La schizophrénie est une maladie mentale grave qui présente une comorbidité fréquente avec la toxicomanie et avec divers troubles immunitaires. Une méta-analyse réalisée récemment dans notre laboratoire a montré une augmentation d’IL-6 (une cytokine pro-inflammatoire), du récepteur soluble d’IL-2 (un marqueur d’activation du système immunitaire), et d’IL-1RA (une cytokine anti-inflammatoire) dans la schizophrénie, suggérant l’existence d’un syndrome inflammatoire dans cette maladie. La toxicomanie aussi est associée au dérèglement du réseau des cytokines inflammatoires, mais les effets dépendent du type de drogues et ils sont parfois diamétralement opposés. On dispose encore de peu d’informations sur le statut immunitaire et inflammatoire des patients qui ont un double diagnostic de schizophrénie et de toxicomanie. Le but de ce travail était d’explorer l’existence d’un état inflammatoire systémique chez les patients schizophrènes et toxicomanes, et l’influence du traitement avec un médicament antipsychotique atypique, la quétiapine. Les objectifs spécifiques étaient : 1) Mesurer les concentrations plasmatiques des cytokines inflammatoires chez les schizophrènes et toxicomanes avant, pendant et après traitement avec la quétiapine ; et 2) Faire des études de corrélations entre les taux de cytokines, les symptômes cliniques, et la consommation de drogues. Les résultats montrent que comparativement aux contrôles normaux, les patients avec un double diagnostic présentent une augmentation d’IL-6, d’IL-1RA, du sIL-2R et d’IL-8 avant traitement à la quétiapine. Les augmentations des concentrations plasmatiques d’IL-1RA sont particulièrement importantes chez les patients avec double diagnostic, si on les compare à celles publiées chez les schizophrènes sans toxicomanie. Le traitement à la quétiapine n’influence pas les concentrations plasmatiques de ces cytokines, sauf sIL-2R qui augmente davantage au cours du traitement. Des corrélations positives de puissance modérée sont retrouvées entre IL-6 et dépression, IL-6 et alcool, IL-1RA et cognition, IL-8 et dépression, IL-8 et alcool, sIL-2R et cannabis. Notre étude révèle que la réponse inflammatoire est activée chez les schizophrènes et toxicomanes. De plus, la toxicomanie semble jouer un rôle facilitant ou potentialisateur dans les augmentations des taux circulants d’IL-1RA. Les études en cours sur différentes populations de schizophrènes avec ou sans toxicomanie, et chez des toxicomanes non schizophrènes permettront de préciser le rôle des différentes drogues d’abus dans le syndrome inflammatoire chez les schizophrènes, ainsi que les implications de ce syndrome sur le plan clinique et thérapeutique. / Schizophrenia is a psychosis which presents a frequent comorbidity with substance use disorders (SUD) and with various immune alterations. Using meta-analysis, we have demonstrated previously establishment of an inflammatory syndrome in schizophrenia patients, illustrated by elevated circulating levels of IL-6 (a pro-inflammatory cytokine), sIL-2R (marker of immune activation) and IL-1RA (an anti-inflammatory cytokine). SUD is also associated with dysregulation of inflammatory cytokines, but the effects may depend on the type of substance of abuse. The goal of this project was: 1) To measure plasma concentrations of inflammatory cytokines in schizophrenia patients with comorbid SUD, before, during and after treatment with an atypical antipsychotic, quetiapine; and 2) To perform correlation studies between plasma concentrations of inflammatory cytokines and clinical symptoms, including positive and negative symptoms, cognition, depression and substance use. Relative to normal controls, patients with a dual diagnosis showed increased plasma concentrations of IL-6, IL-1RA, sIL-2R, and IL-8 at baseline, IL-1RA increases being the most important. Quetiapine treatment did not influence plasma cytokine concentrations, except sIL-2R which increased further. Moderate positive correlations were found between IL-6 and depression, IL-6 and alcohol, IL-1RA and cognition, IL-8 and depression, IL-8 and alcohol and between sIL-2R and cannabis. This study demonstrates that the immune and inflammatory response is activated in schizophrenia patients with comorbid SUD. Furthermore, SUD may play a facilitating or potentiating role in the increases in peripheral levels of IL-1RA. Ongoing studies in different patient populations with schizophrenia with or without SUD, and patients with SUD alone will help elucidate the role of different substances of abuse in the inflammatory syndrome in schizophrenia, as well as the clinical and therapeutic relevance of this syndrome.

