Charles University Faculty of Pharmacy in Hradec Králové Department of Biochemical Sciences Candidate: Nikola Jaščevská Supervisor: PharmDr. Anna Jirkovská, Ph.D. Title of diploma thesis: The effects of topoisomerase II beta on the sensitivity of the cancer cells to the antineoplastics Topoisomerase II (TOP II) is a cellular enzyme responsible for solving topological problems of double-stranded DNA. Alpha and beta isoforms of TOP II are different gene products having similar catalytic activities. The expression of TOP IIα is cell-cycle dependent, peaking in G2/M phase, while TOP II isoform is expressed constitutively throughout the cell cycle. It is therefore present also in non-proliferating differentiated cells. Anthracycline antibiotics are an old class of anticancer drugs, belonging to TOP II poisons. Although their clinical usefulness is high, the incidence of side effects (especially myelotoxicity and cardiotoxicity) may limit the therapy. The key role of TOP II inhibition, which is present also in cardiomyocytes, has been increasingly discussed. Dexrazoxane, the only clinically used cardioprotective, leads to depletion of TOP II in cardiomyocytes, which may explain its cardioprotection. Although TOP II was previously shown to be dispensable for cellular proliferation, its possible...

Human response to ionising radiation (IR) shows a wide variation. This is most clearly seen in the radiation-response of cells as measured by frequencies of chromosomal aberrations. Different frequencies of IR-induced aberrations can be conveniently observed in phytohaemagglutin-stimulated peripheral blood T-lymphocytes from both normal individuals and sporadic cancer cases, in either metaphase chromosomes or as micronuclei in the following cell cycle. Metaphase cells show frequent chromatid breaks, defined as chromatid discontinuities or terminal deletions, if irradiated in the G 2 -phase of the cell cycle. It has been shown that the frequency of chromatid breaks in cells from approximately 40% of sporadic breast cancer patients, are significantly higher than in groups of normal individuals. This suggests that elevated radiation-induced chromatid break frequency may be linked with susceptibility to breast cancer. It is known that chromatid breaks are initiated by a double strand break (DSB), but it appears that the two are linked only indirectly as repair kinetics for DSBs and chromatid breaks do not match. Therefore, the underlying causes of the wide variation in frequencies of chromatid breaks in irradiated T-lymphocytes from different normal individuals and from sporadic breast cancer cases are still unclear but it is unlikely to be linked directly to DSB rejoining. My research has focused on the mechanism through which chromatid breaks are formed from initial DSBs. The lack of a direct association suggested that a signalling process might be involved, connecting the initial DSB and resulting chromatid break. The signal model, suggested that the initial DSB is located within a chromatin loop that leads to an intra- or interchromatid rearrangement resulting in incomplete mis-joining of chromatin ends during the decatenation of chromatids during G 2 . It was therefore proposed that topoisomerase II alpha (topo IIα) might be involved, mainly because of its ability to incise DNA and its role in sister chromatid decatenation. During my PhD research I have used a strategy of altering topo II activity or expression and studying whether this alters IR-induced chromatid break frequency. The first approach involved cell lines that varied in topo IIα expression. The frequency of IR-induced chromatid breaks was found to correlate positively with topo IIα expression level, as measured in three different cell lines by immunoblotting, i.e. two cell lines with lower topo IIα expression exhibited lower chromatid break frequency. Topo II activity in these three cell lines was also estimated indirectly by the ability of a topo IIα poison to activate the G 2 /M checkpoint, and this related well with topo IIα expression. A second approach involved ‘knocking down’ topo IIα protein expression by silencing RNA (siRNA). Lowered topo IIα expression was confirmed by immunoblotting and polymerase chain reaction. SiRNA-lowered topo IIα expression correlated with a decreased IR-induced chromatid break frequency. In a third series of experiments cells were treated with ICRF-193, a topo IIα catalytic inhibitor. It was shown that inhibition of topo IIα also significantly reduced IR-induced chromatid breaks. I also showed that lowered chromatid break frequency was not due to cells with high chromatid break frequencies being blocked in G 2 as the mitotic index was not altered significantly in cells with lowered topo IIα expression or activity. These experiments show that topo IIα is involved in IR-induced chromatid break formation. The final experiments reported here attempted to show how topo II might be recruited in the process of forming IR-induced chromatid breaks. Hydrogen peroxide was used as a source of reactive oxygen species (reported to poison topo IIα) and it was shown that topo IIα under these conditions is involved in the entanglement of metaphase chromosomes and formation of chromatin ‘dots’ as well as chromatid breaks. Experiments using atomic force microscopy attempted to confirm these dots as excised chromatin loops. The possible role of topo IIα in both radiation- and hydrogen peroxide-induced primary DNA damage was also tested. It was shown that topo IIα does not affect radiation-induced DSBs, even though it does affect chromatid break frequency. Also, topo IIα does not affect hydrogen peroxide-induced DNA damage at low doses. The results support the idea that topo IIα is involved in the conversion of DSBs to chromatid breaks after both irradiation and treatment with hydrogen peroxide at a low concentrations. I have demonstrated that topo IIα is involved in forming IR-induced chromatid breaks, most likely by converting the initial DSBs into chromosomal aberrations as suggested by the signal model.

