To ‘feel comfortable in one’s own skin’ is an idiom referring to one’s confidence in interacting with others. However, when the skin is inflamed, as in atopic dermatitis or psoriasis, patients carry a sub-stantial burden leading to opposite effects. Current therapies target redundant, late-stage inflammatory events but not the disease drivers, leading to heterogeneous and insufficient efficacy. Understanding the proximal mechanisms of inflammation will stimulate the development of better therapies. Among the innate immune sensors for stress and microbes in keratinocytes, mutations in the NLRP1 and NLRP10 inflammasomes are linked to skin disorders. These molecules and the pro- and anti-inflammatory IL-1 family members they regulate are differentially expressed in the different layers of the epidermis. We hypothesize that inflammasome signaling in keratinocytes needs context-dependent and spatio-temporal control to avoid inflammation, which poses unique analytical and conceptual challenges. Therefore, to understand how inflammasome signaling in specific keratinocytes drives skin inflammation, 4D-SkINFLAM will i. optogenetically activate specific inflammasome components with spatio-temporal precision and perform a spatial analysis of transcriptomes and proteomes in neighboring cells. With loss-of-function approaches and pathway activity reporters, we will ii. define the ‘sensome’ and the activity of inflammasomes in different areas of the epidermis. Using mouse models, we will iii. evaluate how spatial inflammasome activity drives skin inflammation. Through iv. AI-driven deep visual proteomics combined with an analysis of inflammasome activity, we will discover spatial in-flammasome activation and its effects in inflammatory skin disorders. A precise understanding of spatio-temporal inflammasome signaling in the skin will be critical for se-lecting therapeutic targets acting as upstream drivers of prevalent diseases with high unmet needs.

In line with IMI2 goals for improved therapies and precision medicine, the aim of this proposal is to prevent and treat RA or its progression by inhibiting maturation/expansion of pathogenic autoimmune responses through immune tolerising treatments of subjects not only in early stages of joint inflammation (undifferentiated arthritis and early RA) but also in even earlier defined stages i.e. before onset of joint inflammation, when patients have arthralgia and/or bone loss, or sub-clinical stages of joint inflammation. Today, no drugs are approved for these early phases of RA development, where symptoms such as pain and fatigue cause major loss of life quality and where successful interference would prevent onset of disease. Thus, an important part of our work will be to achieve a better understanding of this as yet unexplored phase of disease. In the proposed project we will develop and validate new methods to identify individuals at high risk for RA, tools to monitor disease progress and expand and further develop cohorts suitable for these purposes. Furthermore we will validate and standardise methods to monitor immune tolerance to be used in clinical trials for tolerising therapies for RA. The aim is thus to interfere with the specific immune reactions that contribute to RA symptoms in such a way that a specific and long-lasting therapeutic effect (ultimately a cure) is accomplished for a major proportion of RA patients and prevention of diseases is accomplished in individuals at high risk for RA. Investigator-initiated as well as company-sponsored clinical trials in well stratified patient groups will be performed in collaboration with SMEs and/or contributing pharma companies and their immune effects studied using the same panel of biomarkers allowing for standardisation across protocols. Our ambition is also to disseminate our experiences from RA to other rheumatic and other immune-mediated diseases.