In the last decade, the potential of β-glucan, a fungal cell wall component, to induce epigenetic and functional modification of innate immune cells, signified as trained innate immunity (TII) has been demonstrated in several pre-clinical and clinical studies. Parenteral administration of β-glucan has resulted in centrally induced TII in the bone marrow/circulating monocytes. Such trained innate immune cells play a critical role in protection against secondary infections. However, there are now indications that inducing local long-lasting immunity at mucosal barrier tissues such as the lung is warranted for protective immunity against respiratory pathogens. Currently, it remains unclear whether respiratory mucosal administration of β-glucan will induce long-lasting resident-memory macrophages and TII and if so, what are the underlying mechanisms of development and maintenance of memory macrophages at respiratory mucosa. To address this, and kinetics of immune responses in the lung were studied. Profound changes in airway macrophage (AM) pools were observed starting from 3 days post-exposure, which was associated with monocyte recruitment, and this was followed by a series of phenotypic shifts in AMs. The altered AM phenotype profile persisted for up to 8 weeks post-exposure. Importantly, β-glucan-trained AMs demonstrated heightened MHC II expression, enhanced responses to secondary stimulation and improved capacity to perform bacterial phagocytosis. Furthermore, mice with, β-glucan-trained AMs displayed higher rates of survival and improved bacterial control, in the lung and periphery, following a lethal S. pneumoniae infection. Our findings together indicate that a single intranasal delivery of β-glucan is able to train AMs. Further work into epigenetics, metabolism, and the contribution of AMs in protection is needed. / Thesis / Master of Health Sciences (MSc) / The immune system has been classically divided into two major compartments known as the innate and adaptive immune system. For decades, the predominant consensus amongst the field was that only the adaptive immune system can form memory against any pathogens encountered. It has been well established that plants and invertebrates only possess an innate immune system and still show boosted responses and enhanced protection against previously encountered as well as new pathogens. Recently, such capacity for innate immune memory has also been demonstrated in humans and pre-clinical animal models. Innate immune memory provides non-specific, broad- spectrum protection whereas adaptive memory is specific to a singular pathogen. Inducing broad-spectrum protection can be crucial for the future of human medicine. Activation of both adaptive and innate immune arms could prove to be extremely beneficial in vaccination strategies. Through the use of a pre-clinical model, we have found that administering β-glucan, a component of fungal cell wall, directly into the lung significantly alters the phenotype and functionality of lung immune cells, and also provides enhanced protection against a heterologous infection.

<p>Majority of new HIV-1 infections world-wide occur via the genital tract. Therefore, achieving effective mucosal immunity will be a critical component of vaccine strategies in the prevention and control of infection during early stages of transmission itself. Rigorous efforts have been made to identify conserved epitopes and develop rational design of immunogens, in order to elicit broadly-reactive protective Abs against HIV. Newly emerging data have highlighted the significance of Ab effector functions other than classical IgG-mediated neutralization in HIV infection. In the studies contributing towards this thesis, an optimized vaccine model is described that successfully elicits potent systemic and mucosal Abs against the highly conserved epitopes of the membrane-proximal external region and the coiled coil region of gp41. Intriguing observations are reported on the IgA-inducing capacity of the coiled coil epitope, QARVLAVERY, which highlight the potential of this epitope as an attractive candidate for mucosal vaccines. Most importantly, the epitope-specific Abs proved to be functional in neutralizing HIV in a standardized assay. With particular relevance to mucosal protection, epitope-specific IgA also effectively inhibited the transcytosis of HIV in an optimized transwell assay. The effect of gp41-specific Abs was also assessed against a novel panel of HIV-1 viral clones, and exhibited significant protection. These clones selectively express envelopes from viruses that would be desired targets of prophylactic immune responses, the earliest founder population in the mucosa after virus transmission.</p> / Doctor of Philosophy (PhD)