(En) Paneth cells are one of the major player in the maintenance of the homeostatic relationship between intestinal microbiota and the immune system. This function is largely achieved by their production of bactericidal enteric α-defensins (ED) and other antimicrobials. Disruption of Paneth cell functions is associated with severe human disorders such as Crohn's disease (CD) and Autoimmune Polyendocrinopathy- Candidiasis-Ectodermal Dystrophy (APECED). However, there is only a very limited information regarding the interactions and regulatory circuits operating between Paneth cells and intestinal immune system in either health or under pathological conditions. The previous study conducted in our laboratory described a new mechanism for the initiation and maintenance of Paneth cells targeted autoimmunity. The suggested model was that ED-specific T cells escape the selection in the thymus, infiltrate the intestine and diminish Paneth cell numbers through autoimmune destruction. This process also lead to the accumulation of inflammation- inducing bacteria, which were implied to exacerbate the inflammatory autoimmunity. Since this model of intestinal autoimmunity is of correlative nature, its intrinsic mechanism and functional relationships between immune system, Paneth cells and microbiota are largely...

Introduction: The pathogenesis and treatment of allergic bronchopulmonary aspergillosis (ABPA), severe asthma-non fungal sensitised (SANFS) and severe asthma with fungal sensitization (SAFS) is poorly understood. IL-17A, IgE and microbiome may be associated with pathogenesis of asthma, but their role in fungal-associated asthma is uncertain. Further, the efficacy of voriconazole, posaconazole and nebulised amphotericin B (NAB) in ABPA and SAFS has not been fully studied. Aims and objectives: The aim of this PhD thesis was to evaluate the role of IL-17A, IgE and lung microbiome in patients with SANFS, SAFS and ABPA. We also studied the efficacy and safety of NAB, voriconazole and posaconazole. Methods: Airway lymphocytes and peripheral blood mononuclear cells (PBMC) from patients with ABPA (n=16), SAFS (n=15), SANFS (n=11), mild asthma (MA) (n=6) and NH (n=11) were characterized by flow cytometric analysis (FACS) to determine the % of CD (+) IL-17A expressing cells. We also evaluated microbiome population using culture and PCR plus sequencing from BAL of these patients. In chapter 3, we analysed total and specific IgE in blood from adult cohorts of SAFS (n=34) and ABPA (n=48) using ImmunoCAP 100. In chapter 5 we studied the efficacy of voriconazole and posaconazole and in chapter 6; we studied the efficacy of NAB.Results: %CD4+IL-17A expressing cells were significantly higher in patients with severe asthma and correlated positively with serum neutrophil and presence of fungi in the airways. ABPA, SAFS and SANFS were similar but all were significantly higher than MA and NH. There were no differences in IL-17A expression between blood and the lung. Fungi were more frequently associated with severe asthma and low FEV1. Steroid treatment significantly increased airway fungal load. IgE against staphylococcal aureus (SE-IgE) correlated positively with FEV1 and OCS dose. Voriconazole and posaconazole improved asthma severity and radiological abnormalities. NAB was associated bronchospasm, but was extrely effective in the few patients (n=3) that took treatment for >12 months. These responders had unique characteristics. Conclusions: IL-17A, SE-IgE, and lung microbiome are associated with asthma severity. Steroid use in these patients may increase airway fungal load. Whereas voriconazole and posaconazole are efficacious, the use of NAB is associated with significant bronchospasm. SE-IgE -high asthma patients may be a distinct asthma phenotype. Larger studies are needed.

