Publications

Autoimmune diseases encompass a diverse group of disorders that collectively affect 5% of the population. Despite large clinical variability, autoimmune disorders share a common etiology in that they all develop from immune responses against self. T-cell receptors and antibodies recognize distinct self-molecules and direct destructive effector mechanisms to the target organs. Characterization of autoimmune targets can help in the understanding autoimmune disease features and is of additional importance for subsequent use in clinical diagnosis.Rare monogenic disorder can provide an access to the study and understanding of mechanisms underlying common and more complex diseases. Autoimmune polyendocrine syndrome type 1 (APS1) is an autosomal recessive disorder caused by mutations in the AIRE gene, and is a valuable model of tissue-specific autoimmune disease. APS1 patients develop multiple autoimmune disease manifestations and display autoantibodies against the affected tissues.Recent development in protein array technology has opened a novel avenue for explorative biomarker studies in autoimmune disorders. Present-day protein arrays contain many thousands of full-length human proteins and enable autoantibody screens at the proteome-scale.In the current work I have utilized proteome arrays to perform a comprehensive study of autoimmune targets in APS1. Survey of established autoantigens revealed highly reliable detection of autoantibodies, and by exploring the full panel of 9000 proteins we further identified three novel, major autoantigens. Our findings revealed a marked enrichment for tissue-specific immune targets and further suggest that only a very limited portion of the proteome becomes targeted by the immune system in APS1. This work identifies prostatic transglutaminase 4 as novel male-specific autoantigen. In the mouse model of APS1 we could link TGM4 immunity with a tissue-destructive prostatitis, a compromised prostatic secretion of TGM4 and with defect in the establishment of central immune tolerance for TGM4. Our findings suggest prostate autoimmunity is a major manifestation in male APS1 patients with potential role in development of subfertility. In this doctoral work we also report on collecting duct autoantibodies in APS1 patients with interstitial nephritis and on the identification of aquaporin 2 as a collecting duct autoantigen. Collectively, the present investigations provide an overview-perspective on the autoimmune target repertoire in APS1 and identify novel autoimmune manifestations of the syndrome.

Mutations of the gene encoding four-and-a-half LIM domain 1 (FHL1) are the causative factor of several X-linked hereditary myopathies that are collectively termed FHL1-related myopathies. These disorders are characterized by severe muscle dysfunction and damage. Here, we have shown that patients with idiopathic inflammatory myopathies (IIMs) develop autoimmunity to FHL1, which is a muscle-specific protein. Anti-FHL1 autoantibodies were detected in 25% of IIM patients, while patients with other autoimmune diseases or muscular dystrophies were largely anti-FHL1 negative. Anti-FHL1 reactivity was predictive for muscle atrophy, dysphagia, pronounced muscle fiber damage, and vasculitis. FHL1 showed an altered expression pattern, with focal accumulation in the muscle fibers of autoantibody-positive patients compared with a homogeneous expression in anti-FHL1-negative patients and healthy controls. We determined that FHL1 is a target of the cytotoxic protease granzyme B, indicating that the generation of FHL1 fragments may initiate FHL1 autoimmunity. Moreover, immunization of myositis-prone mice with FHL1 aggravated muscle weakness and increased mortality, suggesting a direct link between anti-FHL1 responses and muscle damage. Together, our findings provide evidence that FHL1 may be involved in the pathogenesis not only of genetic FHL1-related myopathies but also of autoimmune IIM. Importantly, these results indicate that anti-FHL1 autoantibodies in peripheral blood have promising potential as a biomarker to identify a subset of severe IIM.

Autoimmune polyendocrine syndrome type 1 (APS1), a monogenic disorder caused by AIRE gene mutations, features multiple autoimmune disease components. Infertility is common in both males and females with APS1. Although female infertility can be explained by autoimmune ovarian failure, the mechanisms underlying male infertility have remained poorly understood. We performed a proteome-wide autoantibody screen in APS1 patient sera to assess the autoimmune response against the male reproductive organs. By screening human protein arrays with male and female patient sera and by selecting for gender-imbalanced autoantibody signals, we identified transglutaminase 4 (TGM4) as a male-specific autoantigen. Notably, TGM4 is a prostatic secretory molecule with critical role in male reproduction. TGM4 autoantibodies were detected in most of the adult male APS1 patients but were absent in all the young males. Consecutive serum samples further revealed that TGM4 autoantibodies first presented during pubertal age and subsequent to prostate maturation. We assessed the animal model for APS1, the Aire-deficient mouse, and found spontaneous development of TGM4 autoantibodies specifically in males. Aire-deficient mice failed to present TGM4 in the thymus, consistent with a defect in central tolerance for TGM4. In the mouse, we further link TGM4 immunity with a destructive prostatitis and compromised secretion of TGM4. Collectively, our findings in APS1 patients and Aire-deficient mice reveal prostate autoimmunity as a major manifestation of APS1 with potential role in male subfertility.

AIMS/HYPOTHESIS:Diabetes mellitus is one of the most common endocrine disorders in dogs and is commonly proposed to be of autoimmune origin. Although the clinical presentation of human type 1 diabetes (T1D) and canine diabetes are similar, the aetiologies may differ. The aim of this study was to investigate if autoimmune aetiology resembling human T1D is as prevalent in dogs as previously reported.METHODS:Sera from 121 diabetic dogs representing 40 different breeds were tested for islet cell antibodies (ICA) and GAD65 autoantibodies (GADA) and compared with sera from 133 healthy dogs. ICA was detected by indirect immunofluorescence using both canine and human frozen sections. GADA was detected by in vitro transcription and translation (ITT) of human and canine GAD65, followed by immune precipitation. Sections of pancreata from five diabetic dogs and two control dogs were examined histopathologically including immunostaining for insulin, glucagon, somatostatin and pancreas polypeptide.RESULTS:None of the canine sera analysed tested positive for ICA on sections of frozen canine or human ICA pancreas. However, serum from one diabetic dog was weakly positive in the canine GADA assay and serum from one healthy dog was weakly positive in the human GADA assay. Histopathology showed marked degenerative changes in endocrine islets, including vacuolisation and variable loss of immune-staining for insulin. No sign of inflammation was noted.CONCLUSIONS/INTERPRETATIONS:Contrary to previous observations, based on results from tests for humoral autoreactivity towards islet proteins using four different assays, and histopathological examinations, we do not find any support for an islet autoimmune aetiology in canine diabetes mellitus.

Syftet med denna studie var att göra en komparativ undersökning mellan Sverige och Norge respektive Sverige och Danmark om hur hälsobegreppet används i kursplanerna i idrott och hälsa. Studien utgår från två frågeställningar: Vilka olika synsätt kring hälsobegreppet kan urskiljas? Vilka likheter och skillnader finns det mellan kursplanerna? Studien utgår från en kvalitativ textanalys där kursplaner från Sverige, Norge och Danmark har analyserats. Kursplanerna har analyserats utifrån en framtagen analysmodell. Den teoretiska utgångspunkten i studien är Aaron Antonovskys teori kring KASAM, känslan av sammanhang. Resultatet visar att den fysiska hälsan är dominerande i samtliga kursplaner och att den psykiska hälsan har större utrymme i den norska och den danska kursplanen jämfört med den svenska kursplanen.

Syfte: Syftet med studien var att undersöka vårdpersonals kunskaper, attityder och bemötande i vården av dementa i äldresjukvården.
Metod: En deskriptiv kvalitativ studie genomfördes med sju semi-strukturerade intervjuer med åtta deltagare från äldreboenden i Jönköpings län. Intervjuerna spelades in och bearbeta-des med innehållsanalys.
Resultat: I resultatet framkom att intervjupersonernas personliga erfarenheter av demenssjukdom påverkade deras förståelse för anhöriga till demenssjuka. Vårdpersonalen ansåg att anhörigas kunskaper och åsikter var viktiga. Aktiviteter anpassades efter de demenssjukas förmågor och intressen. Vikten av att se personen bakom sjukdomen betonades, detta var svårt vid tids- och personalbrist. Bra bemötande ansågs bestå av respekt, lugn och tålamod. När de demenssjuka blev aggressiva och oroliga användes lugnt bemötande, närhet, avledning och personcentrerad vård, hellre än lugnande läkemedel.
Slutsats: God kunskap och bra attityder är grunden i bemötandet av demenssjuka, men tids- och personalbrist kan försvåra vården. Det är viktigt med individanpassade aktiviteter och ökad anhörigkunskap. Vidare studier inom ämnet behövs.