Type I interferons (IFN) are a potent antiviral cytokine group that are key regulators of the immune response against virus infection. Not only does this group activate antiviral states within target cells, it can modulate the innate immune response. In the studies presented, we investigate the effects of type I IFN on the innate immune system during a mucosal vaginal virus infection, herpes simplex virus type 2 (HSV-2), a prominent sexually transmitted infection that causes genital herpes and increases risk of human immunodeficiency virus acquisition. It is well known that type I IFN is critical for natural killer (NK) cell activation. These cells contribute to the antiviral response by suppressing virus replication and aiding in the initiation of the adaptive immune response, particularly through the release of IFN-γ. In the work presented, we demonstrate that type I IFN does not act on NK cells directly for their activation, but instead activates NK cell IFN-γ production by inducing inflammatory monocytes to release IL-18, which in turn, signals NK cells to release IFN-γ during a mucosal HSV-2 infection. Rather, direct action of type I IFN on NK cells serves to negatively regulate their IFN-γ response. We also found that type I IFN was critical for suppressing virus-induced innate immunopathology during HSV-2 infection. Overall, our studies further our understanding of type I IFN and the many roles it plays during virus infection, which has become more relevant as specific therapies altering type I IFN are being used in the clinic. Further, we provide a fundamental understanding of type I IFN and its ability to shape the innate immune response to virus infection by suppressing dysregulated and immunopathological functions while promoting beneficial innate immune responses that can help fight the infection. / Thesis / Doctor of Philosophy (PhD) / Type I interferons (IFN) are a group of proteins that are rapidly produced early during infection and is important for combatting virus infections. We show that type I IFN is not just an antiviral molecule, but can modulate the initial immune response to virus infection. As part of the initial immune response, Natural killer (NK) cells are immune cells that respond rapidly to infection and are a key element in controlling the early stages of infection. We found that type I IFN is critical for activating NK cell function by signaling through an intermediary cell, but can also suppress that same function by directly acting on NK cells. We also found that type I IFN is critical for suppressing a dysregulated immune response that causes severe virus-induced vaginal pathology. Overall, our data suggests that type I IFN is a key antiviral molecule that shapes the immune response to virus infection.

La cicatrisation complète de la muqueuse, définie comme l'absence de lésions visibles par endoscopie, est considérée comme un objectif thérapeutique dans la prévention des complications associées aux Maladies Inflammatoires Chroniques de l’Intestin (MICI).Dans ce contexte, le rôle de l’apport protéique alimentaire et les besoins protéiques nécessaires à la cicatrisation ont été peu étudiés. L’objectif de cette thèse était d’évaluer l’effet du niveau d’apport protéique alimentaire sur la réparation épithéliale après un épisode inflammatoire intestinal dans un modèle murin de colite chimio-induite. Dans un premier temps, l’analyse de la progression de certains modulateurs impliqués dans le processus cicatriciel a mis en évidence que la réparation colique s’initiait et se consolidait avant que l’inflammation ne soit résolue et cela, dans un contexte où la composition du microbiote adhérent à la muqueuse était altérée de manière persistante. Les effets de trois régimes alimentaires ayant un niveau d'apport protéique différent (moyen, modérément élevé et élevé) ont ensuite été évalués sur la réparation de la muqueuse colique, ce qui a permis de montrer qu’au-delà d’un certain seuil, le niveau d’apport protéique aggravait et perpétuait l’inflammation colique. En revanche, un apport modérément élevé en protéines était bénéfique par rapport à un apport moyen, de par ses effets sur la perméabilité colique, l'hyper-prolifération cryptique, l’expression de plusieurs gènes codant pour des facteurs de réparation et sur la modulation de la composition du microbiote adhérent. Enfin, ces travaux ont montré que l’inflammation et le niveau d’apport en protéines affectaient le métabolisme protéique dans des organes non-cibles de l’inflammation colique en association avec une endotoxémie persistante.Ce travail a ainsi permis de mieux comprendre les événements locaux et périphériques impliqués dans la cicatrisation de la muqueuse colique et leur modulation par un apport majoré en protéines suite à un épisode inflammatoire aigu. / Advanced mucosal healing, defined by endoscopy as the absence of visible lesions, is considered as a therapeutic goal in the prevention of complications associated with IBD.In this context, the role of dietary protein intake and the protein requirements for mucosal healing have been poorly studied. The aim of this thesis was to evaluate the effect of dietary protein intake level on epithelial repair after an acute intestinal inflammatory episode in a murine model of colitis. Firstly, the progression analysis of several modulators involved in the repairing process showed that colonic repair can be initiated and consolidated in the context of inflamed mucosa, associated with persistent alterations of the colonic luminal environment. The effect of three diets with different levels of protein intake (average, moderately high and high) on colon mucosa repair were evaluated in the same model. This study showed that, beyond a threshold, the level of protein intake aggravated and perpetuated colitis. However, a moderately high protein intake was beneficial due to its effect on colonic permeability, cryptic hyper-proliferation, expression of multiple genes encoding repair factors, and composition modulation of the mucosal-adherent microbiota. Finally, both inflammation and dietary protein intake levels altered protein metabolism of other organs at the periphery of the inflammation in association with persistent endotoxemia.This work deepened the understanding of the events involved in the epithelial repair process and their modulation by an increase in the dietary protein intake after an acute episode of colitis.

