CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Leishmania braziliensis à o agente etiolÃgico mais comum da leishmaniose cutÃnea no Brasil. Camundongos BALB/c sÃo os mais susceptÃveis à infecÃÃo por L. braziliensis, embora desenvolvam lesÃes pequenas e nÃo ulceradas. As lesÃes em BALB/c infectados com L. braziliensis sÃo acompanhadas pela expressÃo de um amplo espectro de quimiocinas, entre elas CXCL10, que à capaz de atrair a ativar cÃlulas NK e Th1 com produÃÃo de IFN-γ. O objetivo deste trabalho foi avaliar se a quimiocina CXCL10, administrada nos estÃgios iniciais da infecÃÃo, poderia alterar o curso da doenÃa, dimunindo o tempo de cura. Para isso, camundongos BALB/c (n=24) foram infectados com L. braziliensis e divididos em dois grupos: um grupo (n=12) recebeu CXCL10 (100 ng/5ÂL) e o outro (n=12) PBS (5ÂL), nos dias 1, 3, 5 e 7 dias de infecÃÃo. Alguns parÃmetros foram avaliados: a espessura das lesÃes a cada trÃs dias; a carga parasitÃria na pata e no linfonodo de drenagem, a concentraÃÃo de NO, IFN-γ, IL-12p40, TNF-α, IL-4, IL-10 e TGF-β, 15 e 30 dias apÃs a infecÃÃo; e anÃlise histopatolÃgica das lesÃes. Os animais que receberam CXCL10 apresentaram uma reduÃÃo no tempo de duraÃÃo da doenÃa, uma vez que as lesÃes comeÃaram a regredir mais precocemente (12 dias), enquanto que nos animais controle (PBS) a doenÃa evoluiu por mais tempo (15 dias). CXCL10 induziu diferenÃas estatisticamente significativas na carga parasitÃria do linfonodo de drenagem nos dois pontos avaliados, quando comparado com o controle (15 dias: p=0,0353; 30 dias: p=0,0292). Nos animais que receberam CXCL10, nÃo foi observada mudanÃa no nÃmero de parasitos no sÃtio de inoculaÃÃo, mesmo com reduÃÃo da espessura da lesÃo, mostrando que nÃo houve correlaÃÃo entre o tamanho da lesÃo e a carga parasitÃria. NÃo houve diferenÃa na concentraÃÃo de NO entre os grupos, no 15 dia de infecÃÃo, e esta concentraÃÃo manteve-se igual no grupo que recebeu CXCL10 no 30 dia, embora tenha sido menor do que a observada no grupo controle. CXCL10 tambÃm induziu concentraÃÃes mais elevadas de IFN-γ e IL-12 e mais reduzidas de IL-4, IL-10, TGF-β 30 dias pÃs-infecÃÃo, quando comparados aos animais controle. A anÃlise histopatolÃgica das patas mostrou uma inflamaÃÃo muito leve em ambos os grupos, com diferenÃa apenas quanto à ausÃncia de neutrÃfilos nas lesÃes dos animais que receberam CXCL10. Em conjunto, os dados mostraram que CXCL10 apresentou um efeito protetor na infecÃÃo por L. braziliensis em camundongos BALB/c, com reduÃÃo no tempo de evoluÃÃo da doenÃa, associada a maior concentraÃÃo de IFN-γ e menor de IL-4 e IL-10. / Leishmania braziliensis is the more common etiologic agent of the cutaneous leishmaniasis in Brazil. BALB/c mice are more susceptible to L. braziliensis infection, although develop small and not ulcerated lesions. The lesions in BALB/c mice infected by L. braziliensis are accompanied by expression of a broad chemokines spectrum, including CXCL10, which is able to attract and activate NK and Th1 cells with IFN-γ production. The aim of this study was to evaluate whether the chemokine CXCL10, administered in early stages of infection could influence the course of disease, leading to a faster and more effective time of healing. Groups of BALB/c mice (n=24) were infected by L. braziliensis and divided into two groups: one group (n=12) received CXCL10 (100 ng/5μL) and the other (n=12) received PBS (5μL), at 1, 3, 5 and 7 days postinfection. Some parameters were evaluated: thickness of the lesions every three days; parasite burden in both the footpad and the draining lymph node, NO concentration, cytokines production (IFN-γ, IL-12p40, TNF-α, IL-4, IL-10 and TGF-β), at 15 and 30 days after infection; and histopathological analysis of lesions. Animals receiving CXCL10 showed reduced disease duration, since the lesions started to regress earlier (12 days), whereas the control animals developed the disease for longer (15 days). CXCL10 induced statistically significant differences in parasite load in the draining lymph nodes compared with control in both times evaluated (15 days: p=0.0353; 30 days: p=0.0292). In the animals receiving CXCL10 was not observed change in the number of parasites in the site of inoculation, even with reduced thickness of the lesion, showing no correlation between lesion size and parasite load. There was no difference in NO concentration between groups with 15 days of infection, and this concentration remained the same in the group receiving CXCL10 at day 30, although it was lower than that observed in the control group. CXCL10 also induced higher levels of IFN-γ and IL-12, and reduced IL-4, IL-10, and TGF-β at 30 days postinfection, when compared to control animals. Histopathology analyses of lesions after 15 days postinfection showed a very mild inflammation in both groups, differing only for the presence of neutrophils, which were practically not observed in lesions of animals receiving CXCL10. Taken together, the data from this study showed CXCL10 chemokine presented a protective effect on L. braziliensis infection in BALB/c mice, with a reduction in the progression of the disease, associated with a higher concentration of IFN-γ and lesser of IL-4 and IL-10.

研究背景及實驗目的: 非酒精性脂肪性肝炎(NASH)使得肥胖和2 型糖尿病變得複雜，肝臟炎症的持續產生是其主要的發病機理。CXCL10 是一種促進炎症的細胞因數，其在肥胖和2 型糖尿病中的表達顯著升高。CXCL10 以及其受體CXCR3 是否在NASH 的發生發展中起作用尚不清楚。在本研究中，我們探索了CXCL10 以及其受體CXCR3 在脂肪性肝炎中的功能， 並評估了CXCL10 在NASH 中的臨床價值。 / 實驗方法：CXCL10 基因敲除鼠，CXCR3 敲除鼠以及野生型C57BL/6 小鼠給予蛋氨酸膽鹼缺乏食(MCD)4 周或者8 周。CXCL10 的信號通路以及下游靶點通過細胞因數分析，cDNA array, 蛋白DNA 結合實驗，自噬溶酶體系統分析進行檢測。為了闡明CXCL10 抑制對NASH 的預防治療作用，我們給MCD 餵養的小鼠注射抗CXCL10 抗體。用不同濃度的CXCL10 抗體以及CXCR3 抑制劑NIBR2130 幹預MCD 培養的肝細胞株AML-12。臨床研究中，我們收集了147個非酒精性脂肪肝患者以及73 個健康對照的血清，用酶聯免疫吸附試驗檢測血清中CXCL10 的水準。 / 結果：野生型小鼠給予MCD 餵養後，CXCL10 以及CXCR3 的表達升高，並出現脂肪性肝炎的表現。然而，MCD 飼養的CXCL10 以及CXCR3 基因敲除鼠中，脂肪性肝炎明顯減輕。CXCL10 通過促炎細胞因數的產生以及NK-κB 信號通路促進MCD 飼養的小鼠NASH 的發生。CXCL10 通過促進脂質合成的基因SREBP-1c, ChREBP 和 SCD-1 引起脂肪變性，並通過CYP2E1 以及 C/EBPβ 的上調引起氧化應激。值得注意的是，自噬的損傷在CXCL10 以及CXCR3 導致的脂肪性肝炎的進展中起重要作用。 MCD 飼養的野生型小鼠中p62 以及LC3-II 表達明顯高於CXCL10 以及CXCR3 基因敲除鼠。通過抗CXCL10 抗體中和CXCL10 可以減輕MCD 食引起的小鼠脂肪性肝炎以及MCD 培養液引起的AML-12 細胞損傷。高選擇性的CXCR3 抑制劑NIBR2130 也可以抑制MCD 引起的肝細胞損傷。我們進一步研究了CXCL10 的臨床應用價值，發現NASH 患者血清以及肝臟中CXCL10 的水準明顯升高。更重要的是，血液中CXCL10 的水準與肝小葉炎症程度有關，是NASH 的獨立危險因素。 / 結論：我們的研究首次發現CXCL10 以及其受體CXCR3 通過促進炎症，脂質聚集，氧化應激以及自噬缺乏在NASH 的發病中起重要作用。抑制CXCL10 或者CXCR3 為NASH 患者的治療提供了新的方法。CXCL10 可作為NASH 患者非侵入性診斷的標誌物。 / Background and aims: Non-alcoholic steatoheaptitis (NASH) complicates obesity and type 2 diabetes, while recruitment and perpetuation of liver inflammation is central to its pathogenesis. Expression of C-X-C motif chemokine 10 (CXCL10), a proinflammatory cytokine, correlates positively with obesity and type 2 diabetes. Whether CXCL10 and its receptor CXCR3 play a role in NASH is unknown. In this study, we investigated the functional significance of CXCL10 and its receptor CXCR3 in steatoheaptitis. Moreover, the clinical impact of CXCL10 in NASH was examined. / Methods: Gene-deleted CXCL10 (CXCL10-/-), CXCL10 receptor CXCR3 (CXCR3-/-) and C57BL/6 wildtype (WT) mice were fed methionine and choline-deficient (MCD) diet for 4 or 8 weeks. Cytokine profiling assay, cDNA array, protein-DNA binding activity assay and autophagosome-lysosome system analysis of CXCL10 signaling and downstream targets were performed. In other experiments, we injected neutralizing anti-CXCL10 monoclonal antibodies (mAb) into MCD diet-fed WT mice, while AML-12 cells were cultured in MCD medium in the