Le souffle chez les chevaux et l’asthme chez l’humain sont des maladies respiratoires qui partagent plusieurs caractéristiques, notamment des épisodes de bronchospasme et de détresse respiratoire dus à une inflammation pulmonaire inappropriée en réponse à une inhalation de substances antigéniques. Les manifestations cliniques incluent des efforts respiratoires augmentés, des sifflements et de la toux. Au niveau des voies respiratoires, on observe une augmentation du muscle lisse péribronchique, une fibrose sous épithéliale, une métaplasie/hyperplasie épithéliale et du mucus en quantité augmentée. L’augmentation du muscle lisse est particulièrement importante car elle n’affecte pas seulement le calibre basal des voies respiratoires, mais elle accentue l’obstruction respiratoire lors de bronchoconstriction. Ces changements sont regroupés sous le terme de « remodelage » et sont associés à un déclin accéléré de la fonction respiratoire chez les patients asthmatiques. Alors que les traitements actuels contrôlent efficacement le bronchospasme et relativement bien l’inflammation, leurs effets sur le remodelage sont mal connus. Dans le cadre de thèse, la réversibilité du remodelage musculaire péribronchique a été investiguée chez des chevaux atteints du souffle dans deux études longitudinales. Ces études, faites principalement sur du tissu pulmonaire prélevé par thoracoscopie, sont difficilement réalisables chez l’humain pour des raisons éthiques, ou chez d’autres animaux, car ceux-ci présentent rarement une inflammation de type asthmatique de façon spontanée. Les résultats démontrent que les chevaux atteints du souffle ont approximativement deux fois plus de muscle péribronchique que les chevaux sains d’âge similaire gardés dans les mêmes conditions, et que la prolifération des myocytes contribue à cette augmentation. Ils démontrent aussi qu’une stimulation antigénique relativement brève chez des chevaux atteints du souffle depuis plusieurs années n’accentue pas le remodelage, ce qui suggère que l’augmentation du muscle lisse atteint un plateau. Nous avons également montré que le remodelage du muscle lisse chez des chevaux adultes est partiellement réversible et que cette réversibilité peut être accélérée par l’administration de corticostéroïdes par inhalation. Il semble toutefois qu’une portion du remodelage chronique est irréversible puisque les corticostéroïdes ont accéléré la diminution du muscle mais sans toutefois mener à une amélioration plus marquée au terme de l’étude qu’avec une modification environnementale stricte. La diminution de trente pourcent observée sur un an paraît modeste mais elle démontre clairement, et pour une première fois, que le remodelage du muscle lisse présent chez des chevaux adultes malades depuis plusieurs années est au moins partiellement réversible. / Equine heaves and asthma in people are two respiratory diseases that share many characteristics, including episodes of bronchospasm and respiratory distress due to an inappropriate airway inflammation in response to inhaled antigens. In both diseases, the main clinical manifestations are increased breathing efforts, wheezing and coughing. Changes in the airway wall include increased airway smooth muscle, subepithelial fibrosis, epithelial changes, and increased mucus. The increase in smooth muscle is of particular importance as it not only affects baseline airway caliber, but also accentuates the effect of bronchoconstriction on airflow limitation. These structural changes are grouped under the term “remodeling” and are associated with the accelerated decline of respiratory function in asthmatics. While current treatments offer adequate control of bronchospasm and inflammation, their effects on remodeling are unknown. In this thesis, airway smooth muscle remodeling reversibility was investigated in heaves-affected horses. The longitudinal studies conducted here, mostly made on peripheral pulmonary tissue harvested under thoracoscopic guidance, can not be easily done in people for ethical reasons, or in other animal species, few of them having spontaneous asthma-like disease like horses. Results have shown that heaves-affected horses have twice as much airway smooth muscle than age-matched controls kept in the same environment, and that myocyte proliferation contributes to this increase. It was also shown that a relatively brief antigenic exposure in chronically affected horses does not further increase smooth muscle mass, which suggests that it may reach a plateau over time. It was also shown that airway smooth muscle is partially reversible and that this reversibility can be accelerated with inhaled corticosteroids. On the other hand, corticosteroids only accelerated the decrease in mass compared to strict environmental control, without affecting the total improvement observed at the end of the study, which suggests that some of this chronic remodeling is irreversible. The thirty percent decrease seems relatively modest but it is nevertheless the first demonstration that airway smooth muscle remodeling of adult horses affected by heaves for years is at least in part reversible.

