Over the last decade, the innate immune system has been the subject of extensive research. Often overlooked by the robustness and specificity of the adaptive immune system, the innate immune system is proving to be just as complex. The identification of several families of pattern recognition receptors (PRRs) has revealed an ancient yet multifaceted system of proteins that are responsible for initiating host defense. A wide array of pathogens, from virus to bacteria, is detected using this assortment of receptors. One such family, the Toll-like receptors (TLRs), has been at the forefront of this research. To date, 10 TLRs have been described in the human genome. Activation of TLRs leads to the induction of immune-related genes that ultimately control the response of the host. However, the signaling pathways emanating from activated TLRs and other PRRs are not fully understood. In particular, the pathway leading to the activation of interferon regulatory factor 3 (IRF3), a transcription factor crucial for the induction of type I interferon, remains undefined. IRF3 activation occurs as the consequence of viral infection and through the activation of TLRs 3 and 4 by dsRNA and lipopolysaccharide (LPS), respectively. The focus of this research is to describe components of the IRF3 activation pathway, partly through the analysis of TLR signal transduction. IRF3 normally resides in the cytoplasm of cells. Upon infection with certain viruses and bacteria, IRF3 is activated though phosphorylation at its C-terminus. Phosphorylated IRF3 homodimerizes and associates with co-activators CBP-p300. After translocating to the nucleus, the activate IRF3 complex induces the activation of type 1 interferon and interferon related genes. Little is known about the pathways that lead to the activation of IRF3, especially the kinases involved. In this study we report that the non-canonical IкB kinase homologues, IкB kinase epsilon (IKKε) and TANK-binding kinase-1 (TBK1), which were previously implicated in NF-кB activation, are also essential components of the IRF3 signaling pathway. In particular, mouse embryonic fibroblasts from TBK1 deficient mice fail to activate IRF3 in response to both viral infection and stimulation with LPS or poly (IC), a dsRNA analog. Thus, both IKKε and TBK1 play a critical role in innate immunity and host defense. In addition to viral infection, IRF3 activation also occurs via the activation of TLR3 and 4. TLRs signal through a subfamily of Toll-IL-1-Resistance (TIR) domain containing adapter molecules. One such adapter, MyD88, is crucial for all TLRs, with the exception of TLR3. MyD88 participates in a signal transduction pathway culminating in the activation of the transcription factor NF-кB. Studies from MyD88-deficient mice reveal that both TLR3 and 4 still are capable of activating NF-кB, although with slightly delayed kinetics. Another aspect of the MyD88-independent signal transduction pathway is the activation of IRF3. A second TIR domain containing adapter molecule called Mal/Tirap was discovered and originally thought to mediate the MyD88-independent pathway. However, Mal-deficient mice were found to be defective in both TLR2 and 4 mediated NF-кB activation. We hypothesized that other TIR domain containing adapters could mediate this MyD88-independent pathway of TLR3 and 4 leading to the activation of IRF3. Two additional TIR adapters were discovered, TRIF and TRAM. TRIF was shown to mediate TLR3 signal transduction. In this study, we report that both TRIF and TRAM mediate the activation of the MyD88-independent pathway in response to LPS/TLR4 activation. Unlike any of the other known TIR domain containing adapters, TRAM appears to be restricted to the LPS/TLR4 activation pathway while TRIF plays a role in both TLR3 and TLR4 pathways leading to IRF3 target gene expression. Our studies revealed that TRAM could be acting upstream of TRIF in the LPS/TLR4 pathway. To this end, we sought to determine the localization of TRAM within the cell. We found that TRAM localizes to the plasma membrane. TRAM localization is the result of myristoylation since mutation of the predicted myristoylation site (G2A) resulted in the re-distribution of TRAM from the membrane into the cytoplasm. Reconstitution of TRAM-deficient macrophages with TRAM G2A is unable to rescue LPS/TLR4 signal transduction. Thus, myristoylation and membrane association of TRAM are critical for LPS/TLR4 signal transduction. The data generated in this dissertation extends our understanding of the signaling pathways of the innate immune system. Indeed, the molecules and pathways described herein could prove to be beneficial targets for ameliorating symptoms of disease, both autoimmune and pathogen-associated. Finally, the research described here will spur further insight into the complex signaling pathways of a once ignored arm of the immune system.

Sepse é a resposta inflamatória sistêmica decorrente de infecção grave, com alto índice de mortalidade, tornando-se um grave problema de saúde pública. Apesar dos inúmeros estudos realizados em busca de alternativas terapêuticas, o entendimento acerca dos mecanismos envolvidos na doença permanece restrito. A interação entre o metabolismo lipídico e a resposta inflamatória tem sido intensamente investigada. Neste estudo, avaliou-se a influência da proteína de transferência de colesterol esterificado (CETP) - glicoproteína plasmática que promove a transferência de lípides entre lipoproteínas - na resposta inflamatória. Inicialmente, foram comparados camundongos transgênicos para CETP humana (CETP) e controles irmãos não transgênicos (WT) submetidos ao modelo de sepse polimicrobiana de ligadura e perfuração do ceco (CLP), avaliando a taxa de sobrevida e o perfil inflamatório entre os grupos. Em seguida, a resposta inflamatória em macrófagos de peritônio de camundongos estimulados com LPS na ausência ou presença da CETP exógena (CETP humana recombinante) e endógena (macrófagos de animais CETP) foi analisada. Verificou-se que camundongos CETP apresentaram maior taxa de sobrevida, maior migração de linfócitos para o foco infeccioso, menores concentrações plasmáticas de IL-6 e menor expressão proteica do receptor Toll-like 4 (TLR4) e da enzima aciloxiacilo hidrolase (AOAH) no fígado, comparados aos WT. Nos macrófagos, observou-se que a presença da CETP recombinante foi capaz de se ligar ao LPS, pela análise da microscopia confocal, e, em cultura, reduziu de forma dose dependente a captação de LPS, a expressão de TLR4, a ativação do NF-kB (p65) e a secreção de IL-6 para o sobrenadante do cultivo celular. Os dados obtidos com os macrófagos de animais CETP corroboraram, em parte, os encontrados com a utilização da CETP exógena. Houve redução da captação de LPS e da ativação do NF-kB (p65), sem alteração na expressão de TLR4 e secreção de IL-6. Entretanto, apresentaram redução das concentrações de TNF-alfa celular e no sobrenadante de cultura. Dessa maneira, foi possível concluir que a CETP atua como agente modulador da resposta inflamatória induzida pela CLP e em macrófagos estimulados pelo LPS. Esses achados devem ser considerados nas doenças inflamatórias e nos futuros estudos relacionados à inibição da CETP, além de estabelecer novas perspectivas de tratamento da sepse / Sepsis is a systemic inflammatory response due to serious infection with high mortality rate, which has become a serious problem for public health. Despite numerous studies seeking for therapeutic alternatives, the understanding of the mechanisms involved in this disease remains limited. The interaction between lipid metabolism and inflammatory response has been intensively investigated. In the present study it was evaluated the influence of CETP (cholesteryl ester transfer protein) - plasma glycoprotein that promotes the transfer of lipids between lipoprotein - in the inflammatory response. Initially transgenic mice for human CETP (CETP) were compared to non transgenic control mice (WT) after polymicrobial sepsis induced by cecal ligation and puncture (CLP), to determine survival rate and the inflammatory profile between groups. Then, macrophages isolated from peritoneal cavity stimulated with LPS in the presence or absence of exogenous CETP (recombinant human CETP) and endogenous CETP (macrophages from CETP mice) were analyzed. It was found that CETP mice showed a higher survival rate, a greater lymphocyte migration to infectious focus, a lower IL-6 plasma concentration and a decrease in Toll-like receptor 4 (TLR4) and acyloxyacyl hydrolase enzyme (AOAH) protein expression in the liver in comparison to WT mice. In macrophages, recombinant CETP was able to bind to LPS, by confocal microscopy analysis and in cell culture, it was observed that in the presence of the recombinant CETP macrophages presented decreased in LPS uptake, TLR4 expression, NF-kB activation (p65) and IL-6 secretion into the cell culture medium. Furthermore, the results with macrophages from animals CETP corroborate partly with what was found in the exogenous experiments. LPS uptake and NF-kB activation (p65) were reduced, but no difference regarding the expression of TLR4, nor the IL-6 secretion to the cell culture medium. However, the CETP group also showed reduced levels of TNF-alfa both in macrophages and in the culture supernatant. Thus, we conclude that CETP acts as modulator of the inflammatory response induced by CLP and in the macrophages stimulated by LPS. In addition, new therapeutic perspectives could be established

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

Orientador : Alexandre Leite Rodrigues de Oliveira / Tese (Doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T00:27:25Z (GMT). No. of bitstreams: 1 Freria_CamilaMarques_D.pdf: 9799936 bytes, checksum: 9a9057c6ab5ca87ea1bc6767c4f71490 (MD5) Previous issue date: 2013 / Resumo: Lesões nervosas periféricas e centrais levam à inflamação local e retrógrada, resultando em alterações axonais, perdas neuronais e sinápticas significativas. Juntamente a tais alterações, as células gliais tornam-se reativas, influenciando na remodelação do SNC após lesão. Os mecanismos que desencadeiam tais mudanças não são completamente compreendidos, mas é evidente que as moléculas classicamente relacionadas com o sistema imune estão envolvidas em tais eventos diretamente ou através da modulação da reatividade glial. Assim, nossa hipótese é que o controle da sinalização inflamatória após a lesão central ou periférica possa afetar indiretamente nos mecanismos endógenos de reparação no SNC, resultando em maior preservação das conexões neurais e melhor recuperação funcional. Para isso, realizamos lesões periféricas e centrais expondo os animais a diferentes microambientes de lesão a fim de investigar o papel das células gliais na sobrevivência, capacidade regenerativa axonal e estabilidade sináptica de motoneurônios medulares. Os resultados mostraram que, após lesão, a modulação da sinalização inflamatória através da administração de citocinas ou deleção de moléculas expressas na superfície das células gliais podem influenciar direta ou indiretamente na estabilidade dos circuitos neuronais, na regeneração axonal e sobrevivência neuronal. Desse modo, conclui-se que o controle da inflamação e da reatividade glial são, provavelmente, críticos para a plasticidade no Sistema Nervoso viabilizando, assim, novas estratégicas de tratamentos / Abstract: Central or peripheral lesions result in local and retrograde inflammation, leading to axonal degeneration, synaptic and/or neuronal loss. Additionally, after injury, reactive glial cells are recruited to the lesion site, influencing the plasticity of the nervous system. The mechanisms which trigger such changes are not completely understood, but evidences have shown that molecules classically related to the immune system are involved in such events directly or indirectly by glial modulation. Based on this, our hypotheses is that the control of inflammatory signaling after central or peripheral injury may indirectly affect the endogenous repair mechanisms, resulting in a greater synaptic preservation and better functional recovery. In this sense, animals were submitted to both central and peripheral lesions in order to investigate the effects of glial cells on neuron survival, axonal regeneration and synaptic plasticity. The results showed that, after lesion, the modulation of inflammatory signaling by cytokines or knocking down molecules on glial surface, directly or indirectly influence the stability of neural circuits, neuronal survival and axonal regeneration. Thus, we believe that this is important findings that may be critical to the development of new therapeutic strategies following nervous system injury / Doutorado / Clinica Medica / Doutora em Ciências

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2016-05-25T16:04:47Z No. of bitstreams: 1 Nicole Cristine Rigonato de Oliveira.pdf: 1240943 bytes, checksum: 14fa67b6692555f3bc76fb1f34186220 (MD5) / Made available in DSpace on 2016-05-25T16:04:47Z (GMT). No. of bitstreams: 1 Nicole Cristine Rigonato de Oliveira.pdf: 1240943 bytes, checksum: 14fa67b6692555f3bc76fb1f34186220 (MD5) Previous issue date: 2014-12-19 / The acute respiratory distress syndrome (ARDS) is a disease characterized by respiratory failure due to an inflammatory response, which has high morbidity and mortality. Several cytokines seem to orchestrate the acute and chronic processes, mainly mediated by toll like receptors (TLRs). The literature demonstrates that aerobic exercise (AE) is capable of decreasing the secretion of pro-inflammatory cytokines in the lungs mediated increased release of interleukin 10 (IL-10), and AE modulate expression of TLRs and antioxidant enzymes. The objective of this study was to evaluate whether the anti-inflammatory effects of AE in an experimental model of intra and extrapulmonary ARDS are mediated by IL-10. For this, the animals were subjected to physical training on a treadmill, moderate for 4 weeks. 24 hours after the last physical test, animals received LPS by intratracheally (it) (10ug / animal) or intraperitoneally (ip) (100ug / animal). After 24 hours, the animals were assessed for the number of cells and pro- and anti-inflammatory cytokines in bronchoalveolar lavage fluid (BAL) and serum were the number of neutrophils in the lung parenchyma and expression of TLR4, TLR7, SOD, ânion and QL in lung homogenates. AE reduced accumulation of neutrophils in the lung parenchyma, so it LPS and LPS ip (p <0.01) and BAL (p <0.01). AE attenuate the levels of proinflammatory cytokines in BAL and serum (p <0.05), as measured by ELISA. AE had levels of anti-inflammatory cytokine IL-10 increased in the serum and BAL (p <0.05). AE also reduced the expression of TLR4 in lung homogenates (p <0.05) and increased the expression of TLR7 in group LPS + AE evaluated by western blotting (p <0.05). The results for the antioxidant enzyme SOD showed a significant increase in the groups submitted to AE. It follows that the impact of reduced LPS-induced ARDS, regardless of etiology, and these effects appear to be mediated by modulation of the AE secretion of anti-inflammatory cytokines, especially IL-10, modulating TLR4 and TLR7 and increased expression of SOD (p <0.05). / A síndrome do desconforto respiratório agudo (SDRA) é uma doença caracterizada pela insuficiência respiratória decorrente a uma resposta inflamatória, que apresenta alta morbi-mortalidade. Diversas citocinas parecem orquestrar os processos agudo e crônico, mediados principalmente por receptores toll like (TLRs). A literatura demonstra que o exercício aeróbio (EA) é capaz de diminuir a secreção de citocinas pró-inflamatórias nos pulmões, mediado pelo aumento da liberação de interleucina 10 (IL-10), além de o EA modular a expressão de TLRs e enzimas antioxidantes. Assim, o objetivo desse estudo foi avaliar se os efeitos anti-inflamatórios do EA em modelo experimental da SDRA intra e extrapulmonar são mediados por IL-10. Para isso, os animais foram submetidos ao treinamento físico em esteira, de intensidade moderada, durante 4 semanas. Após 24 horas ao último teste físico, os animais receberam LPS por via intra-traqueal (it) (10ug/animal) ou por via intra-peritoneal (ip) (100ug/animal). Após 24 horas, os animais foram avaliados para o número de células e de citocinas pró e anti-inflamatórias no fluído do lavado broncoalveolar (LBA) e no soro, número de neutrófilos no parênquima pulmonar e expressão do TLR4, TLR7, SOD, ânion e QL nos homogenatos de pulmão. EA reduziu a acumulação de neutrófilos no parênquima pulmonar, tanto LPS it e LPS ip (p <0,01) e no LBA (p <0,01). EA atenuou os níveis de citocinas pró-inflamatórias no LBA e soro (p <0,05), avaliada por ELISA. EA teve os níveis da citocina anti-inflamatória IL-10 aumentados no soro e LBA (p <0,05). EA também reduziu a expressão de TLR4 nos homogenatos de pulmão (p <0,05) e aumentou a expressão de TLR7 no grupo de LPS + EA avaliada por western blotting (p <0,05). Os resultados para a enzima antioxidante SOD apresentou aumento significante nos grupos submetidos ao EA. Conclui-se que EA reduziu o impacto de SDRA induzida por LPS, independente da etiologia e tais efeitos parecem estar mediados pela modulação do EA na secreção de citocinas anti-inflamatórias, principalmente da IL-10, na modulação de TLR4 e TLR7 e no aumento da expressão de SOD (p<0,05).

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INTRODUÇÃO: Apesar do contínuo progresso no tratamento e suporte clínico a sepse continua sendo uma das principais causas de morbidade e mortalidade nas unidades de terapia intensiva, com desfechos semelhantes ao longo dos últimos 50 anos. A suscetibilidade à infecção grave no recém-nascido é parcialmente devida à imaturidade do sistema imune inato associado à mínima em exposição antigênica in utero e à ação ineficaz das células T efetoras e das célula B. Embora a ativação do sistema imune inato por padrões de reconhecimento (PRR) como os dos receptores Toll-like (TLR) tenham sua importância amplamente reconhecida nos últimos anos, seu comportamento frente a uma infecção in vivo ainda não foi completamente compreendido. Neste trabalho nós analisamos a expressão dos TLR-2 e TLR-4 em células apresentadoras de antígeno em recém-nascidos com e sem sepse. CAUSUÍSTICA E MÉTODO: Trata-se de um estudo prospectivo realizado no período entre fevereiro de 2011 e janeiro de 2013 onde foram incluídos quarenta e cinco recém-nascidos a termo, sem malformação congênita, admitidos na Unidade de Cuidados Intensivos Neonatal do Instituto da Criança-HCFMUSP e divididos em grupos 1 e 2. O grupo 1 consistiu em 27 recém-nascidos com diagnóstico clínico e laboratorial de sepse tardia enquanto que o grupo 2 foi composto por 18 recém-nascidos sem quadro séptico vigente. As citocinas foram determinadas por teste de CBA em sangue periférico. A expressão e MFI dos TLR-2 e TLR-4 foi determinado por imunofenotipagem em APCs e linfócitos no sangue periférico total através de análise pelo citômetro de fluxo BD FACSDiva. RESULTADOS: Os dados clínicos foram semelhantes entre os grupos 1 e 2, exceto para o estado infeccioso. Microrganismos foram identificados em 37 % no grupo 1 e estes tiveram níveis mais elevados de citocinas pró-inflamatórias (IL-8, IL-6, IL-1beta) e de citocina anti-inflamatória (IL-10). Nas células dendríticas, a expressão de TLR-2 e 4 foi semelhante entre os grupos enquanto que houve menor expressão nos pacientes infectados da molécula co-estimuladora CD86 (p < 0,05) e expressão semelhante de CD1a e CD80 em relação aos RN não infectados. No monócito, o MFI para TLR-2 e a freqüência de expressão do TLR-4 foi maior no grupo 1 (p = 0,01). Apesar da frequência de linfócitos totais ter sido mais baixa no grupo 1 (p = 0,002), não foi observada diferença quanto as suas subpopulações exceto em relação a maior frequência de LT efetor no grupo infectado com menor expressão da molécula CD28. Houve maior frequência de LB ativados no grupo 1 enquanto que a população total e as demais subpopulações foram semelhantes em número, moléculas de ativação e na expressão dos TLR-2 e 4 em ambos os grupos. CONCLUSÃO: Este estudo analisou a resposta imune inata no recém-nascido com e sem sepse. As IL-6, IL-8 e IL-10 foram bons indicadores desta doença. Recém-nascidos sépticos, que dependem quase exclusivamente do sistema imune inato, apresentaram pouca resposta in vivo na ativação de células dendríticas e monócitos propiciando uma resposta imune deficiente e maior susceptibilidade à infecção / INTRODUCTION: Despite continuous progress in the clinical treatment and other supportive care therapies, sepsis remains a leading cause of morbidity and mortality in the intensive care unit with similar outcome throughout the past 50 years. The susceptibility to severe infection is partially due to newborn immature innate immune system associated to minimal in utero antigen exposure and effector T and B cell impaired function. Although the importance of pattern recognition domains such as Toll-like receptors (TLR) in the innate immune system activation has been fully acknowledged within the last few years its behavior in front of an in vivo infection scenario is still not completely understood. Here we analyzed the TLR-2 and TLR-4 expression in antigen-presenting cell in healthy and septic newborns. PATIENTS AND METHODS: This prospective study was conducted during the period from February 2011 until January 2013 at Sao Paulo University, Sao Paulo, Brazil. Forty-five term newborns without congenital malformation were included from the Newborn Intensive Care Unit at Children\'s Hospital. As group 1, 27 newborns who had clinical and laboratory diagnostic of late onset sepsis were included while 18 newborns were evaluated in a non-septic status and were included at group 2. Cytokines were measured by cytometric bead array in peripheral blood. TLR-2 and TLR-4 expression and MFI were determined by immunophenotyping at peripheral whole blood in APC cells and lymphocytes and analyzed on a BD FACSDiva flow cytometer. RESULTS: Clinical data was similar between septic and non-septic groups except for the infectious status. Group 1 had microorganisms identified in 37 % septic newborns associated with higher levels of pro-inflammatory (IL-8, IL-6, IL-1beta) and anti-inflammatory interleukins (IL-10). When it comes to dendritic cells, the expression of TLR-2 and 4 was similar between groups whereas there was lower expression of co-molecule CD86 (p < 0,05) and similar expression of CD1a and CD80 between infected and non-infected patients. At monocytes, the MFI for TLR-2 and the frequency of TLR-4 expression was higher in infected newborn (p=0,01). There were lower levels of total lymphocytes in infected patients (p=0,002) but no difference was observed in T cells subtypes frequency except for higher levels of effector T cell in infected group with lower expression of CD28 molecule. Group 1 had higher levels of activated B cell whereas total population and the other subsets were similar in number, activation molecules and TLR-2 and 4 expressions in both groups. CONCLUSION: This study investigated the innate immune response in septic and non-septic newborn. Interleukin levels 6, 8 and 10 were good indicators of sepsis. Septic newborns, which count most exclusively with innate immune system, had little in vivo response at dendritic cell and monocyte activation leading to an impaired immune response and increased susceptibility to infection

INTRODUÇÃO: Apesar do contínuo progresso no tratamento e suporte clínico a sepse continua sendo uma das principais causas de morbidade e mortalidade nas unidades de terapia intensiva, com desfechos semelhantes ao longo dos últimos 50 anos. A suscetibilidade à infecção grave no recém-nascido é parcialmente devida à imaturidade do sistema imune inato associado à mínima em exposição antigênica in utero e à ação ineficaz das células T efetoras e das célula B. Embora a ativação do sistema imune inato por padrões de reconhecimento (PRR) como os dos receptores Toll-like (TLR) tenham sua importância amplamente reconhecida nos últimos anos, seu comportamento frente a uma infecção in vivo ainda não foi completamente compreendido. Neste trabalho nós analisamos a expressão dos TLR-2 e TLR-4 em células apresentadoras de antígeno em recém-nascidos com e sem sepse. CAUSUÍSTICA E MÉTODO: Trata-se de um estudo prospectivo realizado no período entre fevereiro de 2011 e janeiro de 2013 onde foram incluídos quarenta e cinco recém-nascidos a termo, sem malformação congênita, admitidos na Unidade de Cuidados Intensivos Neonatal do Instituto da Criança-HCFMUSP e divididos em grupos 1 e 2. O grupo 1 consistiu em 27 recém-nascidos com diagnóstico clínico e laboratorial de sepse tardia enquanto que o grupo 2 foi composto por 18 recém-nascidos sem quadro séptico vigente. As citocinas foram determinadas por teste de CBA em sangue periférico. A expressão e MFI dos TLR-2 e TLR-4 foi determinado por imunofenotipagem em APCs e linfócitos no sangue periférico total através de análise pelo citômetro de fluxo BD FACSDiva. RESULTADOS: Os dados clínicos foram semelhantes entre os grupos 1 e 2, exceto para o estado infeccioso. Microrganismos foram identificados em 37 % no grupo 1 e estes tiveram níveis mais elevados de citocinas pró-inflamatórias (IL-8, IL-6, IL-1beta) e de citocina anti-inflamatória (IL-10). Nas células dendríticas, a expressão de TLR-2 e 4 foi semelhante entre os grupos enquanto que houve menor expressão nos pacientes infectados da molécula co-estimuladora CD86 (p < 0,05) e expressão semelhante de CD1a e CD80 em relação aos RN não infectados. No monócito, o MFI para TLR-2 e a freqüência de expressão do TLR-4 foi maior no grupo 1 (p = 0,01). Apesar da frequência de linfócitos totais ter sido mais baixa no grupo 1 (p = 0,002), não foi observada diferença quanto as suas subpopulações exceto em relação a maior frequência de LT efetor no grupo infectado com menor expressão da molécula CD28. Houve maior frequência de LB ativados no grupo 1 enquanto que a população total e as demais subpopulações foram semelhantes em número, moléculas de ativação e na expressão dos TLR-2 e 4 em ambos os grupos. CONCLUSÃO: Este estudo analisou a resposta imune inata no recém-nascido com e sem sepse. As IL-6, IL-8 e IL-10 foram bons indicadores desta doença. Recém-nascidos sépticos, que dependem quase exclusivamente do sistema imune inato, apresentaram pouca resposta in vivo na ativação de células dendríticas e monócitos propiciando uma resposta imune deficiente e maior susceptibilidade à infecção / INTRODUCTION: Despite continuous progress in the clinical treatment and other supportive care therapies, sepsis remains a leading cause of morbidity and mortality in the intensive care unit with similar outcome throughout the past 50 years. The susceptibility to severe infection is partially due to newborn immature innate immune system associated to minimal in utero antigen exposure and effector T and B cell impaired function. Although the importance of pattern recognition domains such as Toll-like receptors (TLR) in the innate immune system activation has been fully acknowledged within the last few years its behavior in front of an in vivo infection scenario is still not completely understood. Here we analyzed the TLR-2 and TLR-4 expression in antigen-presenting cell in healthy and septic newborns. PATIENTS AND METHODS: This prospective study was conducted during the period from February 2011 until January 2013 at Sao Paulo University, Sao Paulo, Brazil. Forty-five term newborns without congenital malformation were included from the Newborn Intensive Care Unit at Children\'s Hospital. As group 1, 27 newborns who had clinical and laboratory diagnostic of late onset sepsis were included while 18 newborns were evaluated in a non-septic status and were included at group 2. Cytokines were measured by cytometric bead array in peripheral blood. TLR-2 and TLR-4 expression and MFI were determined by immunophenotyping at peripheral whole blood in APC cells and lymphocytes and analyzed on a BD FACSDiva flow cytometer. RESULTS: Clinical data was similar between septic and non-septic groups except for the infectious status. Group 1 had microorganisms identified in 37 % septic newborns associated with higher levels of pro-inflammatory (IL-8, IL-6, IL-1beta) and anti-inflammatory interleukins (IL-10). When it comes to dendritic cells, the expression of TLR-2 and 4 was similar between groups whereas there was lower expression of co-molecule CD86 (p < 0,05) and similar expression of CD1a and CD80 between infected and non-infected patients. At monocytes, the MFI for TLR-2 and the frequency of TLR-4 expression was higher in infected newborn (p=0,01). There were lower levels of total lymphocytes in infected patients (p=0,002) but no difference was observed in T cells subtypes frequency except for higher levels of effector T cell in infected group with lower expression of CD28 molecule. Group 1 had higher levels of activated B cell whereas total population and the other subsets were similar in number, activation molecules and TLR-2 and 4 expressions in both groups. CONCLUSION: This study investigated the innate immune response in septic and non-septic newborn. Interleukin levels 6, 8 and 10 were good indicators of sepsis. Septic newborns, which count most exclusively with innate immune system, had little in vivo response at dendritic cell and monocyte activation leading to an impaired immune response and increased susceptibility to infection

SUMMARY:<p>The bacterial lipopolysaccharide (LPS)-sensing machinery with the innate immune system receptor Toll-like receptor 4 (TLR4) at its centre has been the subject of extensive research but while TLR4 and myeloid differentiation factor 2 (MD2) were both shown to be essential, the role of other, so-called "accessory", molecules is much less clear. The co-receptor cluster of differentiation 14 (CD14) has been widely perceived as being a mere facilitator for the capture and transfer of LPS to TLR4, until recent studies suggested it might have a determining influence on which TLR4-dependent signaling cascades are triggered in response to LPS. The TLR4 receptor complex was shown to be specifically activated by diC14 amidine, a cationic lipid originally synthesized for its carrier properties. The lipid's immunostimulatory activity extends to both TLR4-dependent signaling cascades, the MyD88 and TRIF pathways.<p>The aim of this work was to gain more insight into how diC14 amidine is able to trigger these cascades and to contribute to the general understanding of the TLR4 machinery and its activation by non-LPS ligands. More precisely we were interested in the role of CD14 in the activation of both MyD88 and TRIF pathways by diC14-amidine and in potential consequences of possible divergent requirements of diC14 amidine and LPS for this co receptor.<p>Our study of the role of the membrane-associated and the soluble form of CD14 in the activation of the TLR4-dependent pathways by diC14 amidine revealed that – unlike LPS – the cationic lipid does not require CD14 to exercise its immunostimulatory activity, although the presence of the co receptor modulates the TLR4 activation and infrared spectroscopy experiments suggest a direct interaction.<p>In the case of sensing LPS, CD14 is required for the endocytosis of TLR4 and the subsequent activation of the TRIF pathway. By blocking the endocytosis mechanism at different stages we found that diC14-amidine generally enters the cell via endocytosis and that it activates – unlike LPS – both signaling cascades from inside endosomal vesicles, albeit at different stages of the endocytosis process.<p>Although the eventual immunological responses caused by diC14 amidine and LPS resemble each other or are even identical, our research revealed differences in the actual mechanism of activating TLR4, the receptor responsible for the corresponding innate immune response. These findings illustrate the uniqueness of diC14 amidine and the potential of further exploring its intriguing properties and mechanisms as a tool to decipher the TLR4 signaling machinery and with the perspective of designing new immunomodulators for vaccination and therapy.<p><p><p>RÉSUMÉ:<p>Le mécanisme de reconnaissance des lipopolysaccharides bactériens (LPS) par le récepteur de l'immunité innée Toll-like receptor 4 (TLR4) a fait l'objet d'une recherche intensive ces dernières années. Alors que TLR4 et son co-récepteur myeloid differentiation factor 2 (MD2) ont été démontrés comme étant essentiels pour la détection du LPS, le rôle des molécules dites "accessoires" est beaucoup moins évident. Le co-récepteur cluster of differentiation 14 (CD14) a largement été considéré comme un simple facilitateur pour la capture et le transfert des LPS à TLR4, mais des études récentes suggèrent qu'il pourrait avoir une influence déterminante sur les cascades de signalisation dépendantes de TLR4 induites en réponse au LPS. La diC14-amidine, un lipide cationique synthétisé initialement pour ses qualités en tant que vecteur de transfection, a révélé récemment une activité immunostimulatrice dépendante du récepteur TLR4, impliquant les deux cascades de signalisation dépendantes de TLR4, les voies MyD88 et TRIF.<p>Le but de ce travail était de mieux comprendre le mécanisme par lequel la diC14¬ amidine induit ces cascades et de contribuer à la compréhension générale du fonctionnement du complexe récepteur TLR4 et son activation par des ligands non-LPS. Plus précisément nous nous sommes intéressés au rôle de CD14 dans l'activation des voies MyD88 et TRIF par la diC14-amidine et des conséquences potentielles d’éventuelles divergences en termes d’exigence pour ce co-récepteur entre la diC14-amidine et le LPS. <p>Notre étude sur le rôle de la forme membranaire ou soluble de CD14 dans l'activation des voies dépendantes de TLR4 par la diC14-amidine a révélé que - contrairement au LPS - le lipide cationique ne nécessite pas de CD14 pour exercer son activité immunostimulatrice. Cependant, la présence du co-récepteur module l'activation de TLR4 et des expériences de spectroscopie infrarouge suggèrent une interaction directe entre le lipide et le CD14. <p>Dans le cas de la détection de LPS, le CD14 est nécessaire pour l'endocytose de TLR4 et l'activation subséquente de la voie TRIF. En bloquant le mécanisme d'endocytose à différents stades, nous avons montré que la diC14-amidine active - contrairement au LPS - les deux cascades de signalisation depuis l'intérieur des vésicules endosomiales, mais à des stades différents du processus d'endocytose.<p>En conclusion, bien que les réponses immunologiques causées par la diC14-amidine et le LPS se ressemblent, notre recherche a mis en évidence des différences substantielles dans leurs modes d'action. Ces différences illustrent le caractère unique de la diC14-amidine et son potentiel comme outil pour explorer la complexité du système de signalisation du TLR4 et en tirer des enseignements qui permettront de contribuer à la conception de nouveaux immunomodulateurs pour la vaccination et la thérapie. / Doctorat en Sciences / info:eu-repo/semantics/nonPublished

Infectious diseases remain a threat to critically ill patients, particularly with the rise of antibiotic-resistant bacteria. Septic shock carries a mortality of up to ∼40% with no compelling evidence of promising therapy to reduce morbidity or mortality. Septic shock survivors are also prone to nosocomial infections. Treatment with toll-like receptor 4 (TLR4) agonists have demonstrated significant protection against common nosocomial pathogens in various clinically relevant models of infection and septic shock. TLR4 agonists are derived from a bacteria cell wall or synthesized de novo, and more recently novel small molecule TLR4 agonists have also been developed. TLR4 agonists augment innate immune functions including expansion and recruitment of innate leukocytes to the site of infection. Recent studies demonstrate TLR4-induced leukocyte metabolic reprogramming of cellular metabolism to improve antimicrobial function. Metabolic changes include sustained augmentation of macrophage glycolysis, mitochondrial function, and tricarboxylic acid cycle flux. These findings set the stage for the use of TLR4 agonists as standalone therapeutic agents or antimicrobial adjuncts in patient populations vulnerable to nosocomial infections.