Herpes simplex virus type 1 (HSV-1) pathogenesis and HSV gene therapy of experimental autoimmune encephalomyelitis

The aim of this thesis was to develop new herpes simplex virus (HSV) vectors for gene therapy of experimental autoimmune encephalomyelitis (EAE), the principal model of multiple sclerosis (MS), and to study the pathogenesis of wild-type HSV-1 and HSV-1 vectors in vivo. By introducing potential immunomodulatory factors into mice with EAE we strived to develop therapies and possibly find molecules improving recovery from EAE. We aimed at altering the immune response by inducing favorable Th2-type cytokines, thus shifting the immune response from a Th1- or a Th17-response. Our HSV vector expressing interleukin (IL)-5 modulated the cytokine responses, decreased inflammation and alleviated EAE. The use of a novel method, bacterial artificial chromosome (BAC), for engineering recombinant HSV facilitated the construction of a new vector expressing leukemia inhibitory factor (LIF). LIF is a neurotropic cytokine with broad functions in the central nervous system (CNS). LIF promotes oligodendrocyte maturation and decreases demyelination and oligodendrocyte loss. The BAC-derived HSV-LIF vector alleviated the clinical symptoms, induced a higher number of oligodendrocytes and modulated T cell responses. By administering HSV via different infection routes, e.g. peripherally via the nose or eye, or intracranially to the brain, the effect of the immune response on HSV spread at different points of the natural infection route was studied. The intranasal infection was an effective delivery route of HSV to the trigeminal ganglion and CNS, whereas corneal infection displayed limited spread. The corneal and intranasal infections induced different peripheral immune responses, which might explain the observed differences in viral spread.

Factors predicting mortality in type 2 diabetes. With special reference to physical exercise, blood pressure, proteinuria, inflammation and P wave duration

Background: Type 2 diabetes patients have a 2-4 fold risk of cardiovascular disease (CVD) compared to the general population. In type 2 diabetes, several CVD risk factors have been identified, including obesity, hypertension, hyperglycemia, proteinuria, sedentary lifestyle and dyslipidemia. Although much of the excess CVD risk can be attributed to these risk factors, a significant proportion is still unknown. Aims: To assess in middle-aged type 2 diabetic subjects the joint relations of several conventional and non-conventional CVD risk factors with respect to cardiovascular and total mortality. Subjects and methods: This thesis is part of a large prospective, population based East-West type 2 diabetes study that was launched in 1982-1984. It includes 1,059 middle-aged (45-64 years old) participants. At baseline, a thorough clinical examination and laboratory measurements were performed and an ECG was recorded. The latest follow-up study was performed 18 years later in January 2001 (when the subjects were 63-81 years old). The study endpoints were total mortality and mortality due to CVD, coronary heart disease (CHD) and stroke. Results: Physically more active patients had significantly reduced total, CVD and CHD mortality independent of high-sensitivity C-reactive protein (hs-CRP) levels unless proteinuria was present. Among physically active patients with a hs-CRP level >3 mg/L, the prognosis of CVD mortality was similar to patients with hs-CRP levels ≤3 mg/L. The worst prognosis was among physically inactive patients with hs-CRP levels >3 mg/L. Physically active patients with proteinuria had significantly increased total and CVD mortality by multivariate analyses. After adjustment for confounding factors, patients with proteinuria and a systolic BP <130 mmHg had a significant increase in total and CVD mortality compared to those with a systolic BP between 130 and 160 mmHg. The prognosis was similar in patients with a systolic BP <130 mmHg and ≥160 mmHg. Among patients without proteinuria, a systolic BP <130 mmHg was associated with a non-significant reduction in mortality. A P wave duration ≥114 ms was associated with a 2.5-fold increase in stroke mortality among patients with prevalent CHD or claudication. This finding persisted in multivariable analyses. Among patients with no comorbidities, there was no relationship between P wave duration and stroke mortality. Conclusions: Physical activity reduces total and CVD mortality in patients with type 2 diabetes without proteinuria or with elevated levels of hs-CRP, suggesting that the anti-inflammatory effect of physical activity can counteract increased CVD morbidity and mortality associated with a high CRP level. In patients with proteinuria the protective effect was not, however, present. Among patients with proteinuria, systolic BP <130 mmHg may increase mortality due to CVD. These results demonstrate the importance of early intervention to prevent CVD and to control all-cause mortality among patients with type 2 diabetes. The presence of proteinuria should be taken into account when defining the target systolic BP level for prevention of CVD deaths. A prolongation of the duration of the P wave was associated with increased stroke mortality among high-risk patients with type 2 diabetes. P wave duration is easy to measure and merits further examination to evaluate its importance for estimation of the risk of stroke among patients with type 2 diabetes.

Clever-1 ja sen ilmeneminen konditionaalisesti poistogeenisissä hiirimalleissa

Proteiinit ovat elimistön perusyksiköitä. Niiden oikeanlainen toiminta ja rakenne ovat välttämättömiä solujen tarkoituksenmukaiselle toiminnalle. CLEVER-1 (common lymphatic endothelial and vascular entohelial receptor-1) on tyypin 2 makrofageissa ja sinusoidaalisessa endoteelissä tavallisesti ilmentyvä proteiini, jonka yhteyttä elimistön normaaliin toimintaan ja moniin eri sairaustiloihin on pyritty selvittämään. Tämän syventävien opintojen kirjallisen työn tarkoituksena on koota kirjallisuuskatsaukseen tämänhetkinen tieto CLEVER-1 -molekyylistä sekä kokeellisessa osiossa tutkia kyseisen molekyylin ilmenemistä eri hiirimalleissa. Kirjallisuuskatsauksen artikkelit valittiin PubMed-tietokannasta. Kokeellisessa osiossa perehdyin CLEVER-1:n ilmenemiseen hiiren maksassa, munuaisessa ja keuhkoissa. Tarkoituksena oli tutkia molekyylin ilmenemistä villityypin hiirissä ja verrata ilmenemistä hiiriin, joissa CLEVER-1 on poistettu vain joko makrofageista tai endoteelisoluista (ns. konditionaalisesti poistogeeniset hiirimallit). Ilmenemistä tutkittiin kaksoisfluoresenssivärjäyksillä. Kirjallisuuskatsauksessa osoitan, miten CLEVER-1 on liitetty moniin eri sairaustiloihin, erityisesti syöpäsairauksiin sekä tulehduksellisiin sairauksiin. Lisäksi pyrin hieman kartoittamaan tulevaisuudennäkymiä CLEVER-1:een liittyvässä tutkimuksessa. Kokeellisessa osiossa sain tuloksia, jotka osoittavat, että konditionaalisesti poistogeeniset hiirimallit eivät toimi aivan odotetulla tavalla. CLEVER-1:tä ei ole kyetty poistamaan täysin halutuista kohdesoluista. Havaitsin kuitenkin joitakin eroja ilmenemisessä poistogeenisten ja villityypin hiirten välillä. Lisäksi CLEVER-1 ilmentyy bronkiolaaristen epiteelisolujen alla kaikkien hiirilinjojen keuhkoissa. Näiden solujen alkuperä on vielä toistaiseksi tuntematon.