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Pregnane X receptor (PXR) is a xenobiotic-sensing nuclear receptor that regulates drug metabolism in the liver and intestine. In our clinical trials on healthy volunteers to discover novel metabolic functions of PXR activation, we observed that rifampicin, a well-established ligand for human PXR, 600 mg daily for a week, increased the plasma alkaline phosphatase (ALP) significantly compared with the placebo. Further analysis with lectin affinity electrophoresis revealed that especially the bone form of ALP was elevated. To investigate the mechanism(s) of bone ALP induction, we employed osteoblast lineage differentiated from human primary bone marrow–derived mesenchymal stromal cells. Rifampicin treatment increased ALP activity and mRNA level of bone biomarker genes (ALP, MGP, OPN and OPG). PXR expression was detected in the cells, but the expression was very low compared with the human liver. To further investigate the potential role of PXR in the ALP induction, we treated mice and rats with a rodent PXR ligand pregnenolone 16α-carbonitrile (PCN). However, PCN treatment did not increase plasma ALP activity or bone ALP mRNA expression. In conclusion, rifampicin treatment induces the bone form of ALP in the serum of healthy human volunteers. Further studies are required to establish the mechanism of this novel finding.

The aim of the current study was to compare changes in serum biomarkers, including inflammatory mediators, signaling molecules, growth factors and markers of bone turnover after a single intravenous infusion of 5 mg zoledronic acid (ZA, a long-acting bisphosphonate; n = 20) or placebo (n = 20) among patients with Modic changes (MC) and chronic low back pain in a randomized controlled design. The MCs were classified into M1, predominating M1, predominating M2, and M2. We measured the serum concentrations of 39 biomarkers at baseline, and one month and one year after treatment. After Benjamini–Hochberg (B–H) correction, we observed significant differences in three biomarkers over one year: Interferon-γ-inducible protein (IP-10) had risen in the ZA group (p = 0.005), whereas alkaline phosphatase (AFOS) and intact procollagen I N-terminal propeptide (iPINP) had significantly decreased in the ZA group, but had not changed in the placebo group (p < 0.001 for both). Change in iPINP correlated with change in the volume of all MC and M1 lesions. ZA downregulated bone turnover markers as expected and, surprisingly, increased the chemokine IP-10 relative to placebo treatment. This adds to our knowledge of the effects of ZA on MC and the biomarkers that signal this process.

Introduction: Evaluation of the nerve fascicular structure can be useful in diagnosing nerve damage, but it is a very challenging task with 3T MRI because of limited resolution. In this pilot study, we present the feasibility of high‐resolution 7T MRI for examining the nerve fascicular structure. Methods: A 3‐dimensional (3D) gradient‐spoiled sequence was used for imaging peripheral nerves in extremities. Images acquired with different in‐plane resolutions (0.42 × 0.42 mm vs. 0.12 × 0.12 mm), and different main field strengths (7T vs. 3T) were compared. Results: The individual nerve fascicles were identified at 0.12 × 0.12 mm resolution in both field strengths but not at 0.42 × 0.42 mm resolution. The fascicular structure was more sharply depicted in 7T images than in 3T images. Discussion: High‐resolution 3D imaging with 7T MRI demonstrated feasibility for imaging nerve fascicular structures.

Objective: Hyperandrogenism, hyperinsulinaemia and obesity, known characteristics of polycystic ovary syndrome (PCOS), may influence bone mineral density and biochemical markers of bone turnover (BTMs) can provide a noninvasive assessment of bone turnover. To this end, the serum concentrations of BTMs and 25‐hydroxyvitamin D (25OHD) were analysed in women with PCOS, and their possible associations with metabolic parameters of PCOS were determined. Subjects and methods: Bone formation markers procollagen type I amino‐terminal propeptide (PINP) and osteocalcin (OC), and bone resorption marker carboxy‐terminal cross‐linking telopeptide of type I collagen (CTX), along with 25OHD, were measured in 298 women with PCOS and 194 healthy controls. Results: Serum levels of PINP (47.0 ± 20.2 vs 58.1 ± 28.6 μg/L, P < .001) and OC (18.2 ± 7.5 vs 20.6 ± 9.8 μg/L, P < .001) were decreased in women with PCOS compared with controls, whereas no significant differences were found in CTX and 25OHD levels. Age‐stratified analyses suggested that PINP (50.5 ± 21.7 vs 68.2 ± 26.6 μg/L, P < .001) and OC levels (20.4 ± 7.6 vs 25.5 ± 9.6 μg/L,P < .001) were decreased only in the younger age group (≤30 years) women with PCOS compared with controls. The formation markers and resorption marker decreased with age in both study groups. Conclusions: Bone formation markers were decreased in younger women with PCOS when compared with healthy women, which may affect bone mass in these women.

Rheumatoid arthritis (RA) is an autoimmune disease causing inflammation of synovial joints, which may lead to permanent changes in cartilage and bone tissues. RA patients have antibodies binding to citrullinated and also to carbamylated proteins. Antibodies binding to citrulline are associated with more severe disease progression and may already appear years before clinical disease onset. Citrulline and the lysine carbamylation product, homocitrulline, are similar in structure. Citrullinated proteins have been studied in RA and in neurological diseases, but researchers have been unaware of the effect of homocitrulline in citrulline detection methods. The purpose of the present study was to clarify the features of protein-bound citrulline and homocitrulline in relation to research done on citrullination and in immunological reactions related to rheumatoid arthritis. In the first study of this thesis the confounding role of homocitrulline in citrulline detection was shown. In the first and second study the features of experimentally induced antibodies were assessed. The antibodies induced with citrulline- and homocitrulline-containing protein structures were shown to react both with the ureido groups and the protein structures. The antibodies were able to distinguish between citrulline and homocitrulline in the same sequence even though binding to both. In the third study the simultaneous presence of citrulline and homocitrulline in RA synovial tissue was shown. In conclusion, considering the simultaneous presence of citrulline and homocitrulline and the binding features of the experimentally induced antibodies, homocitrulline could have a yet unsolved role in RA. Secondly, the existence of homocitrulline should be borne in mind in studies on citrullination. Tiivistelmä Nivelreuma on niveltulehduksen aiheuttava autoimmuunitauti, joka voi johtaa pysyviin muutoksiin nivelen rusto- ja luukudoksessa. Nivelreumaa sairastavilla esiintyy vasta-aineita sitrullinoituneita ja karbamyloituneita proteiineja vastaan. Sitrulliiniin sitoutuvia vasta-aineita voi esiintyä elimistössä jo vuosia ennen taudin puhkeamista, ja niiden esiintyminen on yhdistetty vaikeampaan taudinkuvaan. Sitrulliini ja lysiinin karbamylaatiotuote homositrulliini ovat rakenteellisesti samankaltaisia. Proteiinien sitrullinaatiota on tutkittu nivelreumassa ja neurologisissa taudeissa, mutta homositrulliinin olemassaoloa tai sen vaikutusta tutkimusmenetelmiin ei ole huomioitu. Tämän tutkimuksen tarkoituksena oli selvittää proteiineihin sitoutuneiden sitrulliinin ja homositrulliinin ominaisuuksia aikaisempiin tutkimuksiin ja nivelreuman immunologisiin reaktioihin liittyen. Tässä tutkimuksessa homositrulliinin osoitettiin häiritsevän sitrulliinin tunnistamista. Ensimmäisessä ja toisessa osatyössä aiheutettiin kokeellisesti vasta-aineita sitrulliinia ja homositrulliinia sisältävillä proteiinirakenteilla. Vasta-aineiden havaittiin reagoivan sekä ureidoryhmän että proteiinirakenteen kanssa. Vasta-aineet pystyivät erottamaan sitrulliinin ja homositrulliinin toisistaan samassa rakenteessa, vaikka sitoutuivat kumpaankin. Kolmannessa osatyössä osoitettiin, että sitrulliinia ja homositrulliinia esiintyy samanaikaisesti nivelreumapotilaan tulehtuneessa nivelkalvossa. Tutkimus osoitti, että sitrulliinin ja homositrulliinin samanaikainen esiintyminen ja kokeellisesti aiheutettujen vasta-aineiden ominaisuudet huomioiden homositrulliinilla voi olla jokin toistaiseksi selvittämätön rooli nivelreumassa. Homositrulliinin olemassaolo on syytä huomioida sitrullinaatiota tutkittaessa.

Cancer progression is a multistep process dependent on tumour-stroma interactions. Various cell types, such as fibroblasts, endothelial, inflammatory and stem cells, as well as extracellular matrix (ECM) proteins, such as collagens, contribute to the tumour outcome. Tumour growth and invasion is accompanied by the proteolysis of ECM components mediated by various enzymes, such as matrix metalloproteases (MMPs). Proteolytic fragments released into the circulation may reflect cancer progression. The aim of this study was to develop novel in vitro methods for investigating cell invasion and for measuring cancer-associated collagen degradation. Human carcinoma cell invasion studies in vitro are often performed in organotypic cell culture models, mainly composed of rat or mouse ECM proteins. To create a human microenvironment for invasion studies, a novel organotypic model based on human uterine myoma (benign tumour) tissue was developed. Compared to the conventional collagen-based organotypic model, in the myoma model the carcinoma cell invasion depth was about eightfold and the invasion resembled, to a greater degree, the invasion pattern of dissected tissue samples of cancer patients. In addition, the invasion was easily quantified with a novel radioimmunoassay measuring type III collagen degradation products from the organotypic culture media. As human mesenchymal stem cells (MSCs) are one of the stromal cell types that may affect tumour progression, the mechanisms of stem cell invasion were also studied. On the surface of MSCs, Toll-like receptor 9 (TLR9) functions in immune defence against microbes. The activation of TLR9 with microbial DNA-resembling molecules induced human MSC invasion into the myoma tissue in a MMP-13-mediated fashion. To analyse cancer-associated soft tissue degradation, a novel enzyme immunoassay was developed. This novel assay enabled, for the first time, the measurement of type III collagen degradation products from human serum samples. In head and neck cancer patient sera, high levels of type III and type I collagen degradation products were shown to predict poor survival. In conclusion, the novel myoma model showed that the tumour microenvironment crucially affects carcinoma cell invasion. In addition, cancer-associated type III collagen degradation was successfully measured in cell cultures and in human sera by novel immunoassays. Tiivistelmä Syövän eteneminen on monivaiheinen tapahtuma, jossa syöpäsolut ovat vuorovaikutuksessa lähiympäristönsä kanssa. Ympäristön eri solutyypit, kuten kantasolut ja sidekudoksen fibroblastit sekä soluväliaineen proteiinit kuten kollageenit, vaikuttavat syöpäsolujen invaasioon eli tunkeutumiseen ympäröivään kudokseen. Syövän invaasiossa useat entsyymit, mm. matriksin metalloproteaasit (MMP:t), hajottavat soluväliainetta. Kasvaimen kehittymisen aikana verenkiertoon vapautuu soluväliaineen hajoamistuotteita, joiden määrä voi kuvastaa sairauden etenemistä. Väitöstutkimuksen tarkoituksena oli kehittää uusia menetelmiä solujen invaasion ja syöpään liittyvän kollageenin hajoamisen tutkimiseen. Ihmisen karsinoomasolujen invaasion tutkimuksessa on perinteisesti käytetty kolmiulotteisia soluviljelymalleja, jotka koostuvat pääasiassa rotan tai hiiren soluväliaineproteiineista. Työssä kehitettiin uusi viljelymalli, jossa soluja kasvatettiin ihmisen hyvälaatuisen kohtukasvainkudospalan eli myooman päällä. Perinteiseen kollageenimalliin verrattuna myoomamallissa karsinoomasolut tunkeutuivat noin kahdeksan kertaa syvemmälle, ja solujen kasvu muistutti enemmän potilaiden syöpäkudosnäytteissä havaittua kasvutapaa. Invaasion voimakkuuden määrittämiseen kehitettiin vasta-aineisiin perustuva menetelmä, jolla mitattiin soluviljelmän kasvatusliuokseen myoomakudoksesta vapautuneiden tyypin III kollageenin hajoamistuotteiden määrää. Koska kantasolujen tiedetään voivan vaikuttaa syöpäkasvaimen leviämiseen, tutkimme myös ihmisen luuytimen kantasolujen invaasiota. Kantasolujen pinnalla TLR9-reseptori osallistuu immuunipuolustukseen mikrobeja vastaan. Kun reseptoria aktivoitiin mikrobi-DNA:ta muistuttavilla molekyyleillä, kantasolut alkoivat invasoitua myoomakudokseen ja MMP-13:n aktiivisuus soluissa lisääntyi. Syöpään liittyvän pehmytkudoksen hajoamisen tutkimiseksi kehitettiin vasta-ainemenetelmä, jolla onnistuttiin ensi kertaa mittaamaan potilaiden seeruminäytteistä tyypin III kollageenin hajoamistuotteita. Pään ja kaulan alueen syöpäpotilailla korkean tyypin III kollageenin hajoamistuotepitoisuuden todettiin liittyvän huonoon ennusteeseen. Tutkimus osoitti, että kasvaimen ympäristö vaikuttaa olennaisesti syöpäsolujen leviämiseen. Syöpään liittyvää tyypin III kollageenin hajoamista pystyttiin työssä kehitetyillä menetelmillä mittaamaan sekä soluviljelmistä että potilaiden seeruminäytteistä.