Indiana University-Purdue University Indianapolis (IUPUI)

Background: Community acquired pneumonia (CAP) is a high incidence disease resulting in about 260,000 hospital admissions per year in Germany, more than myocardial infarction or stroke. Worldwide, CAP is the most frequent infectious disease with high lethality ranging from 1.2 % in those 20–29 years old to over 10 % in patients older than 70 years, even in industrial nations. CAP poses numerous medical challenges, which the PROGRESS (Pneumonia Research Network on Genetic Resistance and Susceptibility for the Evolution of Severe Sepsis) network aims to tackle: Operationalization of disease severity throughout the course of disease, outcome prediction for hospitalized patients and prediction of transitions from uncomplicated CAP to severe CAP, and finally, to CAP with sepsis and organ failure as a life-threatening condition. It is a major aim of PROGRESS to understand and predict patient heterogeneity regarding outcome in the hospital and to develop novel treatment concepts. Methods: PROGRESS was designed as a clinical, observational, multi-center study of patients with CAP requiring hospitalization. More than 1600 patients selected for low burden of co-morbidities have been enrolled, aiming at a total of 3000. Course of disease, along with therapy, was closely monitored by daily assessments and long-term follow-up. Daily blood samples allow in depth molecular-genetic characterization of patients. We established a well-organized workflow for sample logistics and a comprehensive data management system to collect and manage data from more than 50 study centers in Germany and Austria. Samples are stored in a central biobank and clinical data are stored in a central data base which also integrates all data from molecular assessments. Discussion: With the PROGRESS study, we established a comprehensive data base of high quality clinical and molecular data allowing investigation of pressing research questions regarding CAP. In-depth molecular characterization will contribute to the discovery of disease mechanisms and establishment of diagnostic and predictive biomarkers. A strength of PROGRESS is the focus on younger patients with low burden of co-morbidities, allowing a more direct look at host biology with less confounding. As a resulting limitation, insights from PROGRESS will require validation in representative patient cohorts to assess clinical utility. Trial registration: The PROGRESS study was retrospectively registered on May 24th, 2016 with ClinicalTrials.gov: NCT02782013

S. aureus est un pathogène humain qui produit une grande variété de facteurs de virulence, dont la leucocidine de Panton Valentine. Cette toxine est à l’origine de symptomatologies potentiellement sévères telles que la pneumonie nécrosante et l’ostéomyélite compliquée récidivante. Malgré la faible prévalence des gènes de la PVL au sein de souches de S. aureus, nous assistons à une émergence et à une diffusion de souches S. aureus résistantes à la méticilline d’origine communautaire (SARM-C) produisant la PVL. Bien que hautement conservée au sein de différents génomes, la PVL produite par les souches SARM-C américaines USA300 porte une substitution His176Arg avec un impact potentiel sur la fonctionnalité de la PVL. Nous avons étudié la distribution de ce polymorphisme au sein d’une sélection de souches SARM-C isolées de divers continents et nous avons confirmé le rôle leucotoxique de la PVL envers les neutrophiles humains quel que soit le fond génétique de la souche d’origine. Nous avons mis au point un modèle expérimental de lapin afin d’étudier le rôle de la PVL secrétée par la souche USA300 dans la pathogenèse de l’ostéomyélite. La PVL s’est révélée être un déterminant de la gravité de la maladie en termes de persistance et extension de l’infection, ainsi que d’amplitude de la réaction inflammatoire. Dès lors que nous avons conforté le rôle pathogène de la PVL, nous avons exploré l’effet des antibiotiques sur l’expression de la leucocidine. Nous avons observé après traitement avec l’oxacilline et l’imipénème une augmentation de la production de PVL. Cette augmentation est le résultat d’une activation transcriptionnelle des gènes de la PVL, activation médiée par les protéines liant la pénicilline et des régulateurs de la virulence staphylococcique, sarA et rot. D’autres antibiotiques la clindamycine, le linézolide et la rifampicine exercent un effet