Immunopathological disorders are no longer defined by dysregulated T-helper (Th) type 1/ Th2 responses but account for modulatory cell types such as regulatory and Th17 cells. The newly defined Th17 subset is an effector memory subtype which regulates mucosal host defense responses. A distinctive feature of interleukin (IL)-17 is its ability to invoke neutrophilic responses and to synergize cytokine responses in proximal structural cells. This effect is most evident for proinflammatory cytokines and neutrophil-mobilizing chemokines which are under the regulatory control of the canonical, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway. The uniqueness of the IL-17A receptor (IL-17RA) signal transduction pathway however has been a limiting factor in uncovering IL-17-mediated effector functions since the receptor bears little homology to other known receptors and contains a unique cytoplasmic consensus binding motif. Hence, the composition, dynamics and subunit interactions of the IL-17R complex have become an emerging area of research where novel recruitment motifs and adaptor proteins are actively being explored. Our study sought to uncover the signal transduction and molecular mechanisms mediating the initiation and amplification responses induced by IL-17. We hypothesize that (i) IL-17 represents a key cytokine which initiates inflammatory responses by acting on proximal structural cells to rapidly release neutrophil-mobilizing chemokines and myeloid growth factors and that (ii) IL-17 directly promotes survival responses of immune effector cells. Genomic analysis of stimulated human airway smooth muscle cells support the proinflammatory nature of IL-17 as NF-κB associated genes and chemokines were most significantly upregulated within 2 hours. However, IL-17 induced a modest fold increase in gene expression levels whereby only 4 genes achieved greater than 2 fold increases. This, along with the observation that IL-17 enhanced IL-1β-mediated CXCL8 expression via transcriptional promoter activation levels and post-transcriptional mRNA stabilization mechanisms suggests that IL-17 cooperatively functions with secondary cytokines to mediate inflammatory responses. Despite activating the p38-mitogen-activated protein kinase (MAPK) signaling pathway in peripheral blood neutrophils, IL-17 did not directly affect the apoptotic capacity of these cells but unexpectedly antagonized the survival response mediated by the granulocyte-macrophage colony stimulating factor (GM-CSF). Collectively, our results suggest that IL-17 is a potent synergistic cytokine which signals via the MAPK-NF-κB pathway to indirectly recruit neutrophils via CXC-chemokines produced by non-hematopoietic cells and that IL-17 may potentially dampen inflammatory responses by directly antagonizing inflammatory effector cells.

Made available in DSpace on 2015-05-14T12:59:35Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1945153 bytes, checksum: 2c1abc7e6111c3fc75af32ff4400e496 (MD5) Previous issue date: 2012-02-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / From Xylopia langsdorfiana A. St-Hil. & Tul. stem bark was isolated the diterpene of trachylobane class, ent-7α-hydroxytrachyloban-18-oic acid (trachylobane-318) that in previous studies showed to be able to relax guinea-pig trachea pre-contracted by carbachol (CCh). Thus, we aimed to investigate the action mechanism underlying in this trachylobane-318 relaxant activity. Trachea rings were suspended in organ baths, containing Kreb s solution, at 37 ºC and aired with carbogenic mixture. Isometric contractions were registered using a digital acquisition system. In order to evaluate a direct effect of the diterpene in Ca2+-calmodulin complex was used chlorpromazine (CPZ) (10-6 M), a calmodulin inhibitor, and we observed that trachylobane-318 relaxation effect (pD2 = 4.38 ± 0.07, n = 5) was not significantly altered in presence of this inhibitor (pD2 = 4.25 ± 0.07, n = 5). Then, was performed a protocol using different potassium (K+) extracellular concentrations which indicated that trachylobane-318 would be acting as a possible potassium channels activator since its relaxation was more potent when guinea-pig trachea was pre-contracted by KCl 18 mM (pD2 = 4.90 ± 0.25, n = 5) than by KCl 60 mM (pD2 = 3.88 ± 0.01, n = 5). To confirm the potassium channels participation was used a non-selective potassium channels blocker, tetraethylammonium (TEA+) 10 mM, that was pre-incubated before CCh addition, that resulted in an attenuation of diterpene relaxation (pD2 = 4.01 ± 0.06, n = 5). To determinate which potassium channels subtypes would be involved in the trachylobane-318 action, the diterpene relaxation curve was assessed in the presence of several potassium channels selective blockers. The fact of the trachylobane-318 relaxation curve was shifted to the right in a significant manner in the presence of 4-AP, a selective blocker of voltage activated K+ channels (Kv) (pD2 = 4.00 ± 0.06, n = 5); glibenclamide, a selective blocker of ATP-sensitive K+ channel (KATP) (pD2 = 3.91 ± 0.003, n = 5); apamin, a selective blocker of small conductance calcium-activated K+ channels (SKCa) (3.45 ± 0.14, n = 5) and big conductance calcium-activated K+ channels (BKCa) (3,80 ± 0,05, n = 5) is suggestive that the diterpene is modulating positively these channels to exert its relaxant effect. On the other hand, the inwardly rectifying K+ channels (Kir) was discarded since the relaxation curve was not altered (pD2 = 4.15 ± 0.10, n = 5) in the presence of BaCl2, selective blocker of these channels. Cyclic nucleotides participation was discarded since the relaxation curve obtained with aminophylline on guinea-pig contracted by CCh (pD2 = 4.27 ± 0.09, n = 5), a phosphodiesterases (PDEs) non-selective inhibitor, was not altered in trachylobane-318 presence (pD2 = 4.46 ± 0.08, n = 5). Thus, trachylobane-318 relaxant effect seems to involve the positive modulation of potassium channels subtypes Kv, KATP, SKCa and BKCa on guinea pig trachea. / A partir das cascas do caule de Xylopia langsdorfiana A. St-Hil. & Tul. foi isolado o diterpeno da classe dos traquilobanos, ent-7α-hidroxitraquiloban-18-oico (traquilobano-318) que em estudos anteriores mostrou-se capaz de relaxar a traqueia de cobaia pré-contraída com carbacol (CCh). Assim, o objetivo deste trabalho foi investigar o mecanismo de ação envolvido nesta atividade relaxante do traquilobano-318. Os anéis de traqueia foram suspensos em cubas para órgão isolado, contendo solução de Krebs, a 37º C e aerados com carbogênio. As contrações isométricas foram registradas com o auxílio de um sistema de aquisição digital. Para avaliar uma possível ação direta do diterpeno sobre o complexo Ca2+-calmodulina foi utilizado a clorpromazina (CPZ) (10-6 M), um inibidor da calmodulina, e observou-se que o efeito relaxante do traquilobano-318 (pD2 = 4,38 ± 0,07, n = 5) não foi significantemente alterado na presença deste inibidor (pD2 = 4,25 ± 0,07, n = 5). Em seguida foi realizado um protocolo usando diferentes concentrações extracelulares de potássio (K+) que indicaram que o traquilobano-318 estaria agindo como um possível ativador dos canais de K+, uma vez que seu efeito relaxante mostrou-se mais potente quando a traqueia era pré-contraída por 18 mM de KCl (pD2 = 4,90 ± 0,25, n = 5) do que quando pré-contraída por 60 mM de KCl (pD2 = 3,88 ± 0,01, n = 5). Para confirmar a participação dos canais de K+ utilizou-se um bloqueador não seletivo destes canais, tetraetilamônio (TEA+) (10 mM) que foi pré-incubado antes da adição de CCh, o que resultou na atenuação do relaxamento promovido pelo diterpeno (pD2 = 4,01 ± 0,06, n = 5). Com o objetivo de se determinar quais subtipos de canais de potássio estariam envolvidos na ação relaxante do traquilobano-318, a curva de relaxamento do diterpeno foi avaliada na presença de vários bloqueadores seletivos destes canais. O fato da curva de relaxamento do traquilobano-318 (pD2 = 4,38 ± 0,07) ter sido desviada para direita, de maneira significante, na presença de 4-AP, bloqueador dos canais de K+ sensíveis a voltagem (Kv) (pD2 = 3,91 ± 0,003); glibenclamida, bloqueador dos canais de K+ sensíveis ao ATP (KATP) (pD2 = 4,00 ± 0,06); apamina, bloqueador dos canais de K+ ativados pelo cálcio de pequena condutância (SKCa) (pD2 = 3,45 ± 0,14) e na presença de iberiotoxina, bloqueador dos canais de K+ ativados pelo cálcio de grande condutância (BKCa) (pD2 = 3,80 ± 0,05) sugere que o diterpeno está modulando positivamente estes canais para exercer seu efeito relaxante. Por outro lado a participação dos canais de potássio retificadores de entrada (Kir) foi descartada pois a curva de relaxamento do traquilobano-318 não foi alterada (pD2 = 4,15 ± 0,10, n = 5) na presença do BaCl2, bloqueador seletivos destes canais. A participação dos nucleotídios cíclicos foi descartada, uma vez que a curva de relaxamento em traqueia pré-contraída por CCh obtida com aminofilina (pD2 = 4,27 ± 0,09, n = 5), um inibidor não seletivo das fosfodiesterases (PDEs), não foi alterada na presença do traquilobano-318 (pD2 = 4,46 ± 0,08, n = 5). Assim, o efeito relaxante do traquilobano-318 parece envolver a modulação positiva dos subtipos de canais de potássio KATP, Kv, SKCa e BKCa em traqueia isolada de cobaia.

No description available.

<p>Asthma is a disease characterized by transient airway smooth muscle contraction leading to episodes of reversible airway narrowing. It affects over 300 million people worldwide and is implicated in over 250 000 deaths annually. The primary clinical features of asthma include airway inflammation, hyperresponsiveness, and remodeling. Generally, asthmatic patients experience exacerbations between periods of diminished symptoms. Interestingly, in addition to these above mentioned hallmarks, asthmatics have also been shown to react differently to ventilatory mechanical strain. This is most evident when assessing the effect of a deep inspiration (DI), clinically measured as a breath taken from functional residual capacity to total lung capacity, in healthy individuals <em>versus</em> asthmatics. These deep inspiratory efforts have been shown to produce a bronchodilatory response in healthy individuals, whereas in asthmatics, DIs are less effective in producing bronchodilation, can cause more rapid airway re-narrowing, and even bronchoconstriction in moderate to severe asthmatics. The mechanism by which a DI is able to cause bronchoconstriction remains ambiguous. Previous theories suggest that this phenomenon is intrinsic to airway smooth muscle (ASM) itself. However, the airway inflammation present in asthmatic airways may also add to the increased ASM contractility following stretch, by the release of mediators that can prime the contractile apparatus to react excessively in the presence of stretch.</p> <p>Thus, collectively, the studies contained in this thesis are linked to the general theme of greater characterization of the signalling mechanisms that regulate airway stretch-activated contractions using a pharmacological approach in intact bovine bronchial segments, with the hope of providing novel insights into the mechanisms that regulate the DI-induced bronchoconstriction seen in asthmatics.</p> / Doctor of Philosophy (Medical Science)

