Recurrent airway obstruction (RAO) and Rhodococcus equi (R. equi) pneumonia are two equine respiratory diseases. RAO is an allergic asthma like disease of the middle-aged horses while the R. equi pneumonia affects only young foals. Respiratory disease is considered among the major causes of economic loss to the equine industry and tops the priority list for research that will focus on preventative and diagnostic facets of such disease. The objective of this research was to investigate the effect of antigen exposure and remission (via allergen avoidance and/or drug) on chronically affected RAO horses. Additionally, we also wanted to understand the changes in equine neonatal immune system due to R. equi exposure and identify molecular biomarkers for early disease screening. Various biological samples (lung tissue for the RAO study and blood leukocytes and nasal epithelial cells for the R. equi study) were used to extract ribonucleic acid (RNA). Complimentary deoxyribonucleic acid (cDNA) obtained from RNA was used to perform microarray hybridization experiments. Our findings suggest that compared to control horses allergen exposure leads to an elevated protein synthesis and inflammation that contributes to aggravation of symptoms and airway changes. We found that allergen avoidance controls inflammation and causes an improvement in lung function and other chronic features of RAO. The drug administration led to an accelerated remission in the chronic RAO features; a complete remission could however not be achieved. Hence it appears that although not a complete resolution, but allergen avoidance and drugs will help in a better management of chronic RAO symptoms. Our results suggest that the neonatal immune system is capable of initiating a protective immune response through birth up to 8 weeks of age. However there are also processes present that may be counter-productive to the host. Induction of such suppressive mechanisms may be a result of bacterial modulation of the host immune response or a result of immature host immune system. We also identified molecular biomarkers that will have the potential to screen foals for R. equi pneumonia soon after birth and before the onset of clinical symptoms. The research findings of this study will improve the current understanding of the two equine diseases.

Asthma is a chronic respiratory disease characterized by reversible airway obstruction, persistent airway hyperresponsiveness, chronic airway inflammation, and chronic airway remodeling. Most adult asthmatics have neutrophilic airway inflammation that correlates to increasing disease severity, and fail to respond to corticosteroid therapies that mitigate other asthma endotypes. Accordingly, there is a need to investigate the molecular mechanisms responsible for neutrophilic asthma. Pasture heaves, a respiratory disease affecting horses housed on pasture in conditions of high heat and humidity, shares the aforementioned characteristics of human asthma, including neutrophilic inflammation. The cause is undetermined, but genetic propensities for reactivity to seasonally inhaled, pasture-associated, aeroallergens are presumed. Complexities of diseases like asthma and pasture heaves, that include temporal interactions between environmental and genetic factors, lend themselves to exploration using -omics technologies. An emergent paradigm in disease pathogenesis views disease as the result of imbalances in a biological system of thousands of proteins that maintain eukaryotic homeostasis. Consistent with this paradigm, this dissertation describes systematic efforts to identify groups of proteins in the bronchoalveolar lavage fluids of horses with pasture heaves that are altered in a manner that influences neutrophilic airway inflammation, and are similarly changed in human asthma. This is the first use of -omics technologies to investigate pasture heaves. This was accomplished first by improving functional annotation of the equine genome by providing functional annotation for an equine oligoarray, thereby facilitating future functional modeling of equine gene products. Next, through comparative modeling of protein functions in normal bronchoalveolar lavage fluid (BALF) proteomes from horse, human, and mouse, we demonstrated conservation of protein functions in lung fluids across these species. Finally, comparative modeling of pasture heaves-affected and non-diseased BALF proteomes demonstrated that proteins in diseased BALF favor airway neutrophilic inflammation by increasing neutrophil migration, chemotaxis, adhesion, detachment, transmigration, and degranulation, while reducing activation, cell spreading, infiltration, phagocytosis, respiratory burst, apoptosis, and clearance. Collectively, these molecular events contribute to airway neutrophilic inflammation in pasture heaves, and are conserved in human asthma. This method further validates pasture heaves as a robust model for human neutrophilic asthma, and highlights proteins of potential clinical and therapeutic relevance.

Asthma is a chronic disease of airway hyper-responsiveness, airway inflammation and episodic bronchoconstriction. With asthma forecasted to increase by an additional 100 million cases by 2025, there is a critical and immediate need to address new asthma therapies. Guidelines for asthma treatment in the emergency department conditionally recommend intravenous magnesium sulfate (MgSO4). However, some investigations have failed to demonstrate beneficial effects. Ethical constraints limit evaluation of the bronchodilatory effects of MgSO4 alone in patients with acute asthma exacerbation, independent of other conventional therapeutics. To address this ethical dilemma, this study consisted of two phases: 1) quantification of the independent pulmonary effect of three doubling doses of MgSO4 in the spontaneous equine model of asthma during naturally occurring exacerbations of bronchoconstriction, and 2) evaluation of arterial blood gas parameters in response to administration of MgSO4 at a dose identified in phase 1 that yielded greatest efficacy without deleterious side effects.

In healthy airways, mucus forms part of the innate immune response protecting the respiratory epithelium from damage by pathogens and environmental debris (Rose and Voynow, 2006). Conversely, in many respiratory diseases, mucus becomes part of the airway disease pathology. Mucus hypersecretion along with reduced clearance can cause blockage of the small airways, impairing gas exchange, promoting inflammation and becoming a culture medium for bacterial colonisation (Thornton et al., 2008). Recurrent airway obstruction (RAO) is a common yet poorly understood equine chronic respiratory disease where such altered mucus properties and clearance have been identified as major factors in the disease pathology (Davis and Rush, 2002; Gerber et al., 2000; Kaup et al., 1990; Robinson, 2001). The gel-forming mucins are largely responsible for the transport properties of mucus. The major equine airway gel-forming mucin in health is Muc5b and to a lesser extent Muc5ac; produced in specialised respiratory epithelial goblet cells and sub-mucosal glands (Rousseau et al., 2011b). Changes in mucin relative and net amounts and their macromolecular properties and interactions have been attributed to the altered physical properties of airway mucus in airways disease (Groneberg et al., 2002a; Jefcoat et al., 2001; Kirkham et al., 2002; Robinson et al., 2003; Sheehan et al., 1995).The project investigates the biochemical properties of mucins present in mucus from healthy horses and horses with RAO. This project identifies the anatomical presence of mucin-producing goblet cells and glands in fixed tissues from the respiratory tracts of healthy horses and subsequently examines mucin-production sites in respiratory tracts from horses with RAO. Finally the project investigates a methodology for the study of mucin production in airway cells harvested from live horses suffering from RAO.Our investigations confirmed that horses with RAO have more endotracheal mucus than healthy controls, and that Muc5b is the predominant mucin with Muc5ac also present in RAO horse mucus, both during symptomatic disease and when horses are asymptomatic. Mucins are produced in epithelial goblet cells and sub-mucosal glands dispersed throughout the length and circumference of the equine trachea and bronchi. Goblet cell hyperplasia occurs in symptomatic exposed RAO horse airways, although goblet cells are smaller than in asymptomatic RAO horse airways. Exposure to a dusty stable environment is associated with more goblet cells per length of bronchial compared to tracheal epithelium in all horses. RAO horses have larger sub-mucosal glands containing more mucin than control horses. Primary epithelial cell cultures grown at an air liquid interface are an alternative approach to study equine airway mucus, although the use of this culture system is in its early stages. We have developed novel ways to harvest equine airway epithelial cells (tracheal brushing) and shown it is possible to freeze cells collected via tracheal epithelial brushing in 20 % FBS and then culture to ALI at a later date.

ABSTRACT Heaves is triggered by exposure to dust and its components, such as endotoxin, and is characterized by clinical signs such as coughing, decreased exercise tolerance, difficulty breathing and abnormal lung sounds which are due to bronchoconstriction and accumulation of neutrophils in the airways. Pulmonary intravascular macrophages (PIMs) are believed to increase horses sensitivity to endotoxemia-induced lung inflammation. The first objective of this study was to investigate a hitherto unknown role of PIMs in equine heaves. I used mouldy hay (MH) to induce heaves and gadolinium chloride (GC) to deplete PIMs in order to compare responses between non-treated and GC-treated heaves horses. A modified randomized crossover study (2X2 factorial) was conducted in which mares (N=9) were exposed to 4 different treatments: alfalfa cubes (Cb), alfalfa cubes + GC (Cb-GC), mouldy hay (MH) and MH + GC (MH-GC). Each treatment was followed by broncholaveolar lavage (BAL). MH was fed for 7 days to induce heaves followed by Cb for 21 days to achieve remission, whereas the treatments in which heaves was not induced (Cb; Cb-GC), the cubes were fed prior to the BAL and for 14 days after the BAL to allow recovery from the BAL procedure. BAL fluids were processed to investigate total cell, neutrophil and alveolar macrophage concentrations. In addition, TNFá protein levels as well as TNFá, IL-8, and TLR4 mRNA expression in BAL cells were assessed in order to infer on their activation state.<p> Data showed higher concentration of dust (3X), endotoxin (20X), and endotoxin per milligram of dust (7X) in MH compared to the Cb environment. Clinical scores and neutrophil concentrations in BAL were higher when mares received MH compared to MH and GC (MH-GC). Real time reverse transcriptase PCR revealed a significant lower expression of IL-8 and TLR4 mRNA in BAL cells from MH-GC mares compared to MH. TNFá mRNA expression as well as protein concentration were not affected by the different treatments. In vitro secondary LPS challenge significantly increased IL-8 mRNA expression in cells from MH treatment compared to without LPS, but not in the MH-GC treatment. TLR4 expression was not affected by the secondary challenge. Although secondary LPS challenge increased expression of TNFá mRNA and protein, the differences among treatment groups were not meaningful. In conclusion, PIM depletion attenuates clinical scores, migration of inflammatory cells into the alveolar space and expression of pro-inflammatory molecules in BAL cells of heaves horses.<p> The observations on the role of PIMs in heaves in horses prompted me to examine the occurrence of PIMs in human lungs. I found a trend for higher numbers of septal macrophages in autopsied lungs from human patients who died of non-pulmonary pathologies compared to those having either COPD or asthma. If these septal macrophages indeed represent the PIMs, this finding is contrary to existing belief that humans, unlike horses, do not have PIMs.

ABSTRACT Heaves is triggered by exposure to dust and its components, such as endotoxin, and is characterized by clinical signs such as coughing, decreased exercise tolerance, difficulty breathing and abnormal lung sounds which are due to bronchoconstriction and accumulation of neutrophils in the airways. Pulmonary intravascular macrophages (PIMs) are believed to increase horses sensitivity to endotoxemia-induced lung inflammation. The first objective of this study was to investigate a hitherto unknown role of PIMs in equine heaves. I used mouldy hay (MH) to induce heaves and gadolinium chloride (GC) to deplete PIMs in order to compare responses between non-treated and GC-treated heaves horses. A modified randomized crossover study (2X2 factorial) was conducted in which mares (N=9) were exposed to 4 different treatments: alfalfa cubes (Cb), alfalfa cubes + GC (Cb-GC), mouldy hay (MH) and MH + GC (MH-GC). Each treatment was followed by broncholaveolar lavage (BAL). MH was fed for 7 days to induce heaves followed by Cb for 21 days to achieve remission, whereas the treatments in which heaves was not induced (Cb; Cb-GC), the cubes were fed prior to the BAL and for 14 days after the BAL to allow recovery from the BAL procedure. BAL fluids were processed to investigate total cell, neutrophil and alveolar macrophage concentrations. In addition, TNFá protein levels as well as TNFá, IL-8, and TLR4 mRNA expression in BAL cells were assessed in order to infer on their activation state.<p> Data showed higher concentration of dust (3X), endotoxin (20X), and endotoxin per milligram of dust (7X) in MH compared to the Cb environment. Clinical scores and neutrophil concentrations in BAL were higher when mares received MH compared to MH and GC (MH-GC). Real time reverse transcriptase PCR revealed a significant lower expression of IL-8 and TLR4 mRNA in BAL cells from MH-GC mares compared to MH. TNFá mRNA expression as well as protein concentration were not affected by the different treatments. In vitro secondary LPS challenge significantly increased IL-8 mRNA expression in cells from MH treatment compared to without LPS, but not in the MH-GC treatment. TLR4 expression was not affected by the secondary challenge. Although secondary LPS challenge increased expression of TNFá mRNA and protein, the differences among treatment groups were not meaningful. In conclusion, PIM depletion attenuates clinical scores, migration of inflammatory cells into the alveolar space and expression of pro-inflammatory molecules in BAL cells of heaves horses.<p> The observations on the role of PIMs in heaves in horses prompted me to examine the occurrence of PIMs in human lungs. I found a trend for higher numbers of septal macrophages in autopsied lungs from human patients who died of non-pulmonary pathologies compared to those having either COPD or asthma. If these septal macrophages indeed represent the PIMs, this finding is contrary to existing belief that humans, unlike horses, do not have PIMs.

