1. Mechanisms by which pro-inflammatory cytokines and anti-heterogeneous nuclear
ribonuclear protein A1-M9 (anti-hnRNP A1-M9) antibodies cause neurodegeneration
in multiple sclerosis
Research proposal:
NIH Medical Student Research Fellowship Program
Peter Ketch
1177 Union Ave, #302
Memphis, TN 38104
(214) 901-4525
pketch@uthsc.edu
University of Tennessee Health Science Center
College of Medicine, Class of 2019
Mentor: Dr. Michael C. Levin, MD
Professor, Department of Neurology & Anatomy Neurobiology
University of Tennessee Health Science Center
Chief, Neurology Service, VAMC-Memphis
Director, Multiple Sclerosis Center
Laboratory for Viral and Demyelinating Diseases
855 Madison Avenue, Room 415
Memphis, TN 38163
(901) 448-2243
mlevin@uthsc.edu
May 31, 2016 – August 16, 2016
Memphis VA Medical Center

2. Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) with
hallmark demyelination and neurodegeneration. Data suggest that Th1 and Th17 CD4+ lymphocytes and their
cytokines are thought to play a role in pathogenesis of neurodegeneration seen in MS. Neuronal exposure to
a mixture of these pro-inflammatory cytokines causes mislocalization of heterogeneous nuclear ribonuclear
protein A1 (hnRNP A1), which accumulates in the cytoplasm. Importantly, MS patients develop an antibody
against hnRNP A1. Similar experiments demonstrate that anti-hnRNP A1-M9 antibodies induce similar
molecular events, in addition to stress granule (SG) formation and changes in RNA metabolism of clinically
relevant RNAs. We hypothesize that an individual or combinations of pro-inflammatory Th17 cytokines can
influence molecular events important to the pathogenesis of MS, including mislocalization of hnRNP A1 and
the formation of SGs. In vitro experiments with SK-N-SH cells demonstrate that select individual and
combinations of Th17 cytokines (IL-17A, IL-23, IL-1β, TGF-β, and IL-6) can induce the formation of SGs,
mislocalization of hnRNP A1, and colocalization of hnRNP A1 with a SG marker, Poly(A)-binding protein
(PABP). Taken together, these data suggest a potential role of pro-inflammatory Th17 cytokines in the
pathogenesis of neurodegeneration through an hnRNP A1 mechanism seen in MS.

3. I. Introduction
Multiple sclerosis (MS) is an immune-mediated inflammatory disease that results in demyelination of
the central nervous system (CNS). The neurological disability seen in patients with MS is highly variable,
but can progress irreversibly in association with neuronal and axonal damage, or neurodegeneration.
Neurodegeneration in the CNS has been shown to contribute to the pathogenesis of MS, but was thought to
be secondary to the disease’s hallmark inflammatory demyelination. However, neurodegeneration can occur
independently of demyelinating plaque formation and is now viewed a critical component of the long-term
neurological disability seen in MS, especially progressive forms. In fact, a number of studies demonstrate a
significant reduction in nerve fiber density in corticospinal tracts and dorsal columns, independent of plaque
formation2,8-22. Although demyelination and its associated inflammatory processes are well described, the
pathophysiological mechanisms of neurodegeneration in MS are not well understood. Evidence of neuronal
and axonal degeneration has been shown in the brains and spinal cords of patients with MS, although
specific mechanisms are not clearly indicated and appear to be multifactorial9-11,23-25.
RNA binding proteins (RBPs) belong to a diverse class of proteins with varying functions including
RNA transcription, transport and translation. An important function of some of these RBPs, including
heterogeneous nuclear ribonuclearprotein A1 (hnRNP A1), is transport of mRNA from the nucleus to the
cytoplasm. Extensive studies in Dr. Levin’s lab have demonstrated that MS patients develop anti-hnRNP A1
antibodies and that these antibodies cause neurodegeneration3,4,21,33,35,37. Normally functioning hnRNP A1
binds mRNA and transportin in the nucleus, transports mRNA to the cytoplasm via a nuclear pore, then
quickly translocates back into nucleus4. The M9 region of hnRNP A1 contains a sequence that binds
transportin. When antibodies bind to this region, hnRNP A1 cannot return to the nucleus. The presence of
autoantibodies to M9 in patients with MS causes hnRNP A1 to accumulate in the cytoplasm, instead of the
nucleus where it is usually observed in highest quantity4,32. Furthermore, this accumulation corresponds to
reduced levels of ATP and increased levels of apoptosis, important markers of neurodegeneration4. These
findings demonstrate an important association between anti-A1-M9 antibodies and neurodegeneration in MS.

4. Anti-hnRNPA1-M9 antibodies can induce stress granule (SG) formation in neurons and can cause
changes in RNA metabolism of the hnRNP A1 protein’s RNA cargo44. During times of cellular stress, SGs
contain dysfunctional RBPs and their translationally repressed mRNA cargo45. Studies in Dr. Levin’s lab
demonstrated that adding anti-A1-M9 antibodies to neuronal cell lines in culture resulted in SG formation
and that the antibodies colocalize with the SGs44. In previous studies, Dr. Levin’s lab showed that the levels
of specific genes, including SPG4 (spastin) and SPG7 (paraplegin), were altered in response to transfection
of neuronal cells with anti-
hnRNP A1-M9 antibodies.
RNA immunoprecipitation
studies revealed that SPG4
and SPG7 (to a lesser
extent) bound hnRNPA1
(Fig SA2-4). Furthermore,
Western blots showed that anti-hnRNP A1-M9 antibodies caused a profound reduction in SPG4 and SPG7
protein levels3. This experiment demonstrated that anti-hnRNPA1-M9 antibodies specifically altered the
translation of clinically relevant RNAs that were shown to bind to A1.
In addition to antibody-mediated
immunoreactivity, there are other factors, like
pro-inflammatory cytokines, that may act in
conjunction to produce the neurodegeneration
seen in MS. Different subtypes of MS display
distinct inflammatory activity. Early forms of
MS (acute and relapsing-remitting) are
characterized by Th1 and Th17 CD4+
lymphocyte responses and demyelination and
neuronal injury correlated with T and B cells11,14,26,29-31. More diffuse CNS inflammation and IgG-positive
Fig SA2-4. RNAImmunoprecipitation andWesternblot
analyses. SK-N-SHcells lysateswere incubated with
agarose beads labeled anti-A1-M9 or control abs. A.
Western blots showed thathnRNP A1 waspresentin the
lysate (L) and the anti-A1-M9 IP (A1) butnotin control IgG
IP (IgG). B. RNA wasisolated from protein eluents and
amplified by RT-PCR. Values were normalizedto GAPDH.
Results revealed thathnRNP A1 and SPG4 are RNA
binding partners ofhnRNP A1 and SPG-7 showed a
positive trend towardsRNA binding. p≤0.05 analyzed by t-
test. C. Anti-hnRNP A1 antibodiesalterproteinlevels as
measuredby WesternBlot. SK-N-SHcells were treated
with anti-A1-M9 abs or control IgG and proteins run on
Western blots. Results revealed hnRNP A1, SPG4,and
SPG7 had markedly reducedprotein levelsin anti-hnRNP
A1-M9 antibody treated cells compared to controls. There
was no change in Beta actin or SPG20.
Fig SA2-5A: In primary
neurons in culture, A1
mis-localizes to the
cytoplasm when
exposed to Th1and
Th17 cytokines. Under
normal conditions (0),
hnRNP A1 (green) co-
localizes in the nucleus
(DAPI-blue). When
exposed to Th1 or Th17
cytokines (see Table
below – column labeled
‘C’), hnRNP A1
mislocalizes to the
cytoplasm (arrows).
Arrowheads identify cell
bodies of neurons.

5. plasma cells predominate in progressive forms of MS14. One specific study showed that neurodegeneration
of specific neural pathways was directly associated with T-cell recruitment5. Other studies have
demonstrated that both CD4+ Th1 and Th17 lymphocytes induced disease6,7,27,28. Preliminary studies in Dr.
Levin’s lab, using a mixture of both Th cytokine inducers (priming cytokines) and effectors (cytokine
products), demonstrated that both Th1 and Th17 cytokines caused mislocalization of A1 from the nucleus to
the cytoplasm (Fig SA2-5A).
II. Hypothesis
We hypothesize that an individual or combinations of pro-inflammatory Th17 cytokines can
influence molecular events important to the pathogenesis of MS.
III. Specific Aims
The objective is to determine the mechanistic role that pro-inflammatory Th17 cytokines play in the
mislocalization of hnRNP A1 and stress granule formation in SK-N-SH cells.
1. Use immunocytochemistry to determine whether individual or combinations of cytokines
cause mislocalization of hnRNP A1
2. Use immunocytochemistry to determine whether individual or combinations of cytokines
induce stress granule formation
IV. Materials and Methods
Cells
The SK-N-SH cell line (ATCC, HTB-11), an immortalized human neuroblastoma cell line was
maintained in Dulbecco’s modified Eagle’s medium/F12 supplemented with 10% fetal bovine serum and 1%
penicillin-streptomycin antibiotics. 105 SK-N-SH cells were seeded per well into 500 uL of complete
DMEM/F12 media into 8 well chamber slides (Corning #354632) for immunocytochemistry experiments.
Exposure of SK-N-SH cells to cytokines in vitro
Anti-hnRNP A1 antibodies were obtained from Millipore (04-1469). Poly(A)-binding protein (PABP)
antibodies were obtained from abcam (ab-21060). The anti-hnRNP A1 antibodies are specific for hnRNP