La schizophrénie est une maladie mentale grave qui présente une comorbidité fréquente avec la toxicomanie et avec divers troubles immunitaires. Une méta-analyse réalisée récemment dans notre laboratoire a montré une augmentation d’IL-6 (une cytokine pro-inflammatoire), du récepteur soluble d’IL-2 (un marqueur d’activation du système immunitaire), et d’IL-1RA (une cytokine anti-inflammatoire) dans la schizophrénie, suggérant l’existence d’un syndrome inflammatoire dans cette maladie. La toxicomanie aussi est associée au dérèglement du réseau des cytokines inflammatoires, mais les effets dépendent du type de drogues et ils sont parfois diamétralement opposés. On dispose encore de peu d’informations sur le statut immunitaire et inflammatoire des patients qui ont un double diagnostic de schizophrénie et de toxicomanie. Le but de ce travail était d’explorer l’existence d’un état inflammatoire systémique chez les patients schizophrènes et toxicomanes, et l’influence du traitement avec un médicament antipsychotique atypique, la quétiapine. Les objectifs spécifiques étaient : 1) Mesurer les concentrations plasmatiques des cytokines inflammatoires chez les schizophrènes et toxicomanes avant, pendant et après traitement avec la quétiapine ; et 2) Faire des études de corrélations entre les taux de cytokines, les symptômes cliniques, et la consommation de drogues. Les résultats montrent que comparativement aux contrôles normaux, les patients avec un double diagnostic présentent une augmentation d’IL-6, d’IL-1RA, du sIL-2R et d’IL-8 avant traitement à la quétiapine. Les augmentations des concentrations plasmatiques d’IL-1RA sont particulièrement importantes chez les patients avec double diagnostic, si on les compare à celles publiées chez les schizophrènes sans toxicomanie. Le traitement à la quétiapine n’influence pas les concentrations plasmatiques de ces cytokines, sauf sIL-2R qui augmente davantage au cours du traitement. Des corrélations positives de puissance modérée sont retrouvées entre IL-6 et dépression, IL-6 et alcool, IL-1RA et cognition, IL-8 et dépression, IL-8 et alcool, sIL-2R et cannabis. Notre étude révèle que la réponse inflammatoire est activée chez les schizophrènes et toxicomanes. De plus, la toxicomanie semble jouer un rôle facilitant ou potentialisateur dans les augmentations des taux circulants d’IL-1RA. Les études en cours sur différentes populations de schizophrènes avec ou sans toxicomanie, et chez des toxicomanes non schizophrènes permettront de préciser le rôle des différentes drogues d’abus dans le syndrome inflammatoire chez les schizophrènes, ainsi que les implications de ce syndrome sur le plan clinique et thérapeutique. / Schizophrenia is a psychosis which presents a frequent comorbidity with substance use disorders (SUD) and with various immune alterations. Using meta-analysis, we have demonstrated previously establishment of an inflammatory syndrome in schizophrenia patients, illustrated by elevated circulating levels of IL-6 (a pro-inflammatory cytokine), sIL-2R (marker of immune activation) and IL-1RA (an anti-inflammatory cytokine). SUD is also associated with dysregulation of inflammatory cytokines, but the effects may depend on the type of substance of abuse. The goal of this project was: 1) To measure plasma concentrations of inflammatory cytokines in schizophrenia patients with comorbid SUD, before, during and after treatment with an atypical antipsychotic, quetiapine; and 2) To perform correlation studies between plasma concentrations of inflammatory cytokines and clinical symptoms, including positive and negative symptoms, cognition, depression and substance use. Relative to normal controls, patients with a dual diagnosis showed increased plasma concentrations of IL-6, IL-1RA, sIL-2R, and IL-8 at baseline, IL-1RA increases being the most important. Quetiapine treatment did not influence plasma cytokine concentrations, except sIL-2R which increased further. Moderate positive correlations were found between IL-6 and depression, IL-6 and alcohol, IL-1RA and cognition, IL-8 and depression, IL-8 and alcohol and between sIL-2R and cannabis. This study demonstrates that the immune and inflammatory response is activated in schizophrenia patients with comorbid SUD. Furthermore, SUD may play a facilitating or potentiating role in the increases in peripheral levels of IL-1RA. Ongoing studies in different patient populations with schizophrenia with or without SUD, and patients with SUD alone will help elucidate the role of different substances of abuse in the inflammatory syndrome in schizophrenia, as well as the clinical and therapeutic relevance of this syndrome.

