The long-term success of lung transplantation has been challenged by chronic graft dysfunction, which is manifested as obliterative bronchiolitis (OB). We demonstrated that allograft airway fibrosis is a dynamic process of tissue remodelling, in which cellular and matrix components dynamically change before or after complete obliteration of the airway lumen. This dynamic process was associated with changes in expression and activity of matrix metalloproteinases (MMPs). The early inflammatory phase was associated with MMP-dependent migration of blood-borne fibrocytes, which highly express MMP-9 and MMP-12. ‘Established’ fibrosis was associated with MMP-2 and MMP-14 expressed by myofibroblasts in both human OB lesions and their animal models. In established allograft airway fibrosis, general MMP inhibition resulted in apoptosis of myofibroblasts in vivo and in vitro, while low-doses of MMP-inhibitor treatment induced upregulation of MMP-2, increased collagenolytic activity, and significantly decreased myofibroblasts and collagen. The dynamic process of tissue remodelling in established allograft airway fibrosis was supported by underlying continuous alloimmune responses, in particular, direct T-cell-myofibroblast contact. iii Modulation of tissue remodelling using a low-dose MMP inhibitor in combination with cyclosporine induced partial regression of fibrosis after its establishment. We further demonstrated the mechanism of alloimmune responses unique to the lung. Human and animal studies demonstrated that bronchioles develop de novo lymphoid tissue characterized by formation of high endothelial venules and homing of effector memory T-cells. A following study demonstrated the important role of local immunological memory maintained by the intrapulmonary lymphoid tissue in exerting effector function in allograft rejection. Collectively, the present studies support the hypothesis that tissue remodelling is an important mechanism of allograft airway fibrosis. Regulation of tissue remodelling and underlying tissue injury is important not only to arrest aberrant remodelling of allograft airways but likely to reverse aberrant remodelling and to regenerate normal tissue architecture in airways after lung transplantation.

The long-term success of lung transplantation has been challenged by chronic graft dysfunction, which is manifested as obliterative bronchiolitis (OB). We demonstrated that allograft airway fibrosis is a dynamic process of tissue remodelling, in which cellular and matrix components dynamically change before or after complete obliteration of the airway lumen. This dynamic process was associated with changes in expression and activity of matrix metalloproteinases (MMPs). The early inflammatory phase was associated with MMP-dependent migration of blood-borne fibrocytes, which highly express MMP-9 and MMP-12. ‘Established’ fibrosis was associated with MMP-2 and MMP-14 expressed by myofibroblasts in both human OB lesions and their animal models. In established allograft airway fibrosis, general MMP inhibition resulted in apoptosis of myofibroblasts in vivo and in vitro, while low-doses of MMP-inhibitor treatment induced upregulation of MMP-2, increased collagenolytic activity, and significantly decreased myofibroblasts and collagen. The dynamic process of tissue remodelling in established allograft airway fibrosis was supported by underlying continuous alloimmune responses, in particular, direct T-cell-myofibroblast contact. iii Modulation of tissue remodelling using a low-dose MMP inhibitor in combination with cyclosporine induced partial regression of fibrosis after its establishment. We further demonstrated the mechanism of alloimmune responses unique to the lung. Human and animal studies demonstrated that bronchioles develop de novo lymphoid tissue characterized by formation of high endothelial venules and homing of effector memory T-cells. A following study demonstrated the important role of local immunological memory maintained by the intrapulmonary lymphoid tissue in exerting effector function in allograft rejection. Collectively, the present studies support the hypothesis that tissue remodelling is an important mechanism of allograft airway fibrosis. Regulation of tissue remodelling and underlying tissue injury is important not only to arrest aberrant remodelling of allograft airways but likely to reverse aberrant remodelling and to regenerate normal tissue architecture in airways after lung transplantation.

Renal transplantation is the optimum treatment for end-stage renal failure. B cells have been identified in chronic allograft damage (CAD) and are associated with the development of tertiary lymphoid tissue within the human renal allograft. To investigate this pathology we utilized a mouse model of renal transplantation. A mouse model of kidney transplantation was first described in 1973. Although the mouse model is technically difficult it is attractive for several reasons: the mouse genome has been characterized and in many aspects is similar to man and there is a greater diversity of experimental reagents and techniques available for mouse studies than other experimental models. We reviewed the literature on all studies of mouse kidney transplantation to report the donor and recipient strain combinations that have been investigated and the resultant survival and histological outcomes. Some models of kidney transplantation have used the transplanted kidney as a life-supporting organ, however in many studies the recipient mouse’s native kidney has been left in situ. Several different combinations of inbred mouse strains have been reported, with varying degrees of injury, survival, or tolerance due to haplotype differences. Both cellular and humoral rejection processes have been observed. This model has been exceptionally useful as an investigational tool to understand multiple aspects of transplantation including acute rejection, cellular and humoral rejection mechanisms and their treatment. Furthermore this model has been used to investigate disease mechanisms beyond transplant rejection including intrinsic renal disease and infection-associated pathology. We performed renal transplantation in mice to model CAD and identified B cells forming tertiary lymphoid tissue with germinal centres. Intra-allograft B220+ B cells comprised of IgMhigh CD23- marginal zone, IgMlo CD23+ follicular zone and IgMlo CD23- transitional-type B cells similar to spleen, and these compartments had elevated expression of CD86. Depletion of B cells with anti-CD20 was associated with an improvement in CAD but only when administered after transplantation and not before. Isolated intra-allograft B cells were cultured and shown to synthesise multiple cytokines, the most abundant of these being GRO-α (CXCL1), RANTES (CCL5), IL-6 and MCP-1 (CCL2). Tubular loss was associated with T cell mediated injury and interstitial fibrosis, whilst type III collagen deposition driven by F4/80+ macrophages and PDGFR-β+ and transgelin+ fibroblasts, all of which were reduced by B cell depletion. In this report we show that intra-allograft B cells are key mediators of chronic damage to the transplant allograft kidney by cytokine orchestration of T cell, macrophage infiltration and fibroblast activation.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23099号 / 医博第4726号 / 新制||医||1050(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 濵﨑 洋子, 教授 浅野 雅秀, 教授 羽賀 博典 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23100号 / 医博第4727号 / 新制||医||1050(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 平井 豊博, 教授 河本 宏, 教授 竹内 理 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

La transplantation d'organe est le meilleur traitement en cas de défaillance terminale d'un organe vital. Cependant, la survie sur le long terme est limitée par la perte inexorable de la fonction des greffons. Cette dernière est attribuée à l'inflammation microvasculaire (1MV) causée par la réponse anticorps contre les alloantigènes (rejet humoral chronique (RHC)). En analysant une cohorte de 129 transplantés rénaux présentant de l'1MV sur une biopsie de greffon, nous avons trouvé que, dans la moitié des cas, les lésions n'étaient pas médiées par les anticorps. Chez ces patients, des études génétiques ont révélé une prévalence plus élevée de « mismatches » entre les molécules HLA de classe 1 (HLA-1) du donneur et les « Killer-cell immunoglobulin-receptors » (K1R) inhibiteurs des NK du receveur. Nous avons émis l'hypothèse que la nature allogénique de l'endothélium du greffon pouvait créer un « pseudo-missing-self ». De ce fait, les NK du receveur, exposés à des stimuli inflammatoires, ne reçoivent plus les signaux inhibiteurs transmis par le HLA-1 de la part des cellules endothéliales du donneur. Dans un modèle de co-culture de cellules endothéliales et de NK humains, nous avons démontré que l'absence d'un ligand HLA-1 du soi sur la cellule endothéliale peut activer les NK. Cette activation dépend de la voie mTOR dans les NK, qui peut être bloquée par la rapamycine, un inhibiteur de mTORC1 disponible en clinique. Enfin, nous avons confirmé l'existence de rejets NK induit par le « missing-self » et leur sensibilité à la rapamycine dans un modèle murin de transplantation cardiaque. Notre travail identifie un nouveau type de rejet chronique, exclusivement médié par l'immunité innée, les NK, ayant le même impact délétère sur la survie des greffons que le RHC. Cependant, alors qu'il n'y a pas de traitement disponible pour le RHC, les inhibiteurs de mTOR préviennent efficacement le développement de lésions dans un modèle murin de rejet vasculaire chronique induit par le « missing self » / Organ transplantation is the best treatment for terminal organ failure. However, long-term outcome of organ transplantation remains limited by inexorable loss of graft function, which the prevalent dogma links to the microvascular inflammation (MVI) triggered by the recipient's antibody response against alloantigens (antibody-mediated chronic rejection, AMR). Analysing a cohort of 129 renal transplant patients with MVI on graft biopsy, we found that, in half of the cases, histological lesions were not mediated by antibodies. In these patients, genetic studies revealed a higher prevalence of mismatches between donor HLA-I and inhibitory Killer-cell immunoglobulin-receptors (KIR) of recipient's NK cells. We hypothesized that the allogeneic nature of graft endothelium could create a "pseudo-missing self" situation, thereby the recipient's NK cells exposed to inflammatory stimuli would not receive HLA I-mediated inhibitory signals from donor endothelial cells. In co-culture experiments with human NK cells and endothelial cells, we demonstrated that the lack of self HLA-I on endothelial cells can activate NK. This activation triggers mTOR pathway in NK, which can be blocked by rapamycin, a commercially available inhibitor of mTORC1. Finally, we confirmed the existence of missing self-induced rejection and its sensitivity to mTOR inhibition in a murine heart transplantation model. Our work identifies a new type of chronic rejection, exclusively mediated by innate NK cells, with the same detrimental impact on graft survival as AMR. However, while no therapy is available for AMR, mTOR inhibitors efficiently prevent the development of lesions in murine models of NK cell-mediated chronic vascular rejection

Le rejet d’allogreffe représente un obstacle majeur en transplantation rénale humaine. Le lymphocyte B (LB) joue un rôle lors de cette réaction contre le greffon, mal défini à ce jour. Notre objectif a été de caractériser et identifier son implication dans le rejet humoral chronique (cABMR) et le rejet cellulaire aigu (ACR). Dans une première partie, la caractérisation phénotypique des LB par cytométrie en flux chez ces patients a mis en évidence d’importantes différences dans la distribution des sous-populations de LB uniquement chez les patients cABMR. Chez les patients ACR, dont la distribution des LB n’est pas altérée, l’analyse de coupes de biopsies rénales a permis de mettre en évidence un infiltrat cellulaire constitué de lymphocytes B et T. Dans une seconde partie, l’activité fonctionnelle et régulatrice des LB issus de patients cABMR et ACR a été évaluée à l’aide d’un modèle in vitro de coculture entre des LB et des LT. Cette étude a révélé que les LB, issus des patients cABMR uniquement, sont dépourvus d’activités régulatrices sur la fonction des LT autologues. Cette étude a aussi mis en exergue que les LB des patients cABMR présentaient une déficience dans la sécrétion de molécules immunosuppressives telles que le TGFβ et l’indoleamine 2,3-dioxygénase (IDO). Ce défaut conduit à une incapacité à générer des lymphocytes T régulateurs. Finalement, notre étude a clairement démontré le rôle du LB dans les mécanismes physiopathologiques conduisant au rejet. Ces travaux ont donc permis de générer d’éventuelles perspectives pour définir de nouvelles stratégies thérapeutiques dans la lutte contre le rejet d’allogreffe. / Allograft rejection is one of the main obstacles in human kidney transplantation. The role of B lymphocytes in the response against the allograft is poorly understood. Our aim is to identify and clarify its involvement in chronical humoral and cellular rejection. First of all, we identify profound changes in the distribution of B lymphocytes in cABMR patients which was not the case for ACR patients. In those last ones, we were able to detect on kidney biopsies an important cellular infiltrate composed with B and T cells. In the second part of this work, the functional and regulatory functions of B cells from both groups of patients were analyzed by using an in vitro coculture model between B and T cells. It appeared that B lymphocytes isolated from cABMR patients were unable to inhibit autologous T cell activity. This study showed those cells failed to produce immunosuppressive molecules as TGFβ and indoleamine 2,3-dioxygenase (IDO) leading to a default in the generation of regulatory T cells. To conclude, this study clearly showed the roles of B cells in physiopathological mechanisms of allograft rejection and helped to define new therapeutical strategies to prevent or reduce its consequences for the patients.

No description available.

Le rejet chronique se manifeste dans le poumon par la bronchiolite oblitérante (BO), une pathologie inflammatoire et fibrotique menant à l’oblitération des bronchioles. L’étiologie exacte de cette maladie demeure inconnue. Certaines études suggèrent qu'un déséquilibre des leucotriènes (LT) sur les prostaglandines (PG) favorise la fibrose pulmonaire. Les taux des LT et des PG dans le poumon humain post-transplantation sont inconnus. Nous proposons qu'un déséquilibre de cystéinyl leucotriènes (CysLT) sur la PGE2 existe dans le poumon transplanté et pourrait être impliqué dans la pathogenèse de la BO. Aussi, les leucotriènes contribueraient à la fibrose par la transition épithélio-mésenchymateuse (TEM). Afin de vérifier ces hypothèses, nous avons déterminé les taux de CysLT et de PGE2 dans le liquide de lavage broncho-alvéolaire (LBA) provenant de poumons transplantés chez l'homme ainsi que leurs corrélations cliniques. Nous avons également déterminé la capacité des CysLT à induire l’expression des marqueurs de la TEM in vitro. Nous avons découvert des taux de CysLT et PGE2 supérieurs à la normale dans les LBA des greffés. Un pic prédominant de CysLT sur PGE2 est observée à 52 semaines postgreffe et deux facteurs de risque de la BO, les infections au CMV et à l’Aspergillus, sont associés au ratio CysLT/PGE2> 1. In vitro, les CysLT induisent une répression des marqueurs épithéliaux mais n’induisent pas l’expression de marqueurs mésenchymateux chez les cellules épithéliales bronchiolaires. / Chronic rejection occurs, in the lung, in the form of bronchiolitis obliterans (BO), an inflammatory and fibroproliferative disease that leads to the obliteration of the bronchioles. A concept of the pathogenesis of BO has been suggested and several risk factors are associated to it, however, the exact etiology of this disease remains unknown. Studies have suggested that an imbalance of leukotrienes (LT) over prostaglandins (PG) promotes pulmonary fibrosis. The levels of LT and PG in the human lung post-transplantation are unknown. We propose that an imbalance of cysteinyl leukotrienes (CysLT) on PGE2 exists in the transplanted lung and may be implicated in the pathogenesis of BO. We also suggest that leukotrienes contribute to fibrosis through epithelial-mesenchymal transition (EMT). In order to test these hypotheses, we have determined the levels of CysLTs and PGE2 in human transplanted lung bronchoalveolar lavage fluid (BALf) samples and their clinical correlations. We have also determined the capacity of CysLT to induce the expression of EMT markers in vitro. We found high average levels of CysLT and PGE2 in the BAL of transplant patients. A predominant peak of CysLT over PGE2 was observed at 52 weeks post-transplantation and two risk factors for BO, CMV infections and Aspergillus were associated with CysLT/PGE2 ratio> 1. According to our experimental parameters, CysLT can induce the repression of epithelial markers but do not induce the expression of mesenchymal markers in vitro in small airway epithelial cells.