La sclérose systémique est une maladie autoimmune dont l’une des complications majeures est la fibrose. La DNA topoisomérase I (topo) est l’un des principaux autoantigènes associés à cette maladie. Toutefois, aucun lien n’a encore pu être établi entre la présence des anti-topo et le développement de la fibrose. Les travaux antérieurs du laboratoire d’accueil ont montré une interaction directe de la topo avec la surface des fibroblastes et la matrice extracellulaire. Nous avons voulu caractériser ces interactions du point de vue moléculaire. La topo a donc été exprimée sous forme de 5 fragments, déterminés à partir de ses principaux domaines structuraux et de ses épitopes majeurs, chez E. coli. Les fragments purifiés ont été analysés pour leur interaction avec l’héparine, représentant les héparane sulfates de la surface des fibroblastes, et avec des protéines purifiées de la matrice extracellulaire. Nous avons montré que le fragment topo-N est le principal responsable de l’interaction avec l’héparine, ce qui suggère donc l’implication potentielle de ce domaine dans l’interaction de la topo avec la surface des fibroblastes. Le fragment topo-DIDII est responsable de l’interaction avec la plupart des protéines de la matrice extracellulaire étudiées, alors que le fragment topo-H15 n’interagit qu’avec la vitronectine. Aucune interaction des fragments topo-DIII et topo-C n’a été décelée. Ces résultats pourront maintenant servir à mieux comprendre le rôle potentiel de la topo et des autoanticorps circulants anti-topo dans la fibrose présente chez les personnes atteintes de sclérose systémique en contribuant à l’identification de la cible de la topo sur les fibroblastes. / Systemic sclerosis is an autoimmune disease in which one of the major complications is fibrosis. DNA topoisomerase I (topo) is a major autoantigen associated with this disease. However, no link has yet been established between the presence of anti-topo and the development of fibrosis. Previous work of the host laboratory showed a direct interaction of the topo with the surface of fibroblasts and extracellular matrix. We wanted to characterize these interactions at the molecular level. Topo was expressed in 5 fragments, determined from its main structural domains and its major epitopes, in E. coli. The purified fragments were analyzed for their interaction with heparin, representing heparan sulfates on the surface of fibroblasts, and with purified proteins of the extracellular matrix. We have shown that the topo-N fragment is responsible for interaction with heparin, suggesting hence, potential involvement of this domain in the interaction of topo with the surface of fibroblasts. The topo-DIDII fragment is responsible for the interaction with most proteins of the extracellular matrix studied, whereas the topo-H15 fragment only binds to vitronectin. No interaction of fragments topo-DIII and topo-C was found. These results can now be used to better understand the potential role of topo and circulating anti-topo autoantibodies in the fibrosis present in patients with systemic sclerosis in helping to identify the target of topo on fibroblasts.

INTRODUÇÃO: A endometriose, uma doença benigna, tem características invasivas com potencial proliferativo. O desenvolvimento das lesões pode ocorrer em decorrência de crescimento celular glandular e/ou estromal ou de alterações na cinética celular. Cinética celular refere-se ao equilíbrio entre a morte celular, ou apoptose, e a proliferação celular, que pode ser avaliada pela expressão de fatores de crescimento como, por exemplo, a topoisomerase 2-alfa (TOP2A). Também influenciam a cinética celular oncoproteínas como p53 e c-erB2, conhecidas por interferir na apoptose, podendo resultar em oncogênese. OBJETIVOS: O objetivo principal deste estudo foi comparar a cinética celular da endometriose infiltrativa de retosigmoide com a do endométrio eutópico de pacientes sem endometriose. Para tanto, foi avaliada a expressão de apoptose e de TOP2A bem como das oncoproteínas p53 e c-erB2. MÉTODOS: Foram obtidas amostras de lesões de endometriose envolvendo o reto-sigmoide de 60 mulheres com a doença e amostras de endométrio eutópico de 20 mulheres sem endometriose. A expressão de TOP2A e das proteínas p53 e c-erB2 foram quantificadas por técnica imuno-histoquímica. Método TUNEL foi utilizado para analisar os padrões de apoptose, que resultaram em índice de apoptose (IA). Índice de proliferação celular (IP) foi determinado a partir do nível de expressão de TOP2A. Índice de renovação celular (IRC) foi calculado pela razão entre IP e IA. As análises imuno-histoquímicas foram realizadas tanto no tecido endometrial como um todo, quanto nos componentes estromal e glandular separadamente. Coeficiente de Correlação de Spearman foi aplicado para identificar eventuais correlações entre variáveis clínicas, morfológicas (tamanho, quantidade e nível de invasão das lesões) e experimentais. RESULTADOS: Na análise da amostra do tecido como um todo, não foram evidenciadas diferenças entre os grupos experimental e controle em relação ao IA (p = 0,389). Por outro lado, o IP foi significativamente maior nas amostras-controle (p < 0,001). Na avaliação em que se sepaxii raram as células estromais dos componentes glandulares, tanto o IP quanto o IRC foram significativamente maiores no grupo-controle em comparação com o grupo experimental (IP estromal: p = 0,006; IP glandular: p = 0,001; IRC estromal: p =0,032; IRC glandular: p = 0,007). Nas pacientes com endometriose, foi encontrada correlação entre IP e IRC glandular e o número de lesões (p = 0,003). Também foi observada correlação entre o IRC glandular e o tamanho das lesões (p = 0,006). Não houve diferença entre os grupos no que se refere à expressão de p53 e cerB2. CONCLUSÕES: A cinética celular se mostrou alterada em pacientes com endometriose do reto-sigmoide, conforme demonstrado pela redução nos níveis e na frequência de TOP2A, e pelos IP e IRC mais baixos; entretanto, apoptose e as expressões de p53 e c-erB2 se mostraram inalteradas / BACKGROUND: Endometriosis, a benign disease, has invasive features with its proliferative potential. Development of lesions may occur due to stromal and/or glandular cell growth and to alterations in cellular kinetics. Cellular kinetics involves a balance between the regulation of cell death, or apoptosis, and cell growth, that can be evaluated by the expression of growth factors, such as topoisomerase 2- alpha (TOP2A). Oncoproteins, such as p53 and c-erB2, known to affect apoptosis resulting in oncogenesis, also influence cellular kinetics. OBJECTIVES: The main objective of this study was to compare the cellular kinetics in deep endometriosis involving the recto-sigmoid to eutopic endometrium from patients without endometriosis. Apoptosis and TOP2A expression were primarily evaluated, as well as p53 and c-erB2 expression. METHODS: Study samples were obtained from endometriosis lesions involving the recto-sigmoid in 60 women, and control samples were obtained from eutopic endometrium from 20 women without endometriosis. The expression of TOP-2A, p53 and c-erB2 proteins were quantified using immuno-histochemistry. TUNEL method was used in the analysis of apoptosis patterns, and the apoptosis index (AI) was derived. The proliferation index (PI) was derived from the level of expression of TOP-2A. Cellular renew index (CRI) was calculated from the ratio of the PI and AI. Immunohistochemical analyses were performed in two ways: on the tissue collectively, and on the stromal and glandular components separately. Spearmans correlation coefficient was used to identify the correlation between clinical, morphological (size, number and level of invasion of lesions) and the study variables. RESULTS: When looked at collectively, there was no difference in the AI between study and control groups (p = 0.389). PI, however, was noted to be significantly higher in the control samples (p < 0.001). When evaluating the stromal cells separately from the glandular components, the PI and CRI were both significantly xiv higher in the control group compared to the study group (Study stromal PI vs control stromal PI; p = 0.006; Study glandular PI vs study glandular PI; p = 0.001; Study stromal CRI vs control stromal CRI; p = 0.032; study glandular CRI vs control glandular CRI; p = 0.007). In patients with endometriosis, a correlation was found between glandular PI, CRI and number of lesions (p = 0.003). The same result was observed in the analysis of stromal CRI and lesion size (p = 0.006). There was no difference in expression of p53 and c-erB2 between groups. CONCLUSIONS: Cellular kinetics is altered in endometriosis of the recto-sigmoid, as shown by the decrease in the levels and frequency of TOP2A expression, and lower PI and CRI; however, apoptosis and p53 and c-erB2 expression were unaffected

INTRODUÇÃO: A endometriose, uma doença benigna, tem características invasivas com potencial proliferativo. O desenvolvimento das lesões pode ocorrer em decorrência de crescimento celular glandular e/ou estromal ou de alterações na cinética celular. Cinética celular refere-se ao equilíbrio entre a morte celular, ou apoptose, e a proliferação celular, que pode ser avaliada pela expressão de fatores de crescimento como, por exemplo, a topoisomerase 2-alfa (TOP2A). Também influenciam a cinética celular oncoproteínas como p53 e c-erB2, conhecidas por interferir na apoptose, podendo resultar em oncogênese. OBJETIVOS: O objetivo principal deste estudo foi comparar a cinética celular da endometriose infiltrativa de retosigmoide com a do endométrio eutópico de pacientes sem endometriose. Para tanto, foi avaliada a expressão de apoptose e de TOP2A bem como das oncoproteínas p53 e c-erB2. MÉTODOS: Foram obtidas amostras de lesões de endometriose envolvendo o reto-sigmoide de 60 mulheres com a doença e amostras de endométrio eutópico de 20 mulheres sem endometriose. A expressão de TOP2A e das proteínas p53 e c-erB2 foram quantificadas por técnica imuno-histoquímica. Método TUNEL foi utilizado para analisar os padrões de apoptose, que resultaram em índice de apoptose (IA). Índice de proliferação celular (IP) foi determinado a partir do nível de expressão de TOP2A. Índice de renovação celular (IRC) foi calculado pela razão entre IP e IA. As análises imuno-histoquímicas foram realizadas tanto no tecido endometrial como um todo, quanto nos componentes estromal e glandular separadamente. Coeficiente de Correlação de Spearman foi aplicado para identificar eventuais correlações entre variáveis clínicas, morfológicas (tamanho, quantidade e nível de invasão das lesões) e experimentais. RESULTADOS: Na análise da amostra do tecido como um todo, não foram evidenciadas diferenças entre os grupos experimental e controle em relação ao IA (p = 0,389). Por outro lado, o IP foi significativamente maior nas amostras-controle (p < 0,001). Na avaliação em que se sepaxii raram as células estromais dos componentes glandulares, tanto o IP quanto o IRC foram significativamente maiores no grupo-controle em comparação com o grupo experimental (IP estromal: p = 0,006; IP glandular: p = 0,001; IRC estromal: p =0,032; IRC glandular: p = 0,007). Nas pacientes com endometriose, foi encontrada correlação entre IP e IRC glandular e o número de lesões (p = 0,003). Também foi observada correlação entre o IRC glandular e o tamanho das lesões (p = 0,006). Não houve diferença entre os grupos no que se refere à expressão de p53 e cerB2. CONCLUSÕES: A cinética celular se mostrou alterada em pacientes com endometriose do reto-sigmoide, conforme demonstrado pela redução nos níveis e na frequência de TOP2A, e pelos IP e IRC mais baixos; entretanto, apoptose e as expressões de p53 e c-erB2 se mostraram inalteradas / BACKGROUND: Endometriosis, a benign disease, has invasive features with its proliferative potential. Development of lesions may occur due to stromal and/or glandular cell growth and to alterations in cellular kinetics. Cellular kinetics involves a balance between the regulation of cell death, or apoptosis, and cell growth, that can be evaluated by the expression of growth factors, such as topoisomerase 2- alpha (TOP2A). Oncoproteins, such as p53 and c-erB2, known to affect apoptosis resulting in oncogenesis, also influence cellular kinetics. OBJECTIVES: The main objective of this study was to compare the cellular kinetics in deep endometriosis involving the recto-sigmoid to eutopic endometrium from patients without endometriosis. Apoptosis and TOP2A expression were primarily evaluated, as well as p53 and c-erB2 expression. METHODS: Study samples were obtained from endometriosis lesions involving the recto-sigmoid in 60 women, and control samples were obtained from eutopic endometrium from 20 women without endometriosis. The expression of TOP-2A, p53 and c-erB2 proteins were quantified using immuno-histochemistry. TUNEL method was used in the analysis of apoptosis patterns, and the apoptosis index (AI) was derived. The proliferation index (PI) was derived from the level of expression of TOP-2A. Cellular renew index (CRI) was calculated from the ratio of the PI and AI. Immunohistochemical analyses were performed in two ways: on the tissue collectively, and on the stromal and glandular components separately. Spearmans correlation coefficient was used to identify the correlation between clinical, morphological (size, number and level of invasion of lesions) and the study variables. RESULTS: When looked at collectively, there was no difference in the AI between study and control groups (p = 0.389). PI, however, was noted to be significantly higher in the control samples (p < 0.001). When evaluating the stromal cells separately from the glandular components, the PI and CRI were both significantly xiv higher in the control group compared to the study group (Study stromal PI vs control stromal PI; p = 0.006; Study glandular PI vs study glandular PI; p = 0.001; Study stromal CRI vs control stromal CRI; p = 0.032; study glandular CRI vs control glandular CRI; p = 0.007). In patients with endometriosis, a correlation was found between glandular PI, CRI and number of lesions (p = 0.003). The same result was observed in the analysis of stromal CRI and lesion size (p = 0.006). There was no difference in expression of p53 and c-erB2 between groups. CONCLUSIONS: Cellular kinetics is altered in endometriosis of the recto-sigmoid, as shown by the decrease in the levels and frequency of TOP2A expression, and lower PI and CRI; however, apoptosis and p53 and c-erB2 expression were unaffected

La sclérose systémique est une maladie autoimmune dont l’une des complications majeures est la fibrose. La DNA topoisomérase I (topo) est l’un des principaux autoantigènes associés à cette maladie. Toutefois, aucun lien n’a encore pu être établi entre la présence des anti-topo et le développement de la fibrose. Les travaux antérieurs du laboratoire d’accueil ont montré une interaction directe de la topo avec la surface des fibroblastes et la matrice extracellulaire. Nous avons voulu caractériser ces interactions du point de vue moléculaire. La topo a donc été exprimée sous forme de 5 fragments, déterminés à partir de ses principaux domaines structuraux et de ses épitopes majeurs, chez E. coli. Les fragments purifiés ont été analysés pour leur interaction avec l’héparine, représentant les héparane sulfates de la surface des fibroblastes, et avec des protéines purifiées de la matrice extracellulaire. Nous avons montré que le fragment topo-N est le principal responsable de l’interaction avec l’héparine, ce qui suggère donc l’implication potentielle de ce domaine dans l’interaction de la topo avec la surface des fibroblastes. Le fragment topo-DIDII est responsable de l’interaction avec la plupart des protéines de la matrice extracellulaire étudiées, alors que le fragment topo-H15 n’interagit qu’avec la vitronectine. Aucune interaction des fragments topo-DIII et topo-C n’a été décelée. Ces résultats pourront maintenant servir à mieux comprendre le rôle potentiel de la topo et des autoanticorps circulants anti-topo dans la fibrose présente chez les personnes atteintes de sclérose systémique en contribuant à l’identification de la cible de la topo sur les fibroblastes. / Systemic sclerosis is an autoimmune disease in which one of the major complications is fibrosis. DNA topoisomerase I (topo) is a major autoantigen associated with this disease. However, no link has yet been established between the presence of anti-topo and the development of fibrosis. Previous work of the host laboratory showed a direct interaction of the topo with the surface of fibroblasts and extracellular matrix. We wanted to characterize these interactions at the molecular level. Topo was expressed in 5 fragments, determined from its main structural domains and its major epitopes, in E. coli. The purified fragments were analyzed for their interaction with heparin, representing heparan sulfates on the surface of fibroblasts, and with purified proteins of the extracellular matrix. We have shown that the topo-N fragment is responsible for interaction with heparin, suggesting hence, potential involvement of this domain in the interaction of topo with the surface of fibroblasts. The topo-DIDII fragment is responsible for the interaction with most proteins of the extracellular matrix studied, whereas the topo-H15 fragment only binds to vitronectin. No interaction of fragments topo-DIII and topo-C was found. These results can now be used to better understand the potential role of topo and circulating anti-topo autoantibodies in the fibrosis present in patients with systemic sclerosis in helping to identify the target of topo on fibroblasts.

La sclérose systémique (ScS) est une maladie auto-immune d’origine inconnue qui est caractérisée par des atteintes vasculaires, des dérèglements cellulaire et immunitaire. La majorité des patients atteints de ScS possède des auto-anticorps dirigés contre des protéines nucléaires. Ces auto-anticorps sont associés à des manifestations cliniques spécifiques favorisant la classification et le diagnostic de la ScS. Les anti-ADN topoisomérase I (antitopo) sont l’un des principaux auto-anticorps retrouvés dans la ScS. Ils sont associés à la forme la plus grave de la maladie, soit la forme diffuse. Celle-ci se caractérise par une importante fibrose progressant vers une atteinte viscérale. La fibrose résulte d’une production excessive et dérégulée de matrice extracellulaire par les fibroblastes. Bien que les anti-topo soient associés à un très mauvais pronostic et qu’ils corrèlent avec l’activité et la sévérité de la maladie, leur rôle dans la pathogenèse de la ScS n’est pas élucidé. Toutefois, depuis que certains auto-antigènes ont démontré des fonctions additionnelles lorsque retrouvés dans le milieu extracellulaire, leur contribution suscite un intérêt marqué. En effet, ces auto-antigènes, dits bifonctionnels, influencent la physiologie de certaines cellules en se liant à leur surface. Ainsi, la détermination du rôle de ces autoantigènes ouvre la voie pour l’exploration du rôle potentiellement pathogène de leurs autoanticorps. Tout d’abord, nous avons démontré que l’auto-antigène topo, ciblée par les antitopo, pouvait influencer la physiologie du fibroblaste suite à l’activation de voies de signalisations intracellulaires stimulant la migration cellulaire. Nos résultats suggèrent fortement que la topo stimule le fibroblaste suite à son interaction avec le CCR7, un récepteur de chimiokine, présent à sa surface. Nous avons également démontré que la topo utilisait les protéoglycans à chaînes d’héparanes sulfates (HSPG) à titre de corécepteurs. Il avait été démontré que la topo liée à la surface des fibroblastes entraînait le recrutement d’anti-topo, l’adhésion et l’activation monocytaires. Nous avons ici démontré que la présence d’anticorps anti-topo entraîne l’amplification de la liaison de la topo au niveau des HSPG. De ce fait, le complexe immun à la surface des fibroblastes pourrait contribuer à l’initiation d’une cascade inflammatoire propice au développement d’une fibrose, caractéristique de la ScS. En dernier lieu, nos résultats nous ont permis de suggérer l’utilisation de l’héparine et des héparines de bas poids moléculaires comme approche thérapeutique pour la ScS puisqu’elles permettent autant de prévenir la liaison du complexe immun topo/anti-topo au niveau des HSPG que de le dissocier une fois lié. En résumé, notre étude soutient d’abord le rôle actif de l’auto-antigène dans la physiologie des fibroblastes mais également le rôle pathogène des anti-topo en présence de la topo dans la ScS. Finalement, les résultats de notre étude permettent de proposer une approche thérapeutique potentielle pour inhiber le développement d’une cascade inflammatoire et pro-fibrotique. / Systemic sclerosis (SSc) is an autoimmune disease of unknown etiology characterized by vascular damage, cellular and immunological disorders. The vast majority of patient sera are characterized by the presence of autoantibodies directed against nuclear proteins. The autoantibodies are associated with specific clinical manifestations and thus useful for diagnostic and classification of the disease. One of the major autoantibody groups are the anti-DNA topoisomerase I (anti-topo). They are associated with the diffuse form of the disease which is characterized by extensive cutaneous and visceral fibrosis. Increased extracellular matrix synthesis and deposition by fibroblast result in the development of fibrosis. Although anti-topo are associated with the worst form of the disease, correlated with the activity and the severity of SSc, their exact role in the pathogenesis of SSc is controversial and still unravelled. On the other hand, there is now strong evidence for active contribution of autoantigens, targeted by autoantibodies, in autoimmune diseases. Indeed, numerous cells have been shown to be influenced by the interaction of autoantigens with their cognate receptors present on their surface. These autoantigens display cytokine-like effects toward their target cell and are called bifunctional autoantigen. Hence, determination of the exact role of these autoantigens and characterization of their interaction with their target cell may open up research perspectives for the elucidation of the potential pathogenic role of their autoantibodies. In our study, we demonstrated that topo activates intracellular signaling pathways leading to the stimulation of fibroblast migration. We undertook experiments to characterize the interaction of the autoantigen topo with fibroblasts responsible of these cellular effects. Our results strongly suggest a direct interaction of topo with CCR7, a chemokine receptor, present on the surface of fibroblasts. Heparan sulfate proteoglycans (HSPG), abundantly present on fibroblast surfaces, were found to act as coreceptors for topo binding. Previous work has demonstrated that once bound to fibroblast surfaces, topo recruits anti-topo autoantibodies, which subsequently lead to adhesion and activation of monocytes. Here, we demonstrated that anti-topo autoantibodies from SSc sera lead to the amplification of topo binding to HSPG on fibroblast surfaces. The binding of topo/anti-topo IC could mediate the initiation and maintenance of an inflammatory cascade and further fibrosis development. Hence, perturbing the binding of topo/anti-topo immune complexes to HSPG became an interesting therapeutic approach. Heparin and low molecular weight heparins were found to prevent the binding of topo and topo/anti-topo immune complexes to the fibroblast surfaces. Moreover, topo/anti-topo immune complexes could be dissociated from fibroblast surfaces by these molecules. Hence, the prevention of topo/anti-topo immune complexes binding to HS chains could result in the absence of the inflammatory cascade initiation. Overall, our results support an active role for topo as a bifunctional autoantigen toward fibroblasts and a pathogenic role for anti-topo autoantibodies in SSc. Finally, a potential therapeutic approach is proposed which could target inflammatory and fibrotic development characteristic of SSc.

La sclérose systémique (ScS) est une maladie auto-immune d’origine inconnue qui est caractérisée par des atteintes vasculaires, des dérèglements cellulaire et immunitaire. La majorité des patients atteints de ScS possède des auto-anticorps dirigés contre des protéines nucléaires. Ces auto-anticorps sont associés à des manifestations cliniques spécifiques favorisant la classification et le diagnostic de la ScS. Les anti-ADN topoisomérase I (antitopo) sont l’un des principaux auto-anticorps retrouvés dans la ScS. Ils sont associés à la forme la plus grave de la maladie, soit la forme diffuse. Celle-ci se caractérise par une importante fibrose progressant vers une atteinte viscérale. La fibrose résulte d’une production excessive et dérégulée de matrice extracellulaire par les fibroblastes. Bien que les anti-topo soient associés à un très mauvais pronostic et qu’ils corrèlent avec l’activité et la sévérité de la maladie, leur rôle dans la pathogenèse de la ScS n’est pas élucidé. Toutefois, depuis que certains auto-antigènes ont démontré des fonctions additionnelles lorsque retrouvés dans le milieu extracellulaire, leur contribution suscite un intérêt marqué. En effet, ces auto-antigènes, dits bifonctionnels, influencent la physiologie de certaines cellules en se liant à leur surface. Ainsi, la détermination du rôle de ces autoantigènes ouvre la voie pour l’exploration du rôle potentiellement pathogène de leurs autoanticorps. Tout d’abord, nous avons démontré que l’auto-antigène topo, ciblée par les antitopo, pouvait influencer la physiologie du fibroblaste suite à l’activation de voies de signalisations intracellulaires stimulant la migration cellulaire. Nos résultats suggèrent fortement que la topo stimule le fibroblaste suite à son interaction avec le CCR7, un récepteur de chimiokine, présent à sa surface. Nous avons également démontré que la topo utilisait les protéoglycans à chaînes d’héparanes sulfates (HSPG) à titre de corécepteurs. Il avait été démontré que la topo liée à la surface des fibroblastes entraînait le recrutement d’anti-topo, l’adhésion et l’activation monocytaires. Nous avons ici démontré que la présence d’anticorps anti-topo entraîne l’amplification de la liaison de la topo au niveau des HSPG. De ce fait, le complexe immun à la surface des fibroblastes pourrait contribuer à l’initiation d’une cascade inflammatoire propice au développement d’une fibrose, caractéristique de la ScS. En dernier lieu, nos résultats nous ont permis de suggérer l’utilisation de l’héparine et des héparines de bas poids moléculaires comme approche thérapeutique pour la ScS puisqu’elles permettent autant de prévenir la liaison du complexe immun topo/anti-topo au niveau des HSPG que de le dissocier une fois lié. En résumé, notre étude soutient d’abord le rôle actif de l’auto-antigène dans la physiologie des fibroblastes mais également le rôle pathogène des anti-topo en présence de la topo dans la ScS. Finalement, les résultats de notre étude permettent de proposer une approche thérapeutique potentielle pour inhiber le développement d’une cascade inflammatoire et pro-fibrotique. / Systemic sclerosis (SSc) is an autoimmune disease of unknown etiology characterized by vascular damage, cellular and immunological disorders. The vast majority of patient sera are characterized by the presence of autoantibodies directed against nuclear proteins. The autoantibodies are associated with specific clinical manifestations and thus useful for diagnostic and classification of the disease. One of the major autoantibody groups are the anti-DNA topoisomerase I (anti-topo). They are associated with the diffuse form of the disease which is characterized by extensive cutaneous and visceral fibrosis. Increased extracellular matrix synthesis and deposition by fibroblast result in the development of fibrosis. Although anti-topo are associated with the worst form of the disease, correlated with the activity and the severity of SSc, their exact role in the pathogenesis of SSc is controversial and still unravelled. On the other hand, there is now strong evidence for active contribution of autoantigens, targeted by autoantibodies, in autoimmune diseases. Indeed, numerous cells have been shown to be influenced by the interaction of autoantigens with their cognate receptors present on their surface. These autoantigens display cytokine-like effects toward their target cell and are called bifunctional autoantigen. Hence, determination of the exact role of these autoantigens and characterization of their interaction with their target cell may open up research perspectives for the elucidation of the potential pathogenic role of their autoantibodies. In our study, we demonstrated that topo activates intracellular signaling pathways leading to the stimulation of fibroblast migration. We undertook experiments to characterize the interaction of the autoantigen topo with fibroblasts responsible of these cellular effects. Our results strongly suggest a direct interaction of topo with CCR7, a chemokine receptor, present on the surface of fibroblasts. Heparan sulfate proteoglycans (HSPG), abundantly present on fibroblast surfaces, were found to act as coreceptors for topo binding. Previous work has demonstrated that once bound to fibroblast surfaces, topo recruits anti-topo autoantibodies, which subsequently lead to adhesion and activation of monocytes. Here, we demonstrated that anti-topo autoantibodies from SSc sera lead to the amplification of topo binding to HSPG on fibroblast surfaces. The binding of topo/anti-topo IC could mediate the initiation and maintenance of an inflammatory cascade and further fibrosis development. Hence, perturbing the binding of topo/anti-topo immune complexes to HSPG became an interesting therapeutic approach. Heparin and low molecular weight heparins were found to prevent the binding of topo and topo/anti-topo immune complexes to the fibroblast surfaces. Moreover, topo/anti-topo immune complexes could be dissociated from fibroblast surfaces by these molecules. Hence, the prevention of topo/anti-topo immune complexes binding to HS chains could result in the absence of the inflammatory cascade initiation. Overall, our results support an active role for topo as a bifunctional autoantigen toward fibroblasts and a pathogenic role for anti-topo autoantibodies in SSc. Finally, a potential therapeutic approach is proposed which could target inflammatory and fibrotic development characteristic of SSc.

The eubacterial genome is maintained in a negatively supercoiled state which facilitates its compaction and storage in a small cellular space. Genome supercoiling can potentially influence various DNA transaction processes such as DNA replication, transcription, recombination, chromosome segregation and gene expression. Alterations in the genome supercoiling have global impact on the gene expression and cell growth. Inside the cell, the genome supercoiling is maintained judiciously by DNA topoisomerases to optimize DNA transaction processes. These enzymes solve the problems associated with the DNA topology by cutting and rejoining the DNA. Due to their essential cellular functions and global regulatory roles, DNA topoisomerases are fascinating candidates for the study of the effect of topology perturbation on a global scale. Genus Mycobacterium includes a large number of species including the well-studied Mycobacterium smegmatis (Msm) as well as various pathogens–Mycobacterium leprae, Mycobacterium abscessus and Mycobacterium tuberculosis (Mtb), the last one being the causative agent of the deadly disease Tuberculosis (TB), which claims millions of lives worldwide annually. The organism combats various stresses and alterations in its environment during the pathogenesis and virulence. During such adaptation, various metabolic pathways and transcriptional networks are reconfigured. Considering their global regulatory role, DNA topoisomerases and genome supercoiling may have an influence on the mycobacterial survival and adaptation. Biochemical studies from our laboratory have revealed several distinctive characteristics of mycobacterial DNA gyrase and topoisomerase I. DNA gyrase has been shown to be a strong decatenase apart from its characteristic supercoiling activity. Similarly, the mycobacterial topoisomerase I exhibits several distinct features such as the ability to bind both single- as well as double-stranded DNA, site specific DNA binding and absence of Zn2+ fingers required for DNA relaxation activity in other Type I enzymes. Although, efforts have been made to understand the biochemistry and mechanism of mycobacterial topoisomerases, in vivo significance and regulatory roles remain to be explored. The present study is aimed at understanding the mechanism, in vivo functions, regulation and genome wide distribution of mycobacterial topoisomerases. Chapter 1 of the thesis provides introduction on DNA topology, genome supercoiling and DNA topoisomerases. The importance of genome supercoiling and its regulatory roles has been discussed. Further, the regulation of topoisomerase activity and the role in the virulence gene regulation is described. Finally, a brief overview of Mtb genome, disease epidemiology, and pathogenesis is presented along with the description of the work on mycobacterial topoisomerases. In Chapter 2, the studies are directed to understand the DNA relaxation mechanism of mycobacterial Type IA topoisomerase which lack Zn2+ fingers. The N-terminal domain (NTD) of the Type IA topoisomerases harbor DNA cleavage and religation activities, but the carboxyl terminal domain (CTD) is highly diverse. Most of these enzymes contain a varied number of Zn2+ finger motifs in the CTD. The Zn2+ finger motifs were found to be essential in Escherichia coli TopoI but dispensable in the Thermotoga maritima enzyme. Although, the CTD of mycobacterial TopoI lacks Zn2+ fingers, it is indispensable for the DNA relaxation activity of the enzyme. The divergent CTD harbors three stretches of basic amino acids needed for the strand passage step of the reaction as demonstrated by a new assay. It is elucidated that the basic amino acids constitute an independent DNA-binding site apart from the NTD and assist the simultaneous binding of two molecules of DNA to the enzyme, as required during the strand passage step of the catalysis. It is hypothesized that the loss of Zn2+ fingers from the mycobacterial TopoI could be associated with Zn2+ export and homeostasis. In Chapter 3, the studies have been carried out to understand the regulation of mycobacterial TopoI. Identification of Transcription Start Site (TSS) suggested the presence of multiple promoters which were found to be sensitive to genome supercoiling. The promoter activity was found to be specific to mycobacteria as the promoter(s) did not show activity in E. coli. Analysis of the putative promoter elements suggested the non-optimal spacing of the putative -35 and -10 promoter elements indicating the involvement of supercoiling for the optimal alignment during the transcription. Moreover, upon genome relaxation, the occupancy of RNA polymerase was decreased on the promoter region of topoI gene implicating the role of DNA topology in the Supercoiling Sensitive Transcription (SST) of TopoI gene from mycobacteria. The involvement of intrinsic promoter elements in such regulation has been proposed. In Chapter 4, the importance of TopoI for the Mtb growth and survival has been validated. Mtb contains only one Type IA topoisomerase (Rv3646c), a sole DNA relaxase in the cell, and hence a candidate drug target. To validate the essentiality of Mtb topoisomerase I for bacterial growth and survival, conditionally regulated strain of topoI in Mtb was generated. The conditional knockdown mutant exhibited delayed growth on agar plate and in liquid culture the growth was drastically impaired when TopoI expression was suppressed. Additionally, novobiocin and isoniazid showed enhanced inhibitory potential against the conditional mutant. Analysis of the nucleoid revealed its altered architecture upon TopoI depletion. These studies establish the essentiality of TopoI for the Mtb growth and open up new avenues for targeting the enzyme. In Chapter 5, the influence of perturbation of TopoI activity on the Msm growth and physiology has been studied. Notably, Msm contains an additional DNA relaxation enzyme– an atypical Type II topoisomerase TopoNM. The TopoI depleted strain exhibited slow growth and drastic change in phenotypic characters. Moreover, the genome architecture was disturbed upon depletion of TopoI. Further, the proteomic and transcript analysis indicated the altered expression of the genes involved in central metabolic pathways and core DNA transaction processes in the mutant. The study suggests the importance of TopoI in the maintenance of cellular phenotype and growth characteristics of fast growing mycobacteria having additional topoisomerases. In Chapter 6, the ChIP-Seq method is used to decipher the genome wide distribution of the DNA gyrase, topoisomerase I (TopoI) and RNA polymerase (RNAP). Analysis of the ChIP-Seq data revealed the genome wide distribution of topoisomerases along with RNAP. Importantly, the signals of topoisomerases and RNAP was found to be co-localized on the genome suggesting their functional association in the twin supercoiled domain model, originally proposed by J. C. Wang. Closer inspection of the occupancy profile of topoisomerases and RNAP on transcription units (TUs) revealed their co-existence validating the topoisomerases occupancy within the twin supercoiled domains. On the genomic scale, the distribution of topoisomerases was found to be more at the ori domains compared to the ter domain which appeared to be an attribute of higher torsional stress at ori. The reappearance of gyrase binding at the ter domain (and the lack of it in the ter domain of E. coli) suggests a role for Mtb gyrase in the decatenation of the daughter chromosomes at the end of replication. The eubacterial genome is maintained in a negatively supercoiled state which facilitates its compaction and storage in a small cellular space. Genome supercoiling can potentially influence various DNA transaction processes such as DNA replication, transcription, recombination, chromosome segregation and gene expression. Alterations in the genome supercoiling have global impact on the gene expression and cell growth. Inside the cell, the genome supercoiling is maintained judiciously by DNA topoisomerases to optimize DNA transaction processes. These enzymes solve the problems associated with the DNA topology by cutting and rejoining the DNA. Due to their essential cellular functions and global regulatory roles, DNA topoisomerases are fascinating candidates for the study of the effect of topology perturbation on a global scale. Genus Mycobacterium includes a large number of species including the well-studied Mycobacterium smegmatis (Msm) as well as various pathogens–Mycobacterium leprae, Mycobacterium abscessus and Mycobacterium tuberculosis (Mtb), the last one being the causative agent of the deadly disease Tuberculosis (TB), which claims millions of lives worldwide annually. The organism combats various stresses and alterations in its environment during the pathogenesis and virulence. During such adaptation, various metabolic pathways and transcriptional networks are reconfigured. Considering their global regulatory role, DNA topoisomerases and genome supercoiling may have an influence on the mycobacterial survival and adaptation. Biochemical studies from our laboratory have revealed several distinctive characteristics of mycobacterial DNA gyrase and topoisomerase I. DNA gyrase has been shown to be a strong decatenase apart from its characteristic supercoiling activity. Similarly, the mycobacterial topoisomerase I exhibits several distinct features such as the ability to bind both single- as well as double-stranded DNA, site specific DNA binding and absence of Zn2+ fingers required for DNA relaxation activity in other Type I enzymes. Although, efforts have been made to understand the biochemistry and mechanism of mycobacterial topoisomerases, in vivo significance and regulatory roles remain to be explored. The present study is aimed at understanding the mechanism, in vivo functions, regulation and genome wide distribution of mycobacterial topoisomerases. Chapter 1 of the thesis provides introduction on DNA topology, genome supercoiling and DNA topoisomerases. The importance of genome supercoiling and its regulatory roles has been discussed. Further, the regulation of topoisomerase activity and the role in the virulence gene regulation is described. Finally, a brief overview of Mtb genome, disease epidemiology, and pathogenesis is presented along with the description of the work on mycobacterial topoisomerases. In Chapter 2, the studies are directed to understand the DNA relaxation mechanism of mycobacterial Type IA topoisomerase which lack Zn2+ fingers. The N-terminal domain (NTD) of the Type IA topoisomerases harbor DNA cleavage and religation activities, but the carboxyl terminal domain (CTD) is highly diverse. Most of these enzymes contain a varied number of Zn2+ finger motifs in the CTD. The Zn2+ finger motifs were found to be essential in Escherichia coli TopoI but dispensable in the Thermotoga maritima enzyme. Although, the CTD of mycobacterial TopoI lacks Zn2+ fingers, it is indispensable for the DNA relaxation activity of the enzyme. The divergent CTD harbors three stretches of basic amino acids needed for the strand passage step of the reaction as demonstrated by a new assay. It is elucidated that the basic amino acids constitute an independent DNA-binding site apart from the NTD and assist the simultaneous binding of two molecules of DNA to the enzyme, as required during the strand passage step of the catalysis. It is hypothesized that the loss of Zn2+ fingers from the mycobacterial TopoI could be associated with Zn2+ export and homeostasis. In Chapter 3, the studies have been carried out to understand the regulation of mycobacterial TopoI. Identification of Transcription Start Site (TSS) suggested the presence of multiple promoters which were found to be sensitive to genome supercoiling. The promoter activity was found to be specific to mycobacteria as the promoter(s) did not show activity in E. coli. Analysis of the putative promoter elements suggested the non-optimal spacing of the putative -35 and -10 promoter elements indicating the involvement of supercoiling for the optimal alignment during the transcription. Moreover, upon genome relaxation, the occupancy of RNA polymerase was decreased on the promoter region of topoI gene implicating the role of DNA topology in the Supercoiling Sensitive Transcription (SST) of TopoI gene from mycobacteria. The involvement of intrinsic promoter elements in such regulation has been proposed. In Chapter 4, the importance of TopoI for the Mtb growth and survival has been validated. Mtb contains only one Type IA topoisomerase (Rv3646c), a sole DNA relaxase in the cell, and hence a candidate drug target. To validate the essentiality of Mtb topoisomerase I for bacterial growth and survival, conditionally regulated strain of topoI in Mtb was generated. The conditional knockdown mutant exhibited delayed growth on agar plate and in liquid culture the growth was drastically impaired when TopoI expression was suppressed. Additionally, novobiocin and isoniazid showed enhanced inhibitory potential against the conditional mutant. Analysis of the nucleoid revealed its altered architecture upon TopoI depletion. These studies establish the essentiality of TopoI for the Mtb growth and open up new avenues for targeting the enzyme. In Chapter 5, the influence of perturbation of TopoI activity on the Msm growth and physiology has been studied. Notably, Msm contains an additional DNA relaxation enzyme– an atypical Type II topoisomerase TopoNM. The TopoI depleted strain exhibited slow growth and drastic change in phenotypic characters. Moreover, the genome architecture was disturbed upon depletion of TopoI. Further, the proteomic and transcript analysis indicated the altered expression of the genes involved in central metabolic pathways and core DNA transaction processes in the mutant. The study suggests the importance of TopoI in the maintenance of cellular phenotype and growth characteristics of fast growing mycobacteria having additional topoisomerases. In Chapter 6, the ChIP-Seq method is used to decipher the genome wide distribution of the DNA gyrase, topoisomerase I (TopoI) and RNA polymerase (RNAP). Analysis of the ChIP-Seq data revealed the genome wide distribution of topoisomerases along with RNAP. Importantly, the signals of topoisomerases and RNAP was found to be co-localized on the genome suggesting their functional association in the twin supercoiled domain model, originally proposed by J. C. Wang. Closer inspection of the occupancy profile of topoisomerases and RNAP on transcription units (TUs) revealed their co-existence validating the topoisomerases occupancy within the twin supercoiled domains. On the genomic scale, the distribution of topoisomerases was found to be more at the ori domains compared to the ter domain which appeared to be an attribute of higher torsional stress at ori. The reappearance of gyrase binding at the ter domain (and the lack of it in the ter domain of E. coli) suggests a role for Mtb gyrase in the decatenation of the daughter chromosomes at the end of replication.

Le stress oxydant joue un rôle majeur dans le déclenchement et le développement de la sclérodermie systémique (ScS). Nous avons mis au point un modèle murin où la maladie est déclenchée par divers types de stress oxydant, puis nous avons exploré les différentes voies d'activation des fibroblastes sous l'effet des formes réactives de l'oxygène, afin de déterminer d'éventuelles cibles thérapeutiques. Pour apprécier les effets d’un stress oxydant chronique, des solutions contenant différents oxydants ont été injectées dans la peau de souris BALB/c et BALB/c SCID. Les solutions contenant le radical hydroxyl OH° ou HOCl ont induit une maladie caractérisée, comme la ScS diffuse, par une fibrose cutanée et viscérale, et des auto-anticorps anti-ADN topoisomérase-1. Les sérums de ces souris contenaient de grandes quantités de dérivés oxydés des protéines et induisaient la prolifération des fibroblastes et la production de formes réactives de l’oxygène par les cellules endothéliales. Une fibrose pulmonaire de moindre importance était induite chez les souris BALB/c SCID. Grâce à ce nouveau modèle murin de SSc, nous avons démontré que le stress oxydant était directement responsable des anomalies observées dans les fibroblastes, les cellules endothéliales et le système immunitaire. Nous avons ensuite utilisé ce modèle pour analyser les voies d’activation fibroblastique dans la ScS. Dans les fibroblastes des souris exposées à HOCl, on observe une dérégulation des voies des récepteurs Notch, des récepteurs aux cannabinoïdes, et des récepteurs au PDGF. On observe les mêmes dérégulations ex vivo dans les fibroblastes de patients atteints de SSc diffuse. Nous avons ainsi observé une amélioration clinique significative chez les souris sclérodermiques traitées avec un inhibiteur de l’activation de Notch, avec un agoniste des récepteurs aux cannabinoïdes, et avec des inhibiteurs de tyrosine-kinase ciblant le récepteur au PDGF. Puisque les fibroblastes sclérodermiques ont un phénotype activé et produisent de forts taux de formes réactives de l’oxygène, nous avons enfin mis à profit cette particularité pour induire l’apoptose sélective de ces cellules dans le derme des souris. Le trioxyde d’arsenic, molécule cytotoxique utilisée en thérapeutique humaine, augmente la production cellulaire de formes réactives de l’oxygène au-delà d’un seuil létal et induit ainsi l’apoptose des fibroblastes sclérodermiques. L’utilisation in vivo de cette molécule dans notre modèle murin prévient la fibrose cutanée et viscérale, et les anomalies endothéliales. Le trioxyde d’arsenic a un effet comparable dans le modèle murin de ScS associée à la réaction du greffon contre l’hôte en détruisant les lymphocytes T CD4+ alloréactifs activés et les cellules dendritiques plasmacytoïdes responsables de l’activation du système immunitaire. Les formes réactives de l’oxygène sont donc impliquées dans l’induction des lésions observées au cours de la ScS. Dans notre modèle, le rôle du système immunitaire intervient dans l'auto-entretien et l’extension systémique de la maladie. Le stress oxydant contribue à la dérégulation de diverses voies de signalisation dont les voies des récepteurs Notch, des récepteurs aux cannabinoïdes et du PDGF dans les fibroblastes. La modulation de ces voies permet d’obtenir une amélioration clinique chez les souris sclérodermiques, tout comme l’utilisation du trioxyde d’arsenic qui entraîne la délétion spécifique des fibroblastes sclérodermiques surpoduisant des formes réactives de l’oxygène. Le trioxyde d’arsenic montre également une efficacité intéressante dans le modèle de sclérodermie associée à la maladie du greffon contre l’hôte via la délétion des lymphocytes T CD4+ alloréactifs. / We defend the thesis that the oxidative stress plays a major role in the initiation and the development of systemic sclerosis. To demonstrate this thesis, we designed an original mouse model: BALB/c and BALB/SCID mice were injected intra-dermally with prooxidative agents, bleomycin or PBS for 6 weeks. Hypochlorite and hydroxyl radicals induced cutaneous and lung fibrosis in BALB/c mice, in association with anti-DNA topoisomerase-1 auto-antibodies that characterize human diffuse systemic sclerosis. Pulmonary fibrosis was less extensive in BALB/c SCID mice submitted to the same protocol. In this model of HOCl-induced systemic sclerosis, cutaneous fibroblasts display a hyperactivated phenotype that prompted us to investigate several pathways of cellular activation. The NOTCH pathway and the PGDF-receptor pathways were found upregulated in the skin of HOCl-mice. DAPT (a gamma secretase inhibitor that prevents NOTCH cleavage), Sunitinib (an inhibitor of PGDF-receptor phosphorylation), and WIN-55,212, an agonist of the cannabinoid receptors 1 and 2, dramatically improved the clinical, histological and biological signs of systemic sclerosis in the HOCl model.In our model as in patients with SSc, activated fibroblasts produce reactive oxygen species that exert an autocrine effect on their own proliferation and collagen synthesis. By analogy with tumor cells that undergo apoptosis upon cytotoxic treatment that triggers an oxidative stress beyond a lethal threshold, we showed that activated fibroblasts can be selectively killed by the cytotoxic molecule arsenic trioxide (As2O3) that generates intracellular ROS. In the mouse model of sclerodermatous-graft versus host disease (Scl-GVHD), daily intra-peritoneal injections of As2O3 abrogated the clinical symptoms (diarrhea, alopecia, vasculitis, fibrosis of the skin and visceral organs) and specifically induced the apoptosis of activated CD4+ T cells and plasmacytoid dendritic cells. Those data provide a rationale for the evaluation of As2O3 in the management of patients affected by systemic sclerosis or chronic GVHD.