Empregando a técnica de biologia molecular Checkerboard DNA-DNA Hybridization e o teste Limulus Amebocyte Lysate, os objetivos do presente estudo clínico randomizado in vivo foram avaliar, em bráquetes ortodônticos metálicos: 1) A presença de 16 espécies de microrganismos periodontopatogênicos Gram-negativos pertencentes aos complexos laranja e vermelho, por meio de sondas de DNA; 2) A quantidade de endotoxina bacteriana presente; e 3) A eficácia da utilização do gluconato de clorexidina a 0,12%, sob a forma de bochechos, na redução da contaminação pelas 16 espécies de microrganismos periodontopatogênicos Gram-negativos e na redução da quantidade de endotoxina bacteriana. Participaram do estudo 33 pacientes de 11 a 33 anos de idade, em tratamento com aparelho ortodôntico fixo, nos quais foram colocados randomicamente 3 bráquetes metálicos novos nos pré-molares. Os pacientes do Grupo Controle (n=17) fizeram 2 bochechos semanais com solução placebo, durante 30 dias. Os pacientes do Grupo Experimental (n=16) fizeram bochechos com solução à base de gluconato de clorexidina a 0,12% (Periogard®), da mesma forma que o grupo Controle. Decorridos 30 dias, os 3 bráquetes foram removidos de cada paciente e processados para a detecção dos microrganismos, pela técnica Checkerboard DNA-DNA Hybridization, e para a quantificação da endotoxina bacteriana por meio do teste Limulus Amebocyte Lysate. Os resultados obtidos foram analisados por meio dos testes não-paramétricos de Kruskal-Wallis, Mann-Whitney e pós-teste de Dunn, utilizando os softwares SAS e Graphpad Prism. O nível de significância adotado foi de 5%. De acordo com os resultados obtidos, observou-se que todos os bráquetes dos pacientes do Grupo Controle encontravam-se densamente contaminados pelos microrganismos avaliados. Nesse grupo, as espécies bacterianas do complexo laranja apresentaram-se em maiores quantidades, em relação às espécies do complexo vermelho (p<0,01). A mediana da quantidade de endotoxina para este grupo foi de 0,6673 EU/ml. Quando comparado ao grupo Controle, observou-se que o número total de microrganismos no grupo Experimental foi estatisticamente menor, com mediana de 29.150.000 no grupo Controle e de 13.130.000 no grupo Experimental (p=0,01). Quando os microrganismos foram avaliados por complexos, foi observada diferença estatisticamente significante entre os grupos Controle e Experimental para o complexo laranja (p=0,04), com contagens menores de bactérias após os bochechos com clorexidina. Por outro lado, observou-se que a quantidade de endotoxina no grupo Experimental foi maior, com mediana de 1,2199 EU/ml (p=0,02). Concluiu-se que os bochechos com solução de gluconato de clorexidina a 0,12% podem ser úteis, na prática clínica, com a finalidade de reduzir os níveis de microrganismos periodontopatogênicos Gram-negativos, em pacientes portadores de aparelhos ortodônticos fixos. No entanto, em função do aumento da quantidade de endotoxina bacteriana após o uso dos bochechos com clorexidina, estudos adicionais são necessários com a finalidade de desenvolver procedimentos clínicos ou agentes antimicrobianos que tenham ação sobre a endotoxina presente nos bráquetes metálicos. / Using the biomolecular technique Checkerboard DNA-DNA Hybridization and the Limulus Amebocyte Lysate (LAL) assay, the purposes of the present randomized clinical study were to evaluate in orthodontic metallic brackets: 1) The presence of 16 Gram-negative periodontopathogenic microbial species of the orange and red complexes by using DNA probes; 2) The amount of bacterial endotoxin; and 3) The efficacy of 0.12% chlorhexidine gluconate mouthwashes in reducing the contamination by the evaluated microbial species and the amount of bacterial endotoxin. Thirty-three 11-33-year-old patients undergoing orthodontic treatment with fixed appliances were enrolled in the study and all subjects had 3 new metallic brackets bonded to different premolars in a randomized manner. The patients in the Control group (n=17) were instructed to use a placebo mouthwash twice a week, while those in the Experimental group (n=16) were instructed to use a 0.12% chlorhexidine gluconate mouthwash (Periogard®) in the same way. After 30 days, the 3 brackets were removed from each patient and processed for detection of the microorganisms by the Checkerboard DNADNA hybridization technique, and for quantification of bacterial endotoxin by the LAL assay. The data were analyzed statistically by the non-parametric Mann-Whitney, Kruskal-Wallis and Dunn\'s post tests using SAS and GraphPad Prism softwares. A significance level of 5% was set for all analyses. The brackets of the patients in the Control group were densely contaminated by the evaluated microbial species. In this group, the number of bacterial species of the orange complex was larger compared to the number of bacterial species of the red complex (p<0.01). The median of the amount of bacterial endotoxin for this group was 0.6673 