presence of anti-CXCL10 mAb or CXCR3 inhibitor (NIBR2130) for 24 hours. Human serum was obtained from 147 patients with biopsy-proven non-alcoholic fatty liver disease and 73 controls. Circulating CXCL10 levels were determined by enzyme-linked immunosorbent assay. / Results: MCD-fed WT mice developed steatohepatitis with higher hepatic CXCL10 and CXCR3 expression. CXCL10-/- and CXCR3-/- mice were refractory to MCDinduced steatohepatitis. In WT mice with steatohepatitis, but not in CXCL10-/- mice, CXCL10 was associated with the induction of pro-inflammatory chemokines and cytokines, as well as activation of nuclear factor-κB (NF-κB) signaling. CXCL10 expression was linked to steatosis through lipogenic factors, including liver X receptors and its downstream targets (SREBP-1c, ChREBP and SCD-1), and also to oxidative stress (up-regulation of CYP2E1 and C/EBPβ). In particular, autophagy deficiency was involved in CXCL10- and CXCR3-induced steatohepatitis as indicated by p62 and LC3-I/II protein accumulation in MCD-fed WT mice than in CXCL10-/- and CXCR3-/- mice. Moreover, the impaired autophagic function was related to the reduction of lysosomal function in CXCL10- or CXCR3-induced NASH. Blockade of CXCL10 by anti-CXCL10 mAb protected against MCD-induced steatohepatitis in vivo and against MCD-mediated injury to AML-12 cells in vitro. The highly selective CXCR3 antagonist NIBR2130 also inhibited MCD-induced injury in AML-12 hepatocytes. We further investigated the clinical impact of CXCL10 and found circulating and hepatic CXCL10 levels were significantly higher in human NASH. Importantly, circulating CXCL10 level was correlated with the degree of lobular inflammation and was an independent risk factor for NASH patients. / Conclusions: We demonstrate for the first time that CXCL10 and its receptor CXCR3 plays a pivotal role in the pathogenesis of NASH by promoting inflammation, fatty acid accumulation, oxidative stress and autophagy deficiency. Blockade of CXCL10 or CXCR3 is a potential novel approach for NASH intervention. CXCL10 is a noninvasive biomarker for NASH patients. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Zhang, Xiang. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 145-167). / Abstracts also in Chinese.

O líquen plano oral (LPO) é uma doença inflamatória crônica que afeta em torno de 1 a 2% da população mundial adulta, entre 30 e 60 anos, principalmente mulheres. As lesões podem estar presentes em diversos sítios, porém tem predileção pela mucosa jugal, gengiva e bordas laterais da língua, todas bilateralmente. As manifestações de LPO são frequentes, e podem se caracterizar clinicamente em seis tipos: reticular, em placas, papular, atrófico, erosivo-ulcerativo e bolhoso, porém o mais comum é o reticular. O presente estudo teve como objetivo avaliar a expressão de genes relacionados à resposta inflamatória e autoimunidade no líquen plano oral (LPO) em pacientes com a variante exclusivamente reticular comparado a controle saudável. Foram incluídos consecutivamente 10 pacientes com LPO que preencheram os critérios de inclusão adotados, sendo 9 mulheres e um homem, e 6 indivíduos controle, sendo 4 mulheres e 2 homens pareados por sexo, idade e uso de medicações sistêmicas. Amostras de mucosa bucal foram coletadas por meio de biópsia incisional em ambos os grupos de pacientes e submetidas à extração de RNA para posterior análise da expressão gênica por PCR-array selecionada para este estudo. Os resultados obtidos foram o aumento da expressão de 8 genes, CXCL 9 e CXCL 10 vão de acordo com a literatura, corroborando com nosso estudo e de certa forma reafirmar mais necessidade de estudos bem desenhados . / The oral lichen planus (OLP) is a chronic inflammatory disease that affects around 1-2% of the adult population between 30 and 60 years, mainly women. The lesions may be present in several sites, but has a predilection for the buccal mucosa, gums and lateral borders of the tongue, all bilaterally. The manifestations of OLP are frequent, and may be characterized clinically in six types: reticular, plaque-like, papular, atrophic, erosive-ulcerative and bullous, but the most common is the reticular . The present study aimed to evaluate the expression of genes related to inflammatory response and autoimmunity in oral lichen planus (OLP) in patients with exclusively reticular variant compared to healthy control. 10 consecutive patients with OLP who met the inclusion criteria, 9 women and one man, and six control subjects were included were 4 women and 2 being proportionally matched by sex, age and use of systemic medications men. Samples of oral mucosa were collected by incisional biopsy in both groups of patients and subjected to RNA extraction for analysis of gene expression by selected for this study-PCR array. The results were the overexpression of genes 8, where only two of them go according to the literature, corroborating our study and somehow reaffirm need for more well-designed studies.

O líquen plano oral (LPO) é uma doença inflamatória crônica que afeta em torno de 1 a 2% da população mundial adulta, entre 30 e 60 anos, principalmente mulheres. As lesões podem estar presentes em diversos sítios, porém tem predileção pela mucosa jugal, gengiva e bordas laterais da língua, todas bilateralmente. As manifestações de LPO são frequentes, e podem se caracterizar clinicamente em seis tipos: reticular, em placas, papular, atrófico, erosivo-ulcerativo e bolhoso, porém o mais comum é o reticular. O presente estudo teve como objetivo avaliar a expressão de genes relacionados à resposta inflamatória e autoimunidade no líquen plano oral (LPO) em pacientes com a variante exclusivamente reticular comparado a controle saudável. Foram incluídos consecutivamente 10 pacientes com LPO que preencheram os critérios de inclusão adotados, sendo 9 mulheres e um homem, e 6 indivíduos controle, sendo 4 mulheres e 2 homens pareados por sexo, idade e uso de medicações sistêmicas. Amostras de mucosa bucal foram coletadas por meio de biópsia incisional em ambos os grupos de pacientes e submetidas à extração de RNA para posterior análise da expressão gênica por PCR-array selecionada para este estudo. Os resultados obtidos foram o aumento da expressão de 8 genes, CXCL 9 e CXCL 10 vão de acordo com a literatura, corroborando com nosso estudo e de certa forma reafirmar mais necessidade de estudos bem desenhados . / The oral lichen planus (OLP) is a chronic inflammatory disease that affects around 1-2% of the adult population between 30 and 60 years, mainly women. The lesions may be present in several sites, but has a predilection for the buccal mucosa, gums and lateral borders of the tongue, all bilaterally. The manifestations of OLP are frequent, and may be characterized clinically in six types: reticular, plaque-like, papular, atrophic, erosive-ulcerative and bullous, but the most common is the reticular . The present study aimed to evaluate the expression of genes related to inflammatory response and autoimmunity in oral lichen planus (OLP) in patients with exclusively reticular variant compared to healthy control. 10 consecutive patients with OLP who met the inclusion criteria, 9 women and one man, and six control subjects were included were 4 women and 2 being proportionally matched by sex, age and use of systemic medications men. Samples of oral mucosa were collected by incisional biopsy in both groups of patients and subjected to RNA extraction for analysis of gene expression by selected for this study-PCR array. The results were the overexpression of genes 8, where only two of them go according to the literature, corroborating our study and somehow reaffirm need for more well-designed studies.