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Sepsis is life-threatening organ dysfunction produced by a dysregulated host response to infection in which neutrophils release neutrophil extracellular traps (NETs). NETs consist of DNA, histones, and antimicrobial peptides which kill pathogens. However, DNA and histones also exert damage by activating the intrinsic pathway of coagulation and inducing endothelial cell death, respectively. AADH, a 15kDa non-anticoagulant unfractionated heparin (UFH), prevents histone-mediated cytotoxicity in vitro and improves survival in septic mice. We explored the effectiveness of Vasoflux, a 5.5kDa low-molecular-weight-heparin as an anti-sepsis treatment as compared to enoxaparin and UFH. Vasoflux has reduced anticoagulant functions and hence reduces the risk of bleeding as compared to enoxaparin or UFH. We showed that UFH, enoxaparin, or Vasoflux at concentrations of up to 13.3uM, 40uM, or 40uM, neutralize histone-mediated cytotoxicity. These results suggest that these glycosaminoglycans (GAGs) are able to neutralize histone-mediated cytotoxicity independent of the AT-binding pentasaccharide. To quantitate the binding affinity between GAGs and histones, surface plasmon resonance was conducted. UFH is a more potent inhibitor of histone-mediated cytotoxicity compared to Vasoflux as UFH has a 10-fold greater binding affinity to histones compared to Vasoflux. To translate our in vitro findings to in vivo, Vasoflux, enoxaparin, and UFH were administered in a murine model of sepsis. Vasoflux at 8mg/kg - 50mg/kg reduced survival and exhibited damage in the lung, liver, and kidney in septic mice compared to 10 mg/kg of UFH or 8mg/kg of enoxaparin. This may be due to Vasoflux and UFH disrupting the DNA-histone complex, thereby releasing free procoagulant DNA. This is evident by our gel electrophoresis experiments, where addition of 1uM Vasoflux or 3.3uM UFH to DNA-histone complexes lead to histone dissociation from DNA. UFH bound to histones may be able to inhibit DNA-mediated thrombin generation, as it retains its anticoagulant properties, demonstrated by UFH-histone complexes attenuating DNA and TF-mediated thrombin generation. In contrast, Vasoflux may not neutralize the procoagulant DNA leading to a hypercoagulable state in the mice. Our study may have important clinical implications as there is an ongoing trial, HALO, which will administer intravenous UFH to patients suspected to have septic shock to reduce mortality. Based on our results, future clinical trials should consider the antithrombin-dependent anticoagulant activity of UFH being used as a sepsis treatment. / Thesis / Master of Science (MSc) / Sepsis is a life threatening condition caused by the body’s extreme response to microbial infection of the blood, whereby neutrophils release traps composed of cell-free DNA (cfDNA), histones, and antimicrobial proteins. In addition to fighting off infections, these traps also exert harmful effects like triggering clotting and killing host cells. Currently, no specific anti-septic drugs exist. Studies have shown that DNase1 (a recombinant protein that digests double stranded cfDNA) or a modified form of heparin (neutralizes histones) improves survival in septic mice. Our goal was to explore the protective effects of Vasoflux, (a non-anticoagulant heparin) and DNase1 in a mouse model of sepsis. We hypothesize that the combined therapy of DNase1 and Vasoflux will improve survival. We found that Vasoflux has minimal blood thinning activity and can prevent histones from killing cells. However, Vasoflux administered into septic mice worsened organ damage and decreased survival. We hypothesize that this damage may be due to Vasoflux’s ability to displace histones from histone-DNA complexes, thereby releasing free DNA, which promotes excessive blood clotting in sepsis.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease, characterized by progressive and largely irreversible airflow limitation due to alveolar destruction (emphysema), small airway narrowing, and chronic bronchitis. It is one of the leading causes of morbidity and mortality worldwide and in the UK, it may affect approximately 1.5 per cent of the population; and up to one in eight emergency admissions may be due to COPD,corresponding to over one million bed days, with some 24160 people in the UK dying as a result of COPD in 2005 (Burden of Lung Disease 2nd Edition,British Thoracic Society 2006). Most cases of COPD are triggered by chronic inhalation of cigarette smoke.However, some people do not suffer from COPD even if they smoke for many years. COPD cannot be cured, and patients usually live with poor life quality. Treatments include giving up smoking, medication and oxygen therapy. Genetic factors contribute to the development of COPD. In Northern Europe,Z-AT homozygotes (342Glu Lys) develop emphysema in their third or forth decade. One explanation is AT deficiency because they form inactive polymers. However, this cannot explain why bronchoalveolar lavage fluid (BALF) from Z-AT homozygotes with emphysema contains more neutrophils than BALF from individuals with emphysema and normal AT (M-AT). Inhaling pollutants which include smoking (cigarettes, pipes, cigars, etc.) and other fumes such as those found in many industrial work environments probably also plays a role in an individual’s development of COPD. Previously, it has been shown that the polymeric conformer of AT is present in BALF from Z-AT homozygotes and that it is a chemoattractant for neutrophils in vitro (Parmar JS, 2002). These findings have been confirmed by others (Mulgrew AT, 2004). However, it is unknown where the polymers form and if 4 they are chemotactic in vivo. My colleague Dr Carl Atkison† showed that polymers of Z 1-AT are present in the alveolar wall of Z-AT homozygotes with emphysema, which accounts for 20% of the total AT from lung homogenates.These Z-AT individuals also have an excess of neutrophils in the alveolar wall compared with M-AT homozygotes. Furthermore, neutrophils and polymeric AT co-localize in the alveolar wall (Mahadeva R, 2005). To investigate whether there was a direct relationship between polymers of Z-AT and the excess neutrophils, polymers of AT were instilled into the lungs of wild-type mice (Mahadeva R, 2005). This produced a significant increase in neutrophil influx into the lungs compared with instillation of the native protein.Examination of the time course demonstrated that the influx of neutrophils was closely linked to the presence of polymeric AT. The mechanism of neutrophil recruitment in this mouse model was subsequently shown to be a direct chemotactic effect rather than stimulation of IL-8 homologues or other CXC chemokines. Oxidized AT (Ox-AT) promotes release of human monocyte chemoattractant protein-1 (MCP-1) and IL-8 from human lung type epithelial cells (A549) and normal human bronchial epithelial (NHBE) cells. Native, cleaved, polymeric AT and secretory leukoproteinase inhibitor (SLPI) and oxidized conformations of cleaved, polymeric AT and SLPI did not have any significant effect on MCP-1 and IL-8 secretion. These findings were supported by the fact that instillation of Ox-AT into murine lungs resulted in an increase in JE (mouse MCP-1) and increased macrophage numbers in the bronchoalveolar lavage fluid. The effect of Ox-AT was dependent on NF- B and activator protein-1 (AP-1)/JNK. These findings have important implications. They demonstrate that the oxidation of methionines in AT by oxidants released by cigarette smoke or inflammatory cells not only reduces the anti-elastase lung protection, but also converts AT into a proinflammatory stimulus. Ox-AT generated in the airway † My colleagues’ contributions are acknowledged in future text where appropriate by the following superscripts: (a) Dr Sam Alam, (b) Dr Jichun Wang, (c) Dr Carl Atkinson, (d) Dr Sabina Janciauskiene. 5 interacts directly with epithelial cells to release chemokines IL-8 and MCP-1,which in turn attracts macrophages and neutrophils into the airways. The release of oxidants by these inflammatory cells oxidizes AT, perpetuating the cycle, potentially contributing to the pathogenesis of COPD. Furthermore, this demonstrates that molecules such as oxidants, anti-proteinases, and chemokines, rather than acting independently, collectively interact to cause emphysema (Li Z, 2009). To investigate the molecular basis for the interaction between Z-AT and Ox-AT associated with cigarette smoking, female mice transgenic for normal (MAT)or Z-AT on CBA background were exposed to cigarette smoke (CS). Transgenic mice for Z-AT developed a significant increase in pulmonary polymers following acute CS exposure. Increased levels of neutrophils in CSZ lungs were tightly correlated with polymer concentrations. Oxidation of human plasma Z-AT by CS or -chlorosuccinimide greatly accelerated polymerization, which could be abrogated by antioxidants. The results showed that cigarette smoke accelerated polymerization of Z-AT by oxidative modification, which in so doing further reduced pulmonary defense and increased neutrophil influx into the lungs. These novel findings provided a molecular explanation for the striking observation of premature emphysema in ZZ homozygote smokers, and raised the prospect of anti-oxidant therapy in ZAT related COPD (Alam S, 2011).

Nous avons identifié l’expression du récepteur des angiopoïétines, le récepteur Tie2, à la surface des neutrophiles humains. De plus, nous avons démontré qu’Ang1 et Ang2 induisent des activités pro-inflammatoires sur les neutrophiles, comme l’adhésion aux cellules endothéliales (CEs) et la synthèse du facteur d’activation plaquettaire (PAF). Puisque le PAF augmente la viabilité des neutrophiles et que les angiopoïétines modulent la survie des CEs, nous avons voulu évaluer l’effet des angiopoïétines sur la survie des neutrophiles. Des neutrophiles humains ont été isolés à partir du sang de donneurs sains en accord avec le comité d’éthique de l’Institut de cardiologie de Montréal. La viabilité des neutrophiles a été mesurée par cytométrie en flux à l’aide de marqueurs d’apoptose et de nécrose. Un traitement avec des témoins positifs, soit l’interleukine 8 (IL-8; 25 nM) ou le PAF (100 nM), a augmenté la survie basale des neutrophiles de 34 et 27%, respectivement. De plus, un traitement avec Ang1 (1 pM – 10 nM) a augmenté la survie des neutrophiles jusqu’à 35%, alors qu’Ang2 n’a eu aucun effet. La combinaison de l’IL-8 ou du PAF avec Ang1 (10 nM) a eu un effet additif sur la viabilité des neutrophiles et a augmenté la survie de 56 et 60%, respectivement. Un prétraitement avec des anticorps bloquants contre l’IL-8 a permis d’inhiber l’activité anti-apoptotique de l’IL-8 et d’Ang1 de 92 et 80%, respectivement. Ainsi, notre étude est la première à démontrer la capacité d’Ang1 à prolonger la viabilité des neutrophiles, qui est principalement causée par la relâche d’IL-8. / We reported the expression of angiopoietin receptor Tie2 on the surface of human neutrophils. In addition, we reported that Ang1 and Ang2 are both capable to promote pro-inflammatory activities in neutrophils, namely their adhesion onto endothelial cells (ECs) and platelet-activating factor (PAF) synthesis. PAF is known to promote pro-survival activity on neutrophils and since both angiopoietins can modulate ECs viability, we addressed whether Ang1 and/or Ang2 could modulate neutrophil viability. Human neutrophils were isolated from blood of healthy volunteers in accordance with the guidelines of the Montreal Heart Institute’s ethical committee. Neutrophil viability was assessed by flow cytometry using apoptotic and necrotic markers. Treatment with anti-apoptotic mediators such as interleukin 8 (IL-8; 25 nM) and PAF (100 nM) increased neutrophil basal viability by 34 and 27%, respectively. In addition, treatment with Ang1 (1 pM – 10 nM) increased neutrophil viability by up to 35%, while Ang2 had no effect. Combination of IL-8 or PAF with Ang1 (10 nM) provided an additive effect on neutrophil viability and further increased viability by 56 and 60%, respectively. Pretreatment of the neutrophils with blocking anti-IL-8 antibodies inhibited the anti-apoptotic effect of IL-8 and Ang1 by 92 and 80%, respectively. In summary, our data are the first one to report Ang1 pro-survival activity on neutrophils, which is mainly driven through IL-8 release.

Neutrophil activation is the most important initial immune defense against invading microbes in newborn infants. The reduced neutrophil migration and uncontrolled regulation of reactive oxygen species (ROS) production observed in neonates, could result in a diminished infectious response or in tissue damage. The aims were to study neutrophil chemotactic response towards IL-8 and fMLP in term neonates; to examine neutrophil receptor expression involved in adhesion, migration, phagocytosis and complement after stimulation with IL-8 and fMLP in term neonates; and to investigate neutrophil production of ROS, induced by PMA and E.coli, after preincubation with IL-8 and fMLP in term and preterm newborn infants. Comparisons were made to neutrophils from healthy adults. Chemotaxis was distinguished from randomly migrating neutrophils, and the neutrophil migration distance and the number of migrating neutrophils per distance was evaluated. Neutrophils were labeled with antibodies to cell surface antigens (CD11b, CD18, CD65, CD15S, CD162, CD44, CD35, CD88, CD181, CD182 and CD64) after stimulation with IL-8 and fMLP. After preincubation of neutrophils with fMLP or IL-8 and stimulation with PMA or E.coli, respiratory burst was detected. The same analyses were also made in preterm infants (median 25+3weeks GA; range 23+0–29+2) within 3 days postnatal age. Neutrophils from neonates exhibited different migratory and receptor responses to IL-8 and fMLP, with a diminished response towards IL-8 in term newborn infants in terms of reduced chemotaxis and modulation of receptors involved in adhesion, chemotaxis, complement and phagocytosis as compared to adults. fMLP reduced PMA- and E.coli-induced respiratory burst in neutrophils from term neonates and adults. The reduced respiratory burst by fMLP may be a mechanism for reducing the detrimental effects of uncontrolled inflammation. Although a similar burst reduction was observed in preterm infants born >25 weeks GA with fMLP, a diminished neutrophil respiratory burst modulation in very preterm infants cannot be excluded and requires further studies at different gestational and postnatal ages.

Lectinas consistem de um vasto grupo de proteínas de origem não-imunológica e de caráter não enzimático, que reconhecem carboidratos de modo específico e não-covalente. Além disso, essas proteínas participam de vários eventos fisiológicos e patológicos, com embriogenese, resposta imunológica, apoptose, diferenciação celular e câncer. Recentemente, foi purificada da peçonha da serpente Bothrops atrox uma lectina do tipo-C, ligante de lactose, com propriedades bioquímicas e funcionais semelhantes à de outras lectinas de serpentes do gênero, denominada Galatrox. O presente projeto teve como objetivos a investigação do envolvimento da Galatrox no processo inflamatório agudo através de experimentos in vivo e in vitro e a produção de anticorpos policlonais anti-Galatrox. A lectina isolada foi obtida através de dois processos cromatográficos, apresentando um valor final de recuperação protéica de 0,3% (mg) em relação ao conteúdo protéico da peçonha bruta. De modo interessante, a Galatrox conjugada ao fluorocromo FITC (8µg/mL) foi capaz de ligar-se a superfície de neutrófilos (91,47%±0,5650). Além disso, está proteína reconheceu a laminina imobilizada, e não a fibronectina, uma glicoproteína da matriz extracelular que contém sequencias de poli-N-acetillactosamina. Avaliando seu potencial inflamatório, Galatrox mostrou-se capaz de induzir a migração de neutrófilos humanos in vitro de forma dose-dependente, tendo máxima atividade quimiotática na concentração de 32µg/mL (41,57±3,42 neutrófilos por campo). Apesar da Galatrox induzir um discreto nível de burst oxidativo em neutrófilos humanos não primados, ela apresentou um efeito três vezes maior quando essas células foram primadas com fMLP. Esta lectina quando injetada na cavidade peritoneal de camundongos Balb/C provocou migração leucocitária, sendo que na dose (50g/cavidade) e no tempo (4 horas) ótimos ocorreu um influxo celular de 2,05x106±0,101 leucócitos/mL. Ainda, esse infiltrado celular mostrou-se, basicamentre, composto por neutrófilos. Avaliando o perfil de mediadores da resposta inflamatória nesse ensaio in vivo, nos lavados peritoneais foi indicada a liberação máxima de IL-1 e IL-6 após 4 horas de tratamento, mas não foram detectadas a presença de TNF- e óxido nitrico em qualquer tempo de resposta. Células de baços murinos tratados com Galatrox produziram as citocinas pró-inflamatórias TNF- e IFN- e não produziram IL-10 ou NO. A produção de anticorpos policlonais foi realizada por imunização de camundongos e purificação cromatografia de afinidade em colunas com Galatrox imobilizada. A monitoração por ELISA e Western blot comprovaram a produção de anticorpos da classe IgG anti-Galatrox reconhecedores