In Green Building Evaluation Indexes, the EAC has been adapted as the central HVAC system energy consumption criteria, has been assigned an energy saving factor£\4 of 0.2, despite of the actual power consumption variations existed among various system. In this study, the PILV values of specific VRV systems were utilized, so that actual energy-saving factor £\4 can be evaluated. Furthermore, being lack of the chilled water distribution system, the weighting of power consumption percentages of a VRV system has also been changed into 0.9 vs. 0.1 for the outdoor and indoor units respectively. The methodology established in this study has been justified by suing the actual VRV projects under commercial operations, which can successfully discriminate different energy efficiencies among various systems.

多發性骨髓瘤(Multiple myeloma) 為骨髓內漿細胞異常增生的惡性腫瘤，到目前為止仍然難以治癒。其發生發展是一個複雜的多步驟事件，涉及腫瘤細胞中遺傳和表觀遺傳的改變，以及骨髓微環境的支持。現已確定骨髓瘤細胞和骨髓微環境之間的相互作用對於骨髓瘤的病理發生，以及骨髓瘤細胞的生長，遷移和抗藥性起著關鍵作用。血小根因子四(Platelet factor 4, or PF4) 是一種抗血管生成的趨化因子。它不僅在體外抑制血管內皮細胞增殖和遷移，而且在體內抑制腫瘤的生長。此前，我們發現PF4 基因在多發性骨髓瘤中等位缺失以及DNA 高度甲基化，因而導致其在骨髓瘤病人及細胞系中的表達缺失或降低。在本研究中，我們利用體內和體外實驗鑒定了PF4 對骨髓瘤細胞以及血管生成的作用，並闡明了其作用機制。 / 首先，我們在體外鑒定了PF4 在骨髓瘤細胞中的功能。我們發現PF4 抑制骨髓瘤細胞系以及從病人骨髓中分離出來的骨髓瘤細胞的生長，以及促進其凋亡。其促凋亡活性與caspase-3 和PARP 的激活有關。我們也檢測了PF4 在骨髓瘤中對血管生成的作用。我們首先分離了病人骨髓中的內皮細胞。結果顯示PF4抑制骨髓瘤內皮細胞的生長和管狀物的形成。這些結果證明PF4 在骨髓瘤中可能是一個抑癌因子。 / 接下來我們進一步檢測了PF4 在體內的抑癌功能。在第一種模型中，骨髓瘤細胞被皮下移植到重症聯合兔疫缺陷型(NOD-SCID) 小鼠中。尾靜脈注射200ngPF4 明顯的抑制了腫瘤的生長，並延長了小鼠的成活率。第二種小鼠模型稱為兔鼠融合模型(SCID-rab model) 。在這一模型中，大白兔的腿骨先被皮下移植到(NOD-SCID) 小鼠中，再將骨髓瘤細胞注射入已植入的大白兔腿骨的骨腔中。兩周後，小鼠被尾靜脈注射入20 或200ng PF4 。結果顯示200ng PF4 顯著抑制了腫瘤的生長。通過兔疫組化分析大白兔腿骨切片，我們進一步證明了PF4 在腫瘤細胞中的增瘟，凋亡以及血管生成的作用。我們的發現因此證實了PF4 是骨髓瘤中的一個抑制因子。 / 為了鑒定PF4 在骨髓瘤中的作用機制，我們用Protein/DNA 微陣列(Protein/DNA array) 分析了PF4 參與的信號通路。結果顯示PF4 調節了若干個轉錄因子，其中包括STAT3 。凝膠遷移(EMSA) 和螢光素酪報告基因(luciferase reporter assay )檢測進一步證實PF4 抑制了STAT3 的DNA 結合能力以及轉錄活性。因此PF4 可能通過抑制STAT3 信號通路而抑制骨髓瘤的生長。我們進一步發現PF4 能抑制組成性的以及自介素6 (IL-6) 誘導的STAT3的激活。我們發現PF4 下調了STAT3 下游的靶基因，包括Mc1-1， Survivin 以及血管內皮細胞生長因子(VEGF)。而過表達組成性激活的STAT3 能逆轉PF4 所誘導的細胞凋亡。在兔鼠敵合模型中，通過兔疫組化分析大白兔腿骨切片，我們發現PF4 能抑制STAT3 的入核。SOCS3 是STAT3 其中的一個抑制因子，我們發現PF4 能誘導SOCS3 的表達。而干擾掉SOCS3 能使PF4 喪失其抑制STAT3 激活的能力。這些結果表明PF4 可能通過誘導SOCS3 的表達，從而抑制STAT3 信號通路，引起骨髓瘤的生長抑制以及抗血管生成。 / 總而言之，本研究表明PF4 是骨髓髓中一個重要調節因子。在體外和體內，PF4 通過抑制STAT3 信號通路，從而抑制腫瘤細胞的生長，促進凋亡以及抑制血管生成。本文為PF4 的臨床研究，作為一種新的治療骨髓瘤藥物，提高骨髓瘤病人的治療效果提供基礎。 / Multiple myeloma (MM) is an incurable hematological malignancy characterized by accumulation of clonal plasma cells in bone marrow (BM). The development and progression of MM is a complex multistep tumorigenic event involving both genetic and epigenetic changes in the tumor cell as well as the support by the BM microenvironment. It has been well established that the physical interaction of MM cells with the BM milieu are crucial for MM pathogenesis, MM cell growth, survival, migration and drug resistance. Platelet factor 4 (PF4), a potent antiangiogenic chemokine, not only inhibits endothelial cell proliferation and migration in vitro but also solid tumor growth in vivo. Our group previously demonstrated loss of PF4 expression in patient MM samples and MM cell lines due to concurrent allelic loss and DNA hypermethylation. In this study, we characterized the effects of PF4 on MM cells and angiogenesis in the BM milieu both in vitro and in vivo and elucidated the mechanism of PF4 effects on MM. / To characterize the effects of PF4 on MM cells in vitro, assays on cell growth, cell cycle arrest and apoptosis were performed and we found that PF4 inhibited growth and induced apoptosis in both MM cell lines and MM cells from patients. The proapoptotic activity of PF4 is associated with activation of caspase-3 and poly (ADP) ribose polymerase (PARP). We also investigated the effects of PF4 on angiogenesis in MM using endothelial cells isolated from patient's BM aspirates (MMECs). Our results showed that PF4 suppressed MMECs growth and tube formation on matrigel in a dose-dependent manner. / Given the ability of PF4 to suppress MM cell growth and angiogenesis in vitro, we evaluated its tumor suppressive function in vivo. In human subcutaneously matrigel xenograft mouse model, tail vein injection of 200ng PF4 significantly reduced MM tumor growth and prolonged survival. We next used the SCID-rab mouse model which recapitulates the human BM milieu in vivo. In this model, MM cells were directly injected into the rabbit bone which was subcutaneously implanted into the NOD-SCID mice. Two weeks after injection, SCID mice were treated with various dose of PF4 (20 or 200ng per injection, three times per week) or PBS by tail vein injection. ELISA assay for hIg (lambda) showed that tumor growth in 200ng PF4-treated mice was markedly reduced by 58% compared with the control group, which was further confirmed by immunohistochemistry analysis of CD 138 staining on rabbit bone section. Consistent with the in vitro results, induction of apoptosis in MM cells and inhibition of angiogenesis by PF4 could also be demonstrated in vivo, as evidenced by the findings on ki67, Cleaved caspase-3, CD31 and VEGF staining on rabbit bone sections from treated versus control mice. Our findings thus confirmed that PF4 is a novel tumor suppressor in MM. / However, the molecular mechanism of how PF4 inhibits MM tumorigenesis is still unclear. To identify the signal pathway PF4 involved in MM, Protein/DNA array was performed. We found that PF4 regulated several transcription factors including STAT3 in U266 cells. EMSA and luciferase reporter assay further confirmed that PF4 suppressed STAT3 DNA binding and transcriptional activity. So it is possible that PF4 mediates its tumor suppressive function, through suppressing STAT3 pathway in MM cells. We further found that pre-treatment of PF4 blocked both constitutive and interleukin-6-induced STAT3 activation in a time-dependent manner in human MM cells. PF4 could also down-regulate the STAT3-regulated gene products including Mcl-I, Survivin and vascular endothelial growth factor (VEGF). Moreover, enforced expression of constitutively active STAT3 rescued cells from PF4-induced apoptosis. In SCID-rab mouse model, we also found that PF4 inhibited STAT3 nuclear translocation by immunostaining of rabbit bone sections. When examined further, we found that PF4 induced the expression of one of the STAT3 inhibitor SOCS3, and gene silencing of SOCS3 by small interfering RNA abolished the ability of PF4 to inhibit STAT3 activation, suggesting a critical role of SOCS3 in the action of PF4. Our findings therefore suggest that by inducing SOCS3 expression, PF4 abrogates STAT3 activity, thus induces tumor growth inhibition and anti-angiogenesis. / Together, these novel studies have shown that PF4 is an important regulator of MM tumorigenesis. By abrogating STAT3 signaling it targets cell growth, induces apoptosis, suppresses angiogenesis both in vitro and in vivo in MM. These scientific observations provide the framework for clinical studies of this chemokine, as a novel drug for treatment of MM to improve patient outcome in MM. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Liang, Pei. / "November 2011." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 139-161). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract in English --- p.I / Abstract in Chinese --- p.IV / List of Publications --- p.VI / Acknowledgements --- p.VII / List of abbreviations --- p.IX / List of Tables --- p.XII / List of Figures --- p.xm / Table of Contents --- p.XV / Chapter Chapter1 --- Introduction and Literature Review --- p.1 / Chapter 1.1 --- Multiple myeloma-General description --- p.1 / Chapter 1.1.1 --- Epidemiology of MM --- p.1 / Chapter 1.1.2 --- Stages of MM --- p.1 / Chapter 1.2 --- The bone marrow (BM) microenvironment in MM --- p.3 / Chapter 1.3 --- Signal pathways in MM cells --- p.5 / Chapter 1.3.1 --- JAK/STAT3 in cancers and MM --- p.5 / Chapter 1.3.1.1 --- IL-6 and its receptor --- p.7 / Chapter 1.3.1.2 --- Activation of downstream signals-The "on" signals --- p.9 / Chapter 1.3.1.3 --- Inactivation of downstream signaling --- p.11 / Chapter 1.3.1.3.1 --- Phosphatases --- p.12 / Chapter 1.3.1.3.2 --- SOCS family --- p.13 / Chapter 1.3.1.3.3 --- The PIAS family --- p.14 / Chapter 1.3.2. --- NF-κB pathway --- p.15 / Chapter 1.3.3 --- RAS-MAPK pathway --- p.17 / Chapter 1.3.4 --- Phosphatidyl inositol-3 kinase (PI3K)/AKT --- p.18 / Chapter 1.4 --- Angiogenesis in MM --- p.18 / Chapter 1.4.1 --- The process of angiogenesis --- p.18 / Chapter 1.4.2 --- Angiogenesis in caner --- p.20 / Chapter 1.4.3 --- Angiogenesis in MM --- p.22 / Chapter 1.5 --- Animal models in MM --- p.24 / Chapter 1.6 --- Treatment of MM --- p.27 / Chapter 1.6.1 --- Chemotherapy --- p.27 / Chapter 1.6.2 --- Autologous stem cell transplantation --- p.28 / Chapter 1.6.3 --- Biologically based therapies --- p.28 / Chapter 1.7 --- Platelet factor 4 (PF4) --- p.30 / Chapter 1.8 --- Structure of PF 4 --- p.30 / Chapter 1.9 --- Role of PF4 in physiological process --- p.32 / Chapter 1.9.1 --- Inhibition of megakaryocytopoiesis --- p.32 / Chapter 1.9.2 --- PF4 and coagulation --- p.33 / Chapter 1.10 --- Role of PF4 in pathological process --- p.34 / Chapter 1.10.1 --- PF4 and cancer --- p.34 / Chapter 1.10.2 --- PF4 is an angiogenic inhibitor --- p.35 / Chapter 1.11 --- Clinical applications of PF4 --- p.37 / Chapter 1.12 --- Summary and project aims --- p.37 / Chapter Chapter 2 --- Materials and Methods --- p.40 / Chapter 2.1 --- Reagents and antibodies --- p.40 / Chapter 2.2 --- MM Cell lines --- p.40 / Chapter 2.3 --- CD138⁺ primary MM cells --- p.41 / Chapter 2.4 --- CD31⁺ MM endothelial cells (MMECs) --- p.42 / Chapter 2.5 --- WST-1 assay --- p.43 / Chapter 2.6 --- Trypan blue exclusion --- p.43 / Chapter 2.7 --- Cell cycle analysis --- p.44 / Chapter 2.8 --- Apoptosis analysis --- p.44 / Chapter 2.9 --- In vitro tube formation assay --- p.45 / Chapter 2.10 --- SCID-rab mice model --- p.45 / Chapter 2.10.1 --- Construction of SCID-rab mice --- p.45 / Chapter 2.10.2 --- Establishment and monitoring of myeloma in SCID-rab mice --- p.46 / Chapter 2.10.3 --- Enzyme-linked immunosorbent assay (ELISA) --- p.46 / Chapter 2.10.4 --- PF4 treatment --- p.47 / Chapter 2.10.5 --- Immunohistochemistry --- p.48 / Chapter 2.11 --- Protein/DNA arrays --- p.49 / Chapter 2.12 --- Electrophoretic mobility shift assay (EMSA) --- p.50 / Chapter 2.13 --- Luciferase reporter assay --- p.52 / Chapter 2.14 --- Western blotting --- p.53 / Chapter 2.15 --- RNA extraction --- p.54 / Chapter 2.16 --- Real-time Polymerase Chain Reaction (Real-time PCR) --- p.54 / Chapter 2.17 --- Nuclear transfection --- p.55 / Chapter 2.18 --- Statistical analysis --- p.55 / Chapter Chapter3 --- The role of PF4 in MM: in vitro studies --- p.58 / Chapter 3.1 --- Results --- p.58 / Chapter 3.1.1 --- PF4 inhibited growth of human MM cell lines --- p.58 / Chapter 3.1.2 --- PF4 did not cause cell cycle arrest --- p.59 / Chapter 3.1.3 --- PF4 induced apoptosis of myeloma cell lines --- p.63 / Chapter 3.1.4 --- PF4 caused cell apoptosis in primary MM cells cultured in vitro --- p.64 / Chapter 3.1.5 --- PF4 suppressed MMECs growth --- p.69 / Chapter 3.1.6 --- PF4 suppressed MMECs tube formation --- p.69 / Chapter 3.2 --- Discussion --- p.73 / Chapter 3.2.1 --- Negative regulation of PF4 in MM cells growth in vitro --- p.73 / Chapter 3.2.2 --- PF4 induces apoptosis in MM cell lines and primary MM cells --- p.74 / Chapter 3.2.3 --- PF4 inhibits angiogenesis in MM in vitro --- p.76 / Chapter 3.3 --- Summary --- p.79 / Chapter Chapter4 --- The role ofPF4 in MM tumorigenesis: in vivo studies --- p.82 / Chapter 4.1 --- Results --- p.82 / Chapter 4.1.1 --- PF4 inhibited MM tumor growth and prolonged survival in subcutaneous matrigel xenograft model --- p.82 / Chapter 4.1.2 --- PF4 inhibited MM tumor growth and prolonged survival in SCID-rab mouse model --- p.85 / Chapter 4.1.3 --- PF4 reduced human MM cell proliferation, angiogenesis and induced apoptosis in SCID-rab mice --- p.88 / Chapter 4.2 --- Discussion --- p.91 / Chapter 4.2.1 --- PF4 inhibited human tumor growth in subcutaneous matrigel xenograft mouse model --- p.91 / Chapter 4.2.2 --- SCID-rab mouse model was successfully established and PF4 inhibited human MM turnor growth in this model --- p.92 / Chapter 4.2.3 --- PF4 inhibited human MM cell proliferation, angiogenesis and induced apoptosis in SCID-rab mice --- p.95 / Chapter 4.3 --- Summary --- p.96 / Chapter Chapter 5 --- The molecular mechanisms of PF4 in MM tumorigenesis --- p.98 / Chapter 5.1 --- Results --- p.98 / Chapter 5.1.1 --- ProteinlDNA array hybridization and Quantification of protein/DNA array spots --- p.98 / Chapter 5.1.2 --- PF4 suppressed DNA binding and transcriptional activity of STAT3 --- p.102 / Chapter 5.1.3 --- PF4 inhibited