6. A1-M9 and have been shown to overlap the M9 immunodominant epitope recognized by IgG isolated from
MS patients3. Cytokines were added to the
culture media of SK-N-SH cells in the
following concentrations, individually and
in combination, represented in Figure 1:
IL-17A (20ng/ml), IL-23 (20ng/ml), IL-1β
(20 ng/ml), TGF-β (2 ng/ml), IL-6 (25
ng/ml) .
Immunocytochemistry of hnRNP A1-M9 mislocalization and stress granule formation
105 SK-N-SH cells were seeded per well into 500 uL of complete DMEM/F12 media into 8 well
chamber slides (Corning #354632). 48 hours following cytokine addition, cells were fixed with 4%
paraformaldehyde for 15 minutes at room temperature (RT). Fixed cells were then blocked and
permeabilized with 6% Milk-PBS + 0.4% TritonX-100. Cells were then labeled for stress granules using
Poly(A)-binding protein (PABP) and hnRNP A1 at the manufacturer’s suggested concentration overnight at
4°C. Following primary antibody incubation, cells were washed 3 X 5 minutes with PBS-T. Cells were
treated with secondary anti-mouse conjugated FITC and anti-rabbit conjugated Texas Red at manufacturer’s
suggested concentration for 2 hours at RT. Cells were washed 3 X 5 minutes with PBS-T, 2 X 5 minutes
with PBS and mounted with DAPI mounting medium, and imaged by dual confocal microscopy.
VII. Results
Untreated SK-N-SH cells show nuclear localization of hnRNP-A1 (Figures 1-7, top) and no stress
granule formation. After treatment with Th17 effector cytokines (IL-17A, IL-23, IL-1β), hnRNP-A1 is
mislocalized to the cytoplasm where it colocalizes with stress granules (Figure 2, bottom, arrows). However
not all stress granules colocalized with hnRNP-A1 (Figure 2, bottom, circles). Following exposure to IL-1β,
SK-N-SH cells show hnRNP-A1 mislocalization and hnRNP-A1 colocalization with stress granules (Figure
3, bottom, arrows). SK-N-SH cells treated with IL-23 showed mislocalization of hnRNP-A1 to the

7. cytoplasm and the formation of stress granules; however hnRNP-A1 does not colocalize with these granules
(Figure 4, bottom). After treatment with IL-17A, hnRNP-A1 is mislocalized to the cytoplasm. PABP
staining revealed several small, punctuated areas of staining suggestive of stress granules, but further studies
are warranted to clarify whether or not IL-17A treatment induces stress granules in SK-N-SH cells (Figure 5,
bottom). Furthermore, hnRNP-A1 did not colocalize with PABP staining in IL-17A treated SK-N-SH cells.
Th17 inducer cytokine (TGF-β, IL-6) treated SK-N-SH cells show decreased localization to the nucleus
compared to untreated cells and possible mislocalization, although high background in this
immunofluorescence image warrants further experimentation to confirm this finding (Figure 6, bottom).
hnRNP-A1 did not colocalize with the stress granules formed in these Th17 inducer cytokine treated cells
(Figure 6, bottom). Following exposure to TGF-β, SK-N-SH cells show hnRNP-A1 mislocalization, the
formation of stress granules, and hnRNP-A1 colocalization with these stress granules (Figure 7, bottom,
arrows). After treatment with IL-6, there was mislocalization of hnRNP-A1 to the cytoplasm and the
formation of stress granules; however hnRNP-A1 does not colocalize with these granules (Figure 8, bottom).
A summary table detailing hnRNP-A1 mislocalization, stress granule formation and colocalization of
hnRNP-A1 with stress granules for each cytokine treatment group is provided (Figure 9).

10. VIII. Conclusion
In vitro experiments with SK-N-SH cells demonstrate that select individual and combinations of
Th17 cytokines (IL-17A, IL-23, IL-1β, TGF-β, and IL-6) can influence molecular events important to the
pathogenesis of MS including, mislocalization of hnRNP A1 (accumulation in the cytoplasm) and formation
of SGs. Furthermore, select individual and combinations of pro-inflammatory cytokines caused
colocalization of hnRNP A1 and PABP, a stress granule marker.
Taken together, these data suggest a potential role of pro-inflammatory Th17 cytokines in the
pathogenesis of neurodegeneration in MS via an hnRNP A1 mechanism. Previous studies have shown that
anti-hnRNP A1-M9 antibodies in patients with MS cause hnRNP A1 to accumulate in the cytoplasm, which
may cause cellular stress and resulting SG formation44. This study showed that similar molecular changes
occur in response to select individual and combinations of Th17 pro-inflammatory cytokines. These findings
suggest that both antibody-mediated immunoreactivity and pro-inflammatory cytokines may share a potential
mechanism that might contribute to neurodegeneration seen in MS, involving mislocalization and
accumulation of hnRNP A1 and SG formation. The exact mechanism by which this occurs requires further

11. study. Studies should be conducted involving simultaneous exposure to anti-hnRNP A1 antibodies and pro-
inflammatory cytokines to more closely mimic in vivo conditions and to further explore the role of Th17 pro-
inflammatory cytokines in the pathogenesis of neurodegeneration in MS.
IX. Potential Conflicts
Dr. Levin is the owner of a patent: “A biomarker for neurodegeneration in neurological disease.”
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