Introduction. La toxoplasmose oculaire (TO) est la première cause d’uvéite postérieure. L’évolution de cette pathologie dépend d’une balance entre la régulation de la réponse immunitaire et la limitation de la prolifération parasitaire.Méthodes. Le but de nos travaux est de déterminer le spectre des cytokines dans l’humeur aqueuse de patients une To ou une autre inflammation intraoculaire (uvéite d’étiologies virales ou secondaires à des maladies inflammatoires systémiques et endophtalmie bactérienne). Pour mieux appréhender les mécanismes immunitaires mis en jeu lors d’une TO, des dosages de transcrits par RT-PCR et de protéines inflammatoires par immunoessaimultiplexe sont réalisés à partir de modèles murins de TO. Enfin, l’effet de l’injection intraoculaire d’anticorps (AC) anti-IL-17A sur l’inflammation intraoculaire et la prolifération parasitaire est étudié.Résultats. Les spectres de cytokines observés dans l’humeur aqueuse diffèrent nettement en fonction de la cause de l’inflammation. Plus particulièrement, IL-17A semble jouer un rôle primordial dans la pathogénicité de la TO humaine et murine. Chez la souris infectée, l’inflammation intraoculaire et le nombre de parasites intraoculaires sont diminués parl’administration d’AC anti-IL-17A. Les niveaux d’ARNm de T-bet et Foxp3, ainsi que la concentration en IFN-γ (marqueurs de l’immunité cellulaire de type Th1 et Treg), sont augmentés après l’injection d’AC anti-IL-17A.Discussion. Les AC anti-IL-17A modèrent la réponse inflammatoire intraoculaire et limitent la prolifération parasitaire en antagonisant les cellules Th17, probablement via l’induction des cellules Th1 et Treg, secrétant IL-10 et IL-27. Ces résultats préliminaires suggèrent une nouvelle approche thérapeutique in vivo lors d’une toxoplasmose oculaire. / Purpose. Toxoplasmosis is the most common cause of posterior uveitis in immunocompetent subjects. Taking into account the opposing needs of limiting parasite multiplication and minimizing tissue destruction, the immune imbalance implies especially Th17 and T regulatory (Treg) cells.Methods. In a prospective clinical study of acute intraocular inflammation including ocular toxoplasmosis, viral uveitis, systemic inflammatory disease related uveitis and bacterial endophthalmitis we evaluated the cytokine pattern in aqueous humors of affected patients. To further study the immunological mechanisms involved during ocular toxoplasmosis, weevaluated the intraocular inflammation, the parasite load and the immunological response characterized on mRNA and protein level in a mouse model. To evaluate the role of IL-17A, anti IL-17A monoclonal antibodies (mAbs) were administered concomitantly with the parasite.Results. Cytokines networks are different, depending on the cause of intraocular inflammation. In OT, we observed severe ocular inflammation and cytokine patterns comparable to human cases, including IL-17A production. Neutralizing IL-17A decreased intraocular inflammation and parasite load in mice. Detailed studies revealed upregulation of Treg and Th1 pathways. When IFN-γ was neutralized concomitantly, the initial parasite multiplication rate was partially restored.Conclusions. Local IL-17A production plays a central role in pathology of OT. The balance of Th17 and Th1 responses (especially IFN-γ) is crucial for the outcome of infection. These data open new in vivo therapeutic approaches by repressing inflammatory pathways using intravitreal injection of IL-17A mAbs.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / IL-17-producing T cells are critical to the development of pathogen and tumor immunity, but also contribute to the pathology of autoimmune diseases and allergic inflammation. CD8+ (Tc17) and CD4+ (Th17) IL-17-secreting T cells develop in response to a cytokine environment that activates Signal Transducer and Activator of Transcription (STAT) proteins, though the mechanisms underlying Tc17/Th17 development and stability are still unclear. In vivo, Tc17 cells clear vaccinia virus infection and acquire cytotoxic potential, that is independent of IL-17 production and the acquisition of IFN-γ-secreting potential, but partially dependent on Fas ligand, suggesting that Tc17-mediated vaccinia virus clearance is through cell killing independent of an acquired Tc1 phenotype. In contrast, memory Th cells and NKT cells display STAT4-dependent IL-23-induced IL-17 production that correlates with Il23r expression. IL-23 does not activate STAT4 nor do other STAT4-activating cytokines induce Il23r expression in these populations, suggesting a T cell-extrinsic role for STAT4 in mediating IL-23 responsiveness. Although IL-23 is important for the maintenance of IL-17-secreting T cells, it also promotes their instability, often resulting in a pathogenic Th1-like phenotype in vitro and in vivo. In vitro-derived Th17 cells are also flexible when cultured under polarizing conditions that promote Th2 or Th9 differentiation, adopting the respective effector programs, and decreasing IL-17 production. However, in models of allergic airway disease, Th17 cells do not secrete alternative cytokines nor adopt other effector programs, and remain stable IL-17-secretors. In contrast to Th1-biased pro-inflammatory environments that induce Th17 instability in vivo, during allergic inflammatory disease, Th17 cells are comparatively stable, and retain the potential to produce IL-17. Together these data document that the inflammatory environment has distinct effects on the stability of IL-17-secreting T cells in vivo.