Equine asthma (EA) is a highly relevant disease, estimated to affect up to 20% of all horses, and compares to human asthma. The pathogenesis of EA is most likely immune-mediated, yet incompletely understood. To study the immune response in the affected lower airways, mixed leukocytes were acquired through bronchoalveolar lavage (BAL) and the cell populations were analyzed on a single-cell basis by flow cytometry (FC). Samples of 38 horses grouped as respiratory healthy or affected by mild to moderate (mEA) or severe EA (sEA) according to their history, clinical signs, and BAL cytology were analyzed. Using FC, BAL cells and PBMC were comprehensively characterized by cell surface markers ex vivo. An increased percentage of DH24A+ polymorphonuclear cells, and decreased percentages of CD14+ macrophages were detected in BAL from horses with sEA compared to healthy horses or horses with mEA, while lymphocyte proportions were similar between all groups. Independently of EA, macrophages in BAL were CD14+CD16+, which contrasts the majority of CD14+CD16- classical monocytes in PBMC. Percentages of CD16-expressing BAL macrophages were reduced in BAL from horses with sEA compared to healthy horses. While PBMC lymphocytes predominantly contain CD4+ T cells, B cells and few CD8+ T cells, BAL lymphocytes comprised mainly CD8+ T cells, fewer CD4+ T cells and hardly any B cells. These lymphocyte subsets' distributions were similar between all groups. After PMA/ionomycin stimulation in vitro, lymphocyte activation (CD154 and T helper cell cytokine expression) was analyzed in BAL cells of 26 of the horses and group differences were observed (p=0.01-0.11). Compared to healthy horses' BAL, CD154+ lymphocytes from horses with mEA, and CD4+IL-17A+ lymphocytes from horses with sEA were increased in frequency. Activated CD4+ T helper cells were more frequent in asthmatics' (mEA, sEA) compared to healthy horses' PBMC lymphocytes. In summary, FC analysis of BAL cells identified increased polymorphonuclear cells frequencies in sEA as established, while macrophage percentages were mildly reduced, and lymphocyte populations remained unaffected by EA. Cytokine production differences of BAL lymphocytes from horses with sEA compared to healthy horses' cells point towards a functional difference, namely increased local type 3 responses in sEA.

La myosine est une protéine motrice impliquée dans la contraction du muscle lisse. Un de ces isoformes, appelé (+)insert lui procure une vélocité accrue. L’objectif de cette étude était d’évaluer la contribution de cet isoforme au bronchospasme observé chez les chevaux atteints de souffle, un modèle d’asthme humain. Nous avons procédé à l’analyse de l’expression génique de l’isoforme (+)insert dans les voies respiratoires de chevaux issus de 3 cohortes afin d’évaluer 1) la présence de cet isoforme chez les chevaux atteints de souffle ; 2) la réversibilité de son expression avec 2 traitements usuels (corticostéroïdes inhalés et retrait antigénique); et 3) la cinétique de réapparition de l’isoforme suite à une période de rémission de la maladie. Les résultats révèlent 1) une expression augmentée de l’isoforme (+)insert dans l’ensemble de l’arbre bronchique des chevaux atteints de souffle en exacerbation comparée aux contrôles et aux chevaux en rémission ; 2) les deux traitements conduisent à une réduction de l’expression de l’isoforme, mais l’administration de corticostéroïdes mène à une diminution plus rapide que celle induite par le retrait antigénique; et 3) une période de 30 jours ou plus d'exposition antigénique est nécessaire pour la réapparition de l’isoforme (+)insert dans l’arbre bronchique des chevaux atteints de souffle. Cette étude montre pour la première fois une modulation et une réversibilité de l’expression de l'isoforme (+)insert de la myosine en fonction du statut médical du sujet. Les données suggèrent que cet isoforme pourrait faire partie d’un mécanisme protecteur activé en réponse à une exposition antigénique prolongée. / Myosin is a motor protein implicated in smooth muscle contraction. The (+)insert isoform doubles smooth muscle velocity. The aim of the study was to evaluate the contribution of the fast contracting myosin isoform to bronchospasm in heaves-affected horses as model of human asthma. Gene expression analysis of the (+)insert myosin isoform in equine airways was performed in three different cohorts to evaluate 1) its presence and anatomical location in heaves-affected horses; 2) the reversibility of its expression with two common therapies (inhaled corticosteroids and antigen avoidance); and 3) its kinetics of reappearance following a chronic antigen exposure. Results showed 1) a significantly increased expression of the (+)insert isoform at all levels of the bronchial tree of horses with heaves in clinical exacerbation when compared to control horses and heaves-affected horses in clinical remission; 2) both treatments reduced the fast isoform expression in horses’ lower airways, but the administration of corticosteroids led to a faster response; and 3) (+)insert isoform does not increase in airways of all horses with heaves within 30 days of antigen exposure. The study shows for the first time a modulation of the fast contracting myosin isoform with the disease status. Data also suggest that (+)insert isoform is part of a protective mechanism enhanced in response to a prolonged antigen exposure.

