Agrin and neuregulin are neurotrophic molecules well known for their roles at synapses in the peripheral and central nervous systems. The expression of these two molecules is not restricted to these sites however, as they are broadly expressed across multiple organ systems. What roles do agrin and neuregulin play within these alternate systems; what is the function of these molecules outside the nervous system? Here I investigate potential roles for agrin and neuregulin in inflammation. Inflammation is an immediate response by innate immune cells, primarily macrophages, to infection and is characterized by the synthesis of pro-inflammatory mediators. The innate immune system possesses multiple redundant mechanisms to locally control inflammation. The neuro-immune axis is one means of control. Often called the cholinergic anti-inflammatory pathway, it acts to regulate local inflammation via nerve-secreted acetylcholine signaling through the homopentameric α7 nicotinic acetylcholine receptors (α7nAChR) present on macrophages. Both agrin and neuregulin have been independently described to share an intricate relationship with acetylcholine receptors (AChR) in the nervous system. Agrin is best known for its role in AChR aggregation at the neuromuscular junction while neuregulin has related roles in AChR transcription, cell survival, communication and differentiation. Based on the common characteristics of synapses in the nervous and immune systems we were curious to see if agrin and neuregulin played analogous roles on macrophages. Here we show that agrin and its receptor dystroglycan are expressed on RAW264.7 macrophages. In addition, agrin treated macrophages demonstrate increased endogenous agrin and α7nAChR expression. By blocking α-dystroglycan (α-DG), a receptor for agrin, with an anti-α-DG antibody we further saw a reduction in agrin expression. We also show that agrin is able to aggregate surface α7nAChRs and transmembrane agrin co-localizes with α7nAChRs therein. Agrin appears to induce approximately a 15-fold increase in anti-inflammatory cytokine IL-10 in macrophages but does not increase pro-inflammatory cytokine TNF-α or IL-6 synthesis. Agrin-treated macrophages challenged with LPS, a potent activator of inflammation, exhibit a 57% decrease in IL-6. Macrophages treated with agrin also exhibit a 4-fold increase in STAT3, a regulator of anti-inflammatory action. The potential anti-inflammatory effects of agrin in the periphery parallel previous work describing the effects of neuregulin in the brain. Previous work completed by our lab suggests a role for neuregulin in augmenting the expression of α7nAChRs on microglia, the macrophages of the brain, but not in peripheral macrophages. Here we show that treatment of LPS challenged microglia with neuregulin produces an 88% decrease in IL-6 and a 33% decrease in TNF-α. These results indicate both agrin and neuregulin are able to induce an increase in α7nAChRs and augment the synthesis of pro- and anti-inflammatory cytokines in their respective systems. These results also further the support the evidence of neuro-immune crosstalk in the immune system. Taken together these results present two novel players in inflammatory regulation by macrophages in the periphery and CNS.

Up to now, solid organ transplantation remains the ultimate life-saving treatment for end-stage organ failure. However, transplantation could be complicated by allograft rejection wherein inflammation plays a pivotal role. In this process, inflammation secondary to ischemia/reperfusion and cell necrosis plays the role of adjuvant and enhances the antigen-specific adaptive response ultimately leading to allograft rejection. Therefore, anti-inflammatory strategies have to be developed to dampen inflammation and secondary alloreactivity. Recently, neuroimmune pathways and particularly the cholinergic anti-inflammatory pathway have been described to modulate inflammation in several experimental models as sepsis. The Vagus Nerve, the α7 nicotinic receptor (α7nAChR) and its agonists are specific targets to regulate the inflammatory response in several pathologies.The aim of this work is to investigate the potential protective effect of the cholinergic pathway in solid organ transplantation. In a model of renal ischemia/reperfusion injury induced by bilateral clamping of renal arteries, nicotine protects from renal dysfunction and tubular damages. This protection is associated to a reduction of inflammatory cytokines and neutrophils and is α7nAChR dependent. In a second part, we test the effect of the α7nACh receptor in a model of minor antigen mismatched skin allograft. Mice deficient for the α7nAChR reject earlier the skin allograft compared to α7nAChR +/+ mice and this is associated to higher Th1 and Th17 T cell responses. α7nAChR expressed on T cells is involved in skin allograft rejection as attested by adoptive transfer experiments in Rag H/H mice with either α7nAChR +/+ or α7nAChR H/H alloreactive T cells. The cholinergic pathway by itself or boosted by nicotinic agonists is able to modulate innate as well as acquired immune components involved in allograft rejection. Other agonists or devices used to stimulate the cholinergic pathway are actually developed in order to be more specific and to reduce toxicity. Our results are particularly relevant in human medicine as grafted organs lose their Vagus Nerve endings and their cholinergic regulatory innervation. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished

Orientador: Aparecido Antonio Camacho / Resumo: O uso de betabloqueadores tem mostrado implicações significativas na terapia de neoplasias através do bloqueio de adrenoreceptores em tecidos tumorais. O sistema nervoso autônomo simpático apresenta um perfil pró-inflamatório e por estímulo das catecolaminas ocorre à ativação de macrófagos teciduais com liberação de citocinas inflamatórias. Estudos recentes sugerem que estímulos inflamatórios crônicos podem acelerar a progressão do câncer, fato este relacionado à ativação do sistema beta adrenérgico. Assim, o objetivo do presente estudo foi avaliar a influência do emprego do propranolol sobre a evolução macroscópica dos nódulos mamários assim como a monitoração da função cardíaca. O estudo foi prospectivo, randomizado e longitudinal. Para tanto, 06 cadelas portadoras de tumores de mama (G1) receberam cloridrato de propranolol (0.2 mg/kg/BID, VO, 30 dias) e, outras 08 cadelas também com neoplasia mamária (G0) receberam apenas medicação placebo (BID, VO, 30 dias). Foram realizados exames ecocardiográfico, eletrocardiográficos convencional e Holter, paquimetria tumoral e exame histopatológico. A análise estatística foi baseada em um estudo experimental, cujos resultados foram submetidos à análise de variância (ANOVA) com medidas repetidas no tempo e em seguida Teste de Tukey. O uso do fármaco mostrou segurança sobre os parâmetros cardíacos avaliados e controle sobre o crescimento tumoral quando comparado com o grupo placebo. / Abstract: The use of beta-blockers has shown significant implications in the therapy of neoplasias through the blockade of adrenoreceptors in tumor tissues. The autonomic sympathetic nervous system presents a pro-inflammatory profile and by stimulating the catecholamines occurs to the activation of tissue macrophages with the release of inflammatory cytokines. Recent studies suggest that chronic inflammatory stimuli may accelerate the progression of cancer, a fact related to activation of the beta adrenergic system. Thus, the objective of the present study was to evaluate the influence of the use of propranolol on the macroscopic evolution of the mammary nodes as well as the monitoring of the cardiac function. The study was prospective, randomized, and longitudinal. For this, 06 bitches bearing breast tumors (G1) received propranolol hydrochloride (0.2 mg / kg / BID, VO, 30 days) and another 08 female mammary glanders (G0) received only placebo medication (BID, VO , 30 days). Echocardiographic, conventional electrocardiographic and Holter tests, tumor pachymetry and histopathological examination were performed. The statistical analysis was based on an experimental study, whose results were submitted to analysis of variance (ANOVA) with measures repeated in time and then Tukey's test. The use of the drug showed safety over the evaluated cardiac parameters and control over tumor growth when compared to the placebo group. / Mestre

Electrical stimulation of the vagus nerve attenuates tumor necrosis factor (TNF) synthesis by macrophages and reduces the systemic inflammatory response. Current evidence suggests that the α7 nicotinic acetylcholine receptor present in the celiac/superior mesenteric ganglia is a key component in vagus nerve signaling to the spleen; however, there is currently no direct anatomical evidence that the α7 receptor is present in the murine celiac/superior mesenteric ganglia. Our study addresses this deficiency by providing anatomical evidence that the α7 receptor is expressed within the celiac/superior mesenteric ganglia and splenic nerve fibers using immunohistochemistry and quantitative polymerase chain reaction (qPCR). α7 receptor mRNA is highly expressed in the celiac/superior mesenteric ganglia and at low levels in the spleen compared to the brain. Double-labeling for α7 and tyrosine hydroxylase shows that α7 receptor protein is present on noradrenergic neurons within the ganglia and prejunctionally on noradrenergic nerve fibers within the spleen. The α7 receptor in the ganglia provides a possible location for the action of α7-selective agonists, while prejunctional α7 receptor expressed on splenic nerves may induce an increase in norepinephrine release in a positive feedback system enhanced by lymphocyte-derived acetylcholine.

Introdução: Colite Ulcerativa (UC) é uma Doença Inflamatória Intestinal (DII) caracterizada por uma resposta imune exacerbada, com sintomas como diarreia, perda de peso e sangue nas fezes. Apesar dos medicamentos disponíveis, a remissão da doença nem sempre consegue ser alcançada e há a necessidade de terapias alternativas. A colite induzida por DSS (Dextran Sulfate Sodium) é um modelo animal utilizado na investigação de novas terapias por sua semelhança à UC humana. DSS provoca dano à barreira epitelial do cólon, induzindo uma resposta imune exacerbada; entretanto, o exato mecanismo não está totalmente esclarecido. O Ultrassom Terapêutico (TUS) foi utilizado para tratamento de injúria renal em modelo experimental, sua ação se dá através da estimulação do nervo vago (VN) e consequente ativação da via antiinflamatória colinérgica (CAIP). Uma vez que pacientes com DII podem exibir atividade disfuncional do VN, TUS pode ser investigado como terapia alternativa. Objetivos: Investigar temporalmente o perfil clínico, proteômico, histológico e imunológico da colite aguda induzida por DSS; e determinar os efeitos de TUS na colite induzida por DSS. Métodos: No primeiro estudo, a severidade da colite foi avaliada pela administração de DSS 1-3%, observando a resposta clínica e histológica. A análise temporal de DSS 3% incluiu uma avaliação proteômica e histológica do cólon, e a resposta imune celular no baço, linfonodo mesentérico (MLN) e cólon. No segundo estudo, utilizando o modelo de DSS 2%, TUS foi aplicado no abdômen dos animais e foram observados os sintomas clínicos, dano histológico, proteômica do cólon e respostas imunes celulares no baço, MLN e cólon. Animais esplenectomizados ou knockout para a7nAChR (marcador clássico para ativação de CAIP) foram utilizados. Resultados: No primeiro estudo, observou-se que a severidade da doença foi aumentada seguindo concentrações de 1-3% DSS. A análise temporal de DSS 3% demonstrou que os macrófagos (F4/80+) se apresentam como a primeira resposta celular, seguidos por células T CD25+, CD4+ e CD8+. A piora clínica da doença correspondeu ao aumento progressivo de fatores pró-inflamatórios e dano tecidual no cólon, exceto no dia 8. Foram observados menores níveis dos marcadores de células T CD25+, CD4+ e CD8+ no MLN e/ou baço, sugerindo a ocorrência de tropismo destas células para o intestino. No segundo estudo, a aplicação de TUS diminuiu a severidade da doença através da melhora de sintomas clínicos, danos teciduais e encurtamento do cólon. A proteômica do cólon demonstrou uma resposta anti-inflamatória durante a fase de injúria (D0-7), induzindo uma resolução acelerada da doença na fase de recuperação (D8-14). TUS diminuiu os níveis de células T CD8+ e normalizou os níveis de células T CD25+ no cólon. Animais esplenectomizados não demonstraram melhora clínica ou histológica, enquanto animais a7nAChR KO apresentaram piora da colite experimental. Além disso, TUS aumentou os níveis de células F4/80+a7nAChR+ no intestino de animais WT DSS 2%. Conclusão: Nossos resultados demonstram que a severidade da doença depende da concentração de DSS, relacionada com as respostas clínica, proteômica e imune no modelo animal de DSS 3%; e TUS diminuiu a severidade da colite induzida por DSS presumidamente pela da estimulação do VN e consequente ativação de CAIP através do baço. / Introduction: Ulcerative Colitis (UC) is an Inflammatory Bowel Disease (IBD) characterized by uncontrolled immune response, presenting with symptoms of diarrhea, weight loss and bloody stools. Despite available treatments, UC sustained remission is not achievable and there is still the need for alternative therapies. Dextran Sulfate Sodium (DSS)-induced colitis is a mouse model used to investigate novel therapies, since it closely mimics human UC. DSS damages the colonic epithelial barrier, leading to an exacerbated immune response. However, the exact mechanism is not totally understood. Previous studies showed the use of Therapeutic Ultrasound (TUS) to prevent kidney injury in mice through stimulation of the vagus nerve (VN) and activation of the cholinergic anti-inflammatory pathway (CAIP). Since IBD patients can present with dysfunctional VN activity, TUS could be studied as an alternative therapy. Objectives: To investigate the temporal clinical, proteomic, histological and cellular immune profiles of DSS-induced acute colitis; and to determine the effects of TUS directed toward the VN and spleen in the course of DSS-induced colitis. Methods: First, we analyzed DSS-induced colitis severity by administration of 1-3% DSS, observing the clinical course and histological damage. A time course analysis was performed at 3% DSS, including colon proteomics, colon histology and immune cell responses in the spleen, MLN (mesenteric lymph node) and colon. Next, utilizing 2% DSS in drinking water, we applied TUS over the mice abdomen and analyzed clinical symptoms, histological damage, colon proteomics and immune cell responses in the spleen, MLN and colon. Splenectomized and a7nAChR (key indicator of CAIP activation) KO animals were also used. Results: In the first study, we observed worsening of the disease when increasing DSS concentrations from 1 to 3%. Time course analysis of 3% DSS revealed macrophages to be the first responders, followed by CD25+, CD4+ and CD8+ T cells. Worsening of the disease corresponded to a progressive increase in pro-inflammatory colonic factors and histological damage, except at day 8. Lower levels of CD25+, CD4+ and CD8+ T cells in MLN and/or spleen suggest an immune cell tropism to the gut. In the second study, TUS attenuated DSS induced colitis through amelioration of clinical symptoms, histological damage and colon shortening. Proteomic colon analysis demonstrated an antiinflammatory profile during the injury phase (D0-7), whilst inducing an early resolution of the disease during the recovery phase (D8-14). TUS decreased CD8+ and normalized CD25+ T cell levels in the gut. Splenectomized animals demonstrated no improved clinical and pathological outcomes, and a7nAChR KO mice presented with worsening of the disease. Furthermore, there were increased levels of F4/80+a7nAChR+ cells in the colon of 2% DSS WT mice under TUS treatment. Conclusion: Our results demonstrate that the severity of colitis is dependent on DSS concentration, correlated with clinical, proteomic and cellular immune responses on 3% DSS; and TUS significantly improved DSS-induced acute colitis presumably through stimulation of the VN and consequent activation of CAIP through the spleen.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-27T14:45:59Z No. of bitstreams: 1 Fernando Oliveira Costa.pdf: 1199928 bytes, checksum: f721f323b7b101614061ea44e7dd6cb3 (MD5) / Made available in DSpace on 2015-07-27T14:45:59Z (GMT). No. of bitstreams: 1 Fernando Oliveira Costa.pdf: 1199928 bytes, checksum: f721f323b7b101614061ea44e7dd6cb3 (MD5) Previous issue date: 2014-02-21 / The metabolic syndrome (MetS) consists of a combination of conditions that tend to cluster together, and increase the risk of type 2 diabetes and cardiovascular disease. The components of the metabolic syndrome include central (abdominal) obesity, elevated fasting glucose, dyslipidemia (abnormally high triglycerides and low high-density lipoprotein cholesterol), and elevated blood pressure. MetS is also associated with proinflammatory and prothrombotic states, non-alcoholic liver steatosis, obstructive sleep apnea and reproduction disorders. Although a common unifying physiopathological mechanism is not known, central obesity and inflammation play a major role in MetS and upon each of its components. The MetS has reached epidemic proportions and to date there are no proven pharmacological interventions that simultaneously target all of the components of this syndrome. Inflammation plays an important role in the pathogenesis of the MetS. Recently, it was discovered that inflammation can be regulated by neural, cholinergic mechanisms and a cholinergic drug, the acetylcholinesterase inhibitor galantamine suppresses abnormal inflammation and alleviates MetS pathologies in rodents. The fact that galantamine is an approved drug, used to treat patients with Alzheimer´s disease with a known safety profile, will facilitate its clinical application in another situations. We hypothesize that treatment of subjects with the MetS with galantamine will result in alleviation in the MetS clinical conditions and inflammation. The objective of our study was to initiate an investigation on the safety profile of galantamine in MetS patients, with special attention on autonomic, hemodynamic and cognitive parameters. A randomized, double-blind, prospective study evaluated clinical, autonomic, hemodynamic and cognitive variables of patients with MetS in two moments: before treatment (basal state) and after 28 days of treatment with galantamine 8 mg daily. There was a statistical tendency in reducing systolic blood pressure in the HRV with Finometer® in patients under galantamine (124.4 ± 4 vs 119.7 ± 3.7 mmHg, basal and 28 days values, respectively) and also a reduction in diastolic blood pressure (72.5 ± 1.3 vs 67.2 ± 1.7 mmHg, basal and 28 days values, respectively). Paradoxically, an increase in the sympathetic modulation of the heart was observed with the HRV study measuring the LF (nu) value (46.2 ± 3.8 vs 57.1 ± 3.4 basal and 28 days, respectively) and a decrease in the parasympathetic modulation HF (nu) value (53.8 ± 3.8 vs 43.0 ± 3.4, basal and 28 days, respectively). We did not observe any significant change in cognitive domains. Our conclusion is that treatment with galantamine 8 mg exhibits a safe clinical profile and can be used in MetS patients. / A síndrome metabólica consiste na combinação de condições agrupadas e aumentam o risco para diabetes tipo 2 e doença cardiovascular. Seus componentes incluem obesidade central, níveis aumentados de glicose, dislipidemia caracterizada por aumento de triglicérides e baixos níveis de HDL e aumento da pressão arterial. Também está associada a um estado proinflamatório, a um estado protrombótico, a esteatose hepática não-alcoólica, apnéia obstrutiva do sono e a desordens reprodutivas. Apesar da não determinação de um mecanismo fisiopatológico unificador, obesidade central e inflamação parecem ser centrais na síndrome metabólica e nos seus componentes individuais. A síndrome metabólica tem alcançado proporções epidêmicas universais e até o presente não há intervenção farmacológica comprovada que atue simultaneamente em todos os seus componentes. Sabe-se hoje que o processo inflamatório tem um papel importante na patogenia da síndrome. Recentemente foi evidenciado que a inflamação pode ser regulada por mecanismos neurais colinérgicos, e que a galantamina, um inibidor da acetilcolinesterase, suprime a inflamação e atua nos componentes da síndrome diminuindo a patogenia em roedores. O fato de a galantamina ser uma droga já aprovada e de perfil seguro em portadores de demência facilita seu uso em outras situações clínicas. Considerando a hipótese de que a galantamina causará melhora da inflamação e dos outros distúrbios relacionados, o objetivo deste estudo foi iniciar a investigação sobre o perfil de segurança da galantamina em pacientes com síndrome metabólica, em especial, em parâmetros hemodinâmicos, autonômicos e de cognição. Realizamos um estudo prospectivo, duplo-cego e randomizado, que avaliou os dados clínicos e os parâmetros descritos, no momento basal e após 28 dias de uso de galantanima (8mg por dia), em portadores de síndrome metabólica. Houve uma tendência à redução da PAS, avaliada batimento-a-batimento com o Finometer no grupo que usou galantamina (124,4 ± 4 vs 119,7 ± 3,7 mmHg, respectivamente basal e após 28 dias de uso, p=0,04), o mesmo ocorrendo com a PAD (72,5 ± 1,3 vs 67,2 ± 1,7, p=0,005), respectivamente basal e após 28 dias de uso). De forma paradoxal, ocorreu um aumento da atividade simpática na modulação autonômica para o coração, avaliada por meio do estudo da variabilidade da freqüência cardíaca como atestado por um valor LF (nu) (46,2 ± 3,8 vs 57,1 ± 3,4 , p=0,0005)), e redução da modulação parassimpática, representada pelo valor do HF (nu) (53,8 ± 3,8 vs 43,0 ± 3,4, p=0,0005) respectivamente basal e após 28 dias de uso. Não observamos alterações significativas nos testes que avaliam o domínio cognitivo dos indivíduos. Concluímos que a dose utilizada de galantamina tem um perfil de segurança clínica que permite expandir seu uso em pacientes portadores de síndrome metabólica.

INTRODUÇÃO: A atuação do sistema nervoso parassimpático em células imunes é conhecida como \"Via Anti-inflamatória Colinérgica\". Trabalhos prévios demonstraram que a estimulação vagal reduz a inflamação e melhora a sobrevida em modelos experimentais com sepse. Neste estudo avaliamos se o uso do anticolinesterásico piridostigmina: altera o número de linfócitos T (CD4+ e CD8+) convencionais (CD25+Foxp3-) e reguladores (CD25+Foxp3+) no sangue periférico, no baço e no miocárdio; modifica a concentração de citocinas (interleucina 1, interleucina 6, TNFalfa) no miocárdio; e influencia a função ventricular após infarto agudo do miocárdio experimental (IAM) em ratos. MÉTODOS: Utilizamos ratos machos adultos da linhagem Wistar, com peso variando entre 200 e 250 g, divididos em 3 grupos de 20 animais cada: grupo controle (GC), grupo infartado sem tratamento (IC) e grupo infartado tratado com piridostigmina (IP). O infarto agudo do miocárdio (IAM) foi obtido com a técnica da ligadura da artéria coronária esquerda, e o grupo IP recebeu piridostigmina na dose de 40mg/kg/dia na água de beber, iniciada 4 dias antes do IAM. Todos os animais foram submetidos à canulação da artéria femoral no dia seguinte ao IAM para registro das curvas de pressão arterial, e posterior análise dos componentes da variabilidade da freqüência cardíaca (VFC), domínio do tempo (SDNN e RMSSD) e da freqüência (componentes LF e HF); o estudo ecocardiográfico foi realizado no segundo dia pós IAM. No terceiro dia pós IAM, os ratos foram divididos em subgrupos de 10 animais, e sacrificados de forma específica para coleta de materiais: 500 ul de sangue periférico e baço fresco para realização da técnica de citometria de fluxo; ventrículo esquerdo para dosagem de citocinas pela técnica de ELISA; e ventrículo esquerdo para realização de imunohistoquímica. Foram usadas as técnicas padronizadas e de uso corrente nos laboratórios. Os resultados foram avaliados por análise de variância (ANOVA) multifatorial, usando o programa GraphPad Prism com teste post hoc de Tukey. RESULTADOS: O grupo IC comparado ao grupo controle apresentou queda significativa da pressão arterial e aumento da freqüência cardíaca. O grupo IP, comparado ao grupo IC, apresentou maior atividade vagal, caracterizada pela significante redução da FC e aumento da VFC (SDNN, 9,2±1,5 vs 5,2±0,5 p < 0,05). Os parâmetros ecocardiográficos avaliados evidenciaram presença de área hipo/acinética e redução da fração de ejeção do ventrículo esquerdo nos grupos infartados, de igual magnitude. Com relação ao número de linfócitos T, verificamos que o grupo IC, comparado ao grupo controle, apresentou número significativamente menor de linfócitos reguladores (CD25+Foxp3+) no sangue periférico (CD4+: 63,5 ±1,4 vs 70,6 ±3,2%, e CD8+: 68,3 ±1,9 vs 76,1 ± 2,8%). O grupo IP, comparado ao grupo IC, apresentou significativa redução do número de linfócitos T convencionais no sangue periférico (respectivamente, CD4+: 1,5 ±0,2 vs 2,2 ± 0,2 %; CD8+: 1,1 ± 0,1 vs 1,8 ± 0,9%), e no baço houve redução somente do tipo CD4+ (respectivamente, 1,4 ± 0,2 vs 2,2 ± 0,2%), com aumento do tipo CD8+ (respectivamente, 1,2 ± 0,1 vs 0,7 ± 0,1 %). O grupo IP também apresentou significativo aumento de linfócitos reguladores (CD25+Foxp3+) no sangue periférico (respectivamente, CD4+: 76,5 ± 2,9 vs 63,5 ± 1,4 %; CD8+: 75,1 ± 1,0 vs 68,3 ± 1,9 %), e não apresentou diferenças significativas no número dessas células no baço. O grupo IC comparado ao grupo controle apresentou significativa marcação de anticorpos para CD4 e CD8 nas áreas infartada e peri-infarto por meio da análise de imunohistoquímica. O grupo IP comparado ao grupo IC, apresentou significativo aumento de CD4+ (respectivamente, 20,9 ± 6,5 vs 12,2 ± 2,5, p < 0,05) e de CD8+ (respectivamente, 17,9 ± 2,8 vs 5,8 ± 1,1%, p < 0,05) na área infartada; observamos redução significativa na marcação de CD4+ (respectivamente, 6,0 ±1,2 vs 12,5 ±4,8) na área peri-infarto, sem alterações significativas na marcação de CD8+. CONCLUSÃO: O tratamento com piridostigmina em ratos com IAM está associado a aumento da atividade vagal, aumento do número de linfócitos reguladores (CD25+Foxp3+) no sangue periférico e maior mobilização de células inflamatórias (CD4+ e CD8+) para a área infartada no miocárdio, com redução de CD4+ na área peri-infarto, no entanto sem mudança de CD8+ nesta região. A mudança do perfil inflamatório decorrente do aumento da atividade vagal na fase aguda do IAM, pode ser um possível mecanismo para explicar os benefícios detectados no remodelamento cardíaco após o IAM, em especial, na redução da área de lesão e na melhora da função ventricular, com uso de anticolinesterásicos / INTRODUTION: The role of the parasympathetic nervous system in immune cells is known as \"Cholinergic anti-inflammatory pathway\". In previous work has demonstrated that vagal stimulation reduces inflammation and improves survival in experimental sepsis models. The aim of the present study evalued the use of anticholinesterase pyridostigmine: change the number of T lymphocytes (CD4+ and CD8+) conventional (CD25+Foxp3-) and regulatory (CD25+Foxp3+) in peripheral blood, spleen, and myocardium: modifies the concentration of cytokines (interleukin-1, interleukin-6, TNFalfa) in the myocardium, and influences ventricular function after experimental myocardial infarction (MI) in rats. METHODS: Adult male rats of Wistar strain, weighing between 200 and 250 g were divided into 3 groups of 20 animals each: control group (GC); untreated group without treatment (IC) and infarcted group treated with pyridostigmine (IP). Acute myocardial infarction (AMI) was obtained with the technique of ligation of the left coronary artery, and the IP group received pyridostigmine dose of 40 mg/Kg/day in drinking water starting 4 days before the AMI. All animals underwent cannulation of the femoral artery on the day following AMI to record the blood pressure curves, and subsequent analysis of the components of heart rate variability (HRV), the time domain (SDNN and RMSSD) and frequency (components LF and HF), the echocardiografic study was performed on the second day after AMI. On the third day post-MI, mice were divided into subgroups of 10 animals, and were sacrificed in order to collet specific materials: 500 ul of fresh peripheral blood and spleen technique for performing flow cytometry left ventricle for measurement of cytokine ELISA, and the left ventricle to perform immunohistochemistry. Techniques used were standardized and commonly used in laboraties. The results were evaluated by analysis of variance (ANOVA) multifactorial, using the GraphPad Prism with Tukey post hoc test RESULTS: The HF group compared to the control group showed a significant drop in blood pressure and increased heart rate. The IP group compared to the IC group showed higher vagal activity, characterized by a significant reduction in HR and increase HVR (SDNN, 9.2 ± 1.5 vs 5.2 ± 0.5, p < 0.05). The echocardiography parameters evaluated showed presence of area hypo/acinetic and reduced ejection fraction of the left ventricle in infracted groups of equal magnitude. Regarding the number of T lymphocytes, we found that the IC group compared with the control group showed significantly fewer lymphocytes regulators (CD25+Foxp3+) in peripheral blood (CD4+:63.5 ± 1.4 vs 70.6 ± 3.2% and CD8+ cells: 68.3 ± 1.9 vs 76.1 ± 2.8%). The IP group compared to the IC group showed a significant reduction in the number of conventional T lymphocytes in peripheral blood (CD4+:1.5 ± 0.2 vs 2.2 ± 0.2%; CD8+: 1.1 ± 0.1 vs 1.8 ± 0.9%) and was reduced only in the spleen of the type CD4+(1.4 ± 0.2 vs 2.2 ± 0,2%) with increased CD8+(1.2 ± 0.1 vs 0.7 ± 0.1%). The IP group also showed a significant increase of lymphocytes regulators (CD25+Foxp3+) in peripheral blood (CD4+: 76.5 ± 2.9 vs 63.5 ± 1.4%; CD8+:75.1 ± 1.0 vs 68.3 ± 1.9%), and no significant differences in the number of these cells in the spleen. The IC group compared to the control group showed significant labeling antibodies to CD4 and CD8 areas infarcted and peri-infarction by immunohistochemical analysis. The IP group compared to the IC group showed a significant increase in CD4 (20.9 ± 6.5 vs 12.2 ± 2.5, p < 0.05) and CD8 (17.9 ± 2.8 vs 5.8 ± 1.1%, p < 0.05) in the infarcted area, and we observed a significant reduction in the labeling of CD4 (6.0 ± 1.2 vs 12.5± 4.8) in the peri-infraction without significant changes in the marking of CD8. CONCLUSION: The treatment with pyridostigmine in rats with acute myocardial infarction is associated with increased vagal activity, increased number of regulatory lymphocytes (CD25+Foxp3+) in peripheral blood and increased mobilization of inflammatory cells (CD4 and CD8) to the infarcted myocardium, with reduction of these cells in the peri-infarction. The change of the inflammatory profile due to increased vagal activity may be a possible mechanism to explain the benefits in the evolution of myocardial infarction, especially in the improvement of cardiac remodeling and maintenance of ventricular function with anticholinesterase drugs

IntroductionLa neurostimulation vagale (NSV) à haute fréquence (30 Hz) est utilisée commethérapeutique de certaines formes d’épilepsie et de dépression réfractaires aux traitements chezl’Homme. De plus, la NSV à basse fréquence (5 Hz) a été expérimentée avec succès chez l’animalpour traiter différentes inflammations périphériques, notamment digestives. Des travaux récents ontmis en évidence que cet effet anti-inflammatoire est induit par l’activation des fibres efférentesvagales, libérant en périphérie de l’acétylcholine, inhibant la sécrétion des cytokines proinflammatoires.Cette voie est connue sous le nom de voie anti-inflammatoire cholinergique.Toutefois, le mécanisme d’action de la NSV 5 Hz reste mal connu et d’autres voies pourraient êtremises en jeu impliquant le système nerveux central (SNC) et le système immunitaire périphérique.ButLes travaux réalisés ont eu pour objectif d’étudier l’implication du SNC et du systèmeimmunitaire dans la modulation de l’inflammation induite par la NSV basse fréquence chez unmodèle de rat anesthésié. Tout d’abord, afin d’étudier l’implication du SNC lors de la NSV 5 Hz, uneétude d’imagerie par résonance magnétique fonctionnelle (IRMf) a été réalisée sur le rat «sain»anesthésié. Ensuite, une étude a été effectuée sur l’effet de la NSV sur les cellules immunitairesspléniques ainsi que sur le tube digestif chez un modèle de rat «sain» puis chez un modèle de ratatteint d’une colite expérimentale induite par une injection intra-colique d’acide trinitrobenzènesulfonique (TNBS).RésultatsLes données obtenues lors de l’étude d’IRMf ont mis en évidence un rôle important desfibres afférentes vagales; elles modulent certaines structures du SNC qui pourraient participer à larégulation de l’inflammation digestive induite par la NSV 5 Hz. Les études réalisées sur les souspopulationslymphocytaires spléniques ont révélé que d’autres cellules immunitaires que lesmacrophages étaient impliquées lors de la NSV. Chez le modèle de rat «sain», les résultats decytométrie en flux ont montré que la NSV 3h 5 Hz induisait une diminution de l’activation deslymphocytes T CD4 ainsi que du pourcentage de NKT par rapport aux lymphocytes T. Ces résultatssont en faveur d’un rôle de la NSV 3h inhibant l’activation lymphocytaire et jouant un rôle sur les NKTpossédant des propriétés immunorégulatrices. La NSV 3h n’a pas le même effet chez le modèle de ratprésentant une colite. En effet, le dosage de cytokines sécrétées par les splénocytes en culturemontre que la NSV augmente le potentiel de sécrétion d’IL-10 (cytokine anti-inflammatoire) dessplénocytes et plus particulièrement des lymphocytes T CD4 spléniques. Parallèlement, l’effet antiinflammatoirede la NSV a été mis en évidence au niveau du côlon transverse (au-dessus de la zonelésée) par une diminution des ARNm de SOCS3 et du TNF-α et de la myéloperoxidase. Ces donnéesont démontré un rôle de la NSV sur la fonctionnalité des lymphocytes T CD4 spléniques. La NSV 3h 5Hz orienterait la réponse immunitaire vers une réponse anti-inflammatoire en phase d’initiationd’inflammation digestive. De plus, l’effet anti-inflammatoire de la NSV est retrouvé au niveau du tubedigestif au-dessus de la zone lésée (côlon transverse).ConclusionCes données expérimentales montrent que d’autres voies impliquant différents typescellulaires sont susceptibles d’être mises en oeuvre par la NSV basse fréquence. Elle induitl’implication du SNC par l’activation des afférences vagales et des cellules immunitaires spléniquestelles que les lymphocytes T CD4 et les NKT. Un effet anti-inflammatoire de la NSV est retrouvé auniveau du côlon transverse, mais pas au niveau des lésions dans le côlon distal. Ces résultatsprésentent des implications thérapeutiques : la NSV basse fréquence est actuellement en essaiclinique pour être utilisée comme traitement dans la maladie de Crohn. / Introduction High frequency(30 Hz)vagus nerve stimulation(VNS)has been approved as a treatment for some types of epilepsy and depression in humans. Low-frequency (5 Hz)VNS has also been successful for the treatment of different animal inflammation models, notably digestive inflammation. Recent studies have shown that the anti-inflammatory effect is induced by the activation of the efferent vagal fibers, which secrete acetylcholine in periphery. It links itself to α-7-nicotinic receptors on the macrophages surface, inhibiting the release of pro-inflammatory cytokines. This pathway is known by the name of the cholinergic anti-inflammatory pathway. However, the mechanism of action of low-frequency VNS remains unclear and other pathways could be involved implicating the central nervous system (CNS) and the immune system. Aim The aim of this study was to evaluate the implication of the CNS and the immune system in the modulation of inflammation induced by low-frequency VNS in an anaesthetized rat model. Firstly, to study the implication of the CNS and the contribution of the afferent vagal fibers during 5Hz VNS, a study using functional magnetic resonance imaging (fMRI) on a «healthy» anaesthetized rat model was carried out. Secondly, an experiment on the effect of VNS on splenic immune cells as well as on the digestive tract was fulfilled on a «healthy» rat model followed by a study on a rat model of colitis induced by intracolonic injection of trinitrobenzene sulfonic acid (TNBS). Results fMRI data brought to light an important role of the afferent vagal fibers. They modulate some structures of the CNS which could contribute to the modulation of digestive inflammation by 5Hz VNS. The studies carried out by FACS on the sub-populations of splenic lymphocytes revealed that other immune cells than macrophages could be implicated by VNS. In the «healthy» rat model, with no digestive inflammation, FACS data show that 3h VNS decreases T CD4 lymphocytes activation and the percentage of NKT in relation to T lymphocytes. These data are in favor of an inhibiting role of VNS on lymphocytes activation and also has an impact on NKT cells which have immunoregulatory properties. 3h VNS does not have the same effect on the rat model of colitis. In fact, the quantification of secreted cytokines by cultured splenocytes show that VNS increases the potential of IL-10(anti-iflammatory)cytokine by splenocytes and particularly splenic T CD4 lymphocytes. In the same way, the anti-inflammatory effect of VNS is seen in the transverse colon (above the lesions): decrease of TNF-α and SOCS3 mRNA and of myeloperoxidase. These results show a role of VNS on the functionality of splenic T CD4 lymphocytes inducing an important secretion of IL-10. 3h low-frequency VNS turns the immune response towards an anti-inflammatory response during the early phase of digestive inflammation. Moreover, VNS anti-inflammatory effect is seen in the transverse colon, above the lesions. Conclusion These results reveal that other pathways implicating different cell types are potentially involved besides the classic cholinergic anti-inflammatory pathway by low-frequency VNS. It implicates CNS by the activation of vagal afferents and splenic immune cells such as T CD4 lymphocytes and NKT cells. An anti-inflammatory effect of VNS is found in the transverse colon (above the lesions) even during the initiation phase of digestive inflammation, but not in the distal colon (in the lesions). These date have therapeutic implications: low-frequency VNS is being clinically tested at the moment as a treatment for Crohn's disease.

INTRODUÇÃO: A atuação do sistema nervoso parassimpático em células imunes é conhecida como \"Via Anti-inflamatória Colinérgica\". Trabalhos prévios demonstraram que a estimulação vagal reduz a inflamação e melhora a sobrevida em modelos experimentais com sepse. Neste estudo avaliamos se o uso do anticolinesterásico piridostigmina: altera o número de linfócitos T (CD4+ e CD8+) convencionais (CD25+Foxp3-) e reguladores (CD25+Foxp3+) no sangue periférico, no baço e no miocárdio; modifica a concentração de citocinas (interleucina 1, interleucina 6, TNFalfa) no miocárdio; e influencia a função ventricular após infarto agudo do miocárdio experimental (IAM) em ratos. MÉTODOS: Utilizamos ratos machos adultos da linhagem Wistar, com peso variando entre 200 e 250 g, divididos em 3 grupos de 20 animais cada: grupo controle (GC), grupo infartado sem tratamento (IC) e grupo infartado tratado com piridostigmina (IP). O infarto agudo do miocárdio (IAM) foi obtido com a técnica da ligadura da artéria coronária esquerda, e o grupo IP recebeu piridostigmina na dose de 40mg/kg/dia na água de beber, iniciada 4 dias antes do IAM. Todos os animais foram submetidos à canulação da artéria femoral no dia seguinte ao IAM para registro das curvas de pressão arterial, e posterior análise dos componentes da variabilidade da freqüência cardíaca (VFC), domínio do tempo (SDNN e RMSSD) e da freqüência (componentes LF e HF); o estudo ecocardiográfico foi realizado no segundo dia pós IAM. No terceiro dia pós IAM, os ratos foram divididos em subgrupos de 10 animais, e sacrificados de forma específica para coleta de materiais: 500 ul de sangue periférico e baço fresco para realização da técnica de citometria de fluxo; ventrículo esquerdo para dosagem de citocinas pela técnica de ELISA; e ventrículo esquerdo para realização de imunohistoquímica. Foram usadas as técnicas padronizadas e de uso corrente nos laboratórios. Os resultados foram avaliados por análise de variância (ANOVA) multifatorial, usando o programa GraphPad Prism com teste post hoc de Tukey. RESULTADOS: O grupo IC comparado ao grupo controle apresentou queda significativa da pressão arterial e aumento da freqüência cardíaca. O grupo IP, comparado ao grupo IC, apresentou maior atividade vagal, caracterizada pela significante redução da FC e aumento da VFC (SDNN, 9,2±1,5 vs 5,2±0,5 p < 0,05). Os parâmetros ecocardiográficos avaliados evidenciaram presença de área hipo/acinética e redução da fração de ejeção do ventrículo esquerdo nos grupos infartados, de igual magnitude. Com relação ao número de linfócitos T, verificamos que o grupo IC, comparado ao grupo controle, apresentou número significativamente menor de linfócitos reguladores (CD25+Foxp3+) no sangue periférico (CD4+: 63,5 ±1,4 vs 70,6 ±3,2%, e CD8+: 68,3 ±1,9 vs 76,1 ± 2,8%). O grupo IP, comparado ao grupo IC, apresentou significativa redução do número de linfócitos T convencionais no sangue periférico (respectivamente, CD4+: 1,5 ±0,2 vs 2,2 ± 0,2 %; CD8+: 1,1 ± 0,1 vs 1,8 ± 0,9%), e no baço houve redução somente do tipo CD4+ (respectivamente, 1,4 ± 0,2 vs 2,2 ± 0,2%), com aumento do tipo CD8+ (respectivamente, 1,2 ± 0,1 vs 0,7 ± 0,1 %). O grupo IP também apresentou significativo aumento de linfócitos reguladores (CD25+Foxp3+) no sangue periférico (respectivamente, CD4+: 76,5 ± 2,9 vs 63,5 ± 1,4 %; CD8+: 75,1 ± 1,0 vs 68,3 ± 1,9 %), e não apresentou diferenças significativas no número dessas células no baço. O grupo IC comparado ao grupo controle apresentou significativa marcação de anticorpos para CD4 e CD8 nas áreas infartada e peri-infarto por meio da análise de imunohistoquímica. O grupo IP comparado ao grupo IC, apresentou significativo aumento de CD4+ (respectivamente, 20,9 ± 6,5 vs 12,2 ± 2,5, p < 0,05) e de CD8+ (respectivamente, 17,9 ± 2,8 vs 5,8 ± 1,1%, p < 0,05) na área infartada; observamos redução significativa na marcação de CD4+ (respectivamente, 6,0 ±1,2 vs 12,5 ±4,8) na área peri-infarto, sem alterações significativas na marcação de CD8+. CONCLUSÃO: O tratamento com piridostigmina em ratos com IAM está associado a aumento da atividade vagal, aumento do número de linfócitos reguladores (CD25+Foxp3+) no sangue periférico e maior mobilização de células inflamatórias (CD4+ e CD8+) para a área infartada no miocárdio, com redução de CD4+ na área peri-infarto, no entanto sem mudança de CD8+ nesta região. A mudança do perfil inflamatório decorrente do aumento da atividade vagal na fase aguda do IAM, pode ser um possível mecanismo para explicar os benefícios detectados no remodelamento cardíaco após o IAM, em especial, na redução da área de lesão e na melhora da função ventricular, com uso de anticolinesterásicos / INTRODUTION: The role of the parasympathetic nervous system in immune cells is known as \"Cholinergic anti-inflammatory pathway\". In previous work has demonstrated that vagal stimulation reduces inflammation and improves survival in experimental sepsis models. The aim of the present study evalued the use of anticholinesterase pyridostigmine: change the number of T lymphocytes (CD4+ and CD8+) conventional (CD25+Foxp3-) and regulatory (CD25+Foxp3+) in peripheral blood, spleen, and myocardium: modifies the concentration of cytokines (interleukin-1, interleukin-6, TNFalfa) in the myocardium, and influences ventricular function after experimental myocardial infarction (MI) in rats. METHODS: Adult male rats of Wistar strain, weighing between 200 and 250 g were divided into 3 groups of 20 animals each: control group (GC); untreated group without treatment (IC) and infarcted group treated with pyridostigmine (IP). Acute myocardial infarction (AMI) was obtained with the technique of ligation of the left coronary artery, and the IP group received pyridostigmine dose of 40 mg/Kg/day in drinking water starting 4 days before the AMI. All animals underwent cannulation of the femoral artery on the day following AMI to record the blood pressure curves, and subsequent analysis of the components of heart rate variability (HRV), the time domain (SDNN and RMSSD) and frequency (components LF and HF), the echocardiografic study was performed on the second day after AMI. On the third day post-MI, mice were divided into subgroups of 10 animals, and were sacrificed in order to collet specific materials: 500 ul of fresh peripheral blood and spleen technique for performing flow cytometry left ventricle for measurement of cytokine ELISA, and the left ventricle to perform immunohistochemistry. Techniques used were standardized and commonly used in laboraties. The results were evaluated by analysis of variance (ANOVA) multifactorial, using the GraphPad Prism with Tukey post hoc test RESULTS: The HF group compared to the control group showed a significant drop in blood pressure and increased heart rate. The IP group compared to the IC group showed higher vagal activity, characterized by a significant reduction in HR and increase HVR (SDNN, 9.2 ± 1.5 vs 5.2 ± 0.5, p < 0.05). The echocardiography parameters evaluated showed presence of area hypo/acinetic and reduced ejection fraction of the left ventricle in infracted groups of equal magnitude. Regarding the number of T lymphocytes, we found that the IC group compared with the control group showed significantly fewer lymphocytes regulators (CD25+Foxp3+) in peripheral blood (CD4+:63.5 ± 1.4 vs 70.6 ± 3.2% and CD8+ cells: 68.3 ± 1.9 vs 76.1 ± 2.8%). The IP group compared to the IC group showed a significant reduction in the number of conventional T lymphocytes in peripheral blood (CD4+:1.5 ± 0.2 vs 2.2 ± 0.2%; CD8+: 1.1 ± 0.1 vs 1.8 ± 0.9%) and was reduced only in the spleen of the type CD4+(1.4 ± 0.2 vs 2.2 ± 0,2%) with increased CD8+(1.2 ± 0.1 vs 0.7 ± 0.1%). The IP group also showed a significant increase of lymphocytes regulators (CD25+Foxp3+) in peripheral blood (CD4+: 76.5 ± 2.9 vs 63.5 ± 1.4%; CD8+:75.1 ± 1.0 vs 68.3 ± 1.9%), and no significant differences in the number of these cells in the spleen. The IC group compared to the control group showed significant labeling antibodies to CD4 and CD8 areas infarcted and peri-infarction by immunohistochemical analysis. The IP group compared to the IC group showed a significant increase in CD4 (20.9 ± 6.5 vs 12.2 ± 2.5, p < 0.05) and CD8 (17.9 ± 2.8 vs 5.8 ± 1.1%, p < 0.05) in the infarcted area, and we observed a significant reduction in the labeling of CD4 (6.0 ± 1.2 vs 12.5± 4.8) in the peri-infraction without significant changes in the marking of CD8. CONCLUSION: The treatment with pyridostigmine in rats with acute myocardial infarction is associated with increased vagal activity, increased number of regulatory lymphocytes (CD25+Foxp3+) in peripheral blood and increased mobilization of inflammatory cells (CD4 and CD8) to the infarcted myocardium, with reduction of these cells in the peri-infarction. The change of the inflammatory profile due to increased vagal activity may be a possible mechanism to explain the benefits in the evolution of myocardial infarction, especially in the improvement of cardiac remodeling and maintenance of ventricular function with anticholinesterase drugs