IL-23 is an essential mediator of chronic intestinal inflammation in experimental models of colitis. Polymorphisms in the IL23R locus are associated with IBD susceptibility in humans. The biological activity of IL-23 has been linked to Th17 cells but little is known about the cellular and molecular mechanism by which IL-23 drives intestinal inflammation. The work presented herein has identified that direct IL-23 signalling into CD4+ T cells was not only required for the accumulation of Th17 cells in the intestine but also modulated their phenotype. Through direct cell intrinsic effects on T cells, IL-23 drove the emergence of an IL-17A+IFN-γ+ population of T cells that co-expressed RORγ and T-bet. Interestingly, we found that expression of RORγ but not T-bet by T cells was required for the development of intestinal inflammation. Furthermore, colitis induced by T-bet deficient T cells was dependent on IL-17A, and showed a unique inflammatory phenotype, thus demonstrating that pathogenic intestinal Th17 responses can develop independently of T-bet. In addition, using transcriptional profiling we identified a core set of genes that is regulated by direct cell-intrinsic IL-23 signals into intestinal CD4+ T cells. This revealed a previously unrecognised role for IL-23 in suppressing Th2 associated genes, such as GATA3 and IL-33R. Functional experiments demonstrated that expression of GATA3 in CD4+ T cells limited their colitogenic potential, suggesting that IL-23-mediated inhibition of GATA3 might contribute to the development of intestinal inflammation. Finally, we described a novel function for IL-33 as a factor that promotes Foxp3+ iTreg differentiation in vitro and in vivo through direct effects on T cells. This activity of IL-33 was inhibited in the presence of IL-23, providing a mechanistic link for the known role of IL-23 in restraining iTreg generation. Collectively, these data suggest that IL-23 promotes acquisition of a pathogenic effector T cell phenotype through multiple mechanisms. This indicates that therapeutic blockade of IL-23 is likely to reduce pro-inflammatory mediators while also facilitating the expansion of regulatory pathways that might help to re-establish intestinal homeostasis.