Forskning visar att flertalet lokala kursplaner är formulerade på så vis att elever blir bedömda efter beteende. Det har visat sig att en viss beteendenorm ska främjas inom ämnet Idrott och hälsa (Larsson, 2004:212). I denna studie undersöks i vilken grad betyget i ämnet påverkas av elevernas beteende under lektionerna i Idrott och hälsa ur ett genusperspektiv. Studien utgår från tre frågeställningar: Skiljer det sig mellan könen på eleverna när det kommer till lärares toleransnivå för oönskat beteende? Vad säger det lokala betygskriterierna i fråga om kunskap kontra beteende inom ämnet Idrott och hälsa? Hur upplever lärarna i Idrott och hälsa sitt hanterande av att skilja på beteende och kunskap?
 
Studien har en kvalitativ forskningsansats där fem lärare i ämnet Idrott och hälsa har intervjuats. Genusperspektivet genomsyrar studien. Studien har kompletterats med observationer och en granskning av de lokala kursplanerna för respektive skola.
 
Denna studie visar att det finns en problematik kring bedömningen i ämnet Idrott och hälsa. Den visar att flertalet lärare påverkas av elevernas beteende och uppträdande i deras betygsättning av dem trots det menar flera av lärarna att de kan skilja på beteende och kunskap. Majoriteten av de intervjuade lärarna menar att beteende är en del av de lokala betygskriterierna. När det kommer till toleransnivå mellan könen så har de olika lärarna varierade åsikter men gemensamt menar de att det finns en problematik kring ämnet.

Aim: To enhance detection sensitivity of phosphorylated α-synuclein (pSynS129) on post mortem synucleinopathy brains using the newly developed PLA and characterize possible ‘strain’-specific differences in the synucleinopathy brains.Experimental plan: Four different antibodies detecting different epitopes from N- to C- terminal of α-syn were paired systematically with an antibody detecting pSynS129 to reveal patho-morphological features of α-syn aggregates on post mortem brain tissue. In addition, we tested the application of our novel PLA technique in the A30P-tg mouse model that shows different types of pSynS129 aggregates in different stages of PD.Results: The PLA experiments revealed a wide distribution of pSynS129 aggregates in post mortem synucleinopathy-patient brains. We observed unique staining patterns on the brain tissue sections using only certain antibody combinations in a PLA setup, which could not be visualized using regular immunohistochemistry. In A30P-tg mice, the morphological pattern of PLA signal indicated an age-progressive, intracellular shift of pSynS129 aggregation species from periphery towards soma in the prefrontal cortex.Significance: Here we demonstrate that employing PLA with certain α-syn antibodies pair combinations can enhance detection sensitivity and specificity of α-syn pathology in the respective synucleinopathies. Additionally, it could be a useful tool to monitor the ‘strain’-specific aggregation and intracellular morphology of α-syn on post mortem brain tissue.

Aim: To monitor temporal evolution of glial and peripheral events occurring, prior to pSynS129 inclusion formation, after a single intra-cranial injection of pre-formed fibrils (PFFs) in the wild-type (wt) mice.Experimental plan: Here we perform intracerebral inoculations with mouse PFFs in wt mice (n=30) to study early pathological and inflammatory events from 1 to 30 days post-injections (dpi) at regular time intervals. The paraffin-fixed brain sections were stained against pSynS129 species with the in house developed  proximity ligation assay. Furthermore, studies using different glial and inflammatory markers revealed more information regarding the early cellular interactions involving formation and propagation pSynS129 species.Results: Already after 1 dpi, we observe strong pSynS129 immunoreactivity close the striatal injection site. Intriguingly, this type of staining disappeared with the concurrent formation of peri-nuclear pSynS129 inclusions in motor and piriform cortex, amygdala and periventricular hypothalamus after 14 dpi. Concomitantly, we observed astrocytic activation as early event happening prior to intracellular formation and propagation pSynS129 inclusions in the brain and peripheral organs.Significance: Our study elucidates the temporal relationship regarding inflammation and formation of pSynS129 inclusions. Our results indicate that a single PFF injection is enough to induce astrocytic activation and neuro-inflammatory response that occur prior to intra-neuronal accumulation of misfolded α-syn.

Since autoantibodies are recognized as valuable biomarkers for clinical diagnostics and prognostics in autoimmune diseases such as Stiff Person Syndrome (SPS) and Type 1 diabetes, detection of such markers at improved sensitivity and specificity could be of significant interest. In addition, as proximity assays have been shown to offer highly sensitive and specific detection of multiple proteins, the technique could be expanded to applications for autoimmunity detection. In the present study, we have applied the newly developed proximity ligation assay with rolling circle amplification (PLARCA), and proximity extension assay (PEA) for the detection of GADA, autoantibodies specific for glutamic acid decarboxylase 65 (GAD65). Through the use of oligonucleotide conjugated autoantigen GAD65 and anti-human antibodies, as proximity probes, we were able to apply these proximity assays to detect GADA in a set of SPS patient samples. In summary, we have applied and established both PLARCA and PEA, as a proof of concept, for the use of the specific and sensitive autoimmune detection.

Aims/hypothesis
Diabetes mellitus (DM) is one of the most common endocrine disorders in dogs, and is commonly proposed to be of autoimmune origin. Although the clinical symptoms of human type 1 diabetes (T1D) and canine DM are similar, the aetiologies may differ. The aim of this study was to investigate if autoimmune aetiology resembling human T1D is as prevalent in dogs as previously reported.
Methods
 Sera from 121 diabetic dogs representing 38 different breeds were tested for islet cell antibodies (ICA) and GAD65 autoantibodies (GADA) and compared with sera from 133 healthy dogs from 40 breeds. ICA was detected by indirect immunofluorescence using both canine and human frozen sections. GADA was detected by in vitro transcription and translation (ITT) of human and canine GAD65, followed by immunoprecipitation.
Results
None of the canine sera analyzed tested positive for ICA on sections of frozen canine or human ICA pancreas. However, serum from one diabetic dog was weakly positive in the canine GADA assay and serum from one healthy dog was weakly positive in the human GADA assay.
Conclusions/interpretations
Based on sera from 121 diabetic dogs from 38 different breeds were tested for humoral autoreactivity using four different assays, contrary to previous observations, we find no support for an autoimmune aetiology  in canine diabetes.

Several neurodegenerative diseases, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), display deposits of phosphorylated tau (pTau) and/or alpha-synuclein (pSyn) in affected parts of the brain. However, the pathological and morphological properties of these protein aggregates remain poorly characterized, due to lack of specificity and sensitivity of in situ detection techniques. The aim of this study was to investigate the patho-morphological properties of phosphorylated tau and α-syn aggregates on AD and PD brain tissues with a novel sensitive in situ proximity ligation assay (PLA) technique. We took advantage of the sensitivity and <40 nm resolution of PLA, along with the selectivity of different antibodies directed against pTau and pSyn epitopes. Most notably, multiplex pTauS202, T205-pTauT231, singleplex pTauT231 and pSynS129 PLA recognized more extensive phosphorylated tau and αSyn pathology, compared to conventional immunohistochemistry (IHC) using the same antibodies on adjacent brain sections. Furthermore, singleplex pTauT231 PLA captured additional pathological aggregates compared to the singleplex pTauS202, T205 PLA in late Braak stage AD brains, where traditional IHC failed to distinguish between pTauS202, T205 and pTauT231 pathology. Similarly, in PD brains, singleplex pSynS129 PLA detected novel pathological structures, such as intercellular thick tunneling nanotubes and pre-Lewy body intracytoplasmic aggregates, whereas pSynS129 IHC was limited to the detection of mature Lewy body/neurite pathology. Lastly, we could demonstrate that our dual PLA approach also can be applied to detect co-aggregates of pSyn-pTau.

It is important to determine the localization of drugs or drug candidates at cellular and subcellular resolution in relevant clinical specimens. This is necessary to evaluate drug candidates from early stages of drug development to clinical evaluation of mutations potentially causing resistance to targeted therapy. We describe a technology where oligonucleotide-conjugated drug molecules are used to visualize and measure target engagement in situ via rolling-circle amplification (RCA) of circularized oligonucleotide probes (padlock probes). We established this target engagement-mediated amplification (TEMA) technique using kinase inhibitor precursor compounds, and we applied the assay to investigate target interactions by microscopy in pathology tissue sections and using flow cytometry for blood samples from patients, as well as in commercial arrays including almost half of all human proteins.  In the variant proxTEMAtechnique, in situ proximity ligation assays were performed by combining drug-DNA conjugates with antibody-DNA conjugates to specifically reveal drug binding to particular on- or off-targets in pathological tissues sections. In conclusion, the TEMA methods successfully visualize drug-target interaction by experimental and clinically approved kinase inhibitors in situ and with kinases among a large collection of arrayed proteins.