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Teipel, Flavio Jan ; Teipel, Flavio: Influence of a dietary supplement with conjugated linoleic acid (CLA) on systemic immune responses in patients with multiple sclerosis. 2020
Inhalt
Abbreviations
1 Introduction
1.1 Multiple sclerosis
1.1.1 Epidemiology
1.1.2 Clinic
1.1.2.1 Symptoms
1.1.2.2 Clinical course
1.1.2.3 Diagnosis
1.1.3 Current therapy options
1.1.4 Pathogenesis
1.1.4.1 Lesional and systemic immune system alterations
1.1.4.2 Genetic influences
1.1.4.3 Environmental influences
1.1.4.4 Immune cell metabolism in MS
1.2 Conjugated linoleic acid
1.2.1 Chemical aspects
1.2.2 Occurrence in food items and natural intake
1.2.3 Effects in the context of inflammatory diseases
1.2.3.1 Effects on the immune system
1.2.3.2 Effects on inflammatory diseases
1.2.3.3 Effects in the context of CNS autoimmunity
1.2.4 Discussed modes of action
1.2.4.1 CLA influencing the immune system directly
1.2.4.2 CLA influencing the immune cell metabolism
1.2.4.3 CLA influencing the gut microbiota
1.2.4.4 CLA metabolites as key molecules
1.3 Aim of the thesis
2 Material
2.1 Devices
2.2 Disposables
2.3 Study medication
2.4 Constituents of media and buffers
2.5 Composition of media and buffers
2.6 Chemicals and reagents
2.7 Assay kits
2.8 Antibodies for cell activation
2.9 Antibodies for flow cytometry
2.10 Software
3 Methods
3.1 Biological sample acquisition
3.1.1 Clinical study
3.1.1.1 Inclusion and exclusion criteria
3.1.1.2 Study design
3.1.1.3 Analysis of baseline demographical and clinical data
3.1.1.4 Analysis of natural fat and CLA intake
3.1.2 HC samples
3.2 Cell culture
3.2.1 PBMC isolation
3.2.2 PBMC thawing
3.2.3 Determination of cell concentrations
3.2.3.1 Manual cell counting
3.2.3.2 Automatic cell counting
3.2.4 Adjustment of cell concentrations
3.2.5 CD4+ T cell isolation
3.2.6 Cell activation
3.2.6.1 PHA activation
3.2.6.2 LAC activation
3.2.6.3 PMA / ionomycin activation
3.2.6.4 anti-CD3 and anti-CD28 activation
3.2.7 in vitro CLA Treatment
3.3 Analytical methods
3.3.1 Enzyme-linked immunosorbent assay (ELISA)
3.3.2 Luminex® assay
3.3.3 Propidium iodide (PI) staining
3.3.4 Flow cytometry
3.3.4.1 Surface staining at 4 C
3.3.4.2 Surface staining at 37 C
3.3.4.3 Combined surface and intracellular staining at 4 C
3.3.4.4 Combined surface and intracellular staining at 37 C / 4 C
3.3.4.5 Combined surface and intracellular staining at 4 C after LAC stimulation
3.3.4.6 Data analysis
3.3.5 Metabolism analysis
3.4 Statistical methods
3.4.1 Descriptive statistics
3.4.2 Inferential statistics
3.4.3 Handling of values < LLOQ or > ULOQ
3.4.3.1 Values < LLOQ
3.4.3.2 Values > ULOQ
4 Results
4.1 in vitro experiments
4.1.1 Cytotoxicity investigation
4.1.2 CD4+ T cell cytokine production upon activation
4.1.2.1 Quantification in an ELISA assay
4.1.2.2 Quantification in a Luminex® assay
4.1.3 CD4+ T cell metabolism
4.2 Clinical study
4.2.1 Baseline demographical and clinical data
4.2.2 Natural fat and CLA intake
4.2.2.1 Fat intake
4.2.2.2 CLA intake
4.2.3 Clinical study endpoints
4.2.3.1 Adherence to study medication
4.2.3.2 Relapses
4.2.3.3 EDSS during follow-up
4.2.3.4 Paraclinical data
4.2.3.5 Correlation of relapses, EDSS during follow-up and paraclinical data
4.2.3.6 Adverse events
4.2.4 In-depth functional immune phenotyping
4.2.4.1 CD4+ T cells
4.2.4.2 CD8+ T cells
4.2.4.3 B cells
4.2.4.4 CD4+ Treg cells
4.2.5 CD4+ T cell cytokine production upon activation
4.2.6 CD4+ T cell metabolism
4.2.6.1 Oxidative phosphorylation (OXPHOS)
4.2.6.2 Glycolysis
5 Discussion
5.1 Clinical data
5.1.1 Baseline demographical and clinical data
5.1.2 Natural fat and CLA intake
5.1.3 Adherence to study medication
5.1.4 Relapses, EDSS and paraclinical development during follow-up
5.1.5 Adverse events
5.2 In-depth functional immune phenotyping
5.2.1 CD4+ T cells
5.2.1.1 TH17 cells and related immune cell subsets
5.2.1.2 CD4+ T cell cytokine production
5.2.2 CD8+ T cells
5.2.2.1 CD226 expression on CD8+ T cells
5.2.2.2 CD8+ T cell cytokine production
5.2.3 B cells
5.2.4 CD4+ Treg cells
5.2.5 Methodological limitations
5.3 CD4+ T cell cytokine production upon activation
5.4 CD4+ T cell metabolism
5.5 Study limitations
5.6 Gut microbiota
5.7 Outlook
6 Summary
Figures
Tables
Literature
Acknowledgments
Curriculum vitae
Appendix