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Plusieurs études ont démontré que les agonistes du PPARgamma, dont la pioglitazone (PGZ), améliorent les paramètres métaboliques et histologiques de la stéatohépatite non-alcoolique (NASH) chez l'homme et la souris, et qu’ils ont des effets bénéfiques sur la fibrose hépatique chez le rat. Les mécanismes d’action sont mal connus. La NASH, caractérisée par de la stéatose, des lésions hépatocytaires, de l’inflammation et une fibrose variable, est considérée comme une complication hépatique du syndrome métabolique. L'obésité, un des facteurs de risque pour le développement de la NASH, est caractérisée par de faibles taux d'adiponectine sérique. Cette adipocytokine, dont l'expression génique est régulée par le PPARgamma, possède des propriétés anti-stéatosique et anti-fibrotique chez la souris. L'activité intracellulaire de l'adiponectine est médiée via ses récepteurs spécifiques qui activent la protéine kinase AMPK et/ou le PPARalpha. Une fois activée, l’AMPK induit les voies cataboliques de production d’énergie (telles que l'oxydation des acide gras) et inhibe les voies consommant de l’ATP (telles que la lipogenèse). L'activation du PPARalpha augmente l'oxydation des acides gras et inhibe la réponse inflammatoire. Le but de notre travail est d’évaluer l'implication de la voie PGZ–adiponectine–AMPK et/ou PPARalpha dans la prévention de la NASH et de la fibrose hépatique. Nous avons tout d’abord évalué l'effet de la PGZ sur la fibrose hépatique chez la souris. Nos observations montrent que, contrairement aux résultats observés chez le rat, la PGZ n’inhibe pas le développement de la fibrose hépatique chez la souris in vivo. Ces résultats ont été confirmés par des études sur les cellules stellaires hépatiques (HSCs), les cellules effectrices de la fibrose, in vitro. Dans une seconde étude, nous avons évalué l'impact de l’AMPK sur la fibrose hépatique in vivo et sur l’activation des HSCs in vitro. Nous avons constaté que l’AMPK jouait un rôle dans le contrôle de la trans-différentiation des HSCs in vitro mais pas dans le développement de la fibrose hépatique chez la souris in vivo. Finalement, nous avons évalué l'hypothèse que l'effet bénéfique de la PGZ sur la NASH résulte de la stimulation de l'AMPK et/ou du PPARalpha par l’adiponectine. Nos résultats ont montrés que cet effet de la PGZ était strictement dépendant de l’adiponectine mais ne semblait pas impliquer l'AMPK ni le PPARalpha. Nous avons également identifié SREBP-1c, régulant la lipogenèse de novo, comme cible thérapeutique potentielle pour le développement de la NASH. Les résultats obtenus dans le cadre de ce travail de thèse fournissent une meilleure compréhension de l’axe PPARgamma–adiponectine–AMPK dans le contrôle du développement de la NASH et de la fibrose hépatique chez la souris. / Several studies have demonstrated that peroxisome proliferator-activated receptor gamma (PPARg) agonists, such as pioglitazone (PGZ), improve metabolic parameters and histology of nonalcoholic steatohepatitis (NASH) development in humans and mice, and have beneficial effects on liver fibrosis in rats. NASH, characterized by steatosis, hepatocellular damage, inflammation and variable fibrosis, is recognised as the hepatic complication of the metabolic syndrome. Obesity, one of the risk factors for NASH development, is characterized by low serum adiponectin levels. This adipocytokine, of which gene expression is regulated by PPARg, demonstrates anti-steatotic and anti-fibrotic properties in mice. Intracellular activity of adiponectin is mediated through its specific receptors which activate AMP-activated protein kinase (AMPK) and PPARalpha. Once activated, AMPK switches on catabolic pathways (such as fatty acid oxidation and glycolysis) and switches off ATP-consuming pathways (such as lipogenesis). Activation of PPARalpha increases fatty acid oxidation and reduces inflammatory reaction. The aim of the present work is to analyse the activation of the axis PGZ-adiponectin-AMPK and/or PPARalpha as a way to control NASH and hepatic fibrosis development. We first evaluated the effect of PGZ on hepatic fibrosis in mice. We observed that, by contrast with results in rats, PGZ did not prevent hepatic fibrosis development in vivo in mice. These results were confirmed by in vitro studies on the key effector cells of fibrogenesis, the hepatic stellate cells (HSCs). We then assessed the impact of AMPK on hepatic fibrosis in vivo and on HSC trans-differentiation/activation phenomenon in vitro. We found that AMPK played a role in the control of HSC trans-differentiation in vitro but was not implicated in the wound-healing fibrosis in vivo in mice. Finally, we tested the hypothesis that the beneficial effect of PGZ on steatohepatitis results from the adiponectin-dependent stimulation of AMPK and/or PPARalpha. We found that this preventive effect was clearly dependent of adiponectin but did not involve AMPK or PPARalpha activation. We have also identified SREBP-1c, implicated in the regulation of de novo lipogenesis, as a potential therapeutic target for the control of the development of NASH. The present thesis provides a better understanding of the axis PPARg–adiponectin–AMPK in the control of NASH and hepatic fibrosis development in mouse.

Chronic immune insult and immunosuppressant-related toxicities have remained an enduring challenge in organ transplantation. Long-term survival of transplant patients has improved marginally in recent decades due to these challenges. To circumvent these issues, transplant investigators have researched immune tolerance mechanisms that demonstrate potential to induce immunosuppression and rejection-free survival in the clinic. One mechanism in particular, the liver tolerance effect, has already demonstrated this experimentally and clinically. Liver transplants in experimental models and human patients have exhibited the ability to become spontaneously accepted without being rejected by the recipient’s immune system. Research in recent decades has revealed that the liver parenchymal and non-parenchymal cell populations harbor potent immunomodulatory properties. In the context of liver transplantation, it has been found that two cell populations in particular, the mesenchyme-derived liver sinusoidal endothelial cells and hepatic stellate cells, mediate the induction of liver transplant tolerance through a mechanism known as mesenchyme-mediated immune control.

Introduction: Hepatic stellate cells (HSC) and myofibroblasts may be relevant stromal drivers of human hepatocellular carcinoma (HCC). It was hypothesised that targeted inhibition of αv integrin-mediated TGF-β activation, by HSC or hepatocytes, may result in reduced peri-tumoural and intra-tumoural extracellular matrix formation, and reduced hepatic carcinogenesis. The role of HSC in acute liver injury is less well characterised. It was anticipated that integrin signalling on HSC and hepatocytes might also be relevant in the acute setting. The emerging technique of intravital microscopy (IVM) allows detailed, real-time investigation of the cellular processes involved in hepatocyte injury, cell death and repair. It was hypothesised that this could be coupled with mouse models of HCC and acute liver injury, to perform sequential imaging under anaesthesia. Aims: (i) To determine the effect of targeted inhibition of αv integrins on HSC and hepatocytes, during hepatocarcinogenesis, in a mouse model of HCC. (ii) To investigate the effect of targeted inhibition of αv and other integrins on HSC, hepatocytes, and liver sinusoidal endothelial cells (LSEC), during acute liver injury, in the mouse model of paracetamol-induced liver injury. (iii) To develop IVM of the liver, via an abdominal imaging window, with optimisation of surgical and imaging techniques, to allow sequential imaging of the same animal. Methods: The diethylnitrosamine (DEN)-induced mouse model of hepatocarcinogenesis was used, and PDGFRβ-Cre;αvfl/fl and Alb-Cre;αvfl/fl mice were employed to deplete αv integrins on HSC and hepatocytes respectively. Tumours were harvested at 40 weeks post-DEN. Tumour size and number was evaluated in all animals. PDGFRβ-Cre;αvfl/fl and Alb-Cre;αvfl/fl mice were used in the paracetamol model, to investigate the role of αv integrins in acute liver injury. PDGFRβ-Cre;β8fl/fl and Alb-Cre;β 8fl/fl animals were also tested in this model. The role of integrins in liver sinusoidal endothelial cells (LSEC) during paracetamol-induced liver injury was evaluated using Cdh5-Cre mice. IVM of the liver was performed by surgical implantation of an abdominal imaging window, consisting of a titanium ring and coverslip, secured in place with a purse string suture. Fluorescent reporter mice were used to identify hepatic and vascular architecture, and other label-free microscope technologies were utilised to image collagen, lipid distribution, necrotic areas and blood flow within tissues. Results: In large cohorts of PDGFRβ-Cre;αvfl/fl, Alb-Cre;αvfl/fl, and control animals, there was no difference in mean tumour size or number, at 40 weeks. Targeted inhibition of α v integrins and β 8 integrin on hepatocytes, HSC or LSEC was not protective in paracetamol-induced liver injury. IVM of the liver can be performed on animals with HCC and throughout paracetamol-induced liver injury, to obtain high quality, real-time images of multiple cell lineages and the hepatic microenvironment. Conclusions: The role of TGF-β in HCC pathogenesis is complex and context-dependent. Targeted loss of αv integrin did not result in reduction in tumour burden in this non-cirrhotic model of HCC. IVM of the liver is a powerful tool to quantify inflammatory infiltrates and assessment of vascular remodelling throughout the course of acute liver injury and regeneration, providing insights into the biological processes determining recovery.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20794号 / 医博第4294号 / 新制||医||1025(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 妹尾 浩, 教授 浅野 雅秀, 教授 川口 義弥 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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