Indiana University-Purdue University Indianapolis (IUPUI) / Cerebral amyloid angiopathy (CAA) is characterized by the cerebrovascular deposition of amyloid. The mechanisms underlying the contribution of CAA to neurodegeneration are not fully understood. In this dissertation, there are three main chapters. The first chapter investigates existing evidence regarding the amyloid diversity in CAA and its relation to tau pathology and immune response, as well as the possible contribution of molecular and cellular mechanisms, previously associated with parenchymal amyloid in Alzheimer disease (AD) and AD-related dementias, to the pathogenesis of CAA. The second chapter demonstrates differential glial reactivity and activation associated with early-stage CAA in a mouse model of Familial Danish Dementia (FDD), a neurodegenerative disease characterized by vascular accumulation of Danish amyloid (ADan). We show that early-stage CAA is associated with dysregulation in immune response networks and lipid processing, severe astrogliosis with a neurotoxic A1-astrocytic phenotype, characterized by increased expression of Complement Component 3 (C3), and decreased levels of Triggering Receptor Expressed On Myeloid Cells 2 (Trem2) with no significant reactive microgliosis. Our results also indicate how cholesterol accumulation and Apolipoprotein E (ApoE) are associated with vascular amyloid deposits at the early stages of pathology. Furthermore, we demonstrate A1 astrocytic mediation of Trem2 and microglia homeostasis. In the final chapter, we addressed whether inflammatory stimulus of other cell types are capable of inducing a subtype of neurotoxic astrocytes. Here we show a subtype of C3+ neurotoxic astrocyte are induced by activated endothelial cells that is distinct from astrocytes classically activated by microglia. We show that endothelial activated astrocytes have upregulated expression of A1-astrocytic genes and exhibit a distinctive extracellular matrix remodeling profile. Finally, we demonstrate that endothelial activated astrocytes are Decorin-positive and are associated to vascular amyloid deposits but not parenchymal amyloid plaques in mouse models and AD/CAA patients. These findings show the existence of potentially extensive and subtle functional diversity of C3+-reactive astrocytes.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20619号 / 医博第4268号 / 新制||医||1023(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 宮本 享, 教授 渡邉 大, 教授 松原 和夫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Dissertation (Ph.D.)--University of South Florida, 2007. / Title from PDF of title page. Document formatted into pages; contains 142 pages. Includes vita. Includes bibliographical references.

Dissertation (Ph.D.)--University of South Florida, 2007. / Includes vita. Includes bibliographical references (leaves 128-139). Also available online.

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O objetivo deste estudo foi verificar o comportamento anatomopatológico e expressão imunohistoquímica das proteínas GFAP, Vimentina, COX-2 e Amilóide β em 14 casos de encefalopatias não infecciosas em cães, mais especificamente Meningoencefalite Granulomatosa (MEG), Meningoencefalite Necrotizante (MEN) e Angiopatia Amilóide Cerebral (CAA). Foram coletadas informações clínicas (gênero, raça, idade) e morfológicas (necrose, presença de proteína amilóide, infiltrado inflamatório) dos animais. Para a expressão das proteínas por imunohistoquímica foram confeccionadas lâminas próprias para tal com amostras dos tecidos, juntamente com controles positivos das reações. A avaliação da expressão das proteínas foi de como positivo ou negativo para a marcação para GFAP, Vimentina e COX-2, e para o Aβ seguiu-se a classificação proposta por Olichney (1995), com quatro graduações. Animais SRD (4/14, 28%), de raça Maltês (2/14, 14%), Labrador (2/14, 14%), Poodle (3/14, 21%), Fox Terrier (1/14, 7%), Pug (1/14, 7%) e Bichon Frisè (1/14, 7%) fizeram parte deste