Pferde als Pflanzenfresser benötigen für die Verdauungsvorgänge im Magen-Darm-Kanal eine Vielzahl von Mikroorganismen. In der Pathogenese der equinen Kolikerkrankungen spielen die aus einem Teil dieser Bakterien stammenden Endotoxine (Lipopolysaccharide, LPS) eine wichtige Rolle. Das Caecum und das Colon ascendens scheinen der Ort einer pathologischen Endotoxinabsorption beim Pferd zu sein. Mit Hilfe von Limulus-Amoebozyten-Lysat-Tests (chromogenes Substrat, Endpunkt Methode) wurden die Endotoxinkonzentrationen bei 52 gesunden Pferden und 105 an Magen-Darm-Kolik erkrankten Pferde bestimmt. Durch wiederholte Messungen wurde die Entwicklung der Endotoxinkonzentration bei Kolikpferden im Krankheitsverlauf untersucht. Im Plasma aller gesunden Pferde wurden Endotoxine nachgewiesen, mit einem Mittelwert von = 5,90 pg/ml ± 2,78 pg/ml. Bei 90,5% der Pferden mit Kolik lag die Endotoxinkonzentration in der ersten Probe nach Einlieferung in die Klinik über 10 pg/ml. Kolikformen mit grundsätzlich hohen Endotoxinkonzentrationen konnten herausgefunden werden. In dieser Untersuchung waren das die Hernia foraminis omentalis mit einem LPS-Mittelwert von 91,57 pg/ml, die Dünndarmstrangulation durch Lipoma pendulans mit einem LPS-Mittelwert von 89,32 pg/ml und die Torsio coli totalis 360° mit einem LPS-Mittelwert von 88,21 pg/ml.:INHALTSVERZEICHNIS Seite ABKÜRZUNGEN .................................................................................................... 12 1. EINLEITUNG ............................................................................................... 14 2. SCHRIFTTUM .............................................................................................. 16 2.1. Herkunft und Aufbau der Endotoxine ........................................ 16 2.1.1. Struktur der Zellwand der gram-negativen Bakterien .............. 16 2.1.2. Chemische Struktur der Endotoxine ............................................ 17 2.1.2.1. Das O-spezifische Polysaccharid .................................................. 18 2.1.2.2. Das Kern-Oligosaccharid ............................................................... 18 2.1.2.3. Das Lipoid-A .................................................................................... 19 2.2. Biologische Wirkung der Endotoxine .......................................... 22 2.2.1. Bindung der LPS und Aktivierung der Zellen ........................... 23 Endotoxinrezeptoren im Plasma ...................................... 24 Endotoxinrezeptoren auf der Zellmembran .................... 24 2.2.2. Freisetzung und biologische Wirkung der Vermittlermoleküle ........................................................................ 25 2.2.2.1. Lipide .............................................................................................. 25 Prostaglandine (PG) .......................................................... 26 Leukotriene (LT) ................................................................. 29 2.2.2.2. Proteine ........................................................................................... 29 Tumor-Nekrose-Faktor und Interleukin-1 ..................... 30 Interleukin-8 ........................................................................ 32 Akute-Phase-Antwort und Interleukin-6 ........................ 33 2.2.2.3. Andere endogene Mediatoren ...................................................... 35 2.2.3. Experimentelle Erfahrungen .......................................................... 37 2.3. Die Darmmikroflora des Pferdes als Ausgangspunkt für die Entstehung einer Endotoxämie ........................................ 38 2.4. Darmkanal/Blut-Schranke für Endotoxine; Rolle der Leber .... 41 2.5. Endotoxine und Krankheiten des Pferdes .................................. 42 2.5.1. Hämodynamische und hämostatische Anomalien .................... 43 2.5.1.1. Der Schock ........................................................................................ 43 2.5.1.2. Disseminierte intravasale Gerinnung (DIG) ................................ 44 Labor-Nachweisverfahren: ................................................. 46 Thrombozyten .......................................................... 46 Antithrombin III ....................................................... 46 Fibrin/Fibrinogen-Degradationsprodukte .......... 48 Fibrinogen ................................................................. 48 Andere hämostatische Parameter .......................... 49 2.5.2. Magen-Darm-Erkrankungen des Pferdes ................................... 50 Begriffsbestimmung: Kolik ................................................ 50 2.5.2.1. Endotoxämie bei Magen-Darm-Koliken ..................................... 51 2.5.2.2. Begleiterkrankungen, die sich durch die Wirkung der Endotoxine aus Magen-Darm-Koliken entwickeln ................... 54 2.5.2.3. Kolitis, Typhlokolitis ..................................................................... 56 Kolitis .................................................................................... 56 Typhlokolitis ....................................................................... 58 Klinisches Bild ......................................................... 59 Pathomorphologische Befunde ............................. 60 Ätiologie und Pathogenese .................................... 62 2.5.2.4. Laktat-Azidose und Anion gap bei Pferden mit Magen-Darm-Kolik ......................................................................... 66 2.6. Therapeutische Möglichkeiten zur Bekämpfung der Endotoxämie .................................................................................... 68 2.6.1. Hemmung der Zytokininduktion durch Lipoid-A-Teilstrukturen ................................................................ 69 2.6.2. Anwendung von entzündungshemmenden Präparaten .......... 70 2.6.3. Infusionstherapie ............................................................................ 72 2.6.4. Eine alternative Möglichkeit zur Vorbeugung der Endotoxinwirkung durch Fütterungsmaßnahmen .................... 73 2.6.5. Antiendotoxische Immuntherapie ............................................... 73 2.6.6. Endotoxinneutralisierendes Protein ............................................ 76 3. EIGENE UNTERSUCHUNGEN ................................................... 77 3.1. Material ............................................................................................. 77 3.2. Methodik .......................................................................................... 79 3.2.1. Angewandte Materialien ............................................................... 79 3.2.2. Gewinnung der Proben .................................................................. 81 3.2.3. Endotoxinbestimmung .................................................................. 82 3.2.3.1. Analysator ........................................................................................ 82 3.2.3.2. Reagenzien ....................................................................................... 82 3.2.3.3. Herstellung der Reaktionsansätze ................................................ 83 3.2.3.4. Analyse ............................................................................................. 83 Reaktionsprinzip ................................................................. 83 Standardisierung ................................................................. 84 Probenbehandlung .............................................................. 84 Beschickung der Mikroküvette ......................................... 85 Erstellung der Standardkurve ........................................... 86 3.2.4. Fibrinogenbestimmung .................................................................. 88 3.2.4.1. Reagenzien ....................................................................................... 88 3.2.4.2. Analyse ............................................................................................. 89 Reaktionsprinzip ................................................................. 89 Standard ................................................................................ 89 Plasmaproben ....................................................................... 90 3.2.5. Erklärung zum Index Endotoxin/Fibrinogen ............................ 90 3.2.6. Bestimmung der Antithrombin III-Aktivität .............................. 91 Reaktionsprinzip ................................................................. 92 3.2.7. Anion gap-Bestimmung ................................................................ 92 3.2.8. Enzymaktivitätsbestimmung ........................................................ 92 3.2.9. Statistische Auswertung ................................................................ 93 Erklärung zu Pearson Korrelationskoeffizienten und der Zeichen der Differenzsignifikanz ...................... 94 Erklärung der Elemente des Plot-Box-Diagrammes ...... 94 3.3. Ergebnisse ........................................................................................ 96 3.3.1. Vergleich der Ergebnisse der klinisch gesunden Pferde und der Pferde mit Kolik .................................................. 96 3.3.2. Untersuchungsergebnisse der Kolikpatienten ........................... 99 3.3.2.1. Ergebnisse der Endotoxinbestimmung ..................................... 101 3.3.2.2. Ergebnisse der Fibrinogenbestimmung ..................................... 104 3.3.2.3. Vergleich der Parameter Endotoxin – Fibrinogen; Index Endotoxin/Fibrinogen ...................................................... 106 3.3.2.4. Ergebnisse der Voruntersuchungen der AT-III-Aktivität im Plasma .......................................................... 109 3.3.2.5. Ergebnisse der Anion gap-Bestimmung .................................... 110 3.3.2.6. Ergebnisse der Enzymaktivitätsbestimmung ........................... 112 3.3.2.7. Vergleich der Ergebnisse von konservativ und chirurgisch behandelten Patienten ............................................. 114 3.3.2.8. Vergleich der Ergebnisse von überlebenden und verendeten Patienten ............................................................ 117 3.3.3. Korrelationsanalyse der Meßparameter .................................... 119 4. DISKUSSION ............................................................................................ 122 4.1. Endotoxine ..................................................................................... 122 Aufgabe und Methodik .................................................... 122 Endotoxine bei gesunden Pferden .................................. 123 Endotoxine bei Pferden mit Kolik .................................. 124 4.2. Endotoxämie und Magen-Darm-Koliken ................................. 125 4.3. Endotoxine und Fieber ................................................................. 127 4.4. Begleiterkrankungen der Magen-Darm-Koliken ..................... 128 Disseminierte intravasale Gerinnung ............................. 128 Hufrehe ............................................................................... 129 Typhlokolitis; Salmonelleninfektion ............................... 130 4.5. Anion gap ....................................................................................... 131 4.6. Schlußwort ..................................................................................... 131 5. ZUSAMMENFASSUNG .......................................................................... 133 6. SUMMARY ................................................................................................ 135 7. LITERATURVERZEICHNIS .................................................................... 137 8. ANHANG ................................................................................................... 160 / Endotoxaemia in colic illnesses in horses; Quantitative analysis and clinical relevance Horses as herbivores require a multitude of micro-organisms for the digestive processes in the gastrointestinal tract. The endotoxins (lipopolysaccharides, LPS) originating from a part of the bacteria play an important role in the pathogenesis of equine colic illnesses. The caecum and the colon ascendens appear to be the site of a pathological absorption of endotoxins in horses. With the aid of limulus-amoebocyte-lysate tests (chromogeneous substrate, end-point method) the endotoxin concentrations were analysed in 52 healthy horses and 105 horses suffering from gastrointestinal colic. The development of the endotoxin concentration in the case of horses suffering from colic was investigated through repeated measurements throughout the course of the illness. Endotoxins were identified in the plasma of all healthy horses at a mean value of = 5.90 pg/ml ± 2.78 pg/ml. In 90.5% of the horses with colic, the concentration of endotoxins in the first sample subsequent to admission to the clinic was over 10 pg/ml. It was possible to determine specific forms of colic accompanied by fundamentally high concentrations of endotoxins. In this investigation these were omental foramen hernia with a mean LPS value of 91.57 pg/ml, small intestinal strangulation by lipoma pendulans with a mean LPS value of 89.32 pg/ml and colon torsion 360° with a mean LPS value of 88.21 pg/ml.:INHALTSVERZEICHNIS Seite ABKÜRZUNGEN .................................................................................................... 12 1. EINLEITUNG ............................................................................................... 14 2. SCHRIFTTUM .............................................................................................. 16 2.1. Herkunft und Aufbau der Endotoxine ........................................ 16 2.1.1. Struktur der Zellwand der gram-negativen Bakterien .............. 16 2.1.2. Chemische Struktur der Endotoxine ............................................ 17 2.1.2.1. Das O-spezifische Polysaccharid .................................................. 18 2.1.2.2. Das Kern-Oligosaccharid ............................................................... 18 2.1.2.3. Das Lipoid-A .................................................................................... 19 2.2. Biologische Wirkung der Endotoxine .......................................... 22 2.2.1. Bindung der LPS und Aktivierung der Zellen ........................... 23 Endotoxinrezeptoren im Plasma ...................................... 24 Endotoxinrezeptoren auf der Zellmembran .................... 24 2.2.2. Freisetzung und biologische Wirkung der Vermittlermoleküle ........................................................................ 25 2.2.2.1. Lipide .............................................................................................. 25 Prostaglandine (PG) .......................................................... 26 Leukotriene (LT) ................................................................. 29 2.2.2.2. Proteine ........................................................................................... 29 Tumor-Nekrose-Faktor und Interleukin-1 ..................... 30 Interleukin-8 ........................................................................ 32 Akute-Phase-Antwort und Interleukin-6 ........................ 33 2.2.2.3. Andere endogene Mediatoren ...................................................... 35 2.2.3. Experimentelle Erfahrungen .......................................................... 37 2.3. Die Darmmikroflora des Pferdes als Ausgangspunkt für die Entstehung einer Endotoxämie ........................................ 38 2.4. Darmkanal/Blut-Schranke für Endotoxine; Rolle der Leber .... 41 2.5. Endotoxine und Krankheiten des Pferdes .................................. 42 2.5.1. Hämodynamische und hämostatische Anomalien .................... 43 2.5.1.1. Der Schock ........................................................................................ 43 2.5.1.2. Disseminierte intravasale Gerinnung (DIG) ................................ 44 Labor-Nachweisverfahren: ................................................. 46 Thrombozyten .......................................................... 46 Antithrombin III ....................................................... 46 Fibrin/Fibrinogen-Degradationsprodukte .......... 48 Fibrinogen ................................................................. 48 Andere hämostatische Parameter .......................... 49 2.5.2. Magen-Darm-Erkrankungen des Pferdes ................................... 50 Begriffsbestimmung: Kolik ................................................ 50 2.5.2.1. Endotoxämie bei Magen-Darm-Koliken ..................................... 51 2.5.2.2. Begleiterkrankungen, die sich durch die Wirkung der Endotoxine aus Magen-Darm-Koliken entwickeln ................... 54 2.5.2.3. Kolitis, Typhlokolitis ..................................................................... 56 Kolitis .................................................................................... 56 Typhlokolitis ....................................................................... 58 Klinisches Bild ......................................................... 59 Pathomorphologische Befunde ............................. 60 Ätiologie und Pathogenese .................................... 62 2.5.2.4. Laktat-Azidose und Anion gap bei Pferden mit Magen-Darm-Kolik ......................................................................... 66 2.6. Therapeutische Möglichkeiten zur Bekämpfung der Endotoxämie .................................................................................... 68 2.6.1. Hemmung der Zytokininduktion durch Lipoid-A-Teilstrukturen ................................................................ 69 2.6.2. Anwendung von entzündungshemmenden Präparaten .......... 70 2.6.3. Infusionstherapie ............................................................................ 72 2.6.4. Eine alternative Möglichkeit zur Vorbeugung der Endotoxinwirkung durch Fütterungsmaßnahmen .................... 73 2.6.5. Antiendotoxische Immuntherapie ............................................... 73 2.6.6. Endotoxinneutralisierendes Protein ............................................ 