The duodenal mucosa is regularly exposed to acid, digestive enzymes and ingested noxious agents. It is thus critical to maintain a protective barrier to prevent the development of mucosal injury and inflammation, which are often observed in situations when barrier function is impaired. The rate of mucosal bicarbonate secretion, the regulation of epithelial paracellular permeability and motility are each key components of duodenal barrier function. The hormone melatonin is present in high levels in the gastrointestinal tract and it has been hypothesized that melatonin exerts protective properties. This thesis aims to investigate the impact of exogenous melatonin on the regulation of duodenal barrier function and motility in anesthetized rats in vivo. In addition, duodenal tissue was examined histologically and the expression levels of tight junction proteins and melatonin receptors were assessed with qRT-PCR. It was found that melatonin stimulated mucosal bicarbonate secretion and decreased basal paracellular permeability. Exposing the duodenal mucosa to the well-characterized barrier breaker ethanol increased mucosal bicarbonate secretion, paracellular permeability and motility. Omission of luminal Clˉ abolished, while pretreatment with a nicotinic receptor antagonist reduced, the ethanol-induced bicarbonate secretion suggesting that the secretory response to ethanol is meditated via Clˉ/HCO3ˉexchangers and enteric neural pathways. Melatonin reduced the ethanol-induced increases in paracellular permeability and motility either when injected intravenously or when administered in drinking water for two weeks. The actions of melatonin were abolished by the melatonin receptor antagonist luzindole and by nicotinic acetylcholine receptor inhibition. Two weeks oral administration of melatonin up-regulated the expression levels of melatonin receptors, down-regulated the expression of ZO-3 while the expression of ZO-1, ZO-2, claudin 2-4, occludin and myosin light chain kinase were unaffected. Superficial epithelial changes in a few villi were seen in response to ethanol exposure, an effect that was histologically unchanged by melatonin pretreatment. In conclusion, the results suggest that melatonin plays an important role in the neurohumoral regulation of gastrointestinal mucosal barrier function and motility via receptor- and enteric neural-dependent pathways in vivo in rats. Melatonin might be a candidate for treatment of barrier dysfunction in humans.

Clostridium difficile is a Gram positive pathogen of significant importance in the UK, Europe and the USA. No vaccine has been developed and current treatments are focused on hospital management and the use of antibiotics. The disease is spread in hospitals in the spore form and the role of spores in C. difficile infecton is poorly understood. In this project spores of C. difficile have been characterised. The proteins from the outermost layers of the spore were identified and the genes cloned. Three of these surface proteins have unique enzymatic properties that maybe important for symptoms of disease. The ability of C. difficile spores to adhere to intestinal cells was found to be far greater than with live cells and through this we have identified that the spore may play an important role in colonisation. The regulation of spore coat gene expression during sporulation was also examined and temporal phases of genes expression identified. A major part of this project was to develop a mucosal vaccine to C. difficile. The approach used was to clone the C-terminus of toxin A onto the surface of Bacillus subtilis spores and use these recombinant spores to immunise mice and hamsters. We found that oral delivery of these spores conferred 75% protection to C. difficile infection in a hamster model of infection. Further, parenteral immunisation of the same antigens (toxin A and B) failed to generate mucosal responses and this showed that mucosal immunisation is critical for good protection. Finally, we found that antibodies to the C-terminus of toxin A were cross reactive to the C-terminus of toxin B. This showed that mucosal delivery of just the C-terminus of toxin A is sufficient to confer protection in an animal model of infection. The outcome of this work is that we have shown the parameters for successful immunisation and vaccination against C. difficile.

The gonococcal transferrin binding proteins (Tbps) are two surface-exposed outer membrane proteins, TbpA and TbpB, which together function to remove and internalized iron from human transferrin. Iron is an essential nutrient to the gonococcus, without which it cannot survive. The Tbps have been established as virulence factors, demonstrating their importance in establishing infection. Both TbpA and TbpB are well conserved among gonococcal isolates, and have been considered potential vaccine targets. Vaccine studies with the closely related species Neisseria meningitidis, have demonstrated these proteins to be protective in murine challenge studies. Though the meningococcal Tbps have demonstrated promise, no similar gonococcal vaccine experiments have been conducted prior to the current studies. Here we demonstrate purification of recombinant TbpA and TbpB. These recombinant proteins were utilized to evaluate the human immune response to these proteins during natural infections, and their immunogenicity in murine vaccine studies. Our results demonstrate a paucity of antibodies elicited to these proteins during natural infections in serum and mucosal secretions from infected individuals. From this study we hypothesized the induction of both serum and genital antibodies to these proteins could serve to protect an individual from infection. To begin testing this hypothesis, we immunized mice both intranasally (IN) and subcutaneously (s.c.) with full-length Tbps in conjunction with the B subunit of cholera toxin (Ctb) as an adjuvant. We also performed another vaccine study using domains from both proteins in genetic fusions with Ctb and E. coli heat labile toxin IIb (LtbIIb). Both studies demonstrated that these antigens were immunogenic, as Tbp-specific antibodies were elicited in the serum and vaginal washes of female Balb/C mice. Intranasal immunization however was the only route with which we were able to elicit vaginal Tbp-specific IgA, and IgG, whereas subcutaneous immunization only elicited vaginal IgG. Furthermore, we found the full-length Tbps and the Ctb/LtbIIb chimeras were able to elicit bactericidal antibodies, which were also effective in killing heterologous gonococcal strains. This body of work comprises the first published study using the gonococcal transferrin binding proteins as vaccine antigens, and highlights their potential as vaccine antigens in the development of an efficacious gonococcal vaccine.