estudo, na maioria machos (9/14, 63%). As lesões em todos os casos foram características, sendo que em MEG foi observado manguitos perivasculares abundantes com infiltrado inflamatório disperso pelo parênquima encefálico, caracterizando os quatro casos como de MEG disseminada. Em MEN foi observado o infiltrado inflamatório acompanhado de áreas de necrose, sinais característicos da doença. Nos casos de CAA foi observado agregados proteicos junto aos vasos sanguíneos do encéfalo, confirmados como sendo material amilóide por meio da coloração Vermelho Congo. Quanto a expressão dos antígenos por imunohistoquímica, houve a marcação de todos anticorpos em todos os casos, e, para os casos de CAA, houve uma maioria de casos com classificação 1 (5/6, 83%). Em conclusão: 1. os dados clínicos obtidos reproduzem o comportamento biológico destas doenças em cães; 2. a análise imunohistoquímica das lesões de MEG, MEN e CAA apresentou resultados dentro dos quadros descritos na literatura; 3. a marcação positiva para COX-2 indica um aumento na atividade macrofágica no encéfalo; 4. as marcações de GFAP e Vimentina indicam uma reação das células da glia frente a lesão apresentada; 5. a utilização da imunohistoquímica como ferramenta de diagnóstico para estas doenças é válida. / The goal of this study was to analyze the anatomopathological and immunohistochemical profile for GFAP, Vimentin, COX-2 and β-amyloid in 14 cases of noninfectious encephalopathies in dogs, more specifically Granulomatous Meningoencephalitis (GME), Necrotizing Meningoencephalitis (NME) and Cerebral Amyloid Angiopathy (CAA). Clinical (gender, breed, age) and morphological (necrosis, presence of amyloid protein, inflammatory infiltrate) informations were collected regarding such animals. Microscopy slides with paraffin-embedded sections of tissue were elaborated for the immunohistochemical analysis, as well as positive controls for the reactions. The expressions of the proteins were graded as positive or negative for GFAP, Vimentin and COX-2, and the grading system described by Olichney was used for the β-amyloid. Animals of mixed breed (4/14, 28%), malteses (2/14, 14%), Labrador (2/14, 14%), Poodle (3/14, 21%), Fox Terrier (1/14, 7%), Pug (1/14, 7%) and Bichon Frisè (1/14, 7%) featured in this study, and most of them were males (9/14, 63%). All of the lesions observed were characteristic of such diseases, as perivascular cuffing with an abundant inflammatory infiltrate was observed in GME cases, being all 4 cases considered as disseminated GME. Necrosis, as well as the inflammatory infiltrate, was observed in all NME cases, which is the hallmark of this disease. The deposition of amyloid protein was observed in cases of CAA, which were confirmed by the Congo Red special staining. As for the immunohistochemical expression, all antibodies performed positive staining, and for the β-amyloid there was a predominance of grade 1 cases (5/6, 83%). In conclusion: 1. the clinical data reproduce the biological behavior of such diseases in dogs; 2. the immunohistochemical analysis of the lesions from GME, NME and CAA presented results coherent with those found in the literature; 3. positive staining for COX-2 presented an increased macrophage activity in the brain of those animals; 4. GFAP and Vimentin positive staining indicate a reaction by the glial cells against the presented lesion; 5. immunohistochemistry is a valid diagnostics tool for such diseases.

O objetivo deste estudo foi verificar o comportamento anatomopatológico e expressão imunohistoquímica das proteínas GFAP, Vimentina, COX-2 e Amilóide β em 14 casos de encefalopatias não infecciosas em cães, mais especificamente Meningoencefalite Granulomatosa (MEG), Meningoencefalite Necrotizante (MEN) e Angiopatia Amilóide Cerebral (CAA). Foram coletadas informações clínicas (gênero, raça, idade) e morfológicas (necrose, presença de proteína amilóide, infiltrado inflamatório) dos animais. Para a expressão das proteínas por imunohistoquímica foram confeccionadas lâminas próprias para tal com amostras dos tecidos, juntamente com controles positivos das reações. A avaliação da expressão das proteínas foi de como positivo ou negativo para a marcação para GFAP, Vimentina e COX-2, e para o Aβ seguiu-se a classificação proposta por Olichney (1995), com quatro graduações. Animais SRD (4/14, 28%), de raça Maltês (2/14, 14%), Labrador (2/14, 14%), Poodle (3/14, 21%), Fox Terrier (1/14, 7%), Pug (1/14, 7%) e Bichon Frisè (1/14, 7%) fizeram parte deste estudo, na maioria machos (9/14, 63%). As lesões em todos os casos foram características, sendo que em MEG foi observado manguitos perivasculares abundantes com infiltrado inflamatório disperso pelo parênquima encefálico, caracterizando os quatro casos como de MEG disseminada. Em MEN foi observado o infiltrado inflamatório acompanhado de áreas de necrose, sinais característicos da doença. Nos casos de CAA foi observado agregados proteicos junto aos vasos sanguíneos do encéfalo, confirmados como sendo material amilóide por meio da coloração Vermelho Congo. Quanto a expressão dos antígenos por imunohistoquímica, houve a marcação de todos anticorpos em todos os casos, e, para os casos de CAA, houve uma maioria de casos com classificação 1 (5/6, 83%). Em conclusão: 1. os dados clínicos obtidos reproduzem o comportamento biológico destas doenças em cães; 2. a análise imunohistoquímica das lesões de MEG, MEN e CAA apresentou resultados dentro dos quadros descritos na literatura; 3. a marcação positiva para COX-2 indica um aumento na atividade macrofágica no encéfalo; 4. as marcações de GFAP e Vimentina indicam uma reação das células da glia frente a lesão apresentada; 5. a utilização da imunohistoquímica como ferramenta de diagnóstico para estas doenças é válida. / The goal of this study was to analyze the anatomopathological and immunohistochemical profile for GFAP, Vimentin, COX-2 and β-amyloid in 14 cases of noninfectious encephalopathies in dogs, more specifically Granulomatous Meningoencephalitis (GME), Necrotizing Meningoencephalitis (NME) and Cerebral Amyloid Angiopathy (CAA). Clinical (gender, breed, age) and morphological (necrosis, presence of amyloid protein, inflammatory infiltrate) informations were collected regarding such animals. Microscopy slides with paraffin-embedded sections of tissue were elaborated for the immunohistochemical analysis, as well as positive controls for the reactions. The expressions of the proteins were graded as positive or negative for GFAP, Vimentin and COX-2, and the grading system described by Olichney was used for the β-amyloid. Animals of mixed breed (4/14, 28%), malteses (2/14, 14%), Labrador (2/14, 14%), Poodle (3/14, 21%), Fox Terrier (1/14, 7%), Pug (1/14, 7%) and Bichon Frisè (1/14, 7%) featured in this study, and most of them were males (9/14, 63%). All of the lesions observed were characteristic of such diseases, as perivascular cuffing with an abundant inflammatory infiltrate was observed in GME cases, being all 4 cases considered as disseminated GME. Necrosis, as well as the inflammatory infiltrate, was observed in all NME cases, which is the hallmark of this disease. The deposition of amyloid protein was observed in cases of CAA, which were confirmed by the Congo Red special staining. As for the immunohistochemical expression, all antibodies performed positive staining, and for the β-amyloid there was a predominance of grade 1 cases (5/6, 83%). In conclusion: 1. the clinical data reproduce the biological behavior of such diseases in dogs; 2. the immunohistochemical analysis of the lesions from GME, NME and CAA presented results coherent with those found in the literature; 3. positive staining for COX-2 presented an increased macrophage activity in the brain of those animals; 4. GFAP and Vimentin positive staining indicate a reaction by the glial cells against the presented lesion; 5. immunohistochemistry is a valid diagnostics tool for such diseases.

La maladie d'Alzheimer (MA) et l'angiopathie amyloïde cérébrale (AAC) sont respectivement caractérisées par des dépôts de peptides amyloïdes β (Aβ) dans le cerveau et la vascularisation cérébrale. Étant donné qu’un régime riche en DHA est associé à une réduction du risque de la MA, l'objectif principal de ma thèse a été d'évaluer l'impact d'un régime enrichi en DHA sur l'inflammation systémique et ses conséquences sur les dépôts Aβ parenchymateux et vasculaires au cours du vieillissement dans un modèle de souris transgéniques de MA/AAC, les Tg2576. Les dépôts amyloïdes ont été détectés en utilisant un anticorps anti-Aβ et les hémorragies avec du bleu prussien sur des coupes cérébrales. A 10, 14 et 18 mois, nous avons démontré une réduction des dépôts vasculaires amyloïdes et des hémorragies en régime DHA par rapport au régime placebo, alors que les dépôts parenchymateux ne sont pas affectés. De plus, nous avons démontré une forte corrélation entre les dépôts amyloïdes vasculaires, les hémorragies et un médiateur pro-inflammatoire lipidique, le 12-HETE. Nous avons ensuite évalué in vitro les effets du peptide Aβ1-40 sur la production de 12-HETE par les cellules musculaires lisses vasculaires. Nous avons démontré que les niveaux d'ARNm de l'enzyme 12-LOX, impliquée dans la synthèse de 12-HETE, était augmenté lorsque les cellules ont été incubées avec du peptide Aβ1-40, suggérant une relation de cause à effet entre les dépôts Aβ et les lipides pro-inflammatoires. Mon travail a de nouveau souligné l'importance de l'inflammation dans la pathogenèse de l'AAC tout en ouvrant une nouvelle voie pour des cibles potentielles dans l'intervention préventive de cette pathologie. / Alzheimer's disease (AD) and cerebral amyloid angiopathy (CAA) are characterized by Amyloid β-peptides depositions in the brain and cerebral vasculature respectively. Because DHA-diet is associated with a reduced risk of AD, the main objective of my thesis was to evaluate the impact of a DHA-diet on cerebrovascular and peripheral inflammation and its consequences on parenchymal and vascular Aβ-deposits during aging in a transgenic mouse model of AD/CAA (Tg2576). The Aβ-peptide deposits were detected using an anti-Aβ peptides and hemorrhages were detected with Prussian Blue on brain sections. At 10, 14 and 18 month-old, we demonstrated a reduction of amyloid vascular deposits and hemorrhages under DHA-diet compared to placebo, while parenchymal Aβ-peptides deposits remain unaffected. Moreover, we demonstrated a strong negative correlation between amyloid vascular deposition, hemorrhage and a lipid-derived pro-inflammatory mediator, 12-HETE. We next evaluated the in vitro effects of Aβ1-40-peptide on 12-HETE production by the Vascular Smooth Muscle Cells. We demonstrated that the mRNA level of the 12-LOX enzyme, involved in 12-HETE synthesis, was increased when cells where incubated with Aβ1-40-peptide, suggesting a cause-to-effect relationship between Aβ deposits and pro-inflammatory biolipids. The work carried out during my thesis made it possible to demonstrate DHA protective effect on evolution and consequences of Aβ peptide cerebrovascular accumulation and link it to plasma 12-HETE level. My work emphasized once again the importance of inflammation in AAC pathogenesis while opening up a new pathway for potential targets in the preventive intervention of this pathology.

L'angiopathie amyloïde cérébrale (AAC) est caractérisée par des dépôts amyloïdes au sein des parois cérébrovasculaires, associés à des altérations vasculaires et des troubles cognitifs. L'inflammation étant un processus délétère au cours de l'AAC, je me suis intéressée à l'effet inflammatoire sur les cellules musculaires lisses (CML) vasculaires du peptide amyloïde principalement accumulé au sein des parois artérielles, le peptide A 1-40. Cette étude met en évidence que le peptide A 1-40 n'induit pas directement de réponse inflammatoire de la part des CML, mais les sensibilise aux stimuli pro-inflammatoires. Aussi, cette sensibilisation cellulaire résulte d'une pré-activation des voies PI3K/Akt et NF- B, insuffisante à elle-seule pour induire une réponse inflammatoire. Dans une seconde partie de ma thèse, je me suis intéressée aux mécanismes moléculaires impliqués dans la migration des CML au cours de la re-sténose post-angioplastie. Lorsque l'athérosclérose conduit à une sténose artérielle, l'angioplastie est l'opération chirurgicale rétablissant le flux sanguin. Cependant, dans les 6 mois postopératoires, 10 à 20% des patients présentent une re-sténose post-angioplastie. Un des principaux facteurs impliqué dans ce processus est la migration des CML de la paroi vers la lumière artérielle. Dans ce contexte, j'ai pu démontrer que la re-sténose post-angioplastie chez le rat est dépendante du niveau d'expression de l'adénylyl cyclase 8 (AC8). Dans cette étude, nous avons également montré que l'expression de l'AC8 induit la migration des CML et l'activation de la métalloprotéinase matricielle-2, en stimulant les voies Epac2/Rap1 et PI3K/Akt. / Cerebral amyloid angiopathy (CAA) is defined by amyloid deposits within cerebral vasculature associated with vascular damages and cognitive impairment. As inflammation is a deleterious event during CAA, I explored the inflammatory effect in vascular smooth muscle cells (VSMC) of the amyloid peptide which is mainly accumulated in arterial wall, the peptide A1-40. This study evidenced that A1-40 does not directly induce inflammatory response of VSMC but sensitizes these cells to pro-inflammatory stimuli. Furthermore, this sensitization results from a pre-activation of PI3K/Akt and NF-B pathways, insufficient alone to induce inflammatory response.In the second part of my thesis, I studied the molecular mechanisms involved in VSMC migration occurring in post-angioplasty restenosis. When atherosclerosis leads to arterial stenosis, angioplasty is the surgery practiced to restore blood flow. However, during the 6 month post-surgery, 10 to 20% of patients display post-angioplasty restenosis. One of the main components of this event is the migration of VSMC from the wall to arterial lumen. In this context, I demonstrated that the severity of rat post-angioplasty restenosis is dependent to the level of adenylyl cyclase 8 (AC8) expression. In this study, we have also shown that AC8 expression promotes VSMC migration and matrix metalloproteinase-2 activation through Epac2/Rap1 and PI3K/Akt pathways.

Contexte : Les hémorragies intracérébrales spontanées (HIC) sont grevées d’une mortalité élevée et d’un pronostic fonctionnel sombre. Les données concernant le pronostic à long terme des HIC sont rares. L’objectif principal de ce travail était d’étudier le pronostic au long cours des HIC en les abordant par le prisme de leur histoire naturelle.Méthodes : Nos populations d’étude sont issues de la cohorte prospective PITCH (Prognosis of IntraCerebral Haemorrhage) qui est une cohorte observationnelle ayant inclus de façon consécutive tous les patients admis au CHU de Lille pour une HIC spontanée entre 2004 et 2009. Nous avons étudié (i) l’incidence de la démence de novo post HIC ainsi que les facteurs prédictifs cliniques et neuroradiologiques associés à sa survenue ; (ii) la prévalence de la sidérose superficielle corticale (SSc) et les facteurs cliniques et radiologiques associés ; (iii) les facteurs prédictifs de récidive hémorragiques.Résultats : Nous avons mis en évidence qu’il existait un risque majeur de démence de novo chez les patients survivant à une HIC. Les facteurs prédictifs de démence identifiés tels que la localisation lobaire ou la SSc suggèrent une implication directe de l’angiopathie amyloïde cérébrale. Nous avons également montré qu’au sein de notre cohorte, un patient sur cinq avait de la SSc sur l’IRM cérébrale réalisée à l’admission. La SSc apparaissait être un facteur neuroradiologique prédictif majeur de récidive hémorragique.Conclusion : Les résultats de ce travail ont un impact important dans la prise en charge des patients ayant eu une HIC spontanée et permettront d’informer de façon adéquate les patients et leurs aidants. Ils apportent des informations nouvelles sur l’évaluation du risque de récidive hémorragique et sur d’éventuelles futures cibles thérapeutiques. / Background: The low frequency of spontaneous intracerebral haemorrhage (ICH) and its high mortality rate may explain the paucity of data in long term outcomes. The main objective was to study long term prognosis of ICH through the prism of their natural history.Methods: Our study populations were based on the PITCH (Prognosis of IntraCerebral Haemorrhage) cohort which is an observational study that included consecutively adults admitted at the Lille University Hospital for spontaneous ICH between 2004 and 2009. We aimed to determine (i) the incidence of new onset dementia and its clinical and radiological predictive factors; (ii) the prevalence of cortical superficial siderosis (cSS) and its associated factors; (iii) predictive factors of recurrent ICH.Results: We showed that the risk of new onset dementia is substantial after spontaneous ICH. Predictive factors of new onset dementia such as ICH lobar location and cSS suggest the implication of underlying cerebral amyloid angiopathy. We found that one out of five patients had cSS on baseline MRI. cSS was a strong predictive factor of recurrent ICH. Conclusion: These findings are of immediate clinical relevance in the management of ICH patients and will allow to adequately inform patients and caregivers. These results may provide additional information on ICH recurrence risk assessment and may contribute to the development of future therapeutic strategies.