76 3. EIGENE UNTERSUCHUNGEN ................................................... 77 3.1. Material ............................................................................................. 77 3.2. Methodik .......................................................................................... 79 3.2.1. Angewandte Materialien ............................................................... 79 3.2.2. Gewinnung der Proben .................................................................. 81 3.2.3. Endotoxinbestimmung .................................................................. 82 3.2.3.1. Analysator ........................................................................................ 82 3.2.3.2. Reagenzien ....................................................................................... 82 3.2.3.3. Herstellung der Reaktionsansätze ................................................ 83 3.2.3.4. Analyse ............................................................................................. 83 Reaktionsprinzip ................................................................. 83 Standardisierung ................................................................. 84 Probenbehandlung .............................................................. 84 Beschickung der Mikroküvette ......................................... 85 Erstellung der Standardkurve ........................................... 86 3.2.4. Fibrinogenbestimmung .................................................................. 88 3.2.4.1. Reagenzien ....................................................................................... 88 3.2.4.2. Analyse ............................................................................................. 89 Reaktionsprinzip ................................................................. 89 Standard ................................................................................ 89 Plasmaproben ....................................................................... 90 3.2.5. Erklärung zum Index Endotoxin/Fibrinogen ............................ 90 3.2.6. Bestimmung der Antithrombin III-Aktivität .............................. 91 Reaktionsprinzip ................................................................. 92 3.2.7. Anion gap-Bestimmung ................................................................ 92 3.2.8. Enzymaktivitätsbestimmung ........................................................ 92 3.2.9. Statistische Auswertung ................................................................ 93 Erklärung zu Pearson Korrelationskoeffizienten und der Zeichen der Differenzsignifikanz ...................... 94 Erklärung der Elemente des Plot-Box-Diagrammes ...... 94 3.3. Ergebnisse ........................................................................................ 96 3.3.1. Vergleich der Ergebnisse der klinisch gesunden Pferde und der Pferde mit Kolik .................................................. 96 3.3.2. Untersuchungsergebnisse der Kolikpatienten ........................... 99 3.3.2.1. Ergebnisse der Endotoxinbestimmung ..................................... 101 3.3.2.2. Ergebnisse der Fibrinogenbestimmung ..................................... 104 3.3.2.3. Vergleich der Parameter Endotoxin – Fibrinogen; Index Endotoxin/Fibrinogen ...................................................... 106 3.3.2.4. Ergebnisse der Voruntersuchungen der AT-III-Aktivität im Plasma .......................................................... 109 3.3.2.5. Ergebnisse der Anion gap-Bestimmung .................................... 110 3.3.2.6. Ergebnisse der Enzymaktivitätsbestimmung ........................... 112 3.3.2.7. Vergleich der Ergebnisse von konservativ und chirurgisch behandelten Patienten ............................................. 114 3.3.2.8. Vergleich der Ergebnisse von überlebenden und verendeten Patienten ............................................................ 117 3.3.3. Korrelationsanalyse der Meßparameter .................................... 119 4. DISKUSSION ............................................................................................ 122 4.1. Endotoxine ..................................................................................... 122 Aufgabe und Methodik .................................................... 122 Endotoxine bei gesunden Pferden .................................. 123 Endotoxine bei Pferden mit Kolik .................................. 124 4.2. Endotoxämie und Magen-Darm-Koliken ................................. 125 4.3. Endotoxine und Fieber ................................................................. 127 4.4. Begleiterkrankungen der Magen-Darm-Koliken ..................... 128 Disseminierte intravasale Gerinnung ............................. 128 Hufrehe ............................................................................... 129 Typhlokolitis; Salmonelleninfektion ............................... 130 4.5. Anion gap ....................................................................................... 131 4.6. Schlußwort ..................................................................................... 131 5. ZUSAMMENFASSUNG .......................................................................... 133 6. SUMMARY ................................................................................................ 135 7. LITERATURVERZEICHNIS .................................................................... 137 8. ANHANG ................................................................................................... 160

Le diabète de type 2 (DT2) est caractérisé par une résistance des tissus périphériques à l’action de l’insuline et par une insuffisance de la sécrétion d’insuline par les cellules β du pancréas. Différents facteurs tels que le stress du réticulum endoplasmique (RE) et l’immunité innée affectent la fonction de la cellule β-pancréatique. Toutefois, leur implication dans la régulation de la transcription du gène de l’insuline demeure imprécise. Le but de cette thèse était d’identifier et de caractériser le rôle du stress du RE et de l’immunité innée dans la régulation de la transcription du gène de l’insuline. Les cellules β-pancréatiques ont un RE très développé, conséquence de leur fonction spécialisée de biosynthèse et de sécrétion d’insuline. Cette particularité les rend très susceptible au stress du RE qui se met en place lors de l’accumulation de protéines mal repliées dans la lumière du RE. Nous avons montré qu’ATF6 (de l’anglais, activating transcription factor 6), un facteur de transcription impliqué dans la réponse au stress du RE, lie directement la boîte A5 de la région promotrice du gène de l’insuline dans les îlots de Langerhans isolés de rat. Nous avons également montré que la surexpression de la forme active d’ATF6α, mais pas ATF6β, réprime l’activité du promoteur de l’insuline. Toutefois, la mutation ou l’absence de la boîte A5 ne préviennent pas l’inhibition de l’activité promotrice du gène de l’insuline par ATF6. Ces résultats montrent qu’ATF6 se lie directement au promoteur du gène de l’insuline, mais que cette liaison ne semble pas contribuer à son activité répressive. Il a été suggéré que le microbiome intestinal joue un rôle dans le développement du DT2. Les patients diabétiques présentent des concentrations plasmatiques élevées de lipopolysaccharides (LPS) qui affectent la fonction de la cellule β-pancréatique. Nous avons montré que l’exposition aux LPS entraîne une réduction de la transcription du gène de l’insuline dans les îlots de Langerhans de rats, de souris et humains. Cette répression du gène de l’insuline par les LPS est associée à une diminution des niveaux d’ARNms de gènes clés de la cellule β-pancréatique, soit PDX-1 (de l’anglais, pancreatic duodenal homeobox 1) et MafA (de l’anglais, mammalian homologue of avian MafA/L-Maf). En utilisant un modèle de souris déficientes pour le récepteur TLR4 (de l’anglais, Toll-like receptor), nous avons montré que les effets délétères des LPS sur l’expression du gène de l’insuline sollicitent le récepteur de TLR4. Nous avons également montré que l’inhibition de la voie NF-kB entraîne une restauration des niveaux messagers de l’insuline en réponse à une exposition aux LPS dans les îlots de Langerhans de rat. Ainsi, nos résultats montrent que les LPS inhibent le gène de l’insuline dans les cellules β-pancréatiques via un mécanisme moléculaire dépendant du récepteur TLR4 et de la voie NF-kB. Ces observations suggèrent ainsi un rôle pour le microbiome intestinal dans la fonction de la cellule β du pancréas. Collectivement, ces résultats nous permettent de mieux comprendre les mécanismes moléculaires impliqués dans la répression du gène de l'insuline en réponse aux divers changements survenant de façon précoce dans l’évolution du diabète de type 2 et d'identifier des cibles thérapeutiques potentielles qui permettraient de prévenir ou ralentir la détérioration de l'homéostasie glycémique au cours de cette maladie, qui affecte plus de deux millions de Canadiens. / Type 2 diabetes is characterized by insulin resistance and impaired insulin secretion from the pancreatic β-cell. Endoplasmic reticulum (ER) stress and innate immunity have both been reported to alter pancreatic β-cell function. However, it is not clear whether these factors can affect the transcription of the insulin gene. The aim of this thesis was to assess the role of ER stress and innate immunity in the regulation of the insulin gene. Pancreatic β-cells have a well-developed endoplasmic reticulum (ER) due to their highly specialized secretory function to produce insulin in response to glucose and nutrients. In a first study, using several approaches we showed that ATF6 (activating transcription factor 6), a protein implicated in the ER stress response, directly binds to the A5/Core of the insulin gene promoter in isolated rat islets. We also showed that overexpression of the active (cleaved) fragment of ATF6α, but not ATF6β, inhibits the activity of an insulin promoter-reporter construct. However, the inhibitory effect of ATF6α was insensitive to mutational inactivation or deletion of the A5/Core. Therefore, although ATF6 binds directly to the A5/Core of the rat insulin II gene promoter, this direct binding does not appear to contribute to its repressive activity. In recent years, the gut microbiota was proposed has an environmental factor increasing the risk of type 2 diabetes. Subjects with diabetes have higher circulating levels of lipopolysaccharides (LPS) than non-diabetic patients. Recent observations suggest that the signalling cascade activated by LPS binding to Toll-Like Receptor 4 (TLR4) exerts deleterious effects on pancreatic β-cell function; however, the molecular mechanisms of these effects are incompletely understood. We showed that exposure of isolated human, rat and mouse islets of Langerhans to LPS dose-dependently reduced insulin gene expression. This was associated in mouse and rat islets with decreased mRNA expression of two key transcription factors of the insulin gene, PDX-1 (pancreatic duodenal homeobox 1) and MafA (mammalian homologue of avian MafA/L-Maf). LPS repression of insulin, PDX-1 and MafA expression was not observed in islets from TLR4-deficient mice and was completely prevented in rat islets by inhibition of the NF-kB signalling pathway. These results demonstrate that LPS inhibits β-cell gene expression in a TLR4-dependent manner and via NF-kB signaling in pancreatic islets, suggesting a novel mechanism by which the gut microbiota might affect pancreatic β-cell function. Our findings provide a better understanding of the molecular mechanisms underlying insulin gene repression in type 2 diabetes, and suggest potential therapeutic targets that might prevent or delay the decline of β-cell function in the course of type 2 diabetes, which affects more than two million Canadians.

Le diabète de type 2 (DT2) est caractérisé par une résistance des tissus périphériques à l’action de l’insuline et par une insuffisance de la sécrétion d’insuline par les cellules β du pancréas. Différents facteurs tels que le stress du réticulum endoplasmique (RE) et l’immunité innée affectent la fonction de la cellule β-pancréatique. Toutefois, leur implication dans la régulation de la transcription du gène de l’insuline demeure imprécise. Le but de cette thèse était d’identifier et de caractériser le rôle du stress du RE et de l’immunité innée dans la régulation de la transcription du gène de l’insuline. Les cellules β-pancréatiques ont un RE très développé, conséquence de leur fonction spécialisée de biosynthèse et de sécrétion d’insuline. Cette particularité les rend très susceptible au stress du RE qui se met en place lors de l’accumulation de protéines mal repliées dans la lumière du RE. Nous avons montré qu’ATF6 (de l’anglais, activating transcription factor 6), un facteur de transcription impliqué dans la réponse au stress du RE, lie directement la boîte A5 de la région promotrice du gène de l’insuline dans les îlots de Langerhans isolés de rat. Nous avons également montré que la surexpression de la forme active d’ATF6α, mais pas ATF6β, réprime l’activité du promoteur de l’insuline. Toutefois, la mutation ou l’absence de la boîte A5 ne préviennent pas l’inhibition de l’activité promotrice du gène de l’insuline par ATF6. Ces résultats montrent qu’ATF6 se lie directement au promoteur du gène de l’insuline, mais que cette liaison ne semble pas contribuer à son activité répressive. Il a été suggéré que le microbiome intestinal joue un rôle dans le développement du DT2. Les patients diabétiques présentent des concentrations plasmatiques élevées de lipopolysaccharides (LPS) qui affectent la fonction de la cellule β-pancréatique. Nous avons montré que l’exposition aux LPS entraîne une réduction de la transcription du gène de l’insuline dans les îlots de Langerhans de rats, de souris et humains. Cette répression du gène de l’insuline par les LPS est associée à une diminution des niveaux d’ARNms de gènes clés de la cellule β-pancréatique, soit PDX-1 (de l’anglais, pancreatic duodenal homeobox 1) et MafA (de l’anglais, mammalian homologue of avian MafA/L-Maf). En utilisant un modèle de souris déficientes pour le récepteur TLR4 (de l’anglais, Toll-like receptor), nous avons montré que les effets délétères des LPS sur l’expression du gène de l’insuline sollicitent le récepteur de TLR4. Nous avons également montré que l’inhibition de la voie NF-kB entraîne une restauration des niveaux messagers de l’insuline en réponse à une exposition aux LPS dans les îlots de Langerhans de rat. Ainsi, nos résultats montrent que les LPS inhibent le gène de l’insuline dans les cellules β-pancréatiques via un mécanisme moléculaire dépendant du récepteur TLR4 et de la voie NF-kB. Ces observations suggèrent ainsi un rôle pour le microbiome intestinal dans la fonction de la cellule β du pancréas. Collectivement, ces résultats nous permettent de mieux comprendre les mécanismes moléculaires impliqués dans la répression du gène de l'insuline en réponse aux divers changements survenant de façon précoce dans l’évolution du diabète de type 2 et d'identifier des cibles thérapeutiques potentielles qui permettraient de prévenir ou ralentir la détérioration de l'homéostasie glycémique au cours de cette maladie, qui affecte plus de deux millions de Canadiens. / Type 2 diabetes is characterized by insulin resistance and impaired insulin secretion from the pancreatic β-cell. Endoplasmic reticulum (ER) stress and innate immunity have both been reported to alter pancreatic β-cell function. However, it is not clear whether these factors can affect the transcription of the insulin gene. The aim of this thesis was to assess the role of ER stress and innate immunity in the regulation of the insulin gene. Pancreatic β-cells have a well-developed endoplasmic reticulum (ER) due to their highly specialized secretory function to produce insulin in response to glucose and nutrients. In a first study, using several approaches we showed that ATF6 (activating transcription factor 6), a protein implicated in the ER stress response, directly binds to the A5/Core of the insulin gene promoter in isolated rat islets. We also showed that overexpression of the active (cleaved) fragment of ATF6α, but not ATF6β, inhibits the activity of an insulin promoter-reporter construct. However, the inhibitory effect of ATF6α was insensitive to mutational inactivation or deletion of the A5/Core. Therefore, although ATF6 binds directly to the A5/Core of the rat insulin II gene promoter, this direct binding does not appear to contribute to its repressive activity. In recent years, the gut microbiota was proposed has an environmental factor increasing the risk of type 2 diabetes. Subjects with diabetes have higher circulating levels of lipopolysaccharides (LPS) than non-diabetic patients. Recent observations suggest that the signalling cascade activated by LPS binding to Toll-Like Receptor 4 (TLR4) exerts deleterious effects on pancreatic β-cell function; however, the molecular mechanisms of these effects are incompletely understood. We showed that exposure of isolated human, rat and mouse islets of Langerhans to LPS dose-dependently reduced insulin gene expression. This was associated in mouse and rat islets with decreased mRNA expression of two key transcription factors of the insulin gene, PDX-1 (pancreatic duodenal homeobox 1) and MafA (mammalian homologue of avian MafA/L-Maf). LPS repression of insulin, PDX-1 and MafA expression was not observed in islets from TLR4-deficient mice and was completely prevented in rat islets by inhibition of the NF-kB signalling pathway. These results demonstrate that LPS inhibits β-cell gene expression in a TLR4-dependent manner and via NF-kB signaling in pancreatic islets, suggesting a novel mechanism by which the gut microbiota might affect pancreatic β-cell function. Our findings provide a better understanding of the molecular mechanisms underlying insulin gene repression in type 2 diabetes, and suggest potential therapeutic targets that might prevent or delay the decline of β-cell function in the course of type 2 diabetes, which affects more than two million Canadians.

Sepse, a resposta do organismo a uma infecção, está associada a altas taxas de mortalidade. A razão pela qual um mecanismo protetor resulta num quadro clínico fatal permanece inexplicada. Em trabalho prévio nosso grupo demonstrou que exossomos de origem plaquetária são os mais freqüentes em plasma de pacientes com choque séptico e que estes podem induzir apoptose em células musculares lisas vasculares e células endoteliais em cultura. Demonstramos ainda que tais exossomos possuíam uma fonte enzimática de ROS, uma NADPH oxidase cuja atividade poderia estar associada à indução da apoptose (Janiszewski et al., 2004). No presente trabalho, nós buscamos criar um modelo de geração ex vivo de exossomos similares aos encontrados em pacientes sépticos e identificar possíveis vias responsáveis pela liberação destes e seus efeitos. Choque séptico é uma condição relacionada com exposição a lipopolissacarídeo (LPS) e geração de alta quantidade de trombina, TNF e espécies reativas de nitrogênio. Através de citometria de fluxo revelamos que plaquetas humanas expostas ao doador de NO dietilamina-NONOato e ao LPS geraram exossomos similares àqueles encontrados em pacientes com choque séptico, expondo alta quantidade de tetraspaninas CD9, CD63 e CD81 mas pouca fosfatidilserina. Por outro lado, plaquetas expostas à trombina ou TNF liberaram partículas com características claramente distintas, com alta exposição de fosfatidilserina e baixa de tetraspaninas. Assim como os exossomos sépticos, os exossomos obtidos pela exposição de NO e LPS geraram radical superóxido e NO, como demonstrado pela quimioluminescência da lucigenina (5M) e celenterazinina (5M) e pela fluorescência da 4,5-diaminofluoresceína (10mM) e 2,7-diclorofluoresceína (10mM). A análise por Western Blot nos permitiu identificar as subunidades Nox1, Nox2 e p22phox da NADPH oxidase e a isoforma induzível da enzima NO sintase (NOS) nesses exossomos. Como esperado, inibidores da NOS e da NADPH oxidase reduziram significamente os sinais fluorescentes e quimioluminescentes. Em adição, as células endoteliais em cultura expostas aos exossomos gerados por dietilamina-NONOato e LPS sofreram significativo aumento da taxa de apoptose quando comparadas àquelas expostas a exossomos controle. A inibição da NADPH oxidase assim como da NOS reduziu expressivamente tal efeito. Adição de urato (1mM), mostrou efeito aditivo sobre a inibição do sinal fluorescente, assim como redução adicional da taxa apoptótica, sugerindo papel importante do radical peroxinitrito. Nós propomos, assim, que exossomos derivados de plaquetas podem representar papel adicional no já complexo cenário da sinalização vascular redox. Nesse sentido, uma abordagem baseada em exossomos pode fornecer novas ferramentas para o entendimento e até tratamento da disfunção vascular na sepse / Sepsis, the bodys response to infection, is associated with high mortality rates. Why a protective mechanism turns into a deadly clinical picture is a matter of debate, and goes largely unexplained. In previous work we demonstrated that plateled derived exosomes are found in the plasma of septic patients with septic shock and can induce endothelial and vascular smooth muscle cell apoptosis in culture through an enzymatic superoxide source (Janiszewski et al., 2004). In this work we sought to create a model for ex vivo generation of exosomes, and to identify the pathways responsible for ROS release by exosomes and their effects. Septic shock is a condition related to exposure of lipopolysaccharide (LPS), generation of high amounts of thrombin, TNF and nitrogen reactive species. Through flow cytometry we demonstrated that human platelets exposed to the NO-donor diethylamine-NONOate, and to LPS, generated exosomes similar to those found in the blood of septic shock patients, with high exposure of the tetraspanin CD9, CD63, and CD81, but little phosphatidylserine. On the other hand, platelets exposed to thrombin or TNF released particles with clearly distinct characteristics, such as high phosphatidylserine and low tetraspanin. Like the septic exosomes, the exosomes obtained by NO and LPS exposure generated superoxide radical and NO, as disclosed by lucigenin and coelenterazine chemiluminescence and by 4,5-diaminofluorescein and 2,7-dichlorofluorescein fluorescence. Western Blot analysis revealed the presence of Nox1, Nox2 and p22phox NADPH oxidase subunits and the inducible isoform of NO synthase (NOS) in these exosomes. As expected, NOS inhibitors or NADPH oxidase inhibitors significantly reduced the fluorescence and chemiluminescente signals. In addition, endothelial cells exposed to NO or LPS generated exosomes underwent apoptotic death, while control exosomes had no effects on apoptosis. NADPH oxidase as well as NOS inhibition significantly reduced apoptosis rates. Concomitant generation of NO and superoxide suggests biological effects of the highly reactive radical peroxynitrite. In fact, the peroxynitrite scavenger urate (1 mM) showed an additive effect on fluorescent signal inhibition, as well as on endothelial apoptosis rate reduction. We thus propose that platelet-derived exosomes may be another class of actors in the complex play known as vascular redox signaling. In this sense, an exosome-based approach can provide novel tools for further understanding and even treating vascular dysfunction related to sepsis

Lipopolissacarídeos (LPS), pode tanto proteger quanto exacerbar o desenvolvimento da asma. LPS inicia a ativação da resposta imune via ligação da molécula Toll-like receptor 4 (TLR4) que sinaliza por duas vias distintas, as moléculas adaptadoras MyD88 e TRIF. LPS é um adjuvante que induz resposta do tipo Th1, enquanto que o hidróxido de alumínio (Alum) desperta respostas Th2, porém, a mistura de ambos adjuvantes na indução da resposta alérgica pulmonar ainda não foi investigada. No presente estudo, nós determinamos o efeito de dois agonistas de TLR4, um natural (LPS) e outro sintético (ER-803022) adsorvidos ao Alum sobre o desenvolvimento de doença alérgica pulmonar. Os animais foram sensibilizados pela via subcutânea com os antígenos, Ovoalbumina (OVA) ou Toxóide Tetânico (TT) na presença ou ausência de agonistas de TLR4 co-adsorvidos ao Alum e desafiados com os respectivos antígenos pela via intranasal. Nossos resultados mostraram que a sensibilização com OVA ou TT e LPS coadsorvidos ao Alum, impede o estabelecimento da resposta alérgica mediada por linfócitos Th2, tais como, influxo de eosinófilos, produção de citocinas do tipo 2, hiperreatividade brônquica, secreção de muco, e produção de IgE ou IgG1 anafilática. Apesar dos níveis de IgG2a, isotipo associado com as respostas Th1 estarem aumentados, análise da histopatologia pulmonar não revelou um desvio para o padrão Th1 de inflamação. Verificamos que a presença das moléculas TLR4, MyD88, IL-12/IFN-g mas não TRIF foram necessários para LPS exercer seu efeito inibitório. O agonista sintético de TLR4, menos tóxico que LPS, também protegeu contra o desenvolvimento de inflamação alérgica pulmonar. Em conclusão, nosso trabalho esclarece o efeito da sinalização do TLR4 na sensibilização alérgica e indica que agonista sintético de TLR4 com baixa toxicidade, pode ser utilizado para modular a capacidade adjuvante do Alum e conseqüentemente diminuir a indução de alergias. / Epidemiological and experimental data suggest that bacterial lipopolysaccharides (LPS) can either protect from or exacerbate allergic asthma. LPS triggers immune responses through Toll-like receptor (TLR) 4 that in turn activates two major signaling pathways via either MyD88 or TRIF adaptor proteins. LPS is a pro-Th1 adjuvant while aluminum hydroxide (Alum) is a strong Th2 adjuvant, but the effect of mixing both adjuvants on development of lung allergy has not been investigated. We determined whether natural (LPS) or synthetic (ER-803022) TLR4 agonists adsorbed onto alum adjuvant affect allergen sensitization and development of airway allergic disease. To dissect LPS-induced molecular pathways we used TLR4, MyD88, TRIF, or IL-12/IFN-g deficient mice. Mice were sensitized subcutaneously to allergens such as ovalbumin (OVA) or tetanus toxoid (TT) with or without TLR4 agonists coadsorbed onto Alum and challenged twice via intranasal route with the same allergens. The development of type 2 immunity was evaluated 24 h after last allergen challenge. We found that sensitization with OVA or TT plus LPS co-adsorbed onto Alum impaired allergeninduced Th2-mediated responses such as airway eosinophilia, type 2 cytokines secretion, airway hyperreactivity, mucus hyper production and serum levels of IgE or IgG1 anaphylactic antibodies. Although the levels of IgG2a, a Th1 affiliated isotype increased, investigation into the lung-specific effects revealed that LPS did not induce a Th1 pattern of inflammation. LPS impaired the development of Th2 immunity, signaling via TLR4 and MyD88 molecules via the IL-12/IFN-g axis, but not through TRIF pathway. Moreover, the synthetic TLR4 agonists that proved to have a less systemic inflammatory response than LPS also protected against allergic asthma development. TLR4 agonists co-adsorbed with allergen onto Alum down modulate Th2 immunity and prevent the development of polarized T cell-mediated airway inflammation. Thus, our work clarifies the effect of TLR4 signaling in allergic sensitization and indicates that TLR4 agonists with low toxicity might be useful for down regulating the pro-Th2 adjuvant activity of alum and consequently decrease the induction of allergy.

INTRODUÇÃO: O receptor tipo Toll 4 (TLR4) pertencente a uma família de receptores do sistema imune inato, reconhece o padrão molecular de lipopolissacarídeos (LPS), expressos por bactérias Gram negativas. Sua cascata de sinalização, nas células apresentadoras de antígeno, ocorre por duas vias principais: MyD88-dependente, que resulta na ativação de NF-B e na expressão de genes de resposta inflamatória e MyD88-independente, responsável pela ativação dos fatores IRF3 e IRF7, culminando na síntese de interferons e , envolvidos na resposta anti-viral e anti-bacteriana. Células não-imunes, de diversos tecidos, também expressam TLR4, incluindo células pancreáticas murinas e humanas. Devido ao seu papel nos processos inflamatórios, os TLR estão implicados em doenças crônicas como obesidade e diabetes. Estudo anterior do grupo identificou TLR4 como uma molécula que ativa sinais inflamatórios e provoca alterações na homeostase das células . Neste trabalho, investigamos qual via é ativada por LPS e quais os efeitos da expressão do TLR4 na viabilidade celular e na produção de insulina em células murinas. MÉTODOS: Células MIN6 (linhagem celular de insulinoma de camundongo) foram cultivadas em condições de hipo (2,8mM glicose), normo (5,6mM glicose) e hiperglicemia (11,2mM glicose), por 4 dias. Após esse período, foi adicionado LPS (50 ng/mL) por 48h e foram feitas análises por PCR em tempo real, Western Blot, ELISA e citometria de fluxo. RESULTADOS: Os resultados confirmam o aumento de TLR4 em células em condições de hiperglicemia e a via de sinalização ativada por LPS é a via MyD88-dependente, envolvida na produção de citocinas pró-inflamatórias. A via de indução de intérferons tipo 1 está ausente nestas células. Além disso, TLR4 ativado por LPS aumentou secreção de insulina em resposta a glicose, mas não induziu a morte celular. CONCLUSÃO: A expressão de TLR4 em células pancreáticas murinas é induzida em resposta ao aumento da glicemia, constituindo um novo elo entre a agressão à célula causada por altos níveis de glicose e a alteração da função celular induzida por LPS / INTRODUCTION: Toll-like receptor 4 (TLR4) belongs to a family of innate immunity receptors and recognizes the molecular pattern present in lipopolysaccharides (LPS), typical of Gram-negative bacteria. There are two TLR4 signaling pathways, typically in antigen-presenting cells: one is MyD88-dependent, activating NF-kB transcription factor and triggering inflammatory cytokine production and the other is MyD88-independent, leading to activation of IRF3 and IRF-7 and production of interferons e , involved in antiviral and antibacterial immune responses. Non-immune cells in several tissues also express TLR4, including human and murine pancreatic cells. Due to their role in inflammatory processes, TLRs have been implicated in chronic diseases like obesity and diabetes. Our previous study identified TLR4 as a molecule which activates inflammatory signals and induces changes in cell homeostasis. In this study, we investigated which of the TLR4 pathways is activated by LPS and the effects of glucose levels on cell viability and insulin production in a mouse insulinoma cell line. METHODS: MIN6 cells were maintained in low (2,8mM), normal (5,6mM) and high (11,2mM) glucose levels for 4 days, and then incubated with LPS (50 ng/mL) for 48 hours. Analyses were done by real-time PCR, Western Blot, ELISA and flow cytometry. RESULTS: Analysis confirmed increase in TLR4 gene expression in hyperglycemic conditions and showed that the signaling pathway activated by LPS is MyD88-dependent. The interferon induction pathway is absent in these cells. Furthermore, upon activation by LPS, TLR4 impacts on insulin secretion in response to glucose, but without triggering cell death. CONCLUSION: We conclude that TLR4 expression in mouse pancreatic cells is induced in response to increased glucose levels, constituting a new link in the chain of events leading to cell stress caused by high glucose levels with concomitant changes in cell function induced by LPS

Sepse é uma resposta inflamatória inapropriada desencadeada pela presença de bactérias e/ou produtos bacterianos como lipopolissacarídeos (LPS). A sepse grave e o choque séptico estão associados a taxas de mortalidade de 40 a 60%. A falência respiratória está entre as mais frequentes complicações da sepse grave, ocorrendo em quase 80% dos casos. Cerca de 40% dos pacientes com sepse desenvolvem a síndrome do desconforto respiratório agudo (SDRA), caracterizada principalmente pela alteração da função respiratória, surgimento de edema intersticial pulmonar e deposição de colágeno nos pulmões. Embora a reposição volêmica seja normalmente utilizada em pacientes sépticos, não há consenso quanto ao volume a ser administrado, sendo atualmente recomendada a utilização de pequenos volumes. Neste contexto, a solução salina hipertônica (NaCl 7,5%, SH) tem sido apresentada como um potencial agente terapêutico. Visando contribuir para o conhecimento dos benefícios da solução salina hipertônica (SH) na sepse, o presente trabalho teve como objetivo avaliar a ação do tratamento precoce e tardio com solução hipertônica no pulmão de ratos endotoxêmicos. Ratos Wistar foram separados em 4 grupos (n=10): CTL (sem nenhum insulto ou tratamento); LPS (injetados com LPS 10mg/Kg i.p); HIPER (animais que receberam tratamento com solução hipertônica 7,5% NaCl i.p na dose de 4ml/Kg 15 min. ou 1,5 horas após injeção de LPS) e SALINA ((animais que receberam tratamento com solução salina 0,9% NaCl i.p na dose de 34ml/Kg 15 min. ou 1,5 horas após injeção de LPS). Foram avaliados a mortalidade, e após 24 horas o edema e a mecânica pulmonar, os colágenos tipo I e tipo III, a expressão e atividade da MMP-9, a expressão de FAK e a síntese de óxido nítrico (NO). Nossos resultados mostraram que o tratamento precoce com solução hipertônica evitou a morte dos animais endotoxêmicos. Nenhum dos tratamentos modulou os mediadores inflamatórios. O tratamento precoce com solução hipertônica diminuiu a síntese de iNOS e nitrito, a expressão e atividade de MMP-9 e de FAK, junto com a deposição de colágeno tipo I evitando a substituição do colágeno III. Observamos melhora dos parâmetros de mecânica respiratória. O tratamento tardio com solução hipertônica não apresentou os mesmos resultados promissores observados no tratamento precoce, sugerindo que o tempo de administração da hipertônica é de grande importância para obtenção de seus efeitos terapêuticos / Sepsis syndrome is caused by inappropriate immune activation due to bacteria and bacterial components released during infection. The respiratory failure is among the most frequent complication of severe sepsis, occurring in almost 80% of the cases. About 40% of septic patients develop acute respiratory distress syndrome (ARDS) which is characterized mainly by the change of respiratory function, interstitial lung edema and fibronectin and collagen deposition in the lung. Fluid resuscitation is normally used in the management of patients with severe sepsis and septic shock. Hypertonic saline solution (HS, NaCl 7,5%) has shown to modulates immune function and decrease pulmonary injury triggered by endotoxemic shock. Our objective was to investigate the effects of early and later HS treatment on the mechanism involved in pulmonary injury, in an experimental model of endotoxemic shock. Wistar rats received lipopolysaccharide - LPS (10mg/kg i.p.) and volume i.v. after 15 minutes (early) or 1,5 hours (later). The animals were assigned in four groups (n=10): control group (not subjected to LPS); LPS group (injected with LPS 10mg/kg i.p); HS group (treated with hypertonic saline, 4 mL/Kg i.v. after LPS) and NS group (treated with normal saline, 34 mL/kg i.v. after LPS). We evaluated mortality and at 24h after treatment, pulmonary edema and mechanics, type I and type III collagen expression, metalloproteinase 9 expression and activity, focal adhesion kinase (FAK) and nitric oxide (NO) synthesis were measured. In the early treatment NS increased pulmonary resistance and elastance, compared to other groups. HS inhibited collagen expression compared to LPS and NS groups and prevented pulmonary injury by decreasing MMP-9 activity in tissue. Expression of FAK was decreased in HS groups compared to LPS and NS groups. NO expression was decreased in HS group, compared to LPS and NS groups. The later treatment with HS did not showed improvement of previous parameters increasing mortality and pulmonary injury. We concluded that HS treatment of endotoxemic shock at the earliest possible time point maximizes its efficacy in preventing pulmonary injury probably acting on nitric oxide-induced FAK activation pathway, which could modulate the collagen deposition in pulmonary tissue, and consequently decrease the progression of pulmonary fibrosis. Later treatment with HS decreased beneficial effects of hypertonic saline observed in early infusion, showed the importance of timing in the result of fluid therapy

Sepse é uma resposta inflamatória inapropriada desencadeada pela presença de bactérias e/ou produtos bacterianos como lipopolissacarídeos (LPS). A sepse grave e o choque séptico estão associados a taxas de mortalidade de 40 a 60%. A falência respiratória está entre as mais frequentes complicações da sepse grave, ocorrendo em quase 80% dos casos. Cerca de 40% dos pacientes com sepse desenvolvem a síndrome do desconforto respiratório agudo (SDRA), caracterizada principalmente pela alteração da função respiratória, surgimento de edema intersticial pulmonar e deposição de colágeno nos pulmões. Embora a reposição volêmica seja normalmente utilizada em pacientes sépticos, não há consenso quanto ao volume a ser administrado, sendo atualmente recomendada a utilização de pequenos volumes. Neste contexto, a solução salina hipertônica (NaCl 7,5%, SH) tem sido apresentada como um potencial agente terapêutico. Visando contribuir para o conhecimento dos benefícios da solução salina hipertônica (SH) na sepse, o presente trabalho teve como objetivo avaliar a ação do tratamento precoce e tardio com solução hipertônica no pulmão de ratos endotoxêmicos. Ratos Wistar foram separados em 4 grupos (n=10): CTL (sem nenhum insulto ou tratamento); LPS (injetados com LPS 10mg/Kg i.p); HIPER (animais que receberam tratamento com solução hipertônica 7,5% NaCl i.p na dose de 4ml/Kg 15 min. ou 1,5 horas após injeção de LPS) e SALINA ((animais que receberam tratamento com solução salina 0,9% NaCl i.p na dose de 34ml/Kg 15 min. ou 1,5 horas após injeção de LPS). Foram avaliados a mortalidade, e após 24 horas o edema e a mecânica pulmonar, os colágenos tipo I e tipo III, a expressão e atividade da MMP-9, a expressão de FAK e a síntese de óxido nítrico (NO). Nossos resultados mostraram que o tratamento precoce com solução hipertônica evitou a morte dos animais endotoxêmicos. Nenhum dos tratamentos modulou os mediadores inflamatórios. O tratamento precoce com solução hipertônica diminuiu a síntese de iNOS e nitrito, a expressão e atividade de MMP-9 e de FAK, junto com a deposição de colágeno tipo I evitando a substituição do colágeno III. Observamos melhora dos parâmetros de mecânica respiratória. O tratamento tardio com solução hipertônica não apresentou os mesmos resultados promissores observados no tratamento precoce, sugerindo que o tempo de administração da hipertônica é de grande importância para obtenção de seus efeitos terapêuticos / Sepsis syndrome is caused by inappropriate immune activation due to bacteria and bacterial components released during infection. The respiratory failure is among the most frequent complication of severe sepsis, occurring in almost 80% of the cases. About 40% of septic patients develop acute respiratory distress syndrome (ARDS) which is characterized mainly by the change of respiratory function, interstitial lung edema and fibronectin and collagen deposition in the lung. Fluid resuscitation is normally used in the management of patients with severe sepsis and septic shock. Hypertonic saline solution (HS, NaCl 7,5%) has shown to modulates immune function and decrease pulmonary injury triggered by endotoxemic shock. Our objective was to investigate the effects of early and later HS treatment on the mechanism involved in pulmonary injury, in an experimental model of endotoxemic shock. Wistar rats received lipopolysaccharide - LPS (10mg/kg i.p.) and volume i.v. after 15 minutes (early) or 1,5 hours (later). The animals were assigned in four groups (n=10): control group (not subjected to LPS); LPS group (injected with LPS 10mg/kg i.p); HS group (treated with hypertonic saline, 4 mL/Kg i.v. after LPS) and NS group (treated with normal saline, 34 mL/kg i.v. after LPS). We evaluated mortality and at 24h after treatment, pulmonary edema and mechanics, type I and type III collagen expression, metalloproteinase 9 expression and activity, focal adhesion kinase (FAK) and nitric oxide (NO) synthesis were measured. In the early treatment NS increased pulmonary resistance and elastance, compared to other groups. HS inhibited collagen expression compared to LPS and NS groups and prevented pulmonary injury by decreasing MMP-9 activity in tissue. Expression of FAK was decreased in HS groups compared to LPS and NS groups. NO expression was decreased in HS group, compared to LPS and NS groups. The later treatment with HS did not showed improvement of previous parameters increasing mortality and pulmonary injury. We concluded that HS treatment of endotoxemic shock at the earliest possible time point maximizes its efficacy in preventing pulmonary injury probably acting on nitric oxide-induced FAK activation pathway, which could modulate the collagen deposition in pulmonary tissue, and consequently decrease the progression of pulmonary fibrosis. Later treatment with HS decreased beneficial effects of hypertonic saline observed in early infusion, showed the importance of timing in the result of fluid therapy

Sepse, a resposta do organismo a uma infecção, está associada a altas taxas de mortalidade. A razão pela qual um mecanismo protetor resulta num quadro clínico fatal permanece inexplicada. Em trabalho prévio nosso grupo demonstrou que exossomos de origem plaquetária são os mais freqüentes em plasma de pacientes com choque séptico e que estes podem induzir apoptose em células musculares lisas vasculares e células endoteliais em cultura. Demonstramos ainda que tais exossomos possuíam uma fonte enzimática de ROS, uma NADPH oxidase cuja atividade poderia estar associada à indução da apoptose (Janiszewski et al., 2004). No presente trabalho, nós buscamos criar um modelo de geração ex vivo de exossomos similares aos encontrados em pacientes sépticos e identificar possíveis vias responsáveis pela liberação destes e seus efeitos. Choque séptico é uma condição relacionada com exposição a lipopolissacarídeo (LPS) e geração de alta quantidade de trombina, TNF e espécies reativas de nitrogênio. Através de citometria de fluxo revelamos que plaquetas humanas expostas ao doador de NO dietilamina-NONOato e ao LPS geraram exossomos similares àqueles encontrados em pacientes com choque séptico, expondo alta quantidade de tetraspaninas CD9, CD63 e CD81 mas pouca fosfatidilserina. Por outro lado, plaquetas expostas à trombina ou TNF liberaram partículas com características claramente distintas, com alta exposição de fosfatidilserina e baixa de tetraspaninas. Assim como os exossomos sépticos, os exossomos obtidos pela exposição de NO e LPS geraram radical superóxido e NO, como demonstrado pela quimioluminescência da lucigenina (5M) e celenterazinina (5M) e pela fluorescência da 4,5-diaminofluoresceína (10mM) e 2,7-diclorofluoresceína (10mM). A análise por Western Blot nos permitiu identificar as subunidades Nox1, Nox2 e p22phox da NADPH oxidase e a isoforma induzível da enzima NO sintase (NOS) nesses exossomos. Como esperado, inibidores da NOS e da NADPH oxidase reduziram significamente os sinais fluorescentes e quimioluminescentes. Em adição, as células endoteliais em cultura expostas aos exossomos gerados por dietilamina-NONOato e LPS sofreram significativo aumento da taxa de apoptose quando comparadas àquelas expostas a exossomos controle. A inibição da NADPH oxidase assim como da NOS reduziu expressivamente tal efeito. Adição de urato (1mM), mostrou efeito aditivo sobre a inibição do sinal fluorescente, assim como redução adicional da taxa apoptótica, sugerindo papel importante do radical peroxinitrito. Nós propomos, assim, que exossomos derivados de plaquetas podem representar papel adicional no já complexo cenário da sinalização vascular redox. Nesse sentido, uma abordagem baseada em exossomos pode fornecer novas ferramentas para o entendimento e até tratamento da disfunção vascular na sepse / Sepsis, the bodys response to infection, is associated with high mortality rates. Why a protective mechanism turns into a deadly clinical picture is a matter of debate, and goes largely unexplained. In previous work we demonstrated that plateled derived exosomes are found in the plasma of septic patients with septic shock and can induce endothelial and vascular smooth muscle cell apoptosis in culture through an enzymatic superoxide source (Janiszewski et al., 2004). In this work we sought to create a model for ex vivo generation of exosomes, and to identify the pathways responsible for ROS release by exosomes and their effects. Septic shock is a condition related to exposure of lipopolysaccharide (LPS), generation of high amounts of thrombin, TNF and nitrogen reactive species. Through flow cytometry we demonstrated that human platelets exposed to the NO-donor diethylamine-NONOate, and to LPS, generated exosomes similar to those found in the blood of septic shock patients, with high exposure of the tetraspanin CD9, CD63, and CD81, but little phosphatidylserine. On the other hand, platelets exposed to thrombin or TNF released particles with clearly distinct characteristics, such as high phosphatidylserine and low tetraspanin. Like the septic exosomes, the exosomes obtained by NO and LPS exposure generated superoxide radical and NO, as disclosed by lucigenin and coelenterazine chemiluminescence and by 4,5-diaminofluorescein and 2,7-dichlorofluorescein fluorescence. Western Blot analysis revealed the presence of Nox1, Nox2 and p22phox NADPH oxidase subunits and the inducible isoform of NO synthase (NOS) in these exosomes. As expected, NOS inhibitors or NADPH oxidase inhibitors significantly reduced the fluorescence and chemiluminescente signals. In addition, endothelial cells exposed to NO or LPS generated exosomes underwent apoptotic death, while control exosomes had no effects on apoptosis. NADPH oxidase as well as NOS inhibition significantly reduced apoptosis rates. Concomitant generation of NO and superoxide suggests biological effects of the highly reactive radical peroxynitrite. In fact, the peroxynitrite scavenger urate (1 mM) showed an additive effect on fluorescent signal inhibition, as well as on endothelial apoptosis rate reduction. We thus propose that platelet-derived exosomes may be another class of actors in the complex play known as vascular redox signaling. In this sense, an exosome-based approach can provide novel tools for further understanding and even treating vascular dysfunction related to sepsis

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).