<p><strong>Introduction</strong></p> <p>Asthma is a chronic respiratory disease that is becoming more prevalent. Airway hyperresponsivness, a key feature of asthma, involves increased narrowing of the airways in response to bronchoconstricting agents. Airway smooth muscle (ASM) functioning is largely responsible for hyperresponsiveness yet the mechanisms behind excitation-contraction coupling are not fully understood. Src tyrosine kinase contributes to contraction in other smooth muscle types. Furthermore, STIM1, Orai1, IPLA₂b and RyRs play a role in ASM excitation-contraction coupling.</p> <p><strong>Aim</strong></p> <p>We sought to determine whether Src activity is involved in serotonin (5-HT)- and acetylcholine (ACh)-induced ASM contraction. We also examined whether the gene expression of molecules involved in sarcoplasmic reticulum emptying and refilling is altered during airway hyperresponsiveness.</p> <p><strong>Methods</strong></p> <p>Bovine tracheal ASM strips were pre-treated with the non-specific tyrosine kinase inhibitor genistein (10^-4M), src kinase family inhibitors PP1 (10^-5M) and PP2 (10^-5M) or vehicle and challenged with either 5-HT or ACh to determine the involvment of Src in contraction. Western blotting was used to examine Src activity following 5-HT or ACh treatment. Female BALB/c mice were exposed to an intranasal injection of [1.7mg/ml] HDM extract or saline. Real time, reverse-transcriptase polymerase chain reaction was used to examine gene expression.</p> <p><strong> </strong></p> <p><strong>Results</strong></p> <p>Genistein, PP1 and PP2 significantly reduced 5-HT-induced ASM contractions and Src activity was significantly increased in response to 5-HT. ACh-induced contractions were significantly reduced by genistein, but not PP1 and PP2. However, Src activity was significantly increased by ACh. RyR3 mRNA expression was significantly increased, Orai1 was significantly decreased, and STIM1, IPLA₂b, RyR1 and RyR2 were unchanged by the house dust mite treatment.</p> <p><strong>Conclusion</strong></p> <p>These data suggets 5-HT-induced ASM contraction involves Src activity. However, ACh-induced ASM contractions might not require Src. The changes in RyR3 and Orai1 expression might alter Ca²⁺-handling in such a way as to potentiate airway hyperresponsiveness but further investigation is required.</p> / Master of Science (MSc)

Chitosan is a biocompatible and biodegradable mucoadhesive polymer with unique advantages, such as the distinct trait of opening the junctions to allow paracellular transport of antigen and good tolerability. However, the poor solubility of chitosan in neutral or alkalinized media has restricted its applications in the pharmaceutical field. Chitosan can be easily carboxymethylated to improve its solubility in aqueous media, while its biodegradability and biocompatibility are preserved. Apart from this, carboxymethyl chitosan (CMCS) can be easily processed into nanoparticles which highlight its suitability and extensive usage for preparing different drug delivery formulations. The present study deals with the development and characterization of a delivery system based on CMCS nanoparticles using ovalbumin as model protein. We demonstrated that ovalbumin loaded nanoparticles were successfully synthetized using calcium chloride as a cross-linker by ionic gelation. The nanoparticles exhibited an average size of approximately 169 nm and presented a pseudo-spherical shape. The nanoparticles size increased according to the addition of CaCl2 due to the strong electrostatic attraction. During storage the nanoparticles size increased was attributed to swelling and aggregation. The loading efficiency of ovalbumin was found to be 17%. Confocal microscopy clearly showed the association between ovalbumin and CMCS chains into nanoparticles. Therefore, we suggest these nanoparticles can be considered as an attractive and promising carrier candidate for proteins and antigens. The major challenge that limits the use of such carriers is their instability in an aqueous medium. Thus, the next step of this work was to determine the robustness of several formulations using distinct freeze-drying protocols. This study demonstrated that mannitol in concentration of 10% (w/v) is well suited to preserve ovalbumin loaded CMCS nanocapsules from aggregation during lyophilization and subsequent reconstitution. Importantly, the results showed that an annealing step has a huge impact on porosity of freeze-dried cake by nearly complete crystallization of mannitol, once the crystalline matrix prevents the partial collapse and the formation of larger pores observed without annealing. Therefore, the usual observation that annealing increases the pore size due to growth of ice crystal size does not always apply, at least when crystallization of solute is involved. Since all characterizations and stability studies had been performed, the main purpose of this study was to develop a stable antigen delivery system for oral immunization using CMCS and inactivated rabies virus (RV) as the antigen. RV loaded nanoparticles was found to enhance both systemic (IgG) and local (IgA) immune responses against RV after oral delivery in mice. The effective doses 50% were 50-times higher than the negative controls, indicating that the immune response started only after the third boosting dose. Furthermore, enough neutralizing antibodies was produced to be protected against the harmful effects of the rabies virus. It is therefore concluded, that the CMCS nanoparticles formulated in this study, are suitable for oral vaccine delivery, and can be suggested as a promising delivery system for a diverse range of antigens as well as a gene/protein delivery system, especially for those positively charged. Since several approaches show that effective intervention in airway allergic inflammation can be achieved with allergen-activated interleukin-10-secreting cells, the final part of this work was dedicated to assessing whether IL-10 loaded chitosan nanoparticles (IL10-CSNPs) could be used as a possible inhalable therapeutic tool for preventing exacerbations in asthmatic patients. As positive controls, we also assess whether interleukin 17A and interleukin 9 have the ability to stimulate human airway smooth muscle (HASM) cell contractility using magnetic twisting cytometry (MTC). Significant decreased baseline cell stiffness was observed in HASM cells pre-treated with IL-10, but not with IL10-CSNPs, whereas treatment with IL-17A significantly enhanced baseline cell stiffening. Our findings reveal a previously unknown mechanism underlying immunotherapy for prevention and treatment of asthma. / A quitosana é um polímero mucoadesivo biocompatível e biodegradável, com vantagens únicas, tais como a característica distinta de abrir as junções que permitim o transporte paracelular de antígenos e boa tolerabilidade. No entanto, sua baixa solubilidade em meios neutros ou alcalinizados tem restringido suas aplicações no campo farmacêutico. A quitosana pode ser facilmente carboximetilada para melhorar de sua solubilidade em meios aquosos, enquanto sua biodegradabilidade e biocompatibilidade são preservadas. Além disso, a carboximetilquitosana (CMCS) pode ser facilmente processada na forma de nanopartículas, o que destaca sua adequabilidade para uso extensivo no preparo de sistemas de delivery de medicamentos. O presente estudo trata do desenvolvimento e caracterização de um sistema de delivery baseado em nanopartículas de CMCS utilizando ovalbumina como proteína modelo. Nós demonstramos que as nanopartículas carregadas com ovalbumina foram sintetizadas com sucesso utilizando cloreto de cálcio como agente de reticulação por gelificação iônica. As nanopartículas exibiram um tamanho médio de aproximadamente 169 nm e apresentaram uma forma pseudo-esférica. O tamanho das nanopartículas aumentou de acordo com a adição de CaCl2 devido à forte atração eletrostática. Durante o armazenamento, o tamanho aumentado das nanopartículas foi atribuído a incorporação de água e agregação. A eficiência de encapsulamento da ovalbumina foi de aproximadamente 17%. A microscopia confocal mostrou claramente a associação entre ovalbumina e a cadeias de CMCS nas nanopartículas. Sugerimos, portanto, que tal sistema pode ser considerado como candidato atraente e promissor para o carreamento de proteínas e antígenos. O principal desafio que limita o uso desses carreadores consiste na instabilidade em meio aquoso. Assim, o próximo passo deste trabalho foi determinar a robustez de várias formulações utilizandose diferentes protocolos de liofilização. Este estudo demonstrou que o manitol em uma concentração de 10% (p/v) é adequado para preservar da agregação as nanocápsulas de CMCS carregadas com ovalbumina durante a liofilização e subsequente reconstituição. Mais importante, os resultados mostraram que uma etapa de annealing tem um enorme impacto sobre a porosidade da amostra liofilizada devido a quase completa cristalização do manitol, uma vez que a matriz cristalina evita o colapso parcial e a formação de poros maiores observados na ausência do annealing. Portanto, a observação comum de que o annealing aumenta o tamanho doporos devido ao crescimento dos cristais de gelo nem sempre se aplica, pelo menos quando a cristalização de um soluto está envolvida. Uma vez que todas as caracterizações e estudos de estabilidade foram realizados, o principal objetivo deste estudo foi desenvolver um sistema estável de delivery de antígeno para imunização oral utilizando CMCS e vírus rábico inativado (RV) como antígeno. Verificou-se que as nanopartículas carregadas com RV aumentam as respostas imune sistêmica (IgG) e local (IgA) contra o RV após administração oral em camundongos. As doses efetivas 50% foram 50 vezes maiores que os controles negativos, indicando que a resposta imune foi iniciada apenas após a terceira dose da vacina. Além disso, foram produzidos anticorpos neutralizantes suficientes para proteção contra os efeitos nocivos do vírus rábico. Conclui-se, portanto, que as nanopartículas de CMCS formuladas neste estudo, são adequadas para o delivery oral de vacinas, e podem ser sugeridas como um sistema promissor de delivery para uma gama diversa de antígenos, bem como para o delivery de genes/proteínas, especialmente para aqueles carregados positivamente. Uma vez que diversas abordagens mostram que uma intervenção efetiva em casos de inflamação alérgica de vias aéreas pode ser conseguida por meio de células secretoras de interleucina 10 (IL-10) mediante ativação por alergenos, a parte final deste trabalho esteve dedicada a avaliação de nanopartículas de quitosana carregadas com IL-10 (IL10-CSNPs) como possível ferramenta terapêutica inalável para prevenção de exacerbações em pacientes asmáticos. Como controles positivos, avaliou-se adicionalmente se as interleucinas 17A (IL-17A) e 9 (IL-9) possuem a capacidade de estimular a contratilidade de células humanas de músculo liso de vias aéreas humanas (HASM) por meio de citometria de torção magnética (MTC). Uma diminuição significativa da rigidez celular basal foi observada em células HASM pré-tratadas com IL-10, mas não com IL10-CSNPs, enquanto que o tratamento com IL-17A aumentou significativamente a magnitude rigidez celular basal. Nossos resultados revelam um mecanismo previamente desconhecido subjacente à imunoterapia para prevenção e tratamento da asma.

L’asthme bronchique est caractérisé par un remodelage et une inflammation des voies aériennes. La masse du muscle lisse ainsi que la déposition de matrice extracellulaire sont augmentées dans la paroi des bronches asthmatiques, ce qui contribue à l’obstruction respiratoire. Peu d’études ont évalué les effets des traitements utilisés dans l’asthme sur le remodelage bronchique, et surtout peu de données sont disponibles concernant les effets sur le muscle lisse. La combinaison de corticostéroïdes et de β2-agonistes à longue durée d’action administrée par inhalation permet de mieux contrôler les crises d’asthme par rapport à la monothérapie avec des médicaments corticostéroïdes. Cependant, l’action spécifique de la combinaison sur le remodelage et sur l’inflammation des bronches périphériques n’est pas décrite. Surtout, il reste à clarifier si l’administration de la combinaison est avantageuse par rapport à la monothérapie corticostéroïde. La plupart des études réalisées chez l’homme utilisent des tissus bronchiques obtenus par biopsie endobronchique, qui ne sont pas représentatifs du processus pathologique affectant les voies respiratoires périphériques. Leur inaccessibilité par des méthodes non invasives est la raison pour laquelle si peu de données existent sur la pathophysiologie des voies périphériques chez les patients asthmatiques. L’asthme équin, aussi connu comme « le souffle », est une pathologie obstructive des chevaux adultes considérée comme un modèle animal d’asthme humain. Elle est caractérisée par un remodelage des bronches périphériques et par une inflammation bronchoalvéolaire de type neutrophilique. En étudiant le modèle équin, cette thèse a évalué la contribution des médicaments corticostéroïdes et de β2-agonistes à longue durée d’action, administrée comme monothérapies ou en combinaison, sur la réversibilité du remodelage et de l’inflammation de voies aériennes dans l’asthme bronchique. A cette fin, nous avons d’abord optimisé et validé l’application de la biopsie endobronchique et de l’échographie endobronchique chez le cheval adulte. Nos résultats indiquent que les échantillons obtenus par biopsie endobronchique sont inadéquats pour l’évaluation quantitative de la masse du muscle lisse chez le cheval. Cependant, ils permettent d’étudier les changements quantitatifs des structures épithéliales et de la lamina propria, ainsi que les aspects qualitatifs du muscle lisse. L’échographie endobronchique, quant à elle, permet d'estimer la masse du muscle lisse bronchique, et ce, chez des chevaux sains et chez des chevaux asthmatiques. Cette thèse démontre aussi que qu’un traitement de 12 semaines avec des corticostéroïdes induit une diminution significative de la masse du muscle lisse périphérique, qui n’est pas amélioré davantage par l’administration concomitante d’un β2-agoniste à longue durée d’action. Cette diminution est toutefois incomplète. Un effet positif et synergique de la combinaison a également été observé au niveau de la déposition de matrice extracellulaire. La combinaison a produit une diminution significative de la quantité de matrices déposées dans la lamina propria et dans la couche du muscle lisse dans les bronches centrales, alors que l’effet été limité à la couche du muscle lisse dans les bronches périphériques. La combinaison n’améliore pas le contrôle de l’inflammation bronchique ni bronchiolaire par rapport aux monothérapies ; cependant, elle diminue la neutrophilie bronchoalvéolaire de façon synergique. / Airway remodeling and inflammation are the hallmarks of asthma. Both airway smooth muscle (ASM) mass and extracellular matrix (ECM) deposition are increased in the central and peripheral airways of asthmatic patients, which contribute to airway obstruction. Few studies have investigated the ability of current asthma medications to reverse airway remodeling, especially the increased ASM mass. Inhaled corticosteroids (ICS) and long-acting β2-agonist combinations (ICS/LABA) are more effective than ICS monotherapy to control asthma exacerbations. However, their efficacy at modifying bronchial inflammation and remodeling at the peripheral level of the lung is not well-described. In fact, most work has been performed using endobronchial biopsy samples obtained from asthmatic subjects, which completely disregard the alterations occurring in peripheral airways. Ethical considerations limit the possibility of biopsying the peripheral airways in humans due to the invasiveness of the procedure. Equine asthma, or heaves, is a naturally-occurring disease of adult horses and a recognized animal model of human asthma characterized by neutrophilic inflammation as well as ASM and ECM remodeling of peripheral airways. This thesis has assessed the contribution of ICS and LABA, alone or combined, to the reversal of remodeling and inflammation in central and peripheral airways using the equine asthma model. To attain this goal, we have first optimized and validated the application of endobronchial biopsy and endobronchial ultrasound (EBUS) in the equine species. EBUS reliably estimates the bronchial ASM. Subsequently, asthmatic horses with ongoing airway remodeling and inflammation were treated with ICS, LABA, ICS/LABA, or antigen avoidance. Lung function, airway remodeling and inflammation were then assessed weekly for 3 months. Our results demonstrated a 30% decrease of peripheral ASM remodeling attained with ICS and ICS/LABA pharmacological treatment. A decrease of a similar magnitude of peripheral ASM was previously reported after 6 and 12 months of ICS monotherapy and antigen avoidance, respectively. A synergistic effect of ICS/LABA was observed on ECM deposition and airway lumen neutrophils. ICS/LABA decreased the ECM fraction of the ASM layer both peripherally and centrally, while the same effect on the lamina propria was observed only in central airways. Both ICS/LABA and ICS monotherapy decreased submucosal inflammation in central airways, while only ICS/LABA and antigen avoidance decreased bronchoalveolar neutrophilia. In conclusion, our results suggest that the enhanced therapeutic effect of ICS/LABA over ICS monotherapy in asthmatic horses was associated with a reduction of ECM deposition, mainly observed within the large airways, and possibly also with a decreased airway neutrophilia. However, ICS/LABA did not provide additional benefit to ICS monotherapy in terms of peripheral ASM remodeling as both induce a 30% decrease of the ASM mass in 3 months.

L’asthme est une des maladies chroniques les plus prévalentes, affectant environ 300 millions d’individus dans le monde et causant plus de 400 000 décès annuellement. La condition se caractérise par une hyperréactivité bronchique, de l’inflammation pulmonaire et des changements structuraux (remodelage) des voies respiratoires. Bien que l’inflammation soit le plus souvent de type éosinophilique dans l’asthme, une proportion importante des patients affectés par la forme sévère de la maladie présente plutôt une infiltration des voies respiratoires par les neutrophiles. Cette inflammation neutrophilique a été associée à plusieurs issues cliniques négatives, notamment à une mauvaise réponse aux traitements, à une obstruction respiratoire permanente et à la mortalité. Malgré l’importance de ces conséquences cliniques pour les patients affectés, le rôle de l’inflammation neutrophilique dans la pathophysiologie de l’asthme, dont ses effets sur le remodelage bronchique, demeure peu exploré. Dans toutes les formes d’asthme, les traitements usuels de la maladie (glucocorticoïdes et bronchodilatateurs) ne permettent pas de renverser entièrement les lésions de remodelage bronchique, dont l’augmentation de la masse du muscle lisse, et ne contrôlent pas adéquatement la neutrophilie pulmonaire. L’augmentation de la masse musculaire lisse bronchique représente pourtant une cible thérapeutique importante vu son implication dans le rétrécissement de la lumière bronchique et le bronchospasme. Les objectifs de cette thèse ont donc été d’étudier les mécanismes potentiellement impliqués dans l’association entre l’inflammation neutrophilique et la sévérité de la maladie, et d’investiguer les effets de thérapies anti-neutrophiliques sur le remodelage bronchique dans le modèle de l’asthme équin sévère. Similairement à la condition humaine, l’asthme équin sévère est caractérisé par une obstruction respiratoire fluctuante, de l’inflammation pulmonaire et un remodelage bronchique, notamment une augmentation de la masse du muscle lisse. Cette maladie se prête particulièrement bien à l’étude du phénotype neutrophilique puisque c’est cette cellule granulocytaire qui infiltre le milieu pulmonaire lors des exacerbations cliniques. Les études réalisées dans ce projet doctoral ont permis de déterminer que l’azithromycine, un macrolide possédant des propriétés immunomodulatrices, réduit l’inflammation neutrophilique dans le modèle de l’asthme équin. Toutefois, ce traitement n’a pas diminué l’obstruction bronchique ni les lésions de remodelage lorsqu’utilisé en monothérapie, et n’a pas potentialisé les effets des corticostéroïdes inhalés. Ces résultats suggèrent que l’atténuation de l’inflammation pulmonaire ne suffit pas à rétablir l’homéostasie tissulaire dans la phase chronique de la maladie. Toutefois, l’hétérogénéité phénotypique des neutrophiles pourrait rendre leur simple quantification dans les sécrétions respiratoires insuffisante pour élucider leurs répercussions dans l’asthme. Par exemple, les neutrophiles pourraient contribuer au remodelage bronchique par la relâche de vésicules extracellulaires, des nanoparticules qui peuvent modifier la biologie des cellules locales et distantes. Ainsi, les caractéristiques des vésicules neutrophiliques et leur effet prolifératif sur le muscle lisse bronchique ont été examinés. Les résultats obtenus indiquent que les vésicules produites par les neutrophiles augmentent la prolifération du muscle lisse bronchique lorsqu’elles proviennent de cellules exposées au lipopolysaccharide, un fragment bactérien omniprésent dans l’environnement et incriminé dans l’infiltration neutrophilique et le développement de l’obstruction bronchique dans l’asthme humain et équin. / Asthma is one of the most prevalent chronic diseases, affecting approximately 300 million people worldwide and causing over 400,000 deaths annually. The condition is characterized by the combination of bronchial hyperreactivity, lung inflammation, and structural changes in the airways (remodeling). Although an eosinophilic inflammation is common in asthma, a significant proportion of patients affected by the severe form of the disease have a neutrophilic airway infiltration. The neutrophilic phenotype has been associated with several negative outcomes in human asthma, including poor response to therapy, permanent airway obstruction and mortality. Despite these associations, the role of neutrophils in asthma, including its effects on airway remodeling, remains insufficiently explored. Unfortunately, standard asthma therapies (glucocorticoids and bronchodilators) do not adequately control neutrophilic inflammation and reverse only partially, if at all, bronchial remodeling lesions, including the increased airway smooth muscle mass. This structural modification is however an important therapeutic target because of its involvement in bronchial lumen narrowing and bronchospasm. The main objectives of this thesis were therefore to study mechanisms potentially involved in the association between neutrophilic inflammation and asthma severity, and to investigate the effects of anti-neutrophilic therapies on bronchial remodeling reversibility in the severe equine asthma model. Similar to the human disease, severe equine asthma is characterized by fluctuating airflow obstruction, pulmonary inflammation, and remodeling lesions, including a large increase in airway smooth muscle mass. Clinical exacerbations are characterized by a marked pulmonary neutrophilic influx, making this disease particularly suitable to study the neutrophilic phenotype. Studies conducted during this doctoral program revealed that azithromycin, a macrolide with immunomodulatory properties, reduces neutrophilic inflammation in the equine asthma model, but fails to alleviate bronchial obstruction and remodeling lesions, suggesting that the control of neutrophilic inflammation is not sufficient to restore tissue homeostasis when the disease reaches its chronic phase. However, the simple quantification of neutrophils within respiratory secretions might not elucidate comprehensively the possible functional consequences of this cell in the pathophysiology of asthma. For instance, neutrophils could lead and sustain bronchial structural lesions through the release of extracellular vesicles. Those nanoparticles can modify the biology of local and distant cells and are involved in the pathophysiology of several inflammatory diseases. Thus, the characteristics and the effect of neutrophil extracellular vesicles on airway smooth muscle proliferation were studied in horses with severe asthma. The results obtained indicate that extracellular vesicles increase bronchial smooth muscle cell proliferation when they are produced by neutrophils exposed to lipopolysaccharide, a ubiquitous environmental contaminant incriminated in the development of neutrophilic infiltration and bronchial obstruction in human and equine asthma.

Typ 2-cytokiner, IL-4 och IL-13 är kända för att spela en viktig roll i airway hyperresponsiveness (AHR) eller luftvägshyperreaktivitet, där de glatta muskelcellerna (ASM) drar ihop sig för lätt och för mycket som svar på direkta eller indirekta stimuli. Detta gör AHR till en avgörande egenskap hos astmatiker. Det har gjorts studier som har visat involvering av typ 2-cytokiner i AHR, men deras specifika inflammatoriska mekanismer är ännu outforskade. Denna experimentella studie på glatta muskelceller från luftvägarna (ASM) syftade till att undersöka involveringen av typ 2-cytokin inducerad kontraktilitet genom att fokusera på receptoraktivering, receptoruttryck samt ge insikter om frisättning av proteiner relaterade till luftvägsfibros, så kallad remodelling. Dessutom studerar den också effekten av IL- 4/IL-13 receptor antagonisten Dupilumab (anti-IL4Ra) på cytokinbehandlade HASM. Efter stimulering av HASM med IL-13 under 24 timmar visade resultaten att IL-13 orsakar en ospecifik, icke-receptormedierad ökning av intracellulärt kalciumflöde som svar på kalciumjonoforen A23187. Detta skulle potentiellt kunna öka kontraktiliteten hos glatta muskelceller som svar på flera olika kontraktila stimuli. Denna forskning ger också preliminära resultat som tyder på att IL-13 och IL-4 också ökar kalciumflödet som svar på aktivering av receptorer för specifika kontraktila mediatorer (Histamin, Carbachol, Leukotriene D4 och Substance P), och att effekten förmedlas via IL-4/IL-13-receptorn vilket blockeras med dupilumab som verkade minska effekten. Närvaron av fler receptorer för kontraktila mediatorer kan också öka kontraktiliteten hos glatta muskelceller som svar på IL-4 och IL-13. Återigen sågs ökat uttryck av receptorer för kontraktila stimuli efter behandling med cytokinerna som inhiberades av dupilumab. Dessutom undersökte vi effekten av IL-13 och IL-4 på frisättning av prokollagen 1 (en prekursor för mogna kollagena former) från mänskliga glatta muskelceller i luftvägarna. Våra resultat visade inte några signifikanta effekter på frisättningen av just detta kollagenprotein. Sammantaget visar vi att typ 2 cytokiner kan på flera olika sätt öka kontraktiliteten av glatta muskelceller vilket ökar vår kunskap om mekanismerna som orsakar luftvägshyperreaktivitet hos astmatiker. / Type 2 cytokines, IL-4 and IL-13 are known to play an essential role in airway hyperresponsiveness (AHR) - in response to direct or indirect stimulus the smooth muscle cells (ASM) contract too easily and too heavily. This makes AHR a defining feature of asthma. There have been studies that have demonstrated involvement of type 2 cytokines in AHR. However, the specific mechanisms involved remain undefined. This experimental study in airway smooth muscle (ASM) was aimed to investigate the involvement of type 2 cytokine on AHR by focusing on the expression and activation of receptors for contractile mediators as well as provide insights on the release of proteins related to airway remodelling. Experiments were performed where human airway smooth muscle cells were treated with IL-4 and/or IL-13, with or without Dupilumab, an antagonist of the joint IL-4/IL-13 receptor (anti-IL4Ra). After stimulating HASMs with IL-13 for 24 hours, results showed that IL-13 caused a non-specific, non-receptor-mediated increase in intracellular calcium flux in response to the calcium ionophore A23187. This could potentially increase the contractility of smooth muscle cells in response to any contractile stimulus. This study also suggests that IL-13 and IL-4 increased calcium flux in response to activation of receptors for specific contractile mediators (Histamine, Carbachol, Leukotriene D4 and Substance P). The mechanism involved likely involves the common IL-4/IL-13 receptor as blocking this with dupilumab seemed to reduce the effect. The presence of more receptors for contractile mediators could also increase contractility of smooth muscle cells in response to IL-4 and IL-13. Preliminary results show that mRNA expression of receptors for Histamine (H1) and LTD4 (CYSLT1) were upregulated by type 2 cytokines and again, this upregulation appeared to be inhibited by dupilumab. Moreover, we examined the effect of IL-13 and IL-4 on release of procollagen 1 (a precursor of mature collagen forms) from human airway smooth muscle cells. Our results did not show any significant effects on the release of this particular collagen protein. Taken together these findings increase our understanding of the mechanisms whereby type 2 cytokines may increase the contractility of airway smooth muscle and provide a basis for follow-up investigations. Improved knowledge of the mechanisms underlying AHR could ultimately lead to improved treatment of asthma.