da lectina em sua forma nativa e desnaturada além de suas formas monoméricas e diméricas. Em todos os ensaios biológicos que a Galatrox foi testada na presença da lactose (carboidrato ligante da Galatrox, 20 mM) ocorreram inibições significativas das atividades dessa lectina, indicando que o seu domínio de reconhecimento de carboidrato participa das funções dessa molécula. Com base nos resultados obtidos é possível sugerir que a Galatrox participe da resposta imune inata por mediar eventos biológicos da resposta inflamatória aguda. No entanto, a lectina mostrou-se como um moderado agente pró-inflamatória, quando relacionada à peçonha bruta tendo em vista a fisiopatologia inflamatória do envenenamento. O anticorpo anti-Galatrox poderá ser usado como uma importante ferramenta estudos moleculares e funcionais dessa lectina de serpente. / Lectins are proteins with no enzymatic activity and are able to bind specifically and non-covalently (reversible manner) to carbohydrates. In addition, these proteins are involved in several physiological and pathological events, as embryogenesis, immune response, cancer, and others. Galatrox, a lactose-binding protein, was purified from Bothrops atrox snake venom and partially characterized concerning its biochemical and functional properties. The present work aimed to investigate the involvement of Galatrox in the inflammatory process. In addition, was carry out the production of a polyclonal antibody against Galatrox. This lectin was purified by one chromatographic step with yield around 0.3% (w/w) of total protein from Bothrops atrox crude venom. Interestingly, Galatrox-FITC (8g/mL) binds on human neutrophil surface (91.47% ± 0.5650). Also, this lectin recognized laminin, but not fibronectin, a glycoprotein of the extracellular matrix that contains poly-N-acetyllactosamine sequences. Galatrox was able to induce human neutrophils migration in vitro in a dose-dependent manner, with maximum chemotactic activity at 32g/mL (41.57 ± 3.42 neutrophils per well). Galatrox is more efficient to induce oxidative burst on fMLP primed neutrophils rather than non-primed neutrophils. When injected into mouse peritoneal cavity, Galatrox induced dose and time-dependent leukocyte migration, with optimal effect at 50g/animal after 4 hours of the injection (2.05x106±0.101 leukocytes/mL). Galatrox also induced release of IL-1 and IL-6 up to 12 hours after injection in the peritoneal cavity. However, TNF- and NO were not detected. The treatment of splenocytes with Galatrox in vitro promotes the production of INF- and TNF-. The biological activities of Galatrox were inhibited by lactose (specific sugar, 20 mM), indicating that its recognition carbohydrate domain participates of its functions. The production of polyclonal antibody anti-Galatrox was performed by immunization of mice and purified by affinity chromatography using immobilized Galatrox resin. Gamma-globulins against Galatrox were able to recognize this lectin under native and reduced conditions, using ELISA and Western-blot, respectively. The antibody anti-Galatrox can be use as important tool to further molecular and functional characterization of this snake venom lectin. These results suggest that Galatrox is immunogenic and may participate in the acute inflammatory process, acting as a pro-inflammatory agent through its lectin property.

Os neutrófilos são células fagocíticas do sistema imunológico mobilizadas principalmente no combate a infecções. Estas células são capazes de matar os micro-organismos através da desgranulação, que leva à liberação de moléculas antimicrobianas, e da produção de espécies reativas de oxigênio. Embora o recrutamento de neutrófilos seja essencial para a proteção do organismo, sua ativação excessiva resulta na intensa liberação de moléculas citotóxicas no meio extracelular, o que pode desencadear o desenvolvimento e/ou agravar o quadro clínico de doenças autoimunes e inflamatórias, como a artrite reumatoide. Uma possível abordagem terapêutica para o tratamento destas doenças é a modulação das funções efetoras dos neutrófilos. Estudos prévios mostraram que o extrato etanólico das folhas de Baccharis dracunculifolia (EEBd) possui grande potencial terapêutico, uma vez que apresenta expressiva atividade antioxidante frente ao metabolismo oxidativo dos neutrófilos. Para dar continuidade à investigação da atividade anti-inflamatória e/ou imunomoduladora deste extrato, o presente trabalho avaliou, na primeira etapa, o seu efeito modulatório sobre importantes funções efetoras de neutrófilos que medeiam o reconhecimento a e eliminação de patógenos - fagocitose, desgranulação e atividade microbicida - e sobre a atividade de enzimas lisossomais. Verificou-se que o EEBd, dependendo da concentração, inibe o metabolismo oxidativo dos neutrófilos sem alterar a capacidade de defesa das células. Na segunda etapa, foi avaliada a atividade antioxidante de sete compostos isolados do EEBd - ácido cafeico, ácido cumárico, ácido ferúlico, ácido cinâmico, aromadendrina-4?