EU/ml. The Experimental group had a significantly smaller number of microorganisms than the Control group (median 13,130,000 versus 29,150,000; p=0.01). When the microorganisms were analyzed by complex, there was statistically significant difference between the Control and Experimental groups for the orange complex (p=0.04) with smaller counts of bacteria after use of chlorhexidine oral rinses. On the other hand, there was a greater amount of bacterial endotoxin in the Experimental (median of 1,2199 EU/ml; p=0.02). In conclusion, 0.12% chlorhexidine oral rinse can be useful in the clinical practice to reduce the levels of Gram-negative periodontopathogenic microorganisms in patients with fixed orthodontic appliances. Considering the increase in the amount of bacterial endotoxin after use of chlorhexidine oral rinses, further research is necessary to develop clinical procedures or antimicrobial agents with action against the endotoxin in the metallic brackets

<p>Patients with peritonitis or malignant obstructive jaundice (HPB⁺) have an increased morbidity and mortality due to sepsis. An altered cell-mediated immunity in the intestinal mucosa might promote gut barrier failure, increased endotoxin and cytokine release and bacterial translocation (BT) in these conditions. A clinically relevant rat model of polymicrobial peritonitis induced sepsis by cecal ligation and puncture (CLP) was used. Septic animals demonstrated a superficial injury in the small intestinal mucosa, and a significant reduction in T lymphocytes in the villi, as well as increased number of macrophages in the villi and in the MLNs as compared to sham. CLP caused increased concentration of TNF-α and IL-6 in ascitic fluid. CLP + the immunomodulator Linomide decreased the TNF-α level, reduced mucosal damage and attenuated the changes in T lymphocytes and macrophages observed following CLP. CLP + selective cyclooxygenase (COX)-2 inhibitor (SC-236) or nonselective COX inhibitor (indometacin) decreased the amount of macrophages in the mucosa and the MLNs compared to untreated CLP. CLP + indometacin decreased T lymphocytes in the villi and MLNs. SC-236 + CLP reduced mucosal injury and cytokine release as compared to indometacin. An increased rate of apoptosis in both the mucosa and MLNs was seen following CLP; COX inhibitors enhanced this phenomenon in the MLNs.</p><p>BT occurred infrequently in patients with acute peritonitis and in HPB⁺ there was no evidence of BT. Peritonitis and HPB⁺causes significant inflammatory cellular reactions as increased endotoxin and cytokine plasma levels and an altered immune cell distribution in MLNs, in HPB⁺a high rate of apoptosis in MLNs was observed. </p><p>An altered pattern of immunocompetent cells within the mucosa and in MLNs was found in experimental and clinical peritonitis as in HPB⁺.Lymphocyte depletion may be a result of increased apoptosis, which could reduce the ability of septic or jaundice patients to eradicate infection.</p>

Patients with peritonitis or malignant obstructive jaundice (HPB+) have an increased morbidity and mortality due to sepsis. An altered cell-mediated immunity in the intestinal mucosa might promote gut barrier failure, increased endotoxin and cytokine release and bacterial translocation (BT) in these conditions. A clinically relevant rat model of polymicrobial peritonitis induced sepsis by cecal ligation and puncture (CLP) was used. Septic animals demonstrated a superficial injury in the small intestinal mucosa, and a significant reduction in T lymphocytes in the villi, as well as increased number of macrophages in the villi and in the MLNs as compared to sham. CLP caused increased concentration of TNF-α and IL-6 in ascitic fluid. CLP + the immunomodulator Linomide decreased the TNF-α level, reduced mucosal damage and attenuated the changes in T lymphocytes and macrophages observed following CLP. CLP + selective cyclooxygenase (COX)-2 inhibitor (SC-236) or nonselective COX inhibitor (indometacin) decreased the amount of macrophages in the mucosa and the MLNs compared to untreated CLP. CLP + indometacin decreased T lymphocytes in the villi and MLNs. SC-236 + CLP reduced mucosal injury and cytokine release as compared to indometacin. An increased rate of apoptosis in both the mucosa and MLNs was seen following CLP; COX inhibitors enhanced this phenomenon in the MLNs. BT occurred infrequently in patients with acute peritonitis and in HPB+ there was no evidence of BT. Peritonitis and HPB+ causes significant inflammatory cellular reactions as increased endotoxin and cytokine plasma levels and an altered immune cell distribution in MLNs, in HPB+ a high rate of apoptosis in MLNs was observed. An altered pattern of immunocompetent cells within the mucosa and in MLNs was found in experimental and clinical peritonitis as in HPB+. Lymphocyte depletion may be a result of increased apoptosis, which could reduce the ability of septic or jaundice patients to eradicate infection.

Endotoxin or Lipopolysaccharide (LPS) is the invariant structural component of gram negative bacterial outer membranes and is the chief causative factor of Sepsis or endotoxic shock. Sepsis is a syndrome that has very high mortality rates even in this age of excellent therapeutics and critical patient care. The treatment for sepsis till date remains nonspecific and supportive due to lack of effective anti-endotoxic drugs. Sepsis is initiated when the circulating bacteria shed LPS from their cell envelopes. Shed LPS aggregates are recognized by LPS binding proteins and receptors, which activate the host's immune system. Uncontrolled and excessive stimulation of the host's immune system precipitates endotoxic shock which in advanced cases involving multiple system organ failure inevitably lead to patient's death. Many strategies have been tested out to combat this deadly affliction. One of the attractive clinical modalities in sepsis treatment is the use of peptides as LPS sequestering anti-endotoxic drugs. A classical peptide antibiotic of this class is Polymyxin B (PMB) a cyclic cationic acylated molecule, that recognizes LPS with a very high affinity. This thesis describes kinetics and thermodynamics of PMB-LPS interactions and applies these parameters over a framework of different models so as to gain insights into the structure-function relationships that govern the interactions of this peptide with endotoxin(s). Classical biophysical techniques like fluorescence, circular dichroism spectroscopy, stopped flow kinetics, titration calorirnetry (ITC) and the relatively new technique of Surface Plasmon Resonance (SPR) have been employed to dissect out the mechanism of the range of non-covalent forces that are involved in peptide-endotoxin recognition. Certain proteins that exhibit LPS binding activity have also been studied to gains insight about their mode of action. Implications of these studies for designing peptides that have better anti-endotoxic properties are also highlighted. The first chapter introduces and highlights the clinical features of sepsis. It also attempts to shed light on the LPS mediated signal transduction pathway that leads to endotoxic shock. This chapter also briefly explains the roles of many LPS receptors that are present in the human system and their specific roles in the signal transduction pathways. The second part of this chapter deals with the role of cationic peptides as anti-endotoxic drugs. Certain key functional aspects of these peptides, which impart in them, the desirable property of LPS recognition have also been discussed The second chapter describes the kinetic studies undertaken to unravel the exact mechanism of LPS-PMB interaction. The studies reveal that PMB recognizes LPS in a biphasic manner, with the second, unimolecular isomerization step of the reaction being the rate-limiting step. The initial reaction is shown to be influenced by the presence of salt in the reaction medium. The dissociation phase of this interaction also shows a biphasic pattern. These data allow us to speculate upon the exact mechanism by which PMB is able to recognize LPS. The studies also shed light on some structural aspects that govern and confer such high LPS binding activity to PMB. Based on these a model has been proposed to explain this recognition (C.J. Thomas et al, 1998). The second chapter discuses the mode of action of various PMB analogs. These analogs have been chosen in terms of their mode of action as well as their structural similarly to PMB. The affinities of these analogs to LPS and lipid A were quantified using the Surface plasmon resonance (SPR) method. SPR, a technique that relies on the quantification of change in mass during a binary binding process occurring between an immobilized entity and a flowing ligand, is a rapid and sensitive method to measure biologically relevant interactions. SPR studies provide us with the binding constants and thermodynamic parameters that allow evaluation of the affinities of these peptides towards LPS (C.J.Thomas and A.Surolia, 1999). The third chapter discusses a hitherto unknown mode by which PMB acts on a LPS lamellae. The results of this study wherein the binding affinities of PMB and its analogs were performed on monolayers and tethered liposomes, show that PMB is able to remove specifically LPS or lipid A from monolayers or bilayer assemblies such as tethered liposomes. The exact mode of action of PMB is deciphered in the light of these new studies, which allow us to posit on the observed efficacy of PMB in neutralizing the endotoxin as compared to peptides with nearly similar affinities for LPS (C.J Thomas et al 1999). In the fourth chapter a series of 23 residue peptides, based on the sequence corresponding to the anti-sense strand of magainin gene have been synthesized. Magainin an amphiphilic helical peptide obtained from frog skins plays a vital role in the innate immune defense mechanisms of these organisms. It also exhibits LPS binding activity that makes it an attractive target as an anti-endotoxic drug. Biochemical and biophysical characterization of these peptides reveal that they have the tendency to perturb both the inner and the outer membranes of E.coli. The peptides are amphiphilic and have helical structure in a membrane bound environment. Three of the peptides tested have high affinities for lipid A that approach the values shown by PMB. The kinetic parameters obtained by stopped flow and SPR studies in conjunction with the therrnodynamic parameters obtained using ITC studies allow us to highlight the key structural features that need to be exhibited by peptides that are designed to be LPS recognizers. The studies also project the fact that ionic forces play an important role in the initial recognition of LPS by these peptides. Fortification of the might of these ionic charges increases affinity for LPS where as the hydrophobic residues that interact at the next phase of binding are more amenable to disruptions in contiguity. These factors are discussed using the helical wheel diagram that shows the clear amphiphilicity displayed by these peptides. (C.J Thomas et al Manuscript under preparation, 2000) Chapter six discusses the mode of action of certain LPS binding proteins. Limulus anti endotoxic factor (LALF) plays a vital role in the innate immune based defense systems of the horseshoe crab. Galectin-3 is a metal ion independent, galactosc binding Icctin of human origin with unknown functions. Both these phylogcntically-unrclatcd proteins exhibit LPS/lipid A recognizing properties. ITC and SPR studies have been used to determine the binding constants displayed by these proteins for lipid A. LALF bind to lipid A with very high affinity than compared to Galectin-3 and is also able to take away selectively lipid A from both monolayers and tethered liposomes. Galectin-3 does not show this property of LALF, which might account for its lowered affinities. Also structurally LALF has amphiphilic nature that confers high lipid A binding activity, which is clearly lacking in Galectin-3. These studies in conjunction with the knowledge gained from the study of LPS-PMB interaction stress on the importance of amphiphilicity in LPS recognition. (C.J Thomas et al Manuscript under preparation, 2000). The final chapter is a general discussion that attempts to collate all these kinetic and thermodynamic observations in the pursuit of designing small easily manipulatable peptides that exhibit high LPS binding activity. These studies are aimed to act as rough guidelines to the design of LPS sequestering peptides that might have better therapeutic and pharmacokinetic properties. The appendix to the main body of work presented in thesis are two pieces of work pertaining to the elucidation the kinetics and mechanism of sugar lectin interactions, when sugars are presented as glycolipids in monolayers or bilaycrs liposomes. Mode of the presentation of sugars at cell-surfaces in the form of glycolipids as ligands influence their recognition by macromolecular receptors like lectins. Appendix 1 is a study of the mode of action of Ulex europeus I lectin binding to H-fucolipid containing tethered liposomes, by SPR. Fucosylated sugars are often used as key markers in histochemical analysis of malignant cancerous tissues. Ulex lectin plays a vital role as a marker for identification of these tissues. The kinetics and thermodynamic parameters that are obtained in this study throw some light on the mode of recognition of glycolipid receptor by Ulex europeus I lectin (C.J Thomas and A. Surolia 2000). Appendix 2 is a study, that attempts to quantify the initial kinetic parameters that correlate the recognition of glycolipid receptors with their inclination at the membrane surface and the influence of charge on them by soyabean agglutinin (SBA), Abrus agglutinin I and II. Studies on the soyabean agglutinin-globoside interaction highlights the divalent cation mediated reorientation of these receptors on their accessibility and recognition to the agglutinin. The divalent cations are speculated to orient the oligosaccharide head groups in a spatial geometry that allows a heightened kinetics of their interaction by SBA. These studies reveal that the reorganization of the binding pocket of a lectin can also have a profound influence on ihc rates of recognition of a glycospingolipid ligand by a lectin as exemplified by Abrus agglutinin II- GM1 interactions (C.J Thomas ct al, Manuscript under preparation).

Early administration of broad-spectrum antibiotics is the first goal in sepsis treatment. Besides from bacteriostatic/bactericidal effects, some antibiotics may also modify the host´s response to infection. The novel antibiotic tigecycline may exert such properties; however, this property has not been evaluated in large-animal trials. We compared tigecycline with doxycycline and placebo in relation to anti-inflammatory, circulatory and organ dysfunction effects in a sterile pig model of sepsis. Doxycycline, but not tigecycline, reduced the inflammatory response as manifested by tumor necrosis factor alpha levels in plasma. Tigecycline, however, had a stabilizing effect on the circulation not exerted by doxycycline or placebo. To achieve rapid restoration of the circulating blood volume - another major goal in sepsis treatment - fluid bolus administration of is some-times practiced. In addition to crystalloids, albumin-containing solutions are suggested. Yet, some animal-experimental data suggests that rapid bolus administration of albumin reduces albumin’s plasma-expanding effect. We compared a rapid intravenous bolus of radiolabeled albumin with a slow infusion in a sterile pig model of sepsis. Rapid bolus of administration did not reduce plasma levels of albumin following administration and did not increase the amount of albumin that left the circulation. Inadequate oxygen delivery (DO2) by the circulation to the tissues may cause increased plasma lactate, which is the most striking effect of sepsis on the metabolism. However, experimental data and clinical trials refute this link, instead, suggesting other mechanisms, including impaired oxygen extraction, mitochondrial dysfunction and accelerated aerobic glycolysis. We investigated the impact of DO2, oxygen consumption (VO2), hemodynamic parameters and inflammatory response on plasma lactate and organ dysfunction in two experimental sepsis models. In the most severe cases of shock, with DO2, there was an increase in plasma lactate, but without a decrease in VO2, invalidating the assumption that the increase in lactate is due to anaerobic metabolism. To identify critical steps in the sepsis-induced increase in lactate, we inhibited the major energy-producing step in the electron transport chain (ETC). The combination of sepsis and ETC inhibition led to a cellular energy crisis. This finding suggests that early sepsis induces a partial mitochondrial dysfunction.

Le choc septique reste une pathologie grave, associée à des taux de mortalité et d'infections nosocomiales (IN) secondaires élevés. La prédiction du pronostic est de la plus haute importance pour sélectionner les patients qui pourraient bénéficier de traitements visant à moduler la réponse immunitaire. Le système immunitaire, classiquement active par des agents externes, peut également être activé par des médiateurs endogènes exprimés à la suite d'une agression d'origine septique ou non. Les protéines S100 font partie de ces signaux de danger endogènes (ou alarmines). Le but de ce travail est d'évaluer la capacité de l'ARNm de S100A9 mesuré dans le sang total de patients en choc septique à prédire la survie et la survenue d'IN. Nous avons également étudié la régulation de l'expression des ARN messagers de S100A8 et S100A9 dans un modèle ex vivo de tolérance à l'endotoxine qui reproduit partiellement les dysfonctions de l'immunité innée induites par le sepsis. L'ARNm de S100A9 est surexprimé dans le sang des patients en choc septique. Un taux élevé entre le 7eme et le 10eme jour du début du choc septique est associé à la survenue d'IN secondaires. Ex vivo, l'expression des ARNm de S100A8 et S100A9 est augmentée durant le phénomène de tolérance à l'endotoxine. Le blocage de l IL-10 et l'administration d'IFN-γ réduisent l'augmentation de ces ARNm dans ce modèle. Apres confirmation dans des études cliniques, ces résultats préliminaires suggèrent que l'expression des ARNm de S100A8 et S100A9 puisse être utilisée comme marqueur du phénomène de tolérance à l'endotoxine et comme outils pour évaluer la dysfonction immunitaire des patients en choc septique. Ces patients pourraient alors bénéficier de thérapies visant à restaurer leurs fonctions immunitaires / Septic shock remains a serious disease with high mortality and increased risk of hospital-acquired infection. The prediction of outcome is of the utmost importance for selecting patients for therapeutic strategies aiming to modify the immune response. Immune system, typically activated by external agents, can also be activated by endogenous mediators induced by various types of stress (trauma, infection, burns). S100 proteins are part of the alarmins family. The aim of this study was to assess the capability of S100A9 messenger RNA in whole blood from patients with septic shock to predict survival and the occurrence of hospital-acquired infection. We also investigate the regulation of S100A8 and S100A9 mRNA expressions in an ex vivo model of endotoxin tolerance which partially reproduces sepsis-induced innate immune alterations. S100A9 messenger RNA is increased in septic shock and its delayed overexpression is associated with the occurrence of secondary hospital-acquired infection. Ex vivo, S100A8 and S100A9 mRNA expressions are increased during endotoxin tolerance. IL-10 blockade and rIFN-γ treatment partially abrogated S100A8/A9 mRNA increases in this model. Pending confirmation in larger, independent clinical studies, these preliminary results suggest that S100A8 and S100A9 mRNA levels might be used as surrogate markers of endotoxin tolerance and as evaluation tools for immune dysfunctions in septic shock patients. These patients could be selected for therapeutic aiming to restore immune functions

Patienten mit chronischem Nierenversagen leiden sowohl klinisch als auch subklinisch unter Entzündungsepisoden. Um einen Frühindikator der Mikroinflammation zu finden, wurde die Expression funktioneller monozytärer Oberflächenantigene (HLA-DR, CD14, CD16, TLR2 (extra-, intrazellulär), TLR4 (extra-, intrazellulär), CD80, CD86), das Zytokinexpressionsprofil (IL1, IL6, IL10, TNFa, TGFb) und der ultrastruktrurelle Phänotyp des Monozyten in vivo bzw. in vitro untersucht. Dabei wurde strikt zwischen der Membranproteinexpression auf antiinflammatorischen (CD14++CD16-), proinflammatorischen (CD14++CD16+, CD14dimCD16+) und CD14+ bzw. CD16+ Monozyten unterschieden und parallel die Serumspiegel von Parathormon (PTH), C-reaktivem Protein (CRP), Calcium und Phosphor untersucht. Inwieweit monozytäre Aktivierungsmarker zum immunologischen Monitoring geeignet sind, sollte vergleichend zwischen Gesunden, Hämodialyse-(HD)- und Peritonealdialyse-(CAPD)-Patienten untersucht werden. Zusätzlich wurde die Expression in einem in-vitro-Zellkulturmodell vergleichend betrachtet. Der Serum-PTH-Spiegel fiel nach Injektion des Vitamin D-Derivates Paricalcitol, der Serumcalciumspiegel stieg signifikant innerhalb des oberen Referenzbereiches bei Patienten mit sekundärem Hyperparathyroidismus drei Wochen nach Beginn der Therapie. Die HLA-DR, extrazelluläre TLR2, intrazelluläre TLR4, CD80, CD86 Expression fiel nach Paricalcitolinjektion. Paricalcitol erhöhte die Anzahl antiinflammatorischer und erniedrigte die Anzahl proinflammatorischer Monozyten. Beim ultrastrukturellen Vergleich zeigte sich eine deutliche Häufung von elektronendichten Granula bei Paricalcitol-inkubierten Zellen im in-vitro-Versuch. Hierbei handelt es sich mit an Sicherheit grenzender Wahrscheinlichkeit um Lysosomen, was die These einer erhöhten phagolysosomalen monozytären Aktivität unter Paricalcitol-Inkubation stützt. Sowohl bei 48- als auch bei 72-stündiger Inkubation in Primärzellkultur wirkte Paricalcitol antiinflammatorisch, indem es Aktivierungsmarker des Monozyten (HLA-DR, TLR2 (extrazellulär), TLR4 (extrazellulär)), die Anzahl proinflammatorischer Monozyten und die Synthese proinflammatorischer Zytokine (IL1, IL6, TNFa) supprimierte. Dialysepatienten unterliegen einem erhöhten Eintrag von Endotoxin (=LPS) über die Dialysemembran, das in der Regel durch Bindung an den LPS-Rezeptor (=CD14) detoxifiziert wird. Dieser wird nicht nur nach LPS Inkubation, sondern v.a. nach Paricalcitol Inkubation vermehrt exprimiert. LPS erhöhte die Anzahl der proinflammatorischen Monozyten in Zellkultur und reflektierte damit den steady state des HD-Patienten. Aktivierungsmarker von Monozyten unterschieden sich zudem bei vergleichender Betrachtung zwischen CAPD-, HD-Patienten und Gesunden und außerdem im Vergleich vor und nach HD. Die intrazelluläre TLR2 und TLR4 Expression von CAPD-Patienten und HD-Patienten war gegenüber Gesunden erniedrigt, während die CD14 Expression signifikant erhöht war. HD-Patienten zeigten einen erhöhten Anteil proinflammatorischer Monozyten vergleichend zu Gesunden aber auch zu Patienten unter CAPD-Substitutionstherapie. Unmittelbar nach HD fielen die proinflammatorischen Monozyten, während v.a. die Expression von extrazellulärem TLR2, intrazellulärem TLR2 und intrazellulärem TLR4 stieg. Somit unterliegt der HD-Patient einer stärkeren Mikroinflammation als der CAPD-Patient. CAPD-, HD- und auch Patienten mit sekundärem Hyperparathyroidismus zeigen Zeichen einer Mikroinflammation. Dabei war CRP (derzeitiger Routineparameter) kein probates diagnostisches Mittel der Entzündung bei CAPD- und HD-Patienten, des Weiteren nicht geeignet zwischen beiden Patientengruppen zu unterscheiden. Die Verteilung der monozytären Subpopulationen und Expression monozytärer Aktivierungsmarker unterschied sich hinreichend zwischen CAPD- und HD-Patienten. Paricalcitol moduliert funktionelle monozytäre Antigene und Zytokine in vivo und in vitro und wirkt damit der Mikroinflammation und dem Immundefekt des CNI-Patienten entgegen. Der Monozyt wirkt ambivalent und initiiert seine „eigene“ Gegenregulation zur Inflammation, die beim Patienten unter Nierenersatztherapie Endotoxin-vermittelt ist. Vitamin D-Derivate wie Paricalcitol wirken nicht nur auf die Calcium-Phosphat-Homöostase sondern auch immunmodulatorisch, indem sie auf monozytäre Antigene, wie Rezeptoren der angeborenen Immunabwehr, Einfluss nehmen.

