor predisposition, while mutations in SDHA lead to a characteristic mitochondrial encephalopathy of childhood. Thus, the citrate cycle, via FH and SDH, seems to have essential roles in mitochondrial function, as well as in the regulation of processes such as cell proliferation, differentiation or death. Tumor predisposition is not a typical feature of mitochondrial energy deficiency diseases. However, defects in citrate cycle enzymes also affect mitochondrial energy metabolism. It is therefore necessary to distinguish what is specific for defects in citrate cycle, and thus possibly associated with the tumor phenotype, from the generic consequences of defects in mitochondrial aerobic metabolism. We used primary fibroblasts from patients with recessive FH defects to study the cellular consequences of FH-deficiency (FH-). Similarly to the tumors observed in FH- patients, these fibroblasts have very low FH activity. The use of primary cells has the advantage that they are diploid, in contrast with the aneuploid tumor cells, thereby enabling the study of the early consequences of FH- in diploid background, before tumorigenesis and aneuploidy. To distinguish the specific consequences of FH- from typical consequences of defects in mitochondrial aerobic metabolism, we used primary fibroblasts from patients with MELAS (mitochondrial encephalopathy with lactic acidosis and stroke-like episodes) and from patients with NARP (neuropathy, ataxia and retinitis pigmentosa). These diseases also affect mitochondrial aerobic metabolism but are not known to predispose to tumor formation. To study in vivo the systemic consequences of defects in mitochondrial aerobic metabolism, we used a transgenic mouse model of late-onset mitochondrial myopathy. The mouse contains a transgene with an in-frame duplication of a segment of Twinkle, the mitochondrial replicative helicase, whose defects underlie the human disease progressive external ophthalmoplegia. This mouse model replicates the phenotype in the patients, particularly neuronal degeneration, mitochondrial myopathy, and subtle decrease of respiratory chain activity associated with mtDNA deletions. Due to the accumulation of mtDNA deletions, the mouse was named deletor. We first studied the consequences of FH- and of respiratory chain defects for energy metabolism in primary fibroblasts. To further characterize the effects of FH- and respiratory chain malfunction in primary fibroblasts at transcriptional level, we used expression microarrays. In order to understand the in vivo consequences of respiratory chain defects in vivo, we also studied the transcriptional consequences of Twinkle defects in deletor mice skeletal muscle, cerebellum and hippocampus. Fumarate accumulated in the FH- homozygous cells, but not in the compound heterozygous lines. However, virtually all FH- lines lacked cytoplasmic FH. Induction of glycolysis was common to FH-, MELAS and NARP fibroblasts. In deletor muscle glycolysis seemed to be upregulated. This was in contrast with deletor cerebellum and hippocampus, where mitochondrial biogenesis was in progress. Despite sharing a glycolytic pattern in energy metabolism, FH- and respiratory chain defects led to opposite consequences in redox environment. FH- was associated with reduced redox environment, while MELAS and NARP displayed evidences of oxidative stress. The deletor cerebellum had transcriptional induction of antioxidant defenses, suggesting increased production of reactive oxygen species. Since the fibroblasts do not represent the tissues where the tumors appear in FH- patients, we compared the fibroblast array data with the data from FH- leiomyomas and normal myometrium. This allowed the determination of the pathways and networks affected by FH-deficiency in primary cells that are also relevant for myoma formation. A key pathway regulating smooth muscle differentiation, SRF (serum response factor)-FOS-JUNB, was found to be downregulated in FH- cells and in myomas. While in the deletor mouse many pathways were affected in a tissue-specific basis, like FGF21 induction in the deletor muscle, others were systemic, such as the downregulation of ALAS2-linked heme synthesis in all deletor tissues analyzed. However, interestingly, even a tissue-specific response of FGF21 excretion could elicit a global starvation response. The work presented in this thesis has contributed to a better understanding of mitochondrial stress signalling and of pathways interpreting and transducing it to human pathology.