-metil éter, isosacuranetina e hispidulina - frente ao metabolismo oxidativo dos neutrófilos, a fim de propor possíveis marcadores químicos para as atividades biológicas do extrato. Os resultados apontaram o ácido cafeico como um potencial marcador químico da atividade biológica em questão. Na terceira etapa, com o intuito de aumentar a biodisponibilidade e favorecer o uso terapêutico dos produtos naturais estudados, o EEBd e o ácido cafeico foram incorporados em lipossomas, e constatou-se que a incorporação não alterou suas atividades antioxidantes frente aos neutrófilos, quando comparado às respectivas amostras na forma livre. Por fim, foi avaliado o efeito terapêutico do EEBd e do ácido cafeico, ambos na forma livre e incorporada em lipossomas, em um modelo animal de artrite. Verificou-se que as amostras na forma livre melhoraram expressivamente os parâmetros inflamatórios nas articulações, promovendo redução do edema e da migração de células totais e de neutrófilos, e discreta diminuição da concentração das citocinas inflamatórias TNF-?, IL-6 e IL-1?. Além disso, a incorporação do EEBd e do ácido cafeico em lipossomas pode auxiliar na redução das suas concentrações necessárias para a obtenção dos efeitos terapêuticos desejados. Assim, pode-se concluir que o EEBd tem grande potencial para se tornar um agente terapêutico adjuvante no tratamento de doenças inflamatórias mediadas por neutrófilos, sendo o ácido cafeico um possível marcador químico para a atividade anti-inflamatória do extrato. / Neutrophils are phagocytic immune cells mobilized primarily to fight against infections. These cells are capable to kill microorganisms through degranulation, which leads to the release of antimicrobial molecules, and production of reactive oxygen species. Although neutrophil recruitment is essential for host protection, excessive activation of these cells culminates in intense discharge of cytotoxic molecules to the extracellular milieu, which can elicit the development of and/or aggravate the clinical condition in autoimmune and inflammatory diseases such as rheumatoid arthritis. Modulation of the effector functions of neutrophils is a possible therapeutic approach to treat these diseases. Previous studies have shown that the ethanolic extract of Baccharis dracunculifolia leaves (EEBd) has a great therapeutic potential due to its significant antioxidant effect towards the oxidative metabolism of neutrophils. To continue investigating the anti-inflammatory and/or immunomodulatory action of such extract, the first part of the present work examined its modulator effect on three important effector functions of human neutrophils that mediate recognition and clearance of pathogens - phagocytosis, degranulation, and microbial killing - and on the activity of lysosomal enzymes. EEBd inhibited the oxidative metabolism of neutrophils without affecting their defense ability, depending on the extract concentration used. To propose possible chemical markers for the biological effects of the extract, the second part of this study evaluated the antioxidant activity of seven compounds isolated from EEBd - caffeic acid, coumaric acid, ferulic acid, cinnamic acid, aromadendrin-4\'-methyl ether, isosakuranetin, and hispidulin - towards the oxidative metabolism of neutrophils. The results pointed to caffeic acid as a potential chemical marker for this biological activity. The third part of this investigation aimed to improve the bioavailability and favor the therapeutic use of the natural products studied. EEBd and caffeic acid were incorporated into liposomal carrier systems. The incorporation of both samples into liposomes did not alter their antioxidant activity towards neutrophils, as compared with their respective free forms. Finally, this study examined the therapeutic effect of EEBd and caffeic acid, both in the free form and incorporated into liposomes, in an animal model of arthritis. The free samples markedly improved the joint inflammatory parameters: they reduced edema and migration of total cells and neutrophils, and slightly lowered the levels of the inflammatory cytokines tumor necrosis factor ? and interleukin 6 and 1? (TNF-?, IL-6, and IL-1?, respectively). In addition, incorporation of EEBd and caffeic acid into liposomes can help to reduce their concentrations required to achieve the desired therapeutic effect. Based on the set of results obtained in this study, we conclude that EEBd has a great potential to become a therapeutic adjuvant in the treatment of neutrophil-mediated inflammatory diseases, and that caffeic acid is a possible chemical marker of the anti-inflammatory activity of the extract.