Bacillus subtilis é uma bactéria gram positiva de solo, não patogênica, não colonizadora de tecidos, naturalmente transformável e formadora de esporos utilizada como modelo de estudo de bactérias gram-positivas. Essas características acarretam em vantagens para a produção de proteases de interesse industrial e para utilização como veículo de antígenos vacinais, porém a falta de vetores induzíveis torna sua utilização como ferramenta biológica pouco explorada. No presente trabalho descrevemos a construção de diferentes vetores capazes de expressar os antígenos subunidade B da toxina termo-lábil (LTB) e subunidade estrutural da fímbria CFA/I (CFAB) de Escherichia coli enterotoxigênica (ETEC) e avaliamos seu potencial vacinal. Foi avaliada a imunogenicidade de linhagens capazes de expressar LTB sob o controle de diferentes promotores: PgsiB (induzido em condições de estresse), PlepA (promotor constitutivo) e Pspac (induzido pela adição de IPTG) e em diferentes locais da célula (ancorada à parede celular ou secretada para o meio externo). Avaliamos ainda a imunogenicidade de linhagens capazes de co-expressar LTB e a listeriolisina O (LLO) de Listeria monocytogenes. O antígeno CFAB foi produzido no citoplasma ou ancorado à parede celular de B. subtilis em condições de estresse e as linhagens bacterianas administradas sozinhas ou conjuntamente com a toxina termo-lábil (LT) como adjuvante de mucosa. Camundongos imunizados com células ou esporos de B. subtilis recombinantes desencadearam respostas de anticorpos sistêmicos e secretados específicos para os antígenos (LTB e CFAB), não alterados pela adição do adjuvante. A expressão de LLO causou a supressão da resposta de anticorpos específicos para o antígeno LTB. Os resultados obtidos demonstram a viabilidade do uso de B. subtilis como veículo vacinal. / Bacillus subtilis is a gram positive, generally regarded as safe and spore forming soil bacteria used as a model for genetic and phisiological studies. This safety status allow its use as host for production of industrial protases and its application as vaccine vehicles, however the lack of epissomal inducible expression systems disable the exploration of this organism as a biotechnologic tool. In this work we describe the construction of epissomal vectors able to express the B subunit of the heat-labile toxin (LTB) and the structural subunit of the CFA/I fimbrae (CFAB) from the enterotoxigenic Escherichia coli (ETEC). We evaluate strains able to express LTB under the control of three promoters: PgsiB (stress inducible), PlepA (constitutive) e Pspac (IPTG inducible) and allowing the expression of LTB secreted or anchored to the cell wall We also evaluate the immunogenicity of strains able to co-express LTB and the listeriolysin O (LLO) from Listeria monocytogenes. CFAB was expressed in the cytoplasm or anchored to the cell wall and administred alone or with the mucosal adjuvant LT. Mice immunized both with cells or spores elicited secreted and systemic specific antibodies responses, which were not altered by the addition of the adjuvant LT. LLO expression suppressed the antibodies responses against LTB. The data shows the ability of B. subtilis to be used as vaccine vehicle.