Des études ont récemment mis en évidence le rôle des lipopolysaccharides (LPS) des bactéries à Gram négatif de la flore intestinale dans le processus de l’inflammation conduisant à l’obésité et au diabète de type 2.Le présent travail est réalisé dans le cadre d’une collaboration entre les équipes du Dr. Caroff (U. Paris-Sud, Orsay) et du Pr. Zhao (U. Jiao Tong, Shanghai). Les expériences présentées ont été réalisées lors de séjours dans les deux laboratoires.Il a été démontré en Chine que des bactéries Sulfato-réductrices (SRB) à Gram négatif étaient présentes en plus forte proportion dans la flore intestinale chez les souris suivant un régime gras. Les mêmes résultats ont été observés chez l'homme. L’hypothèse selon laquelle des SRB seraient à l’origine de grandes quantités d’endotoxines chez les obèses et les patients diabétiques a été émise. Plusieurs souches de SRB isolées de la flore intestinale humaine d’un sujet sain et d’un sujet diabétique ont été cultivées en Chine. Des études de relation structure/activité des LPS isolés de ces bactéries ont été réalisées dans le laboratoire Français pour déterminer leur rôle dans le développement des maladies métaboliques. Les souches isolées des deux sujets ont pu être classées dans le genre Desulfovibrio. Les LPS correspondants ont été extraits et purifiés par des méthodes mises au point dans l’équipe d’Orsay. La structure chimique a été élucidée par les méthodes suivantes : Electrophorèse, Chromatographie sur couche mince, Chromatographie en phase gazeuse et Spectrométrie de masse MALDI. C’est ainsi que des spectres de masse ont été obtenus et que la structure des lipides A, principes actifs des LPS, isolés de SRB a été décrite pour la première fois. Les activités biologiques testées (TNFα, IL-6) varient en fonction du nombre d’acides gras présents. Les LPS de SRB du patient sain ont une structure variable (Smooth versus Rough) en fonction de la quantité de fer présent dans le milieu, et ceux isolés du patient diabétique présentent des structures atypiques qui ne sont pas toutes inflamogènes. Une molécule membranaire inconnue, que nous avons nommée « Glycosyl’X » était co-extraite avec les LPS. Elle joue apparemment un rôle important dans la croissance des SRB et a été étudiée après des étapes de purification complexes. Les structures et le pouvoir inflammatoire de ces molécules dont la structure varie avec les souches, et qui chélatent le fer, ont été étudiées. Elles sont de nature principalement osidique et fixées à la membrane. La proportion de ces molécules par rapport aux LPS varie avec la quantité de fer disponible dans le milieu. Un milieu riche en fer favorise la croissance des Desulfovibrio portant les Glycosyl’X qui n’ont pas de pouvoir inflammatoire eux-mêmes, mais entrent en compétition avec les LPS, modulant ainsi indirectement l’activité de ces derniers. L’augmentation du nombre de Desulfovibrio conduisant à l’augmentation des molécules Glycosyl’X pourrait aussi moduler positivement (par présentation) ou négativement (par élimination des bactéries) l’adsorption du fer dans les intestins dont l’équilibre est essentiel pour l’homéostasie métabolique.Par ailleurs, la croissance des Desulfovibrio augmente la production d’Hydrogène Sulfuré connu pour son action délétère sur les cellules. Nous favorisons l’hypothèse selon laquelle son action sur la disjonction des cellules épithéliales permettrait le passage des différents LPS relargués par la flore Gram-négative intestinale, et même des bactéries entières, vers la circulation sanguine. / Recent studies have highlighted the role of lipopolysaccharide (LPS) in the intestinal flora (gut microbiota) which could contribute to the inflammation process leading to obesity and type 2 diabetes. This thesis is part of a collaborative project between the laboratories of Dr. Caroff (U. Paris -Sud, Orsay, France) and Prof. Zhao (U. Jiao Tong , Shanghai, China). It has been shown by Pr.Zhao’s team in 2010 that the Sulfate -Reducing Bacteria (SRB) were presented in greater proportion in the intestinal mice flora following a fat diet compared to mice following a normal diet. The same results were observed in humans. The starting hypothesis was that SRB could produce a large amount of endotoxin in obese and diabetic patients and play a role in the development of metabolic diseases. Several SRB strains isolated from the human intestinal flora of a healthy subject and of a diabetic subject were grown in the Chinese laboratory. Studies of their LPS structure / activity relationships were carried out in the French laboratory. The aim of this study was to determine their roles in the development of metabolic diseases.Strains isolated from the two subjects could be classified in the Desulfovibrio genus. The corresponding LPS were extracted and purified by the methods developed in the French laboratory. The chemical structure was elucidated by the following methods: Electrophoresis, Thin layer chromatography, Gas chromatography and MALDI mass spectrometry. The mass spectra were obtained and the structure of lipid A, the active part of LPS isolated from SRB was described here for the first time. The biological activities test (TNFα, IL-6) vary depending on the number of fatty acids present in their lipid A structure. The LPS of SRB isolated from the healthy patient had a variable structure (Smooth versus Rough) depending on the amount of iron present in the medium, and those isolated from diabetic patients had atypical structures are not all inflamogenic .An unknown membrane molecule, which we named "Glycosyl'X" was co-extracted with the LPS. It apparently plays an important role in the growth of SRB was investigated after complex purification steps. The structures and the inflammatory power of these molecules variying with strains chelating iron were studied. They are mainly of glycosidic nature and linked to the bacterial membrane.The proportion of these molecules relatively to LPS varies with the amount of iron in the medium. An environment rich in iron promotes the growth of Desulfovibrio Glycosyl'X, molecules but competes with LPS and indirectly modulates the activity of the latter. The increase number of Desulfovibrio leading to increased Glycosyl'X molecules may also modulate positively (by presentation) or negatively (by killing bacteria) the absorption of iron in the intestines which balance is essential for metabolic homeostasis.Furthermore, the growth of Desulfovibrio increasing the production of Hydrogen Sulfide is known for its deleterious effects on the cells. We favor the hypothesis that its action on the separation of epithelial cells favors the passage of different LPS released by the Gram- negative of intestinal flora and even whole cell bacteria into the bloodstream.

Anti-microbial proteins (AMP) are the key effector arm of the innate immune system. The prevalence of AMP in single-celled eukaryotes to humans shows its importance during the course of evolution. The first report for the role of the anti-microbial peptide in clearing infection was given by Alexander Fleming in 1990’s through the discovery of Penicillin and Lysozyme. The search for antimicrobial agents in human granulocytes was begun by Ehrlich in 1870’s but the first successful isolation of an antimicrobial agent from rabbit neutrophils was done by Zeya and Spitznagel in 1969. Later work by Peter Elshbach and his group on AMPs in rabbit neutrophils brought to light an AMP that can increase the permeability of the bacterial membrane. This AMP named as Bactericidal/permeability-increasing protein (BPI) was further isolated from human neutrophils. Since then many studies have been carried out to understand the mode of action of BPI, which culminated in understanding the new functional activity of this protein viz opsonisation, LPS neutralization and anti-angiogenic function. Knowing to the role of BPI as an anti-inflammatory agent, multiple studies have tried to use BPI for treating endotoxic shock. Dysregulation of BPI expression is associated with various inflammatory diseases like Crohn’s Disease (CD), Ulcerative colitis (UC) and Infectious enteritis’s. Mutations in BPI are also linked to susceptibility to various infections. Even though there are several studies focusing on the functional aspects of BPI, the regulation of BPI expression is poorly understood. Knowing the clinical importance of dysregulation of BPI, it is vital to understand the regulation of BPI expression during the course of bacterial infection. The Thesis is divided into four chapters. As the main aim of this study is to understand the regulation of BPI expression, in Chapter 1 we introduce the known facts about the protein. A brief overview of the mode of action and regulation of BPI is discussed in this chapter. The subsequent sections describe the diseases associated with Dysregulation of BPI and the use of BPI as a therapeutic agent in various diseases. Towards the end, the objective of the present study is discussed. BPI is primarily known to be expressed in human neutrophils and epithelial cells. Previous studies have shown that among innate immune cells, murine BPI is expressed only in dendritic cells and neutrophils, but not in macrophages. Based on these results, it was presumed that BPI is not expressed in human macrophages. In Chapter 2, we report the presence of BPI in human macrophages. Our studies revealed increased expression of BPI in human macrophages stimulated with various PAMPs (Pathogen-associated molecular patterns) viz., LPS, flagellin as well as during bacterial infection. Further, during the course of an infection, BPI interacted with Gram-negative bacteria, resulting in enhanced phagocytosis and subsequent control of the bacterial replication. However, it was observed that bacteria which can maintain an active replicating niche (Salmonella Typhimurium) avoid the interaction with BPI during later stages of infection. On the other hand Salmonella mutants, which cannot maintain a replicating niche, as well as Shigella flexneri, which quit the endosomal vesicle, showed interaction with BPI. BPI was induced in both M1 and M2 differentiated macrophages suggesting its role in limiting Gram-negative bacteria and parasitic infection. These results propose an active role of BPI in Gram-negative bacterial clearance by human macrophages. This chapter concludes with a discussion on the importance of BPI expression in human but not murine macrophages. The importance of maintaining an active replicating niche by STM to evade interaction with BPI is also discussed. As the first line of defense against invading pathogens, intestinal epithelium produces various antimicrobial proteins (AMP) that help with clearance of pathogen. The precise mechanism of AMP regulation in intestinal epithelium is not clear. Intestinal epithelium being a primary entry point for various pathogens, we tried to understand the regulation of BPI expression in the intestine during the course of bacterial infection. In Chapter 3, we report a direct correlation between intestinal damage and BPI expression. In Caco-2 cells, we see a significant increase in BPI levels upon membrane damage mediated by S.aureus infection and pore-forming toxins (Streptolysin and Listeriolysin). Cells detect changes in potassium levels as a Danger-associated molecular pattern (DAMP) associated with cell damage and induce BPI expression in a p38 dependent manner. These results are further supported by in vivo findings that BPI expression in the murine intestinal epithelium is induced upon infection with bacteria which cause intestinal damage (Salmonella Typhimurium & Shigella flexneri) whereas mutants which don’t cause intestinal damage (STM fliC & STM invC), didn’t induce BPI expression. These findings have a huge impact on our current understanding of AMP response during inflammatory bowel diseases (IBD). Our results suggest that dysregulation of BPI expression might be an effect rather than a cause of IBD. This chapter concludes with a discussion on the importance of potassium efflux associated with membrane damage as an important signal that helps in discriminating the invading pathogen from the pool of gut microflora. Bactericidal/permeability-increasing protein had been shown to possess anti-inflammatory and endotoxin neutralizing activity by interacting with LPS of Gram-negative bacteria. Even though rBPI (recombinant BPI) has cleared phase III clinical trials for treating endotoxemia, the high cost of purified BPI provided by pharmaceutical companies makes it inaccessible or unavailable for the common man. In Chapter 4, we examined the feasibility of using murine BPI (mBPI) expressed on halophilic Archaeal gas vesicle nanoparticles (GVNPs) for the treatment of endotoxemia in high-risk patients, using a murine model of D-galactosamine-induced endotoxic shock. Halobacterium sp. NRC-1 was used to express the N-terminal 199 amino acid residues of mBPI fused to the GVNP GvpC protein, and bound to the surface of the haloarchaeal GVNPs. Our results indicate that delivery of mBPIN-GVNPs increase the survival rate of mice challenged with lethal concentrations of lipopolysaccharide (LPS) and D-galactosamine. Additionally, the mBPIN-GVNP-treated mice displayed reduced symptoms of inflammation including inflammatory anemia, recruitment of neutrophils, liver apoptosis and pro-inflammatory serum cytokine levels. This chapter concludes with a discussion of the advantages of using mBPIN-GVNPs over purified protein in treating endotoxic shock.

Liver disease is now a leading cause of non-AIDS related morbidity and mortality in people living with HIV (PLWH). The present study investigated the interplay between adverse lifestyle factors that are prevalent in PLWH, biological mediators of liver pathogenesis, and a non-invasive measure of liver fibrosis (FIB-4 index) in HIV mono- and HIV/HCV co-infected individuals. The results of this investigation in the Miami Adult Studies of HIV (MASH) cohort show that the odds of liver fibrosis progression significantly increased over two years for HIV mono-infected participants who drank alcohol hazardously (OR 3.038, P=0.048), and had BMI ≥ 28kg/m2 (OR 2.934, P=0.027). Cocaine use reduced the odds of advancing one stage of liver fibrosis (OR 0.228, P=0.038), but an interaction between high BMI and cocaine use slightly raised the odds by 4.8% of liver fibrosis progression (P=0.072). HIV/HCV co-infected participants showed interactions between cocaine use and high BMI with increased FIB-4 stage (OR 4.985, P= 0.034), however no lifestyle factors could independently predict FIB-4 stage in this group. Biological mediators previously associated with liver pathogenesis were associated with higher FIB-4 index over 2 years in a subset of (n=65) HIV mono-infected participants. Plasma measures of oxidative stress (% oxidized glutathione: OR 4.342, P= 0.046), hepatocyte-specific apoptosis (Cytokeratin-18 (CK-18): OR 1.008, P=0.021), and microbial endotoxin (lipopolysaccharide (LPS): OR 1.098, P= 0.097) were associated with having higher odds of progressing at least one stage of FIB-4 over 2 years. The same biological mediators were also associated with liver fibrosis within HIV infected people who also had a harmful lifestyle characteristic. FIB-4 index was significantly associated with % oxidized glutathione in obese subjects (β=0.563, P=0.018), TGF-β1 in cocaine users (β=0.858, P=0.027), and CK-18 in HIV infected individuals without any adverse lifestyle factors (β=0.435, P=0.015). Taken together, the findings of these studies describe interrelationships between HIV disease status, lifestyle, and biological mediators of liver fibrosis. The results show interactions between lifestyle conditions and the mediators of liver fibrosis may account for higher rates of liver disease in HIV infection. Research is warranted to develop personalized therapeutics for PLWH to curb the burden of liver disease.