Endoplasmic reticulum (ER) stress, which results from the aggregation of misfolded proteins in the ER, has been implicated in many forms of kidney injury, including hypertensive nephrosclerosis. ER stress induction increases levels of active TGFβ1, a pro-fibrotic cytokine, which can lead to epithelial-to-mesenchymal transition (EMT) in renal proximal tubular cells. EMT occurs when epithelial cells undergo phenotypic changes, which can be prevented by inhibiting ER stress. Further, the ER stress protein TDAG51 is essential for the development of TGFβ1-mediated fibrosis. The low molecular weight chemical chaperone 4-phenylbutyrate (4-PBA) can protect against ER stress-mediated kidney injury. It acts directly on the kidney, and can prevent ER stress, renal tubular damage, and acute tubular necrosis. In a tunicamycin-mediated model of kidney injury, this damage is prevented primarily through repression of the pro-apoptotic ER stress protein CHOP. Along with providing renoprotective effects, 4-PBA can inhibit endothelial dysfunction and elevated blood pressure in a rat model of essential hypertension. In addition to lowering blood pressure, 4-PBA reduces contractility, augments endothelial-dependent vasodilation, and normalizes media-to-lumen ratio in mesenteric arteries from spontaneously hypertensive rats. Further, ER stress leads to reactive oxygen species generation, which is reduced with 4-PBA. Dahl salt-sensitive rats given 4-PBA are protected from hypertension, proteinuria, albuminuria, and renal pathology. Rats provided with vasodilatory medications demonstrate that lowering blood pressure alone is not renoprotective. In fact, endothelial dysfunction, as demonstrated by an impaired myogenic response, is culpable in the breakdown of the glomerular filtration barrier and subsequent renal damage. As such, alleviating ER stress using 4-PBA serves as a viable therapeutic strategy to preserve renal function and prevent ER stress-mediated endothelial dysfunction, renal fibrosis, glomerular filtration barrier destruction, and progression of hypertensive nephrosclerosis. / Thesis / Doctor of Philosophy (PhD) / Chronic kidney disease is characterized by progressive loss of kidney function, and is a major public health problem. Kidney cells make proteins that help the kidney function properly. However, if the proteins are made improperly, the kidney does not function as well. This can lead to poor filtration and protein in the urine, damage to important kidney structures, and kidney scarring. High blood pressure, a risk factor for kidney disease, is often accused of causing kidney damage. This thesis shows that malfunctioning blood vessels can cause kidney injury, and lowering blood pressure may not prevent this. However, there are pharmacological molecules that can protect the kidney from damage. These molecules help the cells make proteins properly, preventing blood vessel malfunction and kidney damage. Our findings suggest that helping blood vessels and kidney cells create properly functioning proteins is more protective for the kidney than lowering blood pressure alone.

Le transport de Na+ par ENaC et de Cl- par CFTR, dans l’épithélium des voies aériennes (VA), contrôle la clairance mucociliaire en modulant le volume du liquide de surface (ASL). L’expression et la fonction de ces canaux peuvent être modifiées au cours des maladies inflammatoires chroniques des VA. Dans un modèle de culture primaire de cellules épithéliales nasales humaines (CENH), nous avons démontré l’existence, au cours de la polypose nasosinusienne, d’une chute de la sécrétion de Cl- par CFTR dont l’expression est diminuée par le TGFß1, cytokine de l’inflammation. Nous avons ensuite étudié l’effet de l’élastase, et de son inhibiteur l’EPIhNE4 sur la fonction d’ENaC dans des CENH de patients atteints ou non de mucoviscidose (CF) où l’hyperactivité d’ENaC provoque une déshydratation de l’ASL. Nous avons démontré l’existence d’une activité sérine protéase endogène dans les CENH (patients CF ou non CF) qui, après inhibition, permet de révéler une augmentation de la fonction d’ENaC induite par l’élastase alors inhibable par l’EPI-hNE4. Enfin, nous avons analysé l’effet du 4 phenylbutyrate (4PBA), traitement proposé chez les patients CF, sur le canal ENaC. Le 4- PBA entraîne une augmentation de la fonction d’ENaC dans les CENH de patients CF ou non en adressant des sous-unités du canal à la membrane apicale via la régulation d’une molécule chaperone Hsc70. Le 4-PBA pourrait donc être utilisé dans des pathologies respiratoires avec défaut d’expression d’ENaC mais son usage pourrait être délétère chez les patients CF. La régulation des transports ioniques au cours des maladies inflammatoires chroniques des VA représente donc une cible thérapeutique intéressante / Na+ and Cl- transport by ENaC and CFTR respectively in airway epithelium (AE) control mucociliary clearance by regulating the airway surface liquid (ASL). Ion channel expression and function could be altered by chronic inflammation in AE. In primary cultures from human nasal epithelial cells (HNEC) we demonstrated, in nasal polyposis, a decrease of CFTR expression and Cl- secretion induced by TGFß1, an inflammatory cytokine. We also evaluated the effects of elastase, and its inhibitor EPI-hNE4, on ENaC function in HNEC from cystic fibrosis (CF where ENaC hyperactivity contributes to ASL dehydration) and non CF patients. We detected an endogenous serine protease activity in HNEC (CF or non CF) which, after inhibition, unmask an increase in ENaC function induced by elastase, this increase being then inhibited by EPI-hNE4. Finally, we investigated the effects of a drug now tested in CF patients treatment, the 4-phenylbutyrate (4PBA). 4-PBA promoted ENaC cell surface expression and activity in CF or non CF HNEC by increasing ENaC subunits translocation to plasma membrane via the regulation of Heat Shock Protein 70. 4-PBA treatment could therefore be of interest in the treatment of airway diseases when ENaC trafficking is disrupted but should be used with caution when treating CF patients where ENaC function is already upregulated. All together these results highlight the role of ion transport regulation during chronic inflammatory airway diseases and could lead to new therapeutic strategies

Les mutations de la protéolipide-protéine (PLP) entraînent la mort des oligodendrocytes (OL) et les pathologies de la myéline. Pour contribuer à l'élucidation des mécanismes impliqués, ce travail de thèse, qui a utilisé des lignées d'OL 158N (normale) et 158JP (porteuse de PLP mutée), démontre une mortalité élevée des cultures 158JP comparées aux témoins. Une hausse du ratio Bax (pro-)/Bcl2 (anti-apoptose) est observée chez les 158JP. La protéine BiP, marqueur de stress du réticulum endoplasmique (SRE), est surexprimée chez les 158JP. L'exposition au SRE induit par la tunicamycine a révélé que la DE50 pour les 158JP est 67 fois plus faible que la DE50 pour les 158N. Les 158JP surexpriment aussi les protéines CHOP et caspase-12 qui déterminent le basculement des processus intracellulaires vers l'apoptose. Le 4-Phénylbutyrate, inhibiteur du SRE, améliore la survie des 158JP et diminue les marqueurs du SRE et de l'apoptose. Des perspectives intéressantes sont ouvertes pour l'exploration de stratégies efficaces contre les pathologies dysmyélinisantes. / Mutations of proteolipid-protein (PLP) cause oligodendrocyte (OL) death and myelin disorders. To contribute to the elucidation of the mechanisms involved, the present PhD work has used 158N (normal) and 158JP (mutated PLP) OL lines, to show the occurrence of a high cell death percentage in 158JP OL cultures compared to the controls. An increased Bax (pro-)/Bcl2 (anti-apoptosis) ratio is evidenced in 158JP cells. Also, the endoplasmic reticulum stress marker (SRE) BiP is overexpressed in 158JP OL. Exposure of 158N and 158JP cells to tunicamycin-induced SRE revealed that the ED50 for 158JP OL is 67 times lower than the ED50 for 158N OL. Proteins CHOP and caspase-12, that pivotally determine the switching from survival to apoptotic pathways, are upregulated in 158JP cells. 4-Phenylbutyrate, a SRE inhibitor, which improves 158JP cell survival, also decreases the levels of SRE and apoptosis markers in 158JP OL. The thesis opens promising perspectives for the development of effective strategies against myelin disorders.

Epidermolysis bullosa simplex (EBS) and epidermolytic ichthyosis (EI) are rare skin fragility diseases characterized by intra-epidermal blistering due to autosomal dominant-negative mutations in basal (KRT5 or KRT14) and suprabasal (KRT1 or KRT10) keratin genes,  respectively. Despite vast knowledge in the disease pathogenesis, the pathomechanisms are not fully understood, and no effective remedies exist. The purpose of this work was to search for keratin gene mutations in EBS patients, to develop in vitro models for studying EBS and EI, and to investigate novel pharmacological approaches for both diseases. We identified both novel and recurrent KRT5 mutations in all studied EBS patients but one which did not show any pathogenic keratin mutations. Using cultured primary keratinocytes from EBS patients, we reproduced a correlation between clinical severity and cytoskeletal instability in vitro. Immortalized keratinocyte cell lines were established from three EBS and three EI patients with different phenotypes using HPV16-E6E7. Only cell lines derived from severely affected patients exhibited spontaneous keratin aggregates under normal culture conditions. However, heat stress significantly induced keratin aggregates in all patient cell lines. This effect was more dramatic in cells from patients with a severe phenotype. In organotypic cultures, the immortalized cells were able to differentiate and form a multilayered epidermis reminiscent of those observed in vivo. Addition of two molecular chaperones, trimethylamine N-oxide dihydrate (TMAO) and sodium 4-phenylbutyrate (4-PBA), reduced the keratin aggregates in both stressed and unstressed EBS and EI keratinocytes, respectively. The mechanism of action of TMAO and 4-PBA was shown to involve the endogenous chaperone system (Heat shock proteins e.g. Hsp70). Besides, MAPK signaling pathways also seemed to be incriminated in the pathogenesis of EBS. Furthermore, depending on which type of keratin is mutated, 4-PBA up-regulated Hsp70 and KRT4 (possibly compensating for mutated KRT1/5), and down-regulated KRT1 and KRT10, which could further assist in protecting EBS and EI cells against stress. In conclusion, novel and recurrent pathogenic keratin mutations have been identified in EBS. Immortalized EBS and EI cell lines that functionally reflect the disease phenotype were established. Two pharmacologic agents, TMAO and 4-PBA, were shown to be promising candidates as novel treatment of heritable keratinopathies in this in vitro model.