inhibiteur sur la production de PVL et bloquent l’induction de toxine par les bêta-lactamines. Sur la base de ces observations, nous recommandons pour le traitement des infections sévères à S. aureus producteur de PVL l’utilisation de l’oxacilline en association avec la clindamycine ou la rifampicine pour S. aureus sensible à la méticilline et du linézolide pour le SARM. / S. aureus is a human pathogen producing a large variety of virulence factors such as the Panton Valentine leukocidin (PVL). This toxin has been epidemiologically related to severe diseases such as necrotising pneumonia and recurrent osteomyelitis. The world wide spreading of PVL producing community acquired methicillin resistant S. aureus (CA-MRSA) has been reported. Although highly preserved within various genomes, the sequence of PVL produced by the american CA-MRSA strain USA300 carries a His176Arg substitution with a potential impact on the functionality of the leukocidin. We studied the distribution of this polymorphism within a selection of CA-MRSA strains isolated from various continents and we confirmed PVL toxicity towards human neutrophiles regardless to the genetic background of the harboring strain. We used an experimental rabbit model in order to study the relevancy of USA300 secreted PVL in the pathogenesis of osteomyelitis. We showed that PVL is a determinant of disease severity in terms of persistence and extension of the infection, as well as amplitude of the inflammatory reaction. We investigated the effect of antibiotics on the expression of the leukocidin. We observed increase PVL production after oxacilline and imipenem treatment. This was the consequence of trascriptional activation of PVL genes, mediated by penicillin binding proteins and S. aureus virulence regulators sarA and rot. Other antibiotics such as clindamycin, linezolid and rifampicin decreased PVL production and suppressed the inductor effect of beta-lactams. Based on these observations, we recommend for the treatment of the severe PVL induced diseases the use of oxacillin associated with either clindamycin or rifampicin for methicillin susceptible S. aureus or linezolid for MRSA.

Les pneumopathies acquises sous ventilation mécanique (PAVM) sont responsables d'une mortalité élevée. La nébulisation d'antibiotiques permet d'améliorer l'efficacité de leur traitement. Pour autant, aucune donnée pharmacocinétique portant sur la colistine et la gentamicine ne permet de recommander un schéma posologique particulier.Nous avons comparé les propriétés pharmacocinétiques plasmatique et intra-pulmonaire de la colistine (administrée sous forme de prodrogue, le colistiméthate sodique ou CMS) et de la gentamicine selon le mode d'administration (nébulisation ou perfusion intraveineuse) chez des patients de réanimation présentant une PAVM.Les concentrations intra-pulmonaires de colistine et de gentamicine étaient, respectivement, de 10 à 40 et 50 à 70 fois supérieures, après nébulisation, à celles retrouvées après administration d'une même dose par voie intraveineuse. La nébulisation permettrait également de limiter le risque de toxicité systémique avec une biodisponibilité inférieure à 10%.En assurant de fortes concentrations intra-pulmonaires et un faible passage systémique, la nébulisation de CMS et de gentamicine pourrait être une bonne alternative à leur administration intraveineuse dans le traitement des PAVM. / Ventilator-associated pneumonia (VAP) is associated with high mortality. Nebulization of antibiotics improves outcome of patient with VAP. However, pharmacokinetic data concerning colistin and gentamicin allowing for optimal dosing regimen recommendation are lacking.We compared systemic and pulmonary concentrations of colistin (administered as an inactive prodrug, colistin methanesulfonate or CMS) and gentamicin according to the route of administration (nebulization and intravenous infusion) in critically ill patients with VAP.Intra-pulmonary concentrations of colistin and gentamicin were 10 to 40-fold and 50 to 70-fold much higher after nebulization than after the same dose by intravenous route, respectively. Nebulization has also the theoretical potential advantage to improve patients' safety in relation to the colistin biodisponibility lower than 10%.With high intra-pulmonary concentrations and very low systemic absorption, CMS and gentamicin nebulization may be good alternatives to intravenous infusion for VAP treatment.