constitutive STAT3 phosphorylation in MM cells --- p.104 / Chapter 5.1.4 --- PF4 inhibited IL-6-induced STAT3 activation --- p.105 / Chapter 5.1.5 --- PF4 suppressed STAT3 regulated gene expression --- p.107 / Chapter 5.1.6 --- Enforced expression of constitutively active STAT3 rescued cells from PF4-induced apoptosis --- p.109 / Chapter 5.1.7 --- PF4 induced the expression of SOCS3 --- p.111 / Chapter 5.1.8 --- PF4-induced inhibition of STAT3 activation was reversed by gene silencing of SOCS3 --- p.111 / Chapter 5.1.9 --- PF4 inhibited nuclear accumulation of STAT3 and induced expression of SOCS3 in vivo --- p.114 / Chapter 5.2 --- Discussion --- p.115 / Chapter 5.2.1 --- PF4 regulated several TFs --- p.115 / Chapter 5.2.2 --- PF4 inhibited constitutive activation of STAT3 --- p.118 / Chapter 5.2.3 --- PF4 inhibited IL-6 induced activation of STAT3 --- p.120 / Chapter 5.2.4 --- PF4 suppressed STAT3 regulated gene expression --- p.121 / Chapter 5.2.5 --- PF4 induced the expression of SOCS3 --- p.124 / Chapter 5.3 --- Summary --- p.125 / Chapter Chapter 6 --- Conclusion and future studies --- p.128 / Chapter 6.1 --- Conclusion --- p.128 / Chapter 6.2 --- Future studies --- p.135 / Appendices --- p.137 / References list --- p.139

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22332号 / 医博第4573号 / 新制||医||1041(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 平井 豊博, 教授 滝田 順子, 教授 松田 道行 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Heparin is an anticoagulant widely administered to patients undergoing major orthopedic or cardiac surgery. Though heparin is effective at preventing thrombosis, it is paradoxically associated with the development of heparin-induced thrombocytopenia (HIT). HIT is strongly associated with thrombotic complications and is an adverse drug reaction that occurs when heparin binds to the self-protein, platelet factor 4 (PF4) and forms immunogenic multimolecular complexes. As a result, anti-PF4/heparin antibodies are formed, which bind to these complexes, and can cross-linking Fc receptors on platelets and monocytes causing intense platelet activation, thrombocytopenia, and thrombosis. Patients who receive heparin frequently form antibodies against these PF4/heparin complexes; however, most of these antibodies do not cause HIT. Over-diagnosis of HIT is common due to the detection of clinically insignificant non-pathogenic anti-PF4/heparin antibodies. Current enzyme immunoassays (EIAs) cannot distinguish between pathogenic and non-pathogenic anti-PF4/heparin antibodies and will give a false positive result in the presence of the clinically insignificant non-pathogenic anti-PF4/heparin antibodies. Further functional testing is required to identify samples containing the pathogenic anti-PF4/heparin antibodies that will lead to HIT; however, these tests are not readily available in most centres, and delay timely diagnosis. There is little known about the differences between pathogenic and non-pathogenic HIT antibodies. The identification of antigenic determinations of pathogenic HIT antibodies binding to PF4 from this project will have direct implications for patient care. We will be able to accurately and rapidly identify “true” HIT patients from learning more about the pathogenic HIT antibody epitope. / Dissertation / Doctor of Science (PhD) / At least 30% of patients admitted into the hospital will be exposed to the anticoagulant, heparin. 1-3% of these patients develop heparin-induced thrombocytopenia (HIT): an adverse drug reaction. HIT is a major cause of morbidity and mortality in patients receiving heparin if not diagnosed and treated in a timely manner. HIT occurs when patients form antibodies against the platelet protein, platelet factor 4, in complex with heparin leading to an immune response. However, most heparin-exposed patients produce these antibodies but do not have HIT. Current rapid and available diagnostics tools cannot distinguish between antibodies that can or cannot cause the disease. To improve HIT diagnosis, we will identify the molecular differences between the antibodies that cause HIT and those that do not. From this, we can develop a new diagnostic assay that will be able to dictate whether the antibodies found in patients are specific for HIT.

Bakterielle Pneumonien sind weltweit eine der häufigsten Todesursachen und S. pneumoniae ist das häufigste klinische Isolat. Neutrophile Granulozyten gehören zur Klasse der myeloiden Zellen und sind eine wichtige Komponente der angeborenen Immunität gegen bakterielle Infektionen. Krüppel-like factor 4 (KLF4) spielt dabei nicht nur eine Rolle in der Differenzierung der Zellen des Immunsystems, sondern auch während der Infektion bei der Vermittlung inflammatorischer Signale in unterschiedlichen Zelltypen. Diese Studie zeigt zum ersten Mal in vivo, dass myeloides KLF4 Einfluss auf den Krankheitsverlauf hat und die mit einer bakteriellen Pneumonie einhergehende Entzündungsreaktion reguliert. Die hier aufgeführten Ergebnisse demonstrieren, dass der Transkriptionsfaktor KLF4 während einer Pneumokokken Pneumonie in humanen und murinen neutrophilen Granulozyten induziert wird. Diese Induktion ist Zeit- und Dosisabhängig. Außerdem wird die Expression von myeloidem KLF4 durch die Autolyse von S. pneumoniae reguliert, aber nicht über Toll-like Rezeptor 2 (TLR2), TLR4 oder TLR9 vermittelt. Studien in einem Maus-Pneumonie Modell zeigen, dass myeloides KLF4 einen proinflammatorischen Phänotyp bewirkt. Mäuse mit einem KLF4 knockout (KLF4-/-) in myeloiden Zellen haben im Vergleich zu Wildtyp (KLF4+/+) Mäusen eine höhere Bakterienlast in Lunge, Blut und Milz. Obwohl die Produktion proinflammatorischer Zytokine (wie TNF-α, IL-1β und KC) in BALF und Plasma von KLF4-/- Mäusen geringer war, gab es keine Unterschiede bei der Zellrekrutierung in der BALF von KLF4-/- und KLF4+/+ Mäusen. Allerdings war die Zellrekrutierung im Blut der KLF4-/- Mäuse geringer als bei den KLF4+/+ Mäusen. Außerdem wurde eine erhöhte vaskuläre Permeabilität verbunden mit perivaskulären Ödemen und Pleuritis bei KLF4-/- Mäusen während der S. pneumoniae-induzierten Infektion beobachtet. Diese Mäuse erreichten auch eher die humanen Endpunkte als die vergleichbaren KLF4+/+ Mäuse. / Bacterial pneumonia is one of the leading causes of death worldwide. Streptococcus pneumoniae is the most frequently isolated pathogen from clinical pneumonia samples. Neutrophils belong to the class of myeloid cells and forms an important component of this innate immune system against bacterial infections. Krüppel-like factor 4 (KLF4) has been reported to not only play a role in differentiation of cells of the immune system but also in mediating inflammatory signals in different kinds of host cells during infection. This study shows myeloid KLF4 has an impact on pneumococcal pneumonia outcome and regulates the inflammation associated with bacterial pneumonia in vivo in mice. The results presented in the work show that the transcription factor KLF4 is induced in human and mice neutrophils during pneumococcal pneumonia. The induction of KLF4 is time and dose dependent. Additionally, the expression of myeloid KLF4 is regulated by the autolysis of S. pneumoniae but is not mediated via Toll-like receptor (TLR) 2, TLR4 or TLR9. Studies using a mouse pneumonia model showed that myeloid KLF4 exhibits a pro-inflammatory phenotype. Mice with KLF4 knockout (KO) or KLF4-/- in myeloid cells had higher bacterial load in their lungs, blood and spleen in comparison to wildtype (WT) or KLF4+/+ mice. Although there was less pro-inflammatory cytokine (such as TNF-α, IL-1β and KC) production in the broncho-alveolar lavage fluid (BALF) and plasma of KLF4-/- mice yet there no differences in cell recruitment in the BALF of the KLF4-/- and KLF4+/+ mice. There was however less cell recruitment in the blood of KLF4-/- mice in comparison to KLF4+/+ mice. Additionally, an increased vascular permeability associated with perivascular edema and pleuritis was seen during Streptococcus pneumoniae-induced infection in KLF4-/- mice, which also reached earlier the human endpoints than the KLF4+/+ mice.

Afin de limiter les impacts du changement climatique sur la planète, les experts du Groupe Intergouvernemental d’experts sur l’Evolution du Climat (GIEC) préconisent une division par deux des émissions mondiales de gaz à effet de serre à l’horizon 2050. Cet objectif impose une division par quatre (i.e. facteur 4) des émissions de gaz à effet de serre des pays industrialisés comme la France. Le secteur des transports peut-il se plier à cette exigence ?A l’aide du modèle TILT (Transport Issues in the Long Term), centré sur les relations macroéconomiques entre croissance économique, technologies, mobilité et émissions de CO2, cette thèse recherche les conditions à réunir pour que soit atteint, en France, le « facteur 4 ». Si les progrès techniques annoncés par les ingénieurs sont au rendez-vous, nous pouvons atteindre un facteur 2. L’autre moitié du chemin doit donc être réalisée par une modification des comportements des individus et des entreprises. Trois familles de scénarios sont proposées pour en illustrer le contenu de ces évolutions. / In France an objective of dividing greenhouse gas emissions by four, from the 1990 level, by 2050 has been set. Are these ambitions out of our reach? What will the price to pay for this objective be?We have built a long-term backcasting transport demand model (TILT, Transport Issues in the Long Term). This model is centered on defined behavior types -in which the speed-GDP elasticity plays a key role- in order to determine demand estimations. This model lets us understand past tendencies -the coupling between growth and personal and freight mobility and adapt behavioral hypothesis -linked to the evolution of public policies- in order to show how a 75% reduction objective can be attained.The main results are an estimation of CO2 emissions for the transport sector taking into account technical progress and demand. These results are presented as three scenario families named: Pegasus, Chronos and Hestia. Each family corresponds to a growing degree of constraint on mobility.It is possible to divide greenhouse gas emissions in the transport sector by four. Technical progress is able to lead to more than half of these reductions. The interest of these scenarios is to show that there exist different paths –through organizational change- to getting the other half of the reductions.

The transcription factor Krueppel-like factor (KLF) 4 fosters the pro-inflammatory immune response in macrophages and polymorphonuclear neutrophils (PMNs) when stimulated with Streptococcus pneumoniae, the main causative pathogen of community-acquired pneumonia (CAP). Here, we investigated the impact of KLF4 expression in myeloid cells such as macrophages and PMNs on inflammatory response and disease severity in a pneumococcal pneumonia mouse model and in patients admitted to hospital with CAP. We found that mice with a myeloid-specific knockout of KLF4 mount an insufficient early immune response with reduced levels of pro-inflammatory cytokines and increased levels of the anti-inflammatory cytokine interleukin (IL) 10 in bronchoalveolar lavage fluid and plasma and an impaired bacterial clearance from the lungs 24 hours after infection with S. pneumoniae. This results in higher rates of bacteremia, increased lung tissue damage, more severe symptoms of infection and reduced survival. Higher KLF4 gene expression levels in the peripheral blood of patients with CAP at hospital admission correlate with a favourable clinical presentation (lower sequential organ failure assessment (SOFA) score), lower serum levels of IL-10 at admission, shorter hospital stay and lower mortality or requirement of intensive care unit treatment within 28 days after admission. Thus, KLF4 in myeloid cells such as macrophages and PMNs is an important regulator of the early proinflammatory immune response and, therefore, a potentially interesting target for therapeutic interventions in pneumococcal pneumonia.

Deux fois plus de bien-être en consommant deux fois moins de ressources : visant à l’origine des objectifs d’efficience des modes de production, le concept de « facteur 4 » s’est peu à peu modifié au début du XXIème siècle pour se focaliser sur la division par 4 des émissions de gaz à effet de serre. De nos jours, le facteur 4 est un objectif fractal, faisant référence selon l’échelle étudiée à deux ensembles différents mais reliés : le facteur 4 climatique (à l’échelle nationale) et le facteur 4 énergétique (à l’échelle micro-économique). Le facteur 4 énergétique, transposition des questions climatiques (GES) aux aspects de maîtrise de l’énergie a largement été développé au sein d’un secteur économique : le bâtiment. Ce dernier, de par son gisement d’économies d’énergie, a fait l’objet d’un engouement important s’étant concrétisé par la mise en place de réglementations, labels et scénarios prospectifs dans le but d’orienter et de proposer des directions vers l’atteinte du facteur 4. Malgré tout, la transposition pratique d’objectifs théoriques se heurte à la complexité du système composant ce secteur. Cette complexité est due à la diversité du bâti mais aussi, et surtout, aux nombreux acteurs qu’il est nécessaire de mobiliser. L’enjeu de cette recherche est d’étudier le système complexe que représente le secteur du bâtiment et ses acteurs, face à l’atteinte du Facteur 4. Cette thèse propose notamment d’identifier les points de blocage, ainsi que les facteurs de succès lors d’opérations de rénovation et de construction ; objectif revenant à poser la question suivante : quels sont les freins et leviers d’action rencontrés par les acteurs pour l’atteinte du facteur 4 dans le bâtiment ? Pour ce faire, nous avons choisi d’étudier en détail le cas du département de la Loire et envisagé par la suite la transposition des enseignements tirés sur ce département à l’ensemble de la France. Une vingtaine d’entretiens couplés à un questionnaire semi-directif auprès de plus de 200 acteurs professionnels du bâtiment ont été réalisés. Ces enquêtes qualitatives et quantitatives ont permis d’identifier et classer 24 types de freins, relevant de problématiques financières, techniques, réglementaires et comportementales ainsi que les principaux leviers pouvant permettre de les contourner. Au travers des discours et résultats obtenus, les contraintes financières et comportementales apparaissent prépondérantes pour les acteurs interrogés. Malgré tout, l’enchevêtrement des freins et l’interrelation de ces derniers entre catégories imposent une conclusion : le système actuel, face aux contraintes du facteur 4, nécessite non pas une adaptation voire une évolution mais une refonte des modes de penser et de faire. Cette refonte, prônant les concepts de sobriété et d’efficacité, nécessite d’ordonnancer ces derniers : la sobriété de conception constitue alors une étape préalable à l’efficacité énergétique, elle-même précurseur de la sobriété d’utilisation. Une recherche-action menée sur 3 projets de rénovation sur le territoire de Saint-Etienne Métropole et couplant plus d’une centaine d’entretiens auprès de locataires de logement sociaux confirme cet agencement. Les utilisateurs, acteurs incontournables d’un projet, au travers d’une augmentation de leur niveau de confort conditionnent la sobriété à l’amélioration des niveaux de performances du logement. Cette sobriété, testée au travers de simulations thermiques dynamiques sur trois variables d’utilisation (température, taux d’occupation, fermeture des volets) pouvant permettre une division par deux des consommations du bâti. / Doubling Wealth - Halving Resource Use: from the original goals of efficiency production methods, the concept of "factor 4" has gradually changed in the early twenty-first century to focus on the division by 4 of greenhouse gas emissions. Today, Factor 4 depending on the scale refers to two different but interrelated concepts: climate factor 4 (national scale) and the energy factor 4 (at the micro-economic scale). Energy factor 4, transposition of climate issues (GHG) to the aspects of energy management has largely been developed in one sector of economy: the building sector. This sector, through its pool of savings has demonstrated widespread enthusiasm and has realized the implementation of regulations, labels and scenarios to guide and suggest directions towards the factor 4. Nevertheless, the practical implementation of theoretical objectives is hampered by the complexity of this sector. This complexity is due to the diversity of buildings, but also and above all, to the variety of actors who need to be mobilized. The aim of this research is to study the complex system represented by the construction industry and its actors, faced with the objective of factor 4. This thesis proposes to identify bottlenecks and success factors in operations and construction renovation as so ask the question: what are the barriers and levers encountered by actors trying to achieve the factor 4 in the building sector? To do this, we chose to study in detail the case of the Loire department and then consider whether lessons learned on this department could be applied to all France. Twenty interviews coupled with a questionnaire completed by over 200 professional actors in the building sector have been done. These qualitative and quantitative surveys have identified and classified 24 types of barriers relating to financial, technical, regulatory and behavioural issues as well as key levers that can help to overcome them. Through analysis of results, behavioural and financial issues appear to be paramount for the interviewed actors. Still, the variety of barriers and their interrelationship requires one conclusion: the current system, constrained by the objective of factor 4 requires not an adaptation or an evolution but a redesign of modes of thinking and acting. This redesign, advocating the concepts of sufficiency and efficiency needs to be ordered: the sufficiency of design is a preliminary step to energy efficiency, itself a precursor to the sufficiency of use. Action research conducted on three renovation projects in the territory of Saint-Etienne and combining more than one hundred interviews with tenants of social housing company confirms this arrangement. Inhabitants, as key actors of a project, stipulate that an increase in their comfort level combined to an improvement of housing performance, as a condition to their sufficiency. This sufficiency tested through thermal dynamic simulations (temperature, occupancy, closing the shutters) could allow a halving of building consumption.

O gene fator regulador de interferon 4 (IRF4), localizado na região cromossômica 6p25- p23, é um membro da família de fatores reguladores de interferon (IRF), um grupo de fatores de transcrição de ligação ao DNA, sendo IRF4 primariamente associado ao desenvolvimento e resposta imune e expresso exclusivamente em células do sistema imunológico e em linhagens melanocíticas. Embora muitos estudos tenham associado IRF4 a diversas condições, como melanoma e leucemia linfocítica crônica, um recente Genome-Wide Association Study (GWAS) identificou que alelos do SNP rs12203592 (intron 4) estão associados com variação fenotípica em relação à presença de sardas, pigmentação da pele, cabelos e olhos. Estudos funcionais realizados em células melanocíticas humanas e de camundongos revelaram que este SNP está diretamente envolvido na regulação da expressão de IRF4, sugerindo uma clara função na pigmentação do melanócito. Apesar destes achados, a diversidade das regiões regulatórias e codificadora de IRF4 não foi até o momento analisada em populações miscigenadas. A fim de avaliar se outros sítios de variação ao longo do gene IRF4 podem estar associados à pigmentação humana, as regiões regulatórias (promotora e 3´UTR) e codificadora (9 exons e regiões intrônicas flanqueadoras, incluindo o SNP rs12203592) foram analisadas por sequenciamento de nova geração em uma amostra miscigenada da população brasileira. A amostra populacional foi composta por 228 indivíduos não aparentados de Ribeirão Preto, estado de São Paulo, Brasil, os quais foram estratificados de acordo com a pigmentação da pele (clara, média e escura), olhos (azul, verde, castanho-claros e castanho-escuros), cabelo (ruivo, loiro-claro, loiroescuro, castanho-claro, castanho-escuro e preto) bem como em relação à presença de sardas e intensidade de cabelos grisalhos. Bibliotecas de DNA foram preparadas utilizando o Sistema de Enriquecimento de Alvo Haloplex (Agilent Technologies) e sequenciadas na plataforma MiSeq (Illumina). Os pacotes de software CutAdapt, BWA and GATK foram utilizados, respectivamente, para trimagem das sequências dos adaptadores, alinhamento e identificação de variantes. Haplótipos e alelos não identificados foram inferidos pelo método PHASE, embora a fase conhecida entre os sítios de variação (obtida pelo GATK) tenha sido levada em consideração. Um total de 105 sítios de variação foram identificados. Apenas dois deles apresentaram frequências genotípicas que não atendem ao esperado pelo equilíbrio de Hardy-Weinberg (EHW). Dezoito destes SNPs apresentaram forte associação a pelo menos uma característica de pigmentação. Entretanto, se a conservadora correção de Bonferroni para múltiplos testes for levada em consideração, apenas duas associações, ambas envolvendo o SNP rs12203592, permanecem significativas: a associação do alelo T com pele clara e olhos azuis. Este resultado está de acordo com estudos prévios, que reportam que o alelo rs12203592*T leva a uma menor ativação de IRF4 e a uma expressão reduzida da tirosinase, resultando em sensibilidade ao sol e olhos azuis. Foi inferido um total de 101 haplótipos, estando a distribuição destes de acordo com o esperado pelo EHW. Quando os haplótipos foram divididos em haplótipos da promotora, codificadora e 3´UTR foram observadas, respectivamente, 17, 29 e 37 diferentes combinações haplotípicas. Várias associações foram identificadas, particularmente envolvendo o haplótipo mais frequente da promotora, os dois haplótipos mais frequentes da codificadora e o haplótipo mais frequente da 3´UTR, todos associados com pele clara, olhos azuis, cabelos castanhos e cabelos grisalhos. Estes resultados sugerem que outras variantes além de rs12203592, quando consideradas em um contexto haplotípico, são associadas com a pigmentação humana. / The Interferon Regulatory Factor 4 (IRF4) gene, located at chromosomal region 6p25- p23, is a member of the interferon regulatory factor (IRF) family, a group of DNAbinding transcription factors, with the IRF4 primarily associated with immune system development and response and expressed exclusively in immune system cells and melanocytic lineages. Although many studies have shown that IRF4 is associated with many human conditions, such as melanoma and chronic lymphocytic leukemia, a recent Genome-Wide Association Study (GWAS) identified that alleles from the SNP rs12203592 (intron 4) is also associated with phenotypic variation regarding presence of freckles, hair, eye and skin pigmentation. Functional studies in human and mice melanin-containing cells revealed that such SNP is directly involved in the regulation of IRF4 expression, suggesting a clear role in melanocyte pigmentation. In spite of these findings, the regulatory and coding IRF4 diversities in admixed populations have not been evaluated so far. In order to verify if other variation sites spread across the IRF4 gene may be associated with human pigmentation, the regulatory (promoter and 3\'UTR regions) and coding (9 exons and flanking intronic regions, including the SNP rs12203592) regions were analyzed by next-generation sequencing procedures in a Brazilian admixed population sample. The population sample was composed of 228 unrelated individuals from the Ribeirão Preto area, São Paulo State, Brazil, which were stratified according to eye (blue, green, hazel, light-brown, and dark-brown), hair (red, blond, dark-blond, light-brown, dark-brown and black) and skin (light, intermediate and dark) pigmentation, as well as regarding the presence of freckles and intensity of hair greying. DNA libraries were prepared using the Haloplex Target Enrichment System (Agilent Technologies) and sequenced at the MiSeq platform (Illumina). CutAdapt, BWA and GATK software packages were used for trimming adaptor sequences, alignment and genotype calling, respectively. Missing alleles and haplotypes were inferred by using the PHASE method, although the known phase between variable sites (obtained by GATK) was taken into account. A total of 105 variation sites were identified. Only two of them presented genotype frequencies that did not fit Hardy- Weinberg equilibrium (HWE) expectations. Eighteen of these SNPs presented strong association with at least one pigmentation feature. However, if the conservative Bonferroni correction for multiple tests is taken into account, only two associations, both of them involving the rs12203592 SNP, remain significant: allele T associated with light skin and blue eyes. This result is in agreement with previous reports that the rs12203592*T allele leads to reduced IRF4 activation and reduced tyrosinase expression, leading to sun sensitivity and blue eyes. A total of 101 different haplotypes were inferred, and haplotype distribution was in agreement to HWE expectations. When haplotypes were subdivided in promoter, coding and 3\'UTR haplotypes, 17, 29 and 37 different haplotypes were observed, respectively. Various associations were identified, particularly involving the most frequent promoter haplotype, the two most frequent coding (only one of them with allele rs12203592*T), and the most frequent 3\'UTR, all of them with light skin, blue eyes, brown hair and hair greying. These results suggest that other variation sites besides rs12203592, when considered in a haplotypic background, are associated with human pigmentation.

Immune heparin-induced thrombocytopenia (HIT) is a potentially serious complication of heparin therapy and is associated with antibodies directed against a complex of platelet factor 4 (PF4) and heparin. Early diagnosis of HIT is important to reduce morbidity and mortality. I developed an enzyme immunoassay that detects the binding of HIT IgG to PF4-heparin in the fluid phase. This required techniques to purify and biotinylate PF4. The fluid phase assay produces consistently low background and can detect low levels of anti-PF4-heparin. It is suited to testing alternative anticoagulants because, unlike in an ELISA, a clearly defined amount of antigen is available for antibody binding. I was able to detect anti-PF4-heparin IgG in 93% of HIT patients. I also investigated cross-reactivity of anti-PF4-heparin antibodies with PF4 complexed to alternative heparin-like anticoagulants. Low molecular weight heparins cross-reacted with 88% of the sera from HIT patients while half of the HIT sera weakly cross-reacted with PF4-danaparoid (Orgaran). The thrombocytopenia and thrombosis of most of these patients resolved during danaparoid therapy, indicating that detection of low affinity antibodies to PF4-danaparoid by immunoassay may not be an absolute contraindication for danaparoid administration. While HIT patients possess antibodies to PF4-heparin, I observed that HIT antibodies will also bind to PF4 alone adsorbed on polystyrene ELISA wells but not to soluble PF4 in the absence of heparin. Having developed a technique to affinity-purify anti-PF4-heparin HIT IgG, I provide the first estimates of the avidity of HIT IgG. HIT IgG displayed relatively high functional affinity for both PF4-heparin (Kd=7-30nM) and polystyrene adsorbed PF4 alone (Kd=20-70nM). Furthermore, agarose beads coated with PF4 alone were almost as effective as beads coated with PF4 plus heparin in depleting HIT plasmas of anti-PF4-heparin antibodies. I conclude that the HIT antibodies which bind to polystyrene adsorbed PF4 without heparin are largely the same IgG molecules that bind PF4-heparin and thus most HIT antibodies bind epitope(s) on PF4 and not epitope(s) formed by part of a PF4 molecule and part of a heparin molecule. Binding of PF4 to heparin (optimal) or polystyrene/agarose (sub-optimal) promotes recognition of this epitope. Under conditions that are more physiological and sensitive than previous studies, I observed that affinity-purified HIT IgG will cause platelet aggregation upon the addition of heparin. Platelets activated with HIT IgG increased their release and surface expression of PF4. I quantitated the binding of affinity-purified HIT 125I-IgG to platelets as they activate in a plasma milieu. Binding of the HIT IgG was dependent upon heparin and some degree of platelet activation. Blocking the platelet Fc??? receptor-II with the monoclonal antibody IV.3 did not prevent HIT IgG binding to activated platelets. I conclude that anti-PF4-heparin IgG is the only component specific to HIT plasma that is required to induce platelet aggregation. The Fab region of HIT IgG binds to PF4-heparin that is on the surface of activated platelets. I propose that only then does the Fc portion of the bound IgG activate other platelets via the Fc receptor. My data support a dynamic model of platelet activation where released PF4 enhances further antibody binding and more release.