Le souffle chez les chevaux et l’asthme chez l’humain sont des maladies respiratoires qui partagent plusieurs caractéristiques, notamment des épisodes de bronchospasme et de détresse respiratoire dus à une inflammation pulmonaire inappropriée en réponse à une inhalation de substances antigéniques. Les manifestations cliniques incluent des efforts respiratoires augmentés, des sifflements et de la toux. Au niveau des voies respiratoires, on observe une augmentation du muscle lisse péribronchique, une fibrose sous épithéliale, une métaplasie/hyperplasie épithéliale et du mucus en quantité augmentée. L’augmentation du muscle lisse est particulièrement importante car elle n’affecte pas seulement le calibre basal des voies respiratoires, mais elle accentue l’obstruction respiratoire lors de bronchoconstriction. Ces changements sont regroupés sous le terme de « remodelage » et sont associés à un déclin accéléré de la fonction respiratoire chez les patients asthmatiques. Alors que les traitements actuels contrôlent efficacement le bronchospasme et relativement bien l’inflammation, leurs effets sur le remodelage sont mal connus. Dans le cadre de thèse, la réversibilité du remodelage musculaire péribronchique a été investiguée chez des chevaux atteints du souffle dans deux études longitudinales. Ces études, faites principalement sur du tissu pulmonaire prélevé par thoracoscopie, sont difficilement réalisables chez l’humain pour des raisons éthiques, ou chez d’autres animaux, car ceux-ci présentent rarement une inflammation de type asthmatique de façon spontanée. Les résultats démontrent que les chevaux atteints du souffle ont approximativement deux fois plus de muscle péribronchique que les chevaux sains d’âge similaire gardés dans les mêmes conditions, et que la prolifération des myocytes contribue à cette augmentation. Ils démontrent aussi qu’une stimulation antigénique relativement brève chez des chevaux atteints du souffle depuis plusieurs années n’accentue pas le remodelage, ce qui suggère que l’augmentation du muscle lisse atteint un plateau. Nous avons également montré que le remodelage du muscle lisse chez des chevaux adultes est partiellement réversible et que cette réversibilité peut être accélérée par l’administration de corticostéroïdes par inhalation. Il semble toutefois qu’une portion du remodelage chronique est irréversible puisque les corticostéroïdes ont accéléré la diminution du muscle mais sans toutefois mener à une amélioration plus marquée au terme de l’étude qu’avec une modification environnementale stricte. La diminution de trente pourcent observée sur un an paraît modeste mais elle démontre clairement, et pour une première fois, que le remodelage du muscle lisse présent chez des chevaux adultes malades depuis plusieurs années est au moins partiellement réversible. / Equine heaves and asthma in people are two respiratory diseases that share many characteristics, including episodes of bronchospasm and respiratory distress due to an inappropriate airway inflammation in response to inhaled antigens. In both diseases, the main clinical manifestations are increased breathing efforts, wheezing and coughing. Changes in the airway wall include increased airway smooth muscle, subepithelial fibrosis, epithelial changes, and increased mucus. The increase in smooth muscle is of particular importance as it not only affects baseline airway caliber, but also accentuates the effect of bronchoconstriction on airflow limitation. These structural changes are grouped under the term “remodeling” and are associated with the accelerated decline of respiratory function in asthmatics. While current treatments offer adequate control of bronchospasm and inflammation, their effects on remodeling are unknown. In this thesis, airway smooth muscle remodeling reversibility was investigated in heaves-affected horses. The longitudinal studies conducted here, mostly made on peripheral pulmonary tissue harvested under thoracoscopic guidance, can not be easily done in people for ethical reasons, or in other animal species, few of them having spontaneous asthma-like