Streptococcus pneumoniae é o principal causador da pneumonia bacteriana. As vacinas atualmente disponíveis contêm polissacarídeo capsular conjugado ou não com proteínas carreadoras. No entanto, elas apresentam elevado custo ou proteção reduzida nos grupos de risco (crianças abaixo de 5 anos de idade e idosos). Proteínas de superfície de S. pneumoniae, como a PsaA e PspA, são consideradas fortes candidatas vacinais. Com o objetivo de se desenvolver uma vacina de ampla cobertura e baixo custo contra pneumococos, os genes psaA e pspA foram clonados em vetores de expressão em E. coli, pAE e pET e as proteínas expressas foram purificadas por cromatografias de afinidade e de troca aniônica. O rendimento de proteína recombinante obtido com a construção baseada em pET foi 3 vezes maior que o obtido com pAE. Condições de cultivo foram estabelecidas utilizando meio definido com indução por IPTG e/ou por lactose. As cepas recombinantes estão adequadas para serem usadas em estudos para escalonamento da produção em biorreatores. / Streptococcus pneumoniae is the main causative agent of bacterial pneumonia. The current vaccines available contain capsular polysaccharide conjugated or not with carrier proteins. However these are either too expensive or do not protect the high-risk groups. Surface proteins of S. pneumoniae, such as PsaA and PspA, are considered strong vaccine candidates. With the aim of developing a broad-coverage and low-cost vaccine against pneumococcus, the psaA and pspA genes were cloned in E. coli expression vectors, pAE and pET and the expressed proteins were purified through affinity and anion exchange chromatography. The yield of the recombinant protein obtained with the construction based in pET was 3-fold higher than that obtained with pAE. Culture conditions were established using defined media with IPTG and/or lactose induction. The recombinant strains are now ready to undergo studies for scale-up of production in bioreactors.

Sekundäre bakterielle Infektionen im Verlauf oder in Folge einer Infektion mit Influenza A Viren (IAV) steigern oftmals die Schwere des Krankheitsverlaufes, was besonders während der IAV Pandemien von 1918, 1968 und 2009 deutlich wurde. Genaue mechanistische Ursachen, welche dieser gesteigerten Kopathogenität zugrunde liegen wurden überwiegend in Tierversuchsmodellen adressiert und sind immunologisch unvollständig. Aufgrund organstruktureller und immunfunktioneller Speziesunterschiede ist ungewiss, inwieweit eine Übertragbarkeit der Daten zwischen Mensch und Maus besteht. Fokus der Arbeit bildete die Analyse potentieller IAV assoziierter Änderungen der angeborenen Immunität, welche sekundäre Pneumokokkeninfektionen in humanem ex vivo Lungengewebe begünstigen. Dafür wurden zentrale Zyto - bzw. Chemokine als Reaktion auf Einzelinfektionen mit dem saisonalen IAV Pan/99(H3N2) sowie Streptococcus pneumoniae D39 mit denen subsequenter viral-bakteriellen Koinfektion verglichen. Ausgelöst durch die antivirale Interferonantwort erfolgte die Reduktion der pneumokokkeninduzierten Bildung von IL-1β und GM-CSF auf translationaler und transkriptioneller Ebene. Vermutlich beeinflussen Typ I und II Interferone die IL-1β Bildung, welches über parakrine Wechselwirkungen an der GM-CSF Regulation beteiligt ist. Auf zellulärer Ebene verursachte IAV die Freisetzung von Typ I, II und III Interferonen aus primären humanen Alveolarepithelzellen vom Typ II. In humanen Alveolarmakrophagen unterdrückten Typ I und II Interferone die pneumokokkeninduzierte IL-1β Freisetzung. Folglich unterblieb die IL-1β-regulierte GM-CSF Sekretion aus Alveolarepithelzellen vom Typ II. Die Ergebnisse zeigen, dass influenzainduzierte Interferone durch die Unterdrückung der IL-1β regulierten Bildung von GM-CSF in humanem Lungengewebe beitragen. Damit unterstützt sie das Verständnis immunologischer Faktoren, welche diesem Krankheitsbild im Menschen pathophysiologisch zugrunde liegen können. / Secondary bacterial infections, which occur during or following an IAV infection, exaggerate the severity of the course of disease up to a lethal outcome, clearly recognizable during the fatal IAV pandemics from 1918, 1968 or 2009. Particular mechanisms underlying this exaggerated viral-bacterial copathogenity were almost solely addressed using animal models and are immunologically incomplete. Due to structural and immunofunctional interspecies differences the transferability of data between human and mice remains indeterminate. The study mainly purposed to investigate IAV associated modulations of innate immunity, which potentially facilitates secondary pneumococcal pneumonia in primary human ex vivo lung tissue. Hence secretion of central cyto- and chemokines initiated by single infection with the seasonal IAV Pan/99(H3N2) or the bacterium Streptococcus pneumoniae D39 were compared to subsequent viral-bacterial coinfection. In context of an antiviral interferon response the pneumococcal induced translation and transcription of IL-1β and GM-CSF were reduced. Probably type I and type II interferons affect generation of IL-1β, which participates in the regulation of GM-CSF by paracrine interactions. On a cellular basis the infection of primary human alveolar epithelial cells type II (AECII) with IAV triggered the release of interferon type I, II and III. In human alveolar macrophages type I and II interferons suppressed the pneumococcal induced release of IL-1β. Consequently, the IL-1β regulated generation of GM-CSF in AECII was impeded. The present study indicates, that influenza related induction of interferons suppresses the IL-1β related release of GM-CSF in human lung tissue. Thereby it takes part in contributing to pathophysiological comprehension of immunological factors underlying this copathogenity.

