Transcriptional patterns in inflammatory disease

Abstract: In the studies this thesis is based upon, microarrays were applied to profilemRNA populations in biological samples to gain insights into transcriptionalpatterns and their relation to inflammatory disease.Rheumatoid arthritis (RA) is a chronic inflammatory disease, which leads todegradation of cartilage and bone. RA is characterized by synovial inflammationwith varying levels of tissue heterogeneity. This was confirmed by microarrayanalyses of multiple biopsies from the joints of 13 patients, which showed interindividualvariation in transcript populations to be higher than intra?individualvariationTherapeutic antibodies targeting TNF?? have revolutionized treatment of RA,although some patients do not respond well. Identification of non?responders isimportant, not only because anti?TNF treatment elevates the risk of infections,but also because of the cost of treatment. A proof?of?concept study to investigatetranscriptional effects of anti?TNF treatment demonstrated that differencesbetween response groups could be identified and that these differences revealedbiological themes related to inflammatory disease.A subsequent study was therefore initiated with a larger cohort of 62 patients toinvestigate gene expression patterns in the synovium prior to anti?TNFtreatment. Here, the heterogeneity was even more pronounced, thetranscriptional patterns were confounded by the presence of synovial aggregatesand only a weak therapy?correlated signature was detected. The presence oflymphocyte aggregates was found to correlate to response to therapy, which isconsistent with previous findings indicating a higher level of inflammation ingood responding patients.Periodontitis is an inflammatory disease with many similarities to RA. Both areincurable chronic auto?immune diseases, characterized by tissue destructionwith common genetic associations. Individuals with RA are at higher risk ofaccumulating significant periodontal problems than the general population. PGE2(prostaglandin E2) is known to stimulate inflammation and bone resorption inperiodontitis. In further studies, microarrays were applied in a time seriesdesign on human gingival fibroblats to explore the signal transduction pathwayscontrolling TNF?? induced PGE2 synthesis in order to identify novel therapeutictargets. The JNK and NF?kb pathways were identified as being differentiallyaffected by TNF?a treatment. The transcriptional patterns were further verifiedusing antibodies against phosphorylated JNK/NF?kb molecules and specificinhibitors of the JNK and NF?kb signaling cascades.