disease like horses. Results have shown that heaves-affected horses have twice as much airway smooth muscle than age-matched controls kept in the same environment, and that myocyte proliferation contributes to this increase. It was also shown that a relatively brief antigenic exposure in chronically affected horses does not further increase smooth muscle mass, which suggests that it may reach a plateau over time. It was also shown that airway smooth muscle is partially reversible and that this reversibility can be accelerated with inhaled corticosteroids. On the other hand, corticosteroids only accelerated the decrease in mass compared to strict environmental control, without affecting the total improvement observed at the end of the study, which suggests that some of this chronic remodeling is irreversible. The thirty percent decrease seems relatively modest but it is nevertheless the first demonstration that airway smooth muscle remodeling of adult horses affected by heaves for years is at least in part reversible.

La myosine est une protéine motrice impliquée dans la contraction du muscle lisse. Un de ces isoformes, appelé (+)insert lui procure une vélocité accrue. L’objectif de cette étude était d’évaluer la contribution de cet isoforme au bronchospasme observé chez les chevaux atteints de souffle, un modèle d’asthme humain. Nous avons procédé à l’analyse de l’expression génique de l’isoforme (+)insert dans les voies respiratoires de chevaux issus de 3 cohortes afin d’évaluer 1) la présence de cet isoforme chez les chevaux atteints de souffle ; 2) la réversibilité de son expression avec 2 traitements usuels (corticostéroïdes inhalés et retrait antigénique); et 3) la cinétique de réapparition de l’isoforme suite à une période de rémission de la maladie. Les résultats révèlent 1) une expression augmentée de l’isoforme (+)insert dans l’ensemble de l’arbre bronchique des chevaux atteints de souffle en exacerbation comparée aux contrôles et aux chevaux en rémission ; 2) les deux traitements conduisent à une réduction de l’expression de l’isoforme, mais l’administration de corticostéroïdes mène à une diminution plus rapide que celle induite par le retrait antigénique; et 3) une période de 30 jours ou plus d'exposition antigénique est nécessaire pour la réapparition de l’isoforme (+)insert dans l’arbre bronchique des chevaux atteints de souffle. Cette étude montre pour la première fois une modulation et une réversibilité de l’expression de l'isoforme (+)insert de la myosine en fonction du statut médical du sujet. Les données suggèrent que cet isoforme pourrait faire partie d’un mécanisme protecteur activé en réponse à une exposition antigénique prolongée. / Myosin is a motor protein implicated in smooth muscle contraction. The (+)insert isoform doubles smooth muscle velocity. The aim of the study was to evaluate the contribution of the fast contracting myosin isoform to bronchospasm in heaves-affected horses as model of human asthma. Gene expression analysis of the (+)insert myosin isoform in equine airways was performed in three different cohorts to evaluate 1) its presence and anatomical location in heaves-affected horses; 2) the reversibility of its expression with two common therapies (inhaled corticosteroids and antigen avoidance); and 3) its kinetics of reappearance following a chronic antigen exposure. Results showed 1) a significantly increased expression of the (+)insert isoform at all levels of the bronchial tree of horses with heaves in clinical exacerbation when compared to control horses and heaves-affected horses in clinical remission; 2) both treatments reduced the fast isoform expression in horses’ lower airways, but the administration of corticosteroids led to a faster response; and 3) (+)insert isoform does not increase in airways of all horses with heaves within 30 days of antigen exposure. The study shows for the first time a modulation of the fast contracting myosin isoform with the disease status. Data also suggest that (+)insert isoform is part of a protective mechanism enhanced in response to a prolonged antigen exposure.