INTRODUÇÃO: O adenocarcinoma gástrico precoce (AGP) atinge até a camada submucosa em profundidade, independentemente da presença de metástases linfonodais (MLF). Tumores mucosos, bem diferenciados, menores que 20 mm e sem ulceração são candidatos à ressecção endoscópica (RE) por mucosectomia com taxas de MLF praticamente nulas. Com o advento da técnica de dissecção endoscópica da submucosa (ESD) e após observar ausência de MLF em grande série de pacientes no Japão, foi sugerido que os critérios clássicos pudessem ser expandidos, evitando a gastrectomia em alguns pacientes. Em países ocidentais autores e sociedades têm visto com restrição a ESD para critérios expandidos devido à observação de MLF em alguns subgrupos. A análise crítica e validação dos critérios expandidos de RE para tratamento do AGP em coorte brasileira poderá indicar os pacientes com menor risco de metástases linfonodais nesta população, de modo a individualizar o tratamento com excelência e qualidade de vida. OBJETIVO: Avaliar a presença MLF em produtos de gastrectomia com linfadenectomia de pacientes elegíveis à ressecção endoscópica seguindo os critérios clássicos e expandidos. MÉTODO: Inclusão de pacientes com AGP submetidos a tratamento cirúrgico com dissecção linfonodal. Estadiamento linfonodal e avaliação de características clínicas, macroscópicas e histopatológicas segundo critérios de RE. RESULTADOS: Foram incluídos 389 espécimens cirúrgicos de gastrectomia, dentre os quais 135 cumpriam critérios para ressecção endoscópica. Nenhum dos 31 pacientes com critérios clássicos apresentou MLF (N = 31; 0% IC95% 0 - 13,4%). Dos 104 com critérios expandidos, 3 apresentaram MLF (N = 104; 2,9% IC95% 0,7 - 8,6%), todos pertencentes ao grupo de tumores indiferenciados sem ulceração e menores que 20 mm. Dos pacientes com indicação de tratamento cirúrgico houve 50 MLF positivos (N = 254; 19,7% IC95% 15,3 - 25,1%). CONCLUSÃO: Existe risco mínimo de metástases linfonodais quando adotados os critérios expandidos de RE. Este risco é praticamente nulo para os critérios clássicos e quando se exclui o tumor indiferenciado do critério expandido / INTRODUCTION: Early gastric cancer (EGC) is known to present low rate of lymph nodal metastasis (LNM). Gastrectomy with D2 lymphadenectomy is usually curative for EGC. Endoscopic submucosal dissection (ESD) is a well-accepted treatment modality for lesions that meet the classic criteria, a well-differentiated adenocarcinoma measuring less than 20 mm size and without ulceration. Expanded criteria for ESD have been recently proposed, based on null LNM rate from large gastrectomies series coming from Japan. The expanded criteria for ESD are as follows: intramucosal non-ulcerative well-differentiated tumor > 20 mm, intramucosal ulc mo <= 30 mm, intramucosal non-ulcera mo <= 20 mm, or superficially submucosal ( m1) mo <= 30 mm. There is some resistance to adoption of the expanded criteria, since patients with positive LNM have already been reported in western centers. OBJECTIVE: Evaluate LNM staging in patients who met the expanded endoscopic treatment criteria for ESD. METHOD: Evaluation of gastrectomy specimens including LNM staging of patients submitted to gastrectomy for EGC in a 39-year retrospective cohort. A senior pathologist reviewed the histology slides. RESULTS: A total of 389 surgical specimens were included, of whose 135 met criteria for endoscopic resection. None of the 31 patients with classic criteria had LNM. Of the 104 patients with expanded criteria, 3 had LNM (n = 104, 2.9% CI 95% 0.7 - 8.6%), all of them with undifferentiated tumors without ulceration and less than 20 mm. In the patients with surgical criteria there were 50 LNM positive (n = 254; 19.7% CI 95% 15.3 - 25.1%). CONCLUSION: There is minimal risk of LNM in EGC when expanded criteria for ESD are met. This risk is practically nil for the classic criteria and when the undifferentiated tumor is excluded of the expanded criteria. Refinement of the expanded criteria for the risk of LNM may be desirable. Meanwhile the decision to complement the endoscopic treatment with LNM dissection or D2 gastrectomy will have to take into consideration the individual risk of perioperative morbidity and mortality