La dysfonction chronique du greffon est la cause majeure d’échec en transplantation rénale, que son mécanisme soit immunologique ou non. Lorsque l’épithélium tubulaire rénal subit des changements phénotypiques épithéliaux (CPE), évocateurs de transition épithélio-mésenchymateuse (TEM) et associés au développement de lésions irréversibles de fibrose interstitielle et d’atrophie tubulaire, l’évolution se fait vers la diminution de la fonction rénale et de la perte du greffon. Nous avons étudié le phénotype de l’épithélium tubulaire rénal par immunohistochimie et par la mesure dans les urines des ARN messagers de la vimentine, CD45, GAPDH et Uroplakine 1a par RT-PCR. Nous avons comparé les greffes avec donneurs cadavériques et celles avec donneurs vivants et nous avons évalué les performances diagnostiques de la RT-PCR dans les urines pour le diagnostic de CPE chez les patients greffés, ayant une biopsie rénale de surveillance à 3 mois et une biopsie sur indication particulière. Nous avons montré que le score de TEM sur la biopsie de surveillance et l’évolution de la fonction rénale sont meilleurs chez les greffés à partir de donneur vivant, comparé à ceux ayant un greffon de donneur cadavérique. La valeur de l’ARNm de la vimentine et CD45 rapportée à l’uroplakine 1a est corrélée avec le score de vimentine en immunomarquage dans les biopsies de surveillance. Ces biomarqueurs pourraient être utilisés comme un outil non invasif pour surveiller la fibrogénèse dans le greffon rénal. Ce test pourrait être utilisé pour le dépistage précoce des pathologies fibrosantes du greffon rénal. Une étude transcriptomique indépendante a été réalisée, confirmant l’intérêt de la normalisation des ARN messagers par l’ARNm de l’uroplakine, et montrant / Chronic graft dysfunction is the major cause for end-stage renal failure after renal transplantation, both through immune and non-immune mechanisms. When the renal tubular epithelium undergoes epithelial phenotypic changes (EPC), reminiscent of epithelial mesenchymal transition (EMT), and associated with interstitial fibrosis and tubular atrophy, the prognosis is poor with a diminution of renal function and graft loss. In this prospective study. We studied the renal epithelial phenotype by immunohistochemistry and measured mRNA in urine of vimentin, CD45, GAPDH and uroplakin 1a by RT-PCR. We compared grafts from living donors and those from deceased donors. We evaluated the diagnostic performance of RT-PCR on urine for the diagnosis of epithelial phenotypic changes in transplant patients, with renal biopsy surveillance at 3 months and a biopsy on particular indication. We have shown that the EMT score on renal biopsy surveillance and the evolution of graft renal function were better in the patients from living donors than in those from cadaveric donors. The value of the mRNA of vimentin and CD45 relative to the uroplakin is correlated with the score in vimentin immunostaining in routine biopsies. These biomarkers could be used as a noninvasive tool to monitor the renal graft fibrogenesis. This test could be used for early detection of fibrotic diseases of the kidney transplant. In an independant study, the transcriptome in urine was analyzed, and it was found that normalization of mRNA with uroplakin mRNA was useful, and that EPC were associated with immune and inflammatory profiles.