Long-term outcome and extraintestinal manifestations in congenital chloride diarrhea

The rare autosomal recessive disease congenital chloride diarrhea (CLD) is caused by mutations in the solute carrier family 26 member 3 (SLC26A3) gene on chromosome 7q22.3-31.1. SLC26A3 encodes for an apical epithelial chloride-bicarbonate exchanger, the intestinal loss of which leads to profuse chloride-rich diarrhea, and a tendency to hypochloremic and hypokalemic metabolic alkalosis. Although untreated CLD is usually lethal in early infancy, the development of salt substitution therapy with NaCl and KCl in the late 1960s made the disease treatable. While the salt substitution allows normal childhood growth and development in CLD, data on long-term outcome have remained unclarified. One of the world s highest incidences of CLD 1:30 000 to 1:40 000 occurs in Finland, and CLD is part of the Finnish disease heritage. We utilized a unique sample of Finnish patients to characterize the long-term outcome of CLD. Another purpose of this study was to search for novel manifestations of CLD based on the extraintestinal expression of the SLC26A3 gene. This study on a sample of 36 patients (ages 10-38) shows that the long-term outcome of treated CLD is favorable. In untreated or poorly treated cases, however, chronic contraction and metabolic imbalance may lead to renal injury and even to renal transplantation. Our results demonstrate a low-level expression of SLC26A3 in the human kidney. Although SLC26A3 may play a minor role in homeostasis, post-transplant recurrence of renal changes shows the unlikelihood of direct transporter modulation in the pathogenesis of CLD-related renal injury. Options to resolve the diarrheal symptoms of CLD have been limited. Unfortunately, our pilot trial indicated the inefficacy of oral butyrate as well. This study reveals novel manifestations of CLD. These include an increased risk for hyperuricemia, inguinal hernias, and probably for intestinal inflammation. The most notable finding of this study is CLD-associated male subfertility. This involves a low concentration of poorly motile spermatozoa with abnormal morphology, high seminal plasma chloride with a low pH, and a tendency to form spermatoceles. That SLC26A3 immunoexpression appeared at multiple sites of the male reproductive tract in part together with the main interacting proteins cystic fibrosis transmembrane conductance regulator (CFTR) and sodium-hydrogen exchanger 3 (NHE3) suggests novel sites for the cooperation of these proteins. As evidence of the cooperation, defects occurring in any of these transporters are associated with reduced male fertility. Together with a finding of high sweat chloride in CLD, this study provides novel data on extraintestinal actions of the SLC26A3 gene both in the male reproductive tract and in the sweat gland. These results provide the basis for future studies regarding the role of SLC26A3 in different tissues, especially in the male reproductive tract. Fortunately, normal spermatogenesis in CLD is likely to make artificial reproductive technologies to treat infertility and even make unassisted reproduction possible.

Neurological manifestations and molecular genetics of acute intermittent porphyria in North Western Russia

Acute intermittent porphyria (AIP, MIM #176000) is an inherited metabolic disease due to a partial deficiency of the third enzyme, hydroxymethylbilane synthase (HMBS, EC: 4.3.1.8), 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.

Genetic studies on Finnish lupus erythematosus patients with cutaneous manifestations

Lupus erythematosus (LE) is a chronic, heterogeneous autoimmune disorder with abnormal immune responses, including production of autoantibodies and immune complexes. Clinical presentations of the disease range from mild cutaneous manifestations to a more generalised systemic involvement of internal organs. Cutaneous (CLE) forms are further subclassified into discoid LE (DLE), subacute cutaneous LE (SCLE) and acute cutaneous lupus erythematosus (ACLE), and may later progress to systemic disease (SLE). Both genetic and environmental factors contribute to the disease, although the precise aetiology is still elusive. Furthermore, complex gene-gene or gene-environment interactions may result in different subphenotypes of lupus. The genetic background of CLE is poorly known and only a few genes are confirmed, while the number of robust genetic associations in SLE exceeds 30. The aim of this thesis was to characterise the recruited patients clinically, and identify genetic variants conferring susceptibility to cutaneous variants of LE. Given that cutaneous and systemic disease may share underlying genetic factors, putative CLE candidate genes for genotyping were selected among those showing strong evidence of association in SLE. The correlation between relevant clinical manifestations and risk genotypes was investigated in order to find specific subphenotype associations. In addition, epistatic interactions in SLE were studied. Finally, the role of tissue degrading matrix metalloproteinases (MMP) in LE tissue injury was explored. These studies were conducted in Finnish case-control and family cohort, and Swedish case-control cohort. The clinical picture of the patients in terms of cutaneous, haematological and immunological findings resembled that described in the contemporary literature. However, the proportion of daily smokers was very high supporting the role of smoking in disease aetiology. The results confirmed that, even though clinically distinct entities, CLE and SLE share predisposing genetic factors. For the first time it was shown that known SLE susceptibility genes IRF5 and TYK2 also increase the risk of CLE. A tendency toward gene-gene interaction between these genes was found in SLE. As a remarkable novel finding, it was observed that ITGAM polymorphisms associated even more strongly to DLE than SLE, and the risk estimates were substantially higher than those reported for SLE. Several other recently identified SLE susceptibility genes showed signs of good or modest association especially in DLE. Subphenotype analyses indicated possible associations to clinical features, but marginally significant results reflected lack of sufficient power for these studies. Thorough immunohistochemical analyses of several MMPs demonstrated a role in epidermal changes and dermal tissue remodelling in diseased skin, and suggested that targeted action using selective MMP inhibitors may reduce lupus-induced damage in inflamed tissues. In conclusion, the results provide an insight into the genetics of CLE and demonstrate that genetic predisposition is at least in part shared between cutaneous and systemic variants of LE. This doctoral study has contributed IRF5, TYK2, ITGAM and several other novel genes to the so far short list of genes implicated in CLE susceptibility. Detailed examination of the function of these genes in CLE pathogenesis warrants further studies. Furthermore, the results support the need of subphenotype analysis with sample sizes large enough to reveal possible specific disease associations in order to better understand the heterogeneous nature and clinical specificities of the disease. Comprehensive analysis of clinical data suggests that smoking is an environmental triggering factor.

Genetic Variation and Clinical Manifestations in Inflammatory Bowel Disease

Crohn s disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD), are characterised by chronic inflammation of the gastrointestinal tract. IBD prevalence in Finland is approximately 3-4 per 1000 inhabitants with a peak incidence in adolescence. The symptoms of IBD include diarrhoea, abdominal pain, fever, and weight loss. The precise aetiology of IBD is unknown but interplay of environmental risk factors and immunologic changes trigger the disease in a genetically susceptible individual. Twin and family studies have provided strong evidence for genetic factors in IBD susceptibility, and genetic factors may be more prominent in CD than UC. The first CD susceptibility gene was identified in 2001. Three common mutations R702W, G908R, and 1007fs of the CARD15/NOD2 gene are shown to associate independently with CD but the magnitude of association varies between different populations. The present study aimed at identifying mutations and genetic variations in IBD susceptibility and candidate genes. In addition, correlation to phenotype was also assessed. One of the main objectives of this study was to evaluate the role of CARD15 in a Finnish CD cohort. 271 CD patients were studied for the three common mutations and the results showed a lower mutation frequency than in other Caucasian populations. Only 16% of the patients carried one of the three mutations. Ileal location as well as stricturing and penetrating behaviour of the disease were associated with occurrence of the mutations. The whole protein coding region of CARD15 was screened for possible Finnish founder mutations. In addition to several sequence variants, five novel mutations (R38M, W355X, P727L, W907R, and R1019X) were identified in five patients. Functional consequences of these novel variants were studied in vitro, and these studies demonstrated a profound impairment of MDP response. Investigation of CARD15 mutation frequency in healthy people across three continents showed a large geographic fluctuation. No simple correlation between mutation frequency and disease incidence was seen in populations studied. The occurrence of double mutant carriers in healthy controls suggested that the penetrance of risk alleles is low. Other main objectives aimed at identifying other genetic variations that are involved in the susceptibility to IBD. We investigated the most plausible IBD candidate genes including TRAF6, SLC22A4, SLC22A5, DLG5, TLR4, TNFRSF1A, ABCB1/MDR1, IL23R, and ATG16L1. The marker for a chromosome 5 risk haplotype and the rare HLA-DRB1*0103 allele were also studied. The study cohort consisted of 699 IBD patients (240 CD and 459 UC), of which 23% had a first-degree relative with IBD. Of the several candidate genes studied, IL23R was associated with CD susceptibility, and TNFRSF1A as well as the HLA-DRB1*0103 allele with UC susceptibility. IL23R variants also showed association with the stricturing phenotype and longer disease duration in CD patients. In addition, TNFRSF1A variants were more common among familial UC and ileocolonic CD. In conclusion, the common CARD15 mutations were shown to account for 16% of CD cases in Finland. Novel CARD15 variants identified in the present study are most likely disease-causing mutations, as judged by the results of in vitro studies. The present study also confirms the IL23R association with CD susceptibility and, in addition, TNFRSF1A and HLA-DRB1*0103 allele association with UC of specific clinical phenotypes.

Probiotics in the prevention of clinical manifestations of common infectious diseases in children and in the elderly

Infectious diseases put an enormous burden on both children and the elderly in the forms of respiratory, gastrointestinal and oral infections. There is evidence suggesting that specific probiotics may be antagonistic to pathogens and may enhance the immune system, but the clinical evidence is still too sparce to make general conclusions on the disease-preventive effects of probiotics. This thesis, consisting of four independent, double-blind, placebo-controlled clinical trials, investigated whether Lactobacillus GG (LGG) or a specific probiotic combination containing LGG would reduce the risk of common infections or the prevalence of pathogens in healthy and infection-prone children and in independent and institutionalised elderly people. In healthy day-care children, the 7-month consumption of probiotic milk containing Lactobacillus GG appeared to postpone the first acute respiratory infection (ARI) by one week (p=0.03, adjusted p=0.16), and to reduce complicated infections (39% vs. 47%, p<0.05, adjusted p=0.13), as well as the need for antibiotic treatment (44% vs. 54%, p=0.03, adjusted p=0.08) and day-care absences (4.9 vs. 5.8 days, p=0.03, adjusted p=0.09) compared to the placebo milk. In infection-prone children, the 6-month consumption of a combination of four probiotic bacteria (LGG, L. rhamnosus LC705, Propionibacterium freudenreichii JS, Bifidobacterium breve 99) taken in capsules appeared to reduce recurrent ARIs (72% vs. 82%, p<0.05; adjusted p=0.06), and the effect was particularly noticeable in a subgroup of children with allergic diseases (12% vs. 33%, p=0.03), although no effect on the presence of nasopharyngeal rhinovirus or enterovirus was seen. The 5-month consumption of the same probiotic combination did not show any beneficial effects on the respiratory infections in frail, institutionalised elderly subjects. In healthy children receiving Lactobacillus GG, the reduction in complications resulted in a marginal reduction in the occurrence of acute otitis media (AOM) (31% vs. 39%, p=0.08; adjusted p=0.19), and the postponement of the first AOM episode by 12 days (p=0.04; adjusted p=0.09). However, in otitis-prone children, a probiotic combination did not reduce the occurrence of AOM or the total prevalence of common AOM pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis), except in the case of children with allergic diseases, in whom probiotics reduced recurrent AOM episodes (0% vs. 14%, p=0.03). In addition, interaction between probiotics and bacterial carriage was seen: probiot-ics reduced AOM in children who did not carry any bacterial pathogens (63% vs. 83%), but the effect was the reverse in children carrying bacteria in the nasopharynx (74% vs 62%) (p<0.05). Long-term probiotic treatment, either LGG given in milk to healthy children for 7 months or a combination of probiotics given in capsules to institutionalised elderly subjects for 5 months, did not reduce the occurrence of acute diarrhoea. However, when the probiotic combination (LGG, L. rhamnosus LC705, Propionibacterium JS) was given in cheese to independent elderly subjects for 4 months, the oral carriage of high Candida counts was reduced in the probiotic group vs. the placebo group (21% vs. 34%, p=0.01, adjusted p=0.004). The risk of hyposalivation was also reduced in the probiotic group (p=0.05). In conclusion, probiotics appear to slightly alleviate the severity of infections by postponing their appearance, by reducing complications and the need for antimicrobial treatments. In addition, they appear to prevent recurrent infections in certain subgroups of children, such as in infection-prone children with allergic diseases. Alleviating ARI by probiotics may lead to a marginal reduction in the occurrence of AOM in healthy children but not in infection-prone children with disturbed nasopharyngeal microbiota. On the basis of these results it could be supposed that Lactobacillus GG or a specific combination containing LGG are effective against viral but not against bacterial otitis, and the mechanism is probably mediated through the stimulation of the immune system. A specific probiotic combination does not reduce respiratory infections in frail elderly subjects. Acute diarrhoea, either in children or in the elderly, is not prevented by the continuous, long-term consumption of probiotics, but the consumption of a specific probiotic combination in a food matrix is beneficial to the oral health of the elderly, through the reduction of the carriage of Candida.

Magnetic Resonance Imaging of Atherosclerotic Manifestations in Familial Hypercholesterolemia

Cardiovascular diseases (CVD) are, in developed countries, the leading cause of mortality. The majority of premature deaths and disability caused by CVD are due to atherosclerosis, a degenerating inflammatory disease affecting arterial walls. Early identification of lesions and initiation of treatment is crucial because the first manifestations quite often are major disabling cardiovascular events. Methods of finding individuals at high risk for these events are under development. Because magnetic resonance imaging (MRI) is an excellent non-invasive tool to study the structure and function of vascular system, we sought to discover whether existing MRI methods are able to show any difference in aortic and intracranial atherosclerotic lesions between patients at high risk for atherosclerosis and healthy controls. Our younger group (age 6-48) comprised 39 symptomless familial hypercholesterolemia (FH) patients and 25 healthy controls. Our older group (age 48-64) comprised 19 FH patients and 18 type 2 diabetes mellitus (DM) patients with coronary heart disease (CHD) and 29 healthy controls. Intracranial and aortic MRI was compared with carotid and femoral ultrasound (US). In neither age-group did MRI reveal any difference in the number of ischemic brain lesions or white matter hyperintensities (WMHIs) - possible signs of intracranial atherosclerosis - between patients and controls. Furthermore, MRI showed no difference in the structure or function of the aorta between FH patients and controls in either group. DM patients had lower compliance of the aorta than did controls, while no difference appeared between DM and FH patients. However, ultrasound showed greater plaque burden and increased thickness of carotid arterial walls in FH and DM patients in both age-groups, suggesting a more advanced atherosclerosis. The mortality of FH patients has decreased substantially after the late 1980´s when statin treatment became available. With statins, the progression of atherosclerotic lesions slows. We think that this, in concert with improvements in treatment of other risk factors, is one reason for the lack of differences between FH patients and controls in MRI measurements of the aorta and brain despite the more advanced disease of the carotid arteries assessed with US. Furthermore, whereas atherosclerotic lesions between different vascular territories correlate, differences might still exist in the extent and location of these lesions among different diseases. Small (<5 mm in diameter) WMHIs are more likely a phenomenon related to aging, but the larger ones may be the ones related to CVD and may be intermediate surrogates of stroke. The image quality in aortic imaging, although constantly improving, is not yet optimal and thus is a source of bias.

Modern Societal Impulses and their Nordic Manifestations : On Emancipation and Constraint in Societal Development

The 1980s and the early 1990s have proved to be an important turning point in the history of the Nordic welfare states. After this breaking point, the Nordic social order has been built upon a new foundation. This study shows that the new order is mainly built upon new hierarchies and control mechanisms that have been developed consistently through economic and labour market policy measures. During the post-war period Nordic welfare states to an increasing extent created equality of opportunity and scope for agency among people. Public social services were available for all and the tax-benefit system maintained a level income distribution. During this golden era of Nordic welfare state, the scope for agency was, however, limited by social structures. Public institutions and law tended to categorize people according to their life circumstances ascribing them a predefined role. In the 1980s and 1990s this collectivist social order began to mature and it became subject to political renegotiation. Signs of a new social order in the Nordic countries have included the liberation of the financial markets, the privatizing of public functions and redefining the role of the public sector. It is now possible to reassess the ideological foundations of this new order. As a contrast to widely used political rhetoric, the foundation of the new order has not been the ideas of individual freedom or choice. Instead, the most important aim appears to have been to control and direct people to act in accordance with the rules of the market. The various levels of government and the social security system have been redirected to serve this goal. Instead of being a mechanism for redistributing income, the Nordic social security system has been geared towards creating new hierarchies on the Nordic labour markets. During the past decades, conditions for receiving income support and unemployment benefit have been tightened in all Nordic countries. As a consequence, people have been forced to accept deteriorating terms and conditions on the labour market. Country-specific variations exist, however: in sum Sweden has been most conservative, Denmark most innovative and Finland most radical in reforming labour market policy. The new hierarchies on the labour market have co-incided with slow or non-existent growth of real wages and with a strong growth of the share of capital income. Slow growth of real wages has kept inflation low and thus secured the value of capital. Societal development has thus progressed from equality of opportunity during the age of the welfare states towards a hierarchical social order where the majority of people face increasing constraints and where a fortunate minority enjoys prosperity and security.

Abductive translation studies : The art of marshalling signs

This dissertation contributes to the fields of theoretical translation studies, semiotic translation theory, and the semiotics of translation. The aim of this work is to explore the alternative and potential which the semiotic approaches to translation entail from the viewpoint of contemporary translation studies. The overall objective is thus to show that a general semiotic translation theory, and in particular, a Peircean translation theory, are possible and indispensable. Furthermore, this study contributes to the semiotranslational approach and to its theory-building by developing the concept of abductive translation (studies). The specific theoretical frame of reference adopted in this study is provided by the semiotranslation introduced by Dinda L. Gorlée. This approach is primarily based on the semeiotic of Charles Sanders Peirce (1839 1914), and aims at a fusion of semiotics and translation studies. A more general framework is provided by the threefold background and material: the published and unpublished writings of Peirce, Peirce scholarship and Peircean-semiotic publications, as well as the translation-theoretical literature. Part One of this study concentrates on the justification, existence, and nature of the semiotic approaches to translation. This part provides a historical survey, a status report, and a discussion of this area of research, by employing the findings in a boundary-clearing that is multilayered both conceptually and terminologically. Part Two deals with Peircean semiotranslation. Here Gorlée s semiotranslational research is examined by focusing on the starting points, features, and development of semiotranslation. Attention is also paid to the state-of-the-art of semiotranslation theory and to the possibilities for future elaborations. Part Three focuses on the semiotranslational claim that translation is an abductive activity. The concept of abductive translation is based on abduction, one of Peirce s three modes of reasoning; at the same time Firstness, the category of abduction, becomes foregrounded. So abductive translation as a form of possibilistic translation receives here an extensive theoretical discussion by citing examples in which abduction manifests itself as (scientific) reasoning and as everyday contemplation. During this treatise, translation is first equated with sign action, then with interpretation and finally with reasoning. All these approaches appear to embody different facets of the same phenomenon Peirce s ubiquitous semiosis, and they all suggest that translation is inherently an intersemiotic activity in which a sign is inferred from another sign. Translation is therefore semiosis, semiosis is translation and interpretation, interpretation is reasoning, and so on ad infinitum all being manifestations of the art of marshalling signs. The three parts of this study are linked by the overall goal of abductive translation studies: investigation into abductive translation develops the theory of semiotranslation, and this enrichment of semiotranslation in turn constructs a semiotic paradigm within translation studies.

Patterns of Transcendence : Classical Myth in Marina Tsvetaeva's Poetry of the 1920s

This study examines the position and meaning of Classical mythological plots, themes and characters in the oeuvre of the Russian Modernist poet Marina Tsvetaeva (1892-1941). The material consists of lyric poems from the collection Posle Rossii (1928) and two longer lyrical tragedies, Ariadna (1924) and Fedra (1927). These works are examined in the context of Russian Modernism and Tsvetaeva s own poetic development, also taking into account the author s biography, namely, her correspondence with Boris Pasternak. Tsvetaeva s appropriations of the myths enter into a dialogue with the Classical tradition and with the earlier Russian and Western literary manifestations of the source material. Her Classical texts are inextricably linked with her own authorial myth, they are used to project both her ideas about poetry as well as the authored self of her poems. An important context for Tsvetaeva s application of the Classical myths is the concept of the Platonic ladder of Eros. This plot evokes the process of transcendence of the mortal subject into the immaterial realm and is applied by the author as an extended metaphor of the poet s birth. Emphasizing the dialectical movement between the earthly and the divine, Tsvetaeva s Classical personae foreground various positions of the individual between these two realms. By means of kaleidoscopic reformulations of similar metaphors and concepts, Tsvetaeva s mythological poems illustrate the poet s position between the material and the immaterial and the various consequences of this dichotomy on the creative mission. At the heart of Tsvetaeva s appropriation of the Sibyl, Phaedra, Eurydice and Ariadne is the tension between the body and disembodiment. The two lyrical tragedies develop the dichotomous worldview further, nevertheless emphasizing the dual perspective of the divine and the earthly realms: immaterial existence is often evaluated from a material perspective and vice versa. The Platonic subtext is central for Ariadna, focussing on Theseus development from an earthly hero to a spiritual one. Fedra concentrates on Phaedra s divinely induced physical passion, which is nevertheless evoked in a creative light.

Relocating the American Dream : The America of the 1960s as Portrayed by the New Journalists Norman Mailer, Hunter S. Thompson, and Tom Wolfe

The concept of the American Dream was subject to a strong re-evaluation process in the 1960s, as counterculture became a prominent force in American society. A massive generation of young people, moved by the Vietnam War, the hippie movement, and psychedelic experimentation, created substantial social turbulence in their efforts to break out of conventional patterns and to create a new kind of society. This thesis outlines and analyses the concept of the American Dream in popular imagination through three works of new journalism. My primary data consists of Tom Wolfe’s The Electric Kool-Aid Acid Test (1967), Hunter S. Thompson’s Fear and Loathing in Las Vegas: A Savage Journey to the Heart of the American Dream (1971), and Norman Mailer’s Armies of the Night: History as a Novel, the Novel as History (1968). In defining the American Dream, I discuss the history of the concept as well as its manifestations in popular culture. Because of its elusive and amorphous nature, the concept of the American Dream can only be examined in cultural texts that portray the values, sentiments, and customs of a certain era. I have divided the analytical section of my thesis into three parts. In the first part I examine how the authors discuss the American society of their time in relation to ideology, capitalism, and the media. In the second part I focus on the Vietnam War and the controversy it creates in relation to the notions of freedom and patriotism. In the third part I discuss how the authors portray the countercultural visions of a better America that challenged the traditional interpretations of the American Dream. I also discuss the dark side of the new dream: the problems and disillusions that came with the effort to change the world. This thesis is an effort to trace the relocation of the American Dream in the context of the 1960s counterculture and new journalism. It hopes to provide a valuable addition to the cultural history of the sixties and to the effort of conceptualizing the American Dream.

Kansallista vai modernia : Taidegrafiikka osana 1930-luvun taidejärjestelmää

The theme of this doctoral thesis is the Finnish printmaking in the years 1930-1939. During this decade, there were approximately 100 artists making prints in Finland. Indeed, the period was an especially important one for printmaking. Associations for printmakers were founded in Helsinki and Turku, training in the field was launched, and the number of printmaking exhibitions increased considerably. Through their national organisations, Finnish printmakers participated in many exhibitions abroad, interaction with Nordic printmakers being especially intense. Thus, a firm basis for post-war developments was created. However, printmakers' activity- which had continued throughout the 1930s - declined notably after the Winter War broke out in the autumn of 1939. As a result, the period 1930-1939 forms a coherent and distinct unity in Finnish printmaking history. The study consists of two parts: the main text and an appendix in which the production of each printmaking artist active in the 1930s is examined separately. The study also includes a comprehensive list of the prints made in the course of the decade. One of the central themes is the printmakers' relationship to "Finnish nationalist" art and concepts of art in the 1930s. I analyse the various manifestations of this way of thinking in the visual arts of the period. Finnish fine art in the period between the world wars has usually been characterised as conservative, introverted and spiritually isolated from the modern European trends of the time. On the basis of this study, such a view is too simple. Many artists and printmakers adopted a modernistic notion of art that approached the newest in European modernism, including such trends as avant-garde classicism and general European new Objective Realism (Die neue Sachlichkeit). On the other hand, choosing Finnish nationalist motifs did not necessarily mean that the artist was opposed to modernism: modernist artists could still be interested in national themes. The relationship of 1930s printmaking to the world of nationalist ideas is examined in this doctoral thesis from several perspectives. Towards the end of the main text, I examine the issue from the point of view of selected artists. Another feature that emerged during the study and turned out to be surprisingly widespread was the close relationship of many artists to religious, theosophical and pantheistic views. I deal with this issue in greater detail through a few representative printmakers.

Historiebruk kring Nådendal : och den kommemorativa anatomin av klostrets minnesplats

This thesis examines the ruins of the medieval Bridgettine (Birgittan) monastery of Naantali (Vallis Gratiae, f. 1443) in Finland and the transformation of the site into a national heritage and a memory landscape. It was archaeologically surveyed in the 19th century by Professor Sven Gabriel Elmgren (1817 1897). His work was followed by Dr. Reinhold Hausen (1850 1942), who excavated the site in the 1870s. During this time the memories of Saint Bridget (Birgitta) in Sweden were also invented as heritage. Hausen published his results in 1922 thus forming the connection with the next generation of actors involved with the Naantali site: the magnate Amos Anderson (1878 1961), the teacher Julius Finnberg (1877 1955) and the archaeologist Juhani Rinne (1872 1950). They erected commemorative monuments etc. on the Naantali site, thus creating a memory landscape there. For them, the site represented the good homeland in connection with a western-oriented view of the history of Finland. The network of actors was connected to the Swedish researchers and so-called Birgitta Friends, such as state antiquarian Sigurd Curman (1879 1966), but also to the members of the Societas Sanctae Birgittae and the Society for the Embellishment of Pirita, among others. Historical jubilees as manifestations of the use of history were also arranged in Naantali in 1943, 1993 and 2003. It seems as if Naantali is needed in Finnish history from time to time after a period of crisis, i.e. after the Crimean War in the 1850s, the civil war of 1918, during World War II and also after the economic crisis of the early 1990s. In 2003, there was a stronger focus on the international Saint Bridget Jubilee in Sweden and all over Europe. Methodologically, the thesis belongs to the history of ideas, but also to research on the use of history, invented traditions and lieux de mémoire. The material for the work consists of public articles and scholarly texts in books or newspapers and letters produced by the actors and kept in archives in Finland, Sweden and Estonia, in addition to pictures and erected commemorative monuments in situ in the Western Finnish region. Keywords: Nådendal, Naantali monastery, Bridgettines, St. Bridget, use of history, lieux de mémoire, invented traditions, commemorative anatomy, memory landscape, Saint Bridget jubilees , S. G. Elmgren, R. Hausen, A. Anderson, J. Finnberg, J. Rinne, S. Curman, High Church Movement, Pirita, Vadstena.

Luonto, tiede ja teknologia : Kansanvalistuksen Suomi-kuva 1870-1920

Nature, science and technology. The image of Finland through popular enlightenment texts 1870-1920 This doctoral thesis looks at how Finnish popular enlightenment texts published between 1870 and 1920 took part in the process of forming a genuine Finnish national identity. The same process was occurring in other Nordic countries at the time and the process in Finland was in many ways influenced by them, particularly Sweden. In Finland the political realities under Russian rule especially during the Russification years, and the fact that its history was considered to be short compared to other European countries, made this nation-building process unique. The undertaking was led by members of the national elite, influential in the cultural, academic as well as political arenas, who were keen to support the foundation of a modern Finnish identity. The political realities and national philosophy of history necessitated a search for elements of identity in nature and the Finnish landscape, which were considered to have special national importance: Finland was very much determined as a political entity on the basis of its geography and nature. Nature was also used as means of taking a cultural or political view in terms of, for example, geographical facts such as the nation s borders or the country s geographical connections to Western Europe. In the building of a proper national identity the concept of nature was not, however, static, but was more or less affected by political and economic progress in society. This meant that nature, or the image of the national landscape, was no longer seen only as a visual image of the national identity, but also as a source of science, technology and a prosperous future. The role of technology in this process was very much connected to the ability to harness natural resources to serve national interests. The major change in this respect had occurred by the early 20th century, when indisputable scientific progress altered the relationship between nature and technology. Concerning technology, the thesis is mainly interested in the large and at the time modern technological manifestations, such as railways, factories and industrial areas in Finland. Despite the fact that the symbiosis between national nature and international but successfully localized technology was in Finnish popular enlightenment literature depicted mostly as a national success story, concerns began to arise already in last years of the 19th century. It was argued that the emerging technology would eventually destroy Finland s natural environment, and therefore the basis of its national identity. The question was not how to preserve nature through natural science, but more how to conserve such natural resources and images that were considered to be the basis of national identity and thus of the national history. National parks, isolated from technology, and distant enough so as to have no economic value, were considered the solution to the problem. Methodologically the thesis belongs to the genre of science and technology studies, and offers new viewpoints with regard to both the study of Finnish popular enlightenment literature and the national development process as a whole.

Aineellista ja aineetonta turvaa : Ruokakunnat, ekologis-taloudelliset resurssit ja kontaktinmuodostus Valkealassa 1630 1750

Material and immaterial security. Households, ecological and economic resources and formation of contacts in Valkeala parish from the 1630s to the 1750s. The geographical area of the thesis, Valkeala parish in the region of Kymenlaakso, is a very interesting area owing to its diversity, both in terms of natural setting and economic and cultural structure. The study begins by outlining the ecological and economic features of Valkeala and by analysing household structures. The main focus of the research lies in the contacts of the households with the outside world. The following types of contacts are chosen as indicators of the interaction: trade and credit relations, guarantees, co-operation, marriages and godparentage. The main theme of the contact analysis is to observe the significance of three factors, namely geographical extent, affluence level and kinship, to the formation of contacts. It is also essential to chart the interdependencies between ecological and economic resources, changes in the structure of households and the formation of contacts during the period studied. The time between the 1630s and the 1750s was characterized by wars, crop losses and population changes, which had an effect on the economic framework and on the structural variation of households and contact fields. In the 17th and 18th centuries Valkeala could be divided, economically, into two sections according to the predominant cultivation technique. The western area formed the field area and the eastern and northern villages the swidden area. Multiple family households were dominant in the latter part of the 17th century, and for most of the study period, the majority of people lived in the more complex households rather than in simple families. Economic resources had only a moderate impact on the structure of contacts. There was a clear connection between bigger household size and the extent and intensity of contacts. The jurisdictional boundary that ran across Valkeala from the northwest to the southeast and divided the parish into two areas influenced the formation of contacts more than the parish boundaries. Support and security were offered largely by the primary contacts with one s immediate family, neighbours and friends. Economic support was channelled from the wealthier to the less well off by credits. Cross-marriages, cross-godparentage and marital networks could be seen as manifestations of an aim towards stability and the joining of resources. It was essential for households both to secure the workforce needed for a minimum level of subsistence and to ensure the continuation of the family line. These goals could best be reached by complex households that could adapt to the prevailing circumstances and also had wider and more multi-layered contacts offering material and immaterial security.