Le paludisme et la pneumonie constituent encore des problèmes de santé publique dans les pays à faible revenu, dont Madagascar. Toutefois, si le paludisme a reçu plus d’attention et vu ses programmes de lutte renforcés depuis la création du Fonds mondial en 2002, la pneumonie quant à elle est souvent négligée. Cependant, depuis peu, l’Unicef, s’appuyant sur les résultats encourageants obtenus au niveau communautaire dans la lutte contre le paludisme, pousse à l’intégration du dépistage et de la prise en charge de la pneumonie au niveau communautaire. Pour appuyer ce plaidoyer, des études d’impact et de type coût-efficacité sont nécessaires pour vérifier que cette stratégie est bien efficace et efficiente. C’est l’objet du chapitre 4 de cette thèse qui étudie l’expérience pilote menée par l’Unicef dans le district d’Antalaha. Nous montrons que ce programme a eu un impact notable sur la prise en charge du paludisme et de la pneumonie. Toutefois, la qualité de cette prise en charge est encore remise en question. Cela indique que, avant de décider d’une mise à l’échelle, ce programme mérite d’être révisé pour l’améliorer. Outre la perte de bien-être, le paludisme et la pneumonie ont un coût financier d’abord, économique, ensuite. Un des arguments de plaidoyer est alors de montrer, s’il y en a, les effets économiques des deux maladies. C’est l’objet des chapitres 2 et 3 avec une application à Madagascar. Auparavant, le sous-bassement théorique du lien entre santé et revenu ou développement économique est présenté dans le premier chapitre. / Malaria and pneumonia remain a public health problem in low-income countries, including Madagascar. However, while malaria has received more attention and its control programs have been strengthened since the creation of the Global Fund in 2002, pneumonia is often neglected. Face on the encouraging results of malaria community case management, UNICEF wants to integrate pneumonia management at community level. To support this advocacy, the impact and the cost-effectiveness of this strategy must be known to verify that it is effective and efficient. This is the purpose of Chapter 4 of this thesis which studies the pilot experiment conducted by Unicef in the district of Antalaha. It is shown that this program has had a significant impact on the management of malaria and pneumonia. However, the quality of this care is questioned. This situation indicates that, before scaling up, this program should be revised to improve it. Besides the loss of well-being, malaria and pneumonia have a financial and economic cost. Therefore, the economic effects of the two diseases are shown in the chapters 2 and 3 concerning the case of Madagascar. Previously, the theoretical under-base of the link between health and economic development is presented in the first chapter.

Streptococcus pneumoniae ist die häufigste Ursache für ambulant erworbene Pneumonien weltweit. Daher müssen die Wirts-Pathogen-Interaktionen erforscht werden, um neue Therapiestrategien zu entwickeln. In dieser Studie habe ich 1. den Typ I Interferon (IFN)-stimulierenden Signalweg des angeborenen Immunsystems in Pneumokokken-infizierten Wirtszellen sowie 2. dessen Bedeutung in der Pneumokokkenpneumonie untersucht. Humane und murine Makrophagen, aber nicht alveolare Epithelzellen, produzierten Typ I IFNs nach Infektion mit S. pneumoniae. Dieses war abhängig vom Virulenzfaktor Pneumolysin und erforderte sowohl die Phagozytose der Bakterien als auch die Ansäuerung der Endosomen. Die Induktion der Typ I IFNs wird durch einen zytosolischen Signalweg vermittelt, welcher wahrscheinlich DNA erkennt und sowohl das Adapterprotein STING als auch den Transkriptionsfaktor IRF3 aktiviert. Typ I IFNs, welche von infizierten Makrophagen gebildet wurden, regulierten die Expression von IFN-stimulierten Genen (ISGs) und Chemokinen in Makrophagen und co-kultivierten alveolaren Epithelzellen in vitro und in Mauslungen in vivo. In einem murinen Pneumoniemodell hatten die Typ I IFNs jedoch einen negativen Effekt für den Wirt. Mäuse mit einem Defekt im Typ I IFN-Rezeptor oder mit einem Knockout im Typ I und Typ II IFN-Rezeptor hatten eine signifikant geringere Bakterienlast in der Lunge und eine verminderte Reduktion der Körpertemperatur und des Körpergewichtes als wild-typ Mäuse. Diese Effekte waren nicht durch Änderungen in der Zellrekrutierung oder durch Änderungen der Zytokin-/Chemokinexpression erklärbar. Zusammenfassend lässt sich feststellen, dass Typ I IFNs durch Pneumokokken induziert werden, aber dass sie trotz einiger positiver Effekte auf die Expression von ISGs einen negativen Gesamteffekt in einem murinen Pneumoniemodell aufweisen. Ein detailliertes Verständnis der Typ I IFN-Antwort während der Pneumokokkeninfektion kann die Entwicklung neuer Therapiestrategien unterstützen. / Streptococcus pneumoniae is the leading cause of community-acquired pneumonia world-wide. A detailed understanding of the host-pathogen interactions is required in order to foster the development of new therapeutic strategies. Here, I (I) characterized an innate immune recognition pathway that senses pneumococcal infection and triggers the production of type I interferons (IFNs), and (II) examined the role of type I IFNs in pneumococcal pneumonia in mice. Human and murine macrophages, but not alveolar epithelial cells, produced type I IFNs after infection with S. pneumoniae. This induction was dependent on the virulence factor pneumolysin, the phagocytosis of the bacteria, and the acidification of the endosome. Moreover, it appeared to be mediated by a cytosolic DNA-sensing pathway involving the adaptor molecule STING and the transcription factor IRF3. Type I IFNs produced by S. pneumoniae-infected macrophages positively regulated the expression of IFN-stimulated genes (ISGs) and chemokines in macrophages and co-cultured alveolar epithelial cells in vitro and in mouse lungs in vivo. However, in a murine model of pneumococcal pneumonia, type I IFN signaling was detrimental to the host defense. Mice deficient in the type I IFN signaling or double deficient in type I and type II IFN signaling had a significantly reduced bacterial load in the lung and a diminished reduction of body temperature and body weight compared to wild-type mice. The decreased susceptibility of the knockout mice was unlikely to be attributable to alterations in cell recruitment or cytokine/chemokine production. In conclusion, type I IFNs are induced during pneumococcal infection. However, despite their positive effects on the expression of some ISGs and chemokines, they negatively affect the outcome of pneumococcal pneumonia in an in vivo mouse model. Targeting the type I IFN system could potentially be an effective way in enhancing the immune response in patients with S. pneumoniae pneumonia.

A suinocultura brasileira representa uma importante atividade econômica para o país, o qual ocupa lugar de destaque na produção e exportação de carne suína no mundo. O destaque do país na produção de suínos, deve-se a melhorias na sanidade, manejo, produção integrada e, principalmente, no aprimoramento gerencial dos produtores. O primeiro artigo consistiu em determinar a frequência e a distribuição das doenças infecciosas (DI) diagnosticadas através de exame de necropsia e histopatologia em suínos nas fases de crescimento e terminação ao longo de 12 anos (2005-2016) no sul do Brasil. Foram avaliados 1906 laudos anatomopatológicos de suínos nas fases de crescimento/terminação, dos quais as DI corresponderam a 75,6% (1441 casos) do total. As infecções por circovírus suíno tipo 2 (PCV2) foram as mais frequentes, contabilizando 51,3% (739/1441) dos casos, seguidas por DI que afetam o sistema respiratório (30,1% dos casos). Dentre essas, destacam-se a influenza suína A (15,1%; 218/1441) e pneumonias bacterianas (15%; 216/1441). O diagnóstico de influenza exibiu uma frequência elevada entre os anos de 2010 a 2013, totalizando 43,1% (167/387) dos casos. Após este período, ambas DI respiratórias exibiram caráter endêmico. As DI que afetam o sistema digestório totalizaram 10,5% (151/1441) dos diagnósticos, com as seguintes condições: enterocolite por Salmonella spp. (43,7%; 66/151), enteropatia proliferativa por Lawsonia spp. (41,7%; 63/151) e colite por Brachyspira spp. (14,6%; 22/151). Além dessas, as polisserosites e meningites bacterianas representaram 5,8% (84/1441) e 2,3% (33/1441) dos casos diagnosticados, respectivamente. O segundo artigo descreve três surtos de doença por circovírus suíno tipo-2 (PCVD) com lesões envolvendo musculatura esquelética. Em um curso clínico de 7 a 10 dias, 92 suínos apresentaram apatia, emagrecimento e diarreia. Ainda, cerca de 30 dos suínos afetados, apresentavam dificuldade de locomoção, fraqueza muscular, paresia de membros pélvicos e decúbito permanente. Quatro suínos exibiram palidez em músculos esqueléticos dos membros pélvicos, torácicos e dorso-lombares. As lesões microscópicas observadas consistiam de miosite necrótica granulomatosa, predominantemente, em membros pélvicos e torácicos, e em menor intensidade nos músculos dorso-lombares. No exame imuno-histoquímico para PCV2 observou-se marcação multifocal acentuada, predominantemente, no citoplasma e núcleos de macrófagos, linfócitos e células gigantes multinucleadas, além de marcação discreta no citoplasma no citoplasma de fibras necróticas da musculatura esquelética. As amostras de músculo esquelético foram positivas na reação em cadeia de polimerase para PCV2 e a ampliação exibiu 99% de identidade com sequências pertencentes ao genótipo PCV2b. / Brazilian pig farms represent an important economic activity for the country, which occupies a prominent place in the production and export of pork in the world. The country's prominence in pork production is due to improvements in sanitation, management, integrated production and, mainly, in the managerial improvement of the producers. The first study aimed to determine the frequency and distribution of infectious diseases (ID) diagnosed through necropsy and histopathology examination in growing-finishing swine along 12 years (2005-2016) in Southern Brazil. A total of 1906 anatomopathological exams performed in growing-finishing swine were evaluated, of which ID accounted for 75.6% (1441 cases) of the total. Porcine circovirus type 2 (PCV2) infections were the most frequent, accounting for 51.3% of the cases (739/1441), followed by respiratory system ID (30.1% of the cases). Among these, the main conditions were swine influenza (15.1%; 218/1441) and bacterial pneumonia (15%; 216/1441). Influenza diagnosis had a higher frequency between 2010 and 2013, accounting for 43,1% (167/387) of the cases. After this period, both respiratory ID had an endemic occurrence. Digestive system ID accounted for 10.5% (151/1441) of the diagnosis, with the main conditions diagnosed: Salmonella spp. enterocolitis (43.7%; 66/151), Lawsonia spp. proliferative enteropathy (41.7%; 63/151) and Brachyspira spp. colitis (14.6%; 22/151). Besides these, polyserositis and bacterial meningitis represented, respectively, 5.8% (84/1441) and 2.3% (33/1441) of the cases diagnosed. The second study describes three outbreak of porcine circovirus disease (PCVD) with the involvement of skeletal muscle. In a clinical course of 7 to 10 days, 92 pigs had apathy, weight loss and diarrhea. Approximately 30 of these 92 pigs had stiff gait, muscle weakness, hind limb paresis, and recumbency. 4 pigs necropsied presented pale discoloration from hind and thoracic limbs, as well from dorsal lumbar skeletal muscles. The microscopical lesions consisted of granulomatous necrotizing myositis mainly of hind and thoracic limbs, and mildly from dorsal lumbar muscles. Immunohistochemistry exam for PCV2 revealed marked multifocal intracytoplasmic and intranuclear staining predominantly in macrophages, lymphocytes and multinucleated giant cells, with a lower amount in the cytoplasm of necrotic fibers of the skeletal muscle. Affected muscle samples were polymerase chain reaction– positive for PCV2 and the amplicon exhibited 99% identity with sequences belonging to the PCV2b genotype.

Chemoattractant agents play a crucial role in the initiation of immune responses, by regulating the traffic and function of leucocyte populations. Their receptors are therefore considered as potential targets for the development of new therapies in the fields of cancer and inflammatory diseases. ChemR23, a previously orphan receptor discovered in the laboratory, is structurally related to receptors for chemoattractant agents. It is expressed on immature myeloid and plasmacytoid dendritic cells (mDCs and pDCs respectively), as well as on adipocytes, macrophages, NK and endothelial cells. Chemerin, the endogenous ligand of ChemR23, is abundant in various human samples originating from inflammatory diseases, including pleural effusions. Chemerin is secreted as an inactive precursor, prochemerin, and is activated by the removal of six or seven amino-acids from its carboxy-terminus by serine proteases, such as as cathepsin G and elastase. Chemerin acts as a chemoattractant agent of low nanomolar potency for macrophages, immature mDCs and pDCs. It is however more active on pDCs, in line with the higher expression of ChemR23 on these cells. pDCs possess important immunoregulatory properties in lung diseases, and their ability to secrete large amounts of type I interferon (IFN) upon viral infection makes them crucial players in anti-viral immunity.<p>According to these elements, and to the role of neutrophils in the physiopathology of many inflammatory lung diseases and in the generation of active chemerin, we began in 2007 to study the role of chemerin and its receptor ChemR23 in inflammatory lung diseases. We first characterized the mouse chemerin/ChemR23 system, and described that this system was very similar to the human one, in terms of distribution, pharmacology and functional properties. We then used wild type mice (WT) and mice invalidated for the receptor (ChemR23-/-) in various models of inflammatory lung diseases, including asthma, lung fibrosis, viral pneumonia, and acute lung injury. <p>Whereas the asthma and lung fibrosis models did not allow to demonstrate a significant role of the chemerin/ChemR23 system (possibly as a result of the lack of production of active chemerin in these models), infection by either the Pneumonia Virus of Mice (PVM), the mouse counterpart of human RSV, or by a murinized H1N1 influenza strain resulted in a significantly higher mortality rate in ChemR23-/- mice as compared to their WT counterparts. Using the PVM-induced pneumonia model, we observed that the excessive mortality of knock-out mice is caused by an inadequate and excessive innate immune response characterized by a massive recruitment of neutrophils to the lungs, associated with a delayed viral clearance and lower type I IFN synthesis. This latter observation suggested an impairment of pDC recruitment, according to the important contribution of pDCs to the production of type I IFNs in viral diseases, and the role of chemerin in the recruitment of these cells. We indeed confirmed a lower recruitment of pDCs in the lung of infected ChemR23-/- mice, as compared to WT mice. However, experiments of adoptive transfert and depletion of pDCs failed to proof a link between impaired pDC recruitment and the excessive morbidity and mortality observed in ChemR23-invalidated mice. <p>In parallel, we studied the role of the chemerin/ChemR23 system in the control of innate immune responses, by using a model of acute lung injury caused by the intra-tracheal instillation of bacterial lipopolysaccharide (LPS). In this model, administration of recombinant chemerin together with LPS in WT mice resulted in a significant (about 50%) reduction of neutrophil recruitment to both lung parenchyma and airways. Assessment of pro-inflammatory cytokines and chemokines in broncho-alveolar lavage fluids confirmed this anti-inflammatory effect of chemerin, which was ChemR23-dependent, as the inflammatory response of ChemR23-/- mice was unaffected by chemerin. In our hands, chemerin does not modulate macrophage functions, in contrast to data recently published by other groups, attributing anti-inflammatory effects of chemerin or chemerin-derived peptide to the modulation of macrophage activation and phagocytosis. Other hypotheses that could take our observations into account are presently investigated, including an immunomodulatory role of chemerin on lung epithelial or endothelial cells, and/or the ChemR23-dependent recruitment of subtypes of macrophages or other myeloid cells endowed with immunosuppressive properties. <p>In conclusion, our studies characterized the mouse chemerin/ChemR23 system and highlighted the role of this system in the physiopathology of some inflammatory lung diseases. Our results suggest that the chemerin/ChemR23 system might be considered as a potential therapeutic target for the development of future anti-infectious and anti-inflammatory therapies, particularly for viral pneumonia, which represent a major public health problem, as well as for acute respiratory distress syndrome (ARDS) following severe acute lung injuries.<p> <p><p>Les agents chimioattractants jouent un rôle fondamental dans l’initiation des réponses immunes en régulant le trafic et la fonction des populations leucocytaires. Leurs récepteurs constituent dès lors des cibles d’intérêt pour le développement de traitements contre les maladies inflammatoires et le cancer. Le laboratoire d’accueil a identifié le récepteur ChemR23, exprimé à la surface des cellules dendritiques myéloïdes (mDCs) et plasmacytoïdes (pDCs) immatures, des macrophages, des cellules NK, des adipocytes, et des cellules endothéliales. Le ligand endogène du récepteur ChemR23, la chémérine, est présent en abondance dans divers échantillons pathologiques d’origine inflammatoire. La chémérine est produite sous la forme d'un précurseur inactif, la prochémérine, qui nécessite pour devenir active le clivage protéolytique de six ou sept acides aminés à son extrémité carboxy-terminale. La chémérine induit le chimiotactisme des macrophages et des DCs immatures, et en particulier des pDCs immatures en accord avec l’expression plus importante de ChemR23 par les pDCs. Les pDCs jouent un rôle immunorégulateur important en pathologie pulmonaire, en particulier dans la physiopathologie des pneumonies virales, par leur capacité à produire d’importantes quantités d’interféron (IFN) de type I.<p>Compte tenu de ces éléments et du rôle des polynucléaires neutrophiles dans de nombreuses pathologies pulmonaires, ainsi que dans la génération de chémérine active à partir de son précurseur, nous avons débuté en octobre 2007, l’étude du rôle de la chémérine et de son récepteur ChemR23 dans le contrôle des pathologies pulmonaires inflammatoires. Nous avons tout d’abord caractérisé le système chémérine/ChemR23 chez la souris et avons montré que ce système présentait des caractéristiques similaires à celles décrites chez l’homme, en termes de distribution, de pharmacologie et de propriétés fonctionnelles. <p>Ensuite, nous avons comparé des souris sauvages et invalidées pour le récepteur ChemR23 (ChemR23-/-) dans divers modèles de pathologies pulmonaires. Les modèles d’asthme et de fibrose pulmonaire induite par instillation de bléomycine ou de silice n’ont pas permis de mettre en évidence un rôle important du couple chémérine/ChemR23, peut-être en raison de l’absence de génération de forme active de chémérine dans ces modèles. En revanche, l’administration de deux agents viraux différents, le PVM (Pneumonia Virus of Mice), l’équivalent murin du RSV humain, et un virus de l’influenza H1N1 murinisé, a résulté en un taux de mortalité 40% plus élevé pour les souris ChemR23-/- par rapport à leurs homologues sauvages. En utilisant le modèle de pneumonie induite par le PVM, nous avons montré que cette différence de mortalité est causée par une réponse immune inappropriée et excessive, associée à une réduction de l’élimination du virus, ainsi qu’à un déficit de synthèse d’IFN de type I. Les pDCs, dans un contexte d’infection virale, sont capables de synthétiser d’importantes quantités d’IFN de type I, et nous avons mis en évidence un déficit relatif de recrutement en pDCs chez les souris ChemR23-/- infectées. Néanmoins, les expériences de transfert adoptif et de déplétion de pDCs n’ont pas permis de lier ce défaut de recrutement à l’excès de morbidité et de mortalité observé chez les souris ChemR23-/- infectées. <p>En parallèle, le rôle de ce couple ligand-récepteur dans le contrôle des réponses immunitaires innées a été étudié dans un modèle de pneumopathie aiguë induite par instillation intra-trachéale de lipopolysaccharide (LPS). Dans ce modèle, l’administration simultanée de chémérine recombinante avec le LPS entraîne chez les souris sauvages une diminution significative (environ 50%) du nombre de polynucléaires neutrophiles recrutés dans les voies aériennes et dans le parenchyme pulmonaire, ainsi qu’une importante diminution de synthèse de cytokines pro-inflammatoires. Cet effet anti-inflammatoire de la chémérine est dépendant de ChemR23, et ne semble pas être secondaire à un effet de la chémérine sur l’activation des macrophages, contrairement à certaines données publiées récemment par d’autres groupes. D’autres hypothèses permettraient cependant de prendre en compte ces observations, notamment un effet de la chémérine sur les cellules épithéliales et/ou endothéliales pulmonaires, ainsi que sur le recrutement de sous-populations de macrophages ou d’autres cellules myéloïdes possédant des propriétés immunosuppressives. Des expériences complémentaires ont été initiées afin de tester ces hypothèses. <p>En conclusion, après avoir caractérisé le système chémérine/ChemR23 chez la souris, nos études ont permis de mettre en évidence le rôle de ce couple ligand/récepteur dans la physiopathologie de certaines pneumopathies inflammatoires, ouvrant ainsi de nouvelles perspectives thérapeutiques, en particulier pour le traitement des pneumopathies virales, qui constituent un problème de santé publique majeur, ainsi que des syndromes de détresse respiratoire aiguë (ARDS). / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished