This paper reviewed the mechanisms of systemic inflammation and the nutritional status of the individuals who suffer from chronic diseases including rheumatoid arthritis, systemic lupus erythematous, chronic obstructive pulmonary disease, irritable bowel diseases include ulcerative colitis and Crohn’s disease, asthma, and atherosclerosis. Treatment modalities such as diet regimens will also be discussed. The Anti-Inflammatory diet, Mediterranean Diet, and the Dash diet will be discussed. Nutritional status and inflammation go hand in hand according to the findings available today. There is still more research required to completely understand the mechanisms that occur in inflammation.

Les patients HIV controllers (HICs) sont des patients infectés par le VIH contrôlant spontanément la réplication virale sans traitement anti-rétroviral (TARV). Certains de ces patients présentent, au cours de leur suivi, une baisse de leurs lymphocytes T CD4 (LT CD4) et parfois, perdent le contrôle antiviral. Nous avons ainsi voulu étudier les paramètres d’activation immunitaire et d’inflammation systémique chez ces patients.Dans le travail n°1, nous avons quantifié plusieurs biomarqueurs de l’inflammation, et nous avons mis en évidence qu’en dépit d’une charge virale ARN VIH très faible, les HICs présentaient des taux de TNFα, IP10 et CD14 soluble anormalement élevés. La chimiokine IP10, produite sous l’effet des IFN de type I et II, était celle qui permettait le mieux de distinguer le profil inflammatoire des HICs par rapport aux témoins non infectés ou aux patients progresseurs. Notamment, les taux d’IP10 étaient inversement corrélés aux LT CD4 circulants. Nous avons poursuivi cette analyse dans le Travail n°2 par l’analyse en qPCR de gènes induits par l’Interféron (ISGs), au sein des LT CD4, LT CD8 et monocytes triés ex vivo. Le niveau d’expression des ISGs et leur régulation étaient différents selon le type cellulaire. En outre, le gène ifitm1 était surexprimé au sein des LT CD4 des HICs. Son rôle exact mérite d’être caractérisé précisément. Enfin, nous avons analysé les causes d’échappement immunologique et virologique des HICs de la cohorte ANRS CO21 CODEX, montrant queles taux de LT CD4, de charge virale ultra-sensible et d’IP10 à l’inclusion étaient anormaux chez les patients à risque d’échappement.Ces résultats soulignent donc que chez certains HICs, une inflammation anormale persiste. La place de ces biomarqueurs pour identifier les HICs à risque de progresser, chez lesquels un TARV devrait être instauré, doit être précisée. De même, le ciblage de ces voies d’activation immunitaire doit être étudié afin d’en réduire les conséquences. / HIV controllers patients (HICs) are HIV-infected patients who spontaneously control the viral replication without anti-retroviral treatment (ART). Some of these patients experience a decline of their CD4 T cell count (CD4 Tc) and/or lose their ability to control the virus during follow-up. Our aim was to study the parameters of immune activation and systemic inflammation in such settings.In the first article, we quantified several biomarkers of inflammation in HICs, and we highlighted that despite very low circulating HIV RNA viral load, HICs had higher levels of TNF, soluble CD14 and IP10 than healthy volunteers. IP10, depending on the production of type I and II IFN, was the one that allowed the better distinction in the inflammatory profile of HICs compared with uninfected controls or viremic patients. In particular, IP10 levels were negatively correlated to circulating CD4 T cell counts. We continued this analysis by performing qPCR analyses of the expression of 4 Interferon stimulated genes (ISGs) in sorted circulating CD4 T lymphocytes, CD8 T lymphocytes and monocytes ex vivo. The level of ISGs and their regulation differed depending on the cell type. In addition, Ifitm1 was overexpressed in HICs’ CD4 T cells. His precise role in antiviral control and/or regulation of inflammation should be further characterized. Lastly, we analyzed the immunological and virological progression causes in the HICs ANRS CO21 CODEX cohort, showing that CD4 T cell counts (nadir and at inclusion), as well as ultra-sensitive HIV viral load and IP10 levels at inclusion were abnormal in patients at risk of progression. These results point out that in some HICs, abnormal inflammation persists. The role of these biomarkers in the biological follow up of HICs must be specified to better identify patients at risk of progression, in which ART should be earlier initiated. Similarly, immunomodulatory drugs should be further studied in order to reduce the long term consequences of persistent inflammation in HICs.

Submitted by Maria Aparecida (cidazen@gmail.com) on 2017-11-27T18:12:10Z No. of bitstreams: 1 Juliana Macedo.pdf: 3843653 bytes, checksum: a40308c73af9a3d7ce2e665d6464831f (MD5) / Made available in DSpace on 2017-11-27T18:12:10Z (GMT). No. of bitstreams: 1 Juliana Macedo.pdf: 3843653 bytes, checksum: a40308c73af9a3d7ce2e665d6464831f (MD5) Previous issue date: 2017-08-28 / FAPEMA. / Penile cancer (PeCa) is a rare neoplasm with higher incidence in regions with low socioeconomic indexes. In Brazil, most of the men afflicted by this disease reside in the North and Northeast. Among the main risk factors are lack of hygiene, phimosis, high-risk human papillomavirus (HPV) infection and chronic inflammation. Although the role of inflammation and HPV infection is known in some cancers, the relationship between these two factors and the disruption of genes involved in the CaPe genesis is not yet well established. Thus, our main goal was to determine the expression of genes involved in the process of chronic inflammation and in the carcinogenesis mediated by HPV infection and the role of the deregulation of these genes in the establishment and progression of penile tumor. For this purpose, fresh and formalin-fixed paraffin-embedded (FFPE) tissues from 55 patients with penile cancer were evaluated. HPV detection and genotyping were carried out by nested PCR and direct sequencing in all samples. A subgroup (N = 37) was evaluated by qRT-PCR to determine COX-2, EGFR, MYC, RB and P53 gene expression. For this, sections of FFPE tissues containing more than 70% tumor cells were analyzed. Protein expression of these genes and PGE2 were determined by immunohistochemistry in the same tumor tissues. An analysis of the association between the clinical-histopathological parameters, presence of HPV, and gene and protein expression was performed. All tumors were classified as epidermoid squamous cell carcinoma. HPV DNA was detected in 80% of tumors, of which 95% had at least one high-risk subtype, and HPV16 was the most frequent subtype (63%). Among the HPV negative samples in the tumor tissue, 14% were positive in the tissue adjacent to the tumor, so that 94% of the patients, in total, were positive for the presence of HPV DNA.. Overexpression was identified in all genes involved in the inflammatory process. EGFR showed overexpression in 84% of the samples, while COX2 and PGE were overexpressed in 40% of the tumors, each. There was an associationbetween the levels of EGFR and COX2 expression, and between COX2 and PGE2. On the other hand, the genes related to HPV infection, MYC, RB and P53, were underexpressed in 97%, 85% and 81% of the samples, respectively. The gene expressions did not show any association with clinical-histopathological variables. This study describes the repression of RB and P53 activity in HPV + tumors, suggesting that there is a mechanism of control of these genes, possibly mediated by the virus. The high detection of HPV infection shows the importance of the immunization of boys in the prevention of penile cancer. Our data emphasize the need to expand the vaccine coverage to cover types of HPV present in penile cancer. The overexpression of EGFR / COX2 / PGE2, and the association found between them, support the possibility of therapeutic use of anti-EGFR and anti-COX drugs in penile tumors. / Câncer peniano (CaPe) é uma neoplasia rara com maior incidência em regiões com baixos índices socioeconômicos. No Brasil, a maior parte dos homens acometidos por essa doença residem nas regiões Norte e Nordeste. Entre os principais fatores de risco estão a falta de higiene, fimose, infecção por papilomavírus humano (HPV) de alto risco e inflamação crônica. Embora o papel d a inflamação e da infecção por HPV sejam conhecidas em alguns cânceres, ainda não é bem estabelecida a relação entre esses dois fatores e a disrupção de genes envolvidos na gênese de CaPe. Assim, neste estudo foi avaliada a expressão de genes envolvidos no processo de inflamação crônica e na infecção pelo HPV e o papel da desregulação desses genes no estabelecimento e progressão de tumor peniano. Para isto, foram avaliadas amostras teciduais frescas e fixadas em formalina embebidas em parafina (FFPE) de 55 pacientes com câncer de pênis. Foram realizadas detecção e genotipagem de HPV por nested PCR e sequenciamento direto em todas as amostras Um subgrupo amostral (N=37) foi avaliado por qRT-PCR para determinação da expressão dos genes COX-2, EGFR, MYC, RB e P53. Para isso, foram usadas secões de tecidos de FFPE contendo mais de 70% de células tumorais. A expressão proteica desses genes e de PGE2 foi determinada por imunohistoquímica em 42 amostras. Foi feita análise de associação entre os parâmetros clínico-histopatológicos, presença de HPV e expressão gênica e proteica. Todos os tumores foram classificados como carcinoma epidermóide de células escamosas. DNA de HPV foi detectado em 80% dos tumores (N=55), dos quais 95% apresentaram, pelo menos, um subtipo de alto risco, e destes, HPV16 foi o subtipo mais frequente (63%). Dentre as amostras negativas para HPV no tecido tumoral, 14% foram positivas no tecido adjacente ao tumor, de modo que 94% dos pacientes, no total, foram positivos para presença de DNA de HPV. Nas amostras nas quais foi feita análise de expressão gênica (N=37), detectou-se 94,4% de infecção, sendo 94% dos infectados possuem, pelo menos um, tipo de alto risco. Foi Identificada superexpressão em todos os genes envolvidos no processo inflamatório. EGFR mostrou superexpressão em 84% das amostras, enquanto COX2 e PGE mostraram-se, cada um, superexpressos em 40% dos tumores. Houve associação entre níveis de expressão de EGFR e COX2, e entre COX2 e PGE2. Por outro lado, os genes relacionados à infecção por HPV, MYC, RB e P53, mostraram-se subexpressos em 97%, 85% e 81% das amostras, respectivamente. A expressão dos genes estudados não mostrou associação com as variáveis clínico-histopatológicas. Este estudo descreve a repressão da atividade de RB e P53 em tumores HPV+, sugerindo que há um mecanismo de controle desses genes em câncer peniano, possivelmente mediado pelo vírus. A alta detecção de infecção por HPV mostra a importância da imunização de meninos na prevenção de câncer peniano, e ressalta-se a necessidade de ampliação da cobertura vacinal de modo a abranger tipos de vírus presentes em câncer peniano. A superexpressão de EGFR/COX2/PGE2, e a associação encontrada entre eles, sustenta a possibilidade de uso terapêutico de drogas anti-EGFR e anti-COX em tumores penianos.

L'inflammation chronique relayée par la glie activée contribue à la dégénérescence des neurones dopaminergiques (ND) au cours de la maladie de Parkinson (MP). L'étendue des dégâts cellulaires provoqués par la réaction inflammatoire dépend de l'efficacité des mécanismes régulateurs de l'inflammation. Les glucocorticoïdes endogènes sont des régulateurs puissants de l'inflammation agissant via le récepteur des glucocorticoïdes (GR). Notre équipe a récemment montré le rôle central du GR microglial dans la régulation de la mort neuronale dont la sévérité est corrélée à l'intensité et la durée de l'inflammation. Mon projet de thèse a été d'étudier le rôle des GR microglial et astrocytaire dans la régulation des réponses inflammatoires au cours de la dégénerescence des ND. Dans la première partie de ma thèse, nous avons effectué une analyse transcriptomique comparative de microglie ex vivo isolée de souris traitées au MPTP (modèle de parkinsonisme) et avons identifié des gènes régulés par le GR microglial, potentiellement impliqués dans l'inflammation chronique. Dans la deuxième partie de ma thèse, nous avons mis en évidence la régulation par le GR microglial de la mort neuronale induite par l'activation de TLR9. L'ADN mitochondrial endogène peut engendrer la mort neuronale en activant le TLR9, en cas de dysfonction du GR microglial. Dans la troisième partie de mon travail, nous avons démontré que le GR astrocytaire régule la survie des ND en modulant l'expression de gènes pro-inflammatoires et l'activité excessive des hémicanaux à connexine 43. Globalement, les GR microglial et astroglial jouent des rôles essentiels dans la régulation de l'inflammation aigue et chronique. / Chronic inflammation, mounted by activated glia, contributes to dopamine neuron (DN) loss, a major hallmark of Parkinson’s disease. It can be postulated that the extent of DN injury inflicted by inflammation is affected by the efficacy of regulatory mechanisms. The activation of hypothalamic–pituitary–adrenal axis results in release of glucocorticoids, which activate glucocorticoid receptor (GR). GR exerts adaptive responses including resolution of inflammation to restore the homeostatic state. We previously demonstrated the role of microglial GR in regulating the intensity and duration of inflammation, which influences DN survival. My thesis was centered on dissecting the roles of microglial and astrocytic GR during DN degeneration in experimental Parkinsonism. In the first part of my thesis, we conducted comparative transcriptome experiments of ex vivo microglia acutely isolated from mice treated with MPTP (model of parkinsonism) and identified genes and pathways in microglia regulated by GR, potentially involved in chronic inflammation in PD. In the second part of my thesis, we found that microglial GR regulates Toll-Like Receptor 9-induced DN loss by regulating the lysosomal compartment and demonstrated that diminished sensitivity of GR in microglia creates a permissive environment for TLR9 activation by endogenous mitochondrial DNA to become lethal for DNs. In the third part of my work, we showed that during DN degeneration, astrocytic GR regulates inflammatory gene expression and prevents connexin-43 hemichannel activity that contributes to DN loss. Overall, both microglial and astrocytic GR play essential roles in regulating chronic and acute inflammation.

Chronic abdominal pain is a major cause of patient morbidity in inflammatory bowel diseases (IBD). A balance of pro- and anti-nociceptive factors regulating colonic dorsal root ganglion (DRG) neurons, which synapse onto second order dorsal horn neurons, are known to regulate chronic pain but the mechanisms are poorly understood. This thesis examined whether neuroanatomical remodeling of DRG central nerve terminals underlies pro-nociceptive signaling and whether subsets of immune cells source the anti-nociceptive factor, β-endorphin. To examine pro-nociceptive mechanisms, acute and chronic dextran sulfate sodium (DSS) mouse models of colitis were established and substance P (SP; marker of nociceptor terminals) immunohistochemistry used to investigate changes in immunoreactivity of DRG terminals in the thoracic dorsal horn (segments T9-T13). SP immunoreactivity was increased in the dorsal horn (4 fold; P < 0.001) and central canal (P < 0.001) following chronic colitis. In contrast, SP immunoreactivity was unchanged in acute colitis. However, five weeks later SP immunoreactivity was increased both in the dorsal horn (4 fold; P < 0.01) and central canal (P < 0.001). In the cervical spinal cord, SP immunoreactivity was not increased following colitis, suggesting that changes seen in the thoracic level were specific to signaling from colonic DRG neurons. Immunoreactivity for the SP NK1 receptor on second order neurons was also examined and a significant increase in immunoreactivity was observed on post-synaptic second order cell bodies following chronic DSS. This could provide an additional mechanism for enhanced SP neurotransmission centrally. ii The source of the anti-nociceptive mediator, β-endorphin, during chronic DSS colitis was investigated using magnetic cell sorting and flow cytometry. The number of β- endorphin expressing CD4+ (2.4 fold; P < 0.05) and CD11b+ (2.6 fold; P < 0.05) cells in mice increased following chronic colitis. These findings suggest that during colitis there is a time-dependent increase of SP immunoreactivity in thoracic DRG central terminals, which could play a role in pro- nociceptive signaling in chronic inflammation. These actions may be balanced by anti- nociceptive factors such as β-endorphin which are found in subsets of immune cells. / Thesis (Master, Physiology) -- Queen's University, 2012-08-29 16:28:41.166

Inflammation is an integral part of the body defense mechanism that occurs in vascularized tissue in response to harmful stimuli that is perceived as being a threat to tissue homeostasis. It is a complex physiological host response that is designed to neutralize and eliminate harmful agents, initiate tissue healing, and orchestrate a return to tissue homeostasis. While inflammation is designed to be an acute event that resolves following the elimination of harmful stimuli and tissue healing, there are instances where inflammation fails to resolve and instead evolves into chronic inflammation. It is now well understood that ongoing inflammation can serve as the underlying cause of many chronic inflammatory diseases, including atherosclerosis. In fact, one of the most pressing issues that is currently faced in the field of inflammation research, one that has also become the focus of numerous ongoing investigations, is how to turn this excessive, unwarranted and undesirable inflammation response off. Once thought to be a passive and simple process, resolution is now understood to be an active and complex process that is orchestrated by various inflammatory mediators, signaling pathways and biophysical processes. The discovery of novel biosynthetic pathways that turn on the pro-resolution signals has lead to a surge in research aimed at taking a closer look at processes that can stimulate the resolution of inflammation. While major advances in the field have resulted in a better understanding of the proactive nature of resolution, many of the mechanisms involved are still unknown. To date, the repertoire of chemokine receptors that participate in macrophage clearance during resolution, for the most part, remain unidentified. Overall, there is a growing appreciation that the discovery of mechanisms involved in the resolution responses can lead to the development of novel therapeutic approaches to resolve many chronic inflammatory diseases. Syndecan-1 (Sdc-1), a member of a family of cell surface proteoglycans, has been previously shown to regulate events relevant to tissue repair and chronic injury responses. Macrophage Sdc-1 expression during inflammation has been reported to be protective in various inflammatory models. Given these observations, we hypothesize that Sdc-1 expression on macrophages is a critical component of an anti-inflammatory, pro resolution program necessary for the successful resolution of inflammatory response. In this dissertation, we report the presence of a unique population of macrophages expressing Sdc-1 that are present within the vascular wall of mice undergoing atherosclerosis. Consistent with previous publications, the presence of Sdc-1 expressing macrophages was found to limit atherosclerosis progression. In addition, Sdc-1 expression on macrophages was associated with anti-inflammatory M2 polarization state and high intrinsic motility. Macrophage Sdc-1 expression was also linked with efferocytosis and enhanced macrophage egress from the site of inflammation to the draining lymphatic network. Moreover, we discovered that the chemokine receptor CXCR4, which was found on Sdc-1 expressing macrophages, was also involved in macrophage egress during inflammation resolution. In summary, while the overall mechanism regulating resolution processes is still unknown, our work has managed to identify two components that are involved in the process: macrophage Sdc-1 and CXCR4. Collectively, these results reinforce the physiological significance of macrophage efferocytosis and macrophage motility as endogenous modulators of the inflammatory response.

Lors de l'inflammation chronique, les cellules immunitaires, dont les lymphocytes Th17 (LTh17), migrent au niveau du site inflammatoire et interagissent avec les cellules mésenchymateuses locales. Dans deux contextes inflammatoires, la polyarthrite rhumatoïde (PR) et le psoriasis (Pso), le but de ce travail a été d'étudier le rôle de ces interactions cellulaires sur la production de cytokines pro-inflammatoires, et principalement l'IL-17, et d'identifier les mécanismes impliqués.L'utilisation d'un système de co-culture entre cellules mésenchymateuses (synoviocytes PR ou fibroblastes de peau Pso) et cellules mononuclées du sang périphérique mimant la situation in vivo, a permis d'étudier l'effet de ces interactions. Le contact cellulaire suffisait à l'induction de la sécrétion d'IL-6, d'IL-8 ou d'IL-1ß. En revanche, la forte sécrétion d'IL-17 nécessitait le contact cellulaire mais également l'activation du TCR. L'inhibition de la podoplanine (pdpn), molécule d'interaction exprimée par différents types cellulaires (cellules mésenchymateuses mais également LTh17), diminuait significativement la production d'IL-17. Toutefois, cette inhibition n'était pas totale, c'est pourquoi une étude en collaboration est en cours afin d'identifier d'autres molécules impliquées.Cette étude a donc montré que les interactions entre cellules mésenchymateuses et cellules immunitaires jouent un rôle majeur dans la sécrétion de cytokines pro-inflammatoires, notamment dans la forte production d'IL-17. La podoplanine semble largement impliquée dans ce mécanisme, ce qui en fait une cible thérapeutique potentielle pour bloquer l'activité Th17 lors de l'inflammation chronique / During chronic inflammation, immune cells, including Th17 lymphocytes, migrate to the inflammatory site and interact with the local mesenchymal cells. In two inflammatory contexts, rheumatoid arthritis (RA) and psoriasis (Pso), the aim of this work was to study the effect of cellular interactions on pro-inflammatory cytokine production, with a focus on IL-17, and to identify the involved mechanisms. Using a co-culture system between mesenchymal cells (RA synoviocytes or Pso skin fibroblasts) and peripheral blood mononuclear cells mimicking the in vivo situation, allowed studying the effect of these cell interactions. The cell contact alone was sufficient to induce IL-6, IL-8 and IL-1ß secretion. On the contrary, the heightened IL-17 production required the cell contact and the TCR activation. The inhibition of the podoplanin (pdpn), interaction molecule expressed by different cell types (including mesenchymal cells but also Th17 lymphocytes), decreased significantly the IL-17 production. Nevertheless, this inhibition was only partial, which leads to a collaboration in order to identify other involved molecules. In conclusion, this study showed that cell interactions between mesenchymal cells and immune cells play a major role in the pro-inflammatory cytokine production, leading to a heightened IL-17 secretion. The podoplanin molecule seems play a crucial role in this mechanism, and thus pdpn could be a potential therapeutic target to block Th17 cell activity during chronic inflammation

Obesity has in recent times become a more serious health issue and was estimated to affect over 650 million people world-wide in 2016. Furthermore, the list of obesity-associated diseases is countless, many of which have severe consequences. Type 2 diabetes (T2D) is such a disease, and it was estimated to be over 1.5 million new cases in America alone in 2015. It is thought that insulin resistance development which causes T2D is associated with a low-level chronic inflammation in the adipose tissue. The inflammatory state is caused by the pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-α) which is secreted by macrophages. To further understand the complexity of the underlying mechanisms of both the adipocytes as well as the macrophages, mathematical models are being developed in the fields of systems biology. However, as of now, no mathematical model has been developed which can explain the association between chronic inflammation and the development of insulin resistance. Because of this, a first model will be presented which is able to describe the mechanisms of insulin resistance development caused by chronic inflammation. The model was fitted to data from intraperitoneal glucose tolerance test in mice and yielded a cost below the threshold of chi-square test, which suggests that the model cannot be rejected. Furthermore, the model was expanded, introducing more complexity in the intracellular cascade reaction of an activated macrophage. Once again, the model was fitted to the same data and yielded a cost below the threshold of chi-square test. Uncertainty tests were made to further validate the models and showed a low uncertainty for both models. These results increase the understanding regarding the association between adipocytes and macrophages, in the role of insulin resistance caused by chronic inflammation. This increased knowledge can help, for instance, in the development of new drugs which are able to prevent the development of insulin resistance and T2D.

Final publication is available at http://onlinelibrary.wiley.com/doi/10.1002/art.38173/abstract;jsessionid=DA29F0C067C89EC1147E79EE7380D21A.f01t04?systemMessage=Wiley+Online+Library+will+be+disrupted+on+24th+October+2015+at+10%3A00-10%3A30+BST+%2F+05%3A00-05%3A30+EDT+%2F+17%3A00-17%3A30++SGT++for+essential+maintenance.++Apologies+for+the+inconvenience / 京都大学 / 0048 / 新制・論文博士 / 博士(医科学) / 乙第13003号 / 論医科博第3号 / 新制||医科||5(附属図書館) / 32931 / (主査)教授 杉田 昌彦, 教授 生田 宏一, 教授 三森 経世 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20246号 / 医博第4205号 / 新制||医||1020(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 長船 健二, 教授 杉田